ICR DRUGS

phenytoin (Dilantin) class

Hyantoins

phenytoin (Dilantin) use

tonic clonic (generalized seizure)

phenytoin (Dilantin) MOA

decreases excitability to stimulation by decreasing conduction through nerve pathways, LESS SEDATING THAN OTHER MEDS

phenytoin (Dilantin) ADR

bradycardia, THROMBOCYTOPENIA, toxic hepatitis, STEVENS JOHNSON SYNDROME (presents with flue like symptoms at first then a rash)

phenytoin (Dilantin) nursing

Monitor CBC, glucose, hepatic function, Dilantin levels, IV SITE (vesicant!), avoid with pregnancy

phenytoin (Dilantin) level

10

20 mcg/mL

phenytoin (Dilantin) education

common se: CNS depression, gingival hyperplasia, hyperglycemia, NO ALCOHOL, DONT STOP ABRUBTLY (major status epilepticus), RED/BROWN URINE

phenobarbital (Luminal) class

barbiturates

phenobarbital (Luminal) use

long term tx of tonic

clonic seizures, acute seizures with eclampsia

phenobarbital (Luminal) MOA

inhibits impulse conduction, depresses cerebral cortex, alters cerebellar function, decreases motor output

phenobarbital (Luminal) ADR

lethargy, insomnia, nervousness, bradycardia/hypotension, respiratory depression, tissue necrosis at injection site (vesicant!), withdrawal syndrome

phenobarbital (Luminal) serum level

15

40 mcg/ml

phenobarbital (Luminal) nursing

dermatological (affects skin), tolerance and dependence

phenobarbital (Luminal) education

common se: CNS depression, NO ALCOHOL, Avoid with pregnancy and lactation

diazepam (Valium) class

benzodiazepines

diazepam (Valium) use

status epilepticus

diazepam (Valium) MOA

acts on limbic system and potentiates the effects of GABA

diazepam (Valium) ADR

bradycardia, Respiratory depression, apnea, drug dependence with withdrawal syndrome (BLACK BOX WARNING)

diazepam (Valium) nursing

assess hx of substance use, liver and kidney function, HR, R, BP

diazepam (Valium) education

NO ALC OR OPIODS, common se: dry mouth, CNS depression

carbamazepine (Tegretol) use

partial seizures

carbamazepine (Tegretol) MOA

increases the activity of GABA

carbamazepine (Tegretol) ADR

thrombocytopenia, hepatitis, worsening of seizures, suicidal idealation, arrythmias, STEVEN JOHNSON SYNDROME (higher rate for Asian Americans)

carbamazepine (Tegretol) nursing

Ethnicity, cardiac, psychological,monitor renal, liver, bone marrow changes

carbamazepine (Tegretol) education

common se: CNS depression, GI depression, upper respiratory infections, AVOID ALC, XR tablet coating may appear in stoo