Antiepileptic Medications

Phenytoin (Dilantin) MOA

Decreases Na+ entry into the cell

Phenytoin (Dilantin) Indications

• Partial Seizures

• Tonic-Clonic Seizures

• Post-neurological symptoms

Off-Label:

• Antiarrhythmic

• Severe Preeclampsia

Phenytoin (Dilantin) Adverse Effects

• Nystagmus

• Ataxia

• Dysarthria

• Slurred Speech

• Mental Confusion

• Tremor

• Headache

• Insomnia

• Hirsutism

• Gingival Hyperplasia

• Increased Blood Glucose

• Teratogenic effects

• Purple Glove Syndrome (Vesicant)

Phenytoin (Dilantin) Nursing Interventions

• Therapeutic Range: 10-20 mcg/mL

• Toxicity Range: >20 mcg/mL

• Check levels Q 5-7 days

• Taper off (DO NOT stop abruptly)

• Take with food

Carbamazepine (Tegretol) MOA

Delayed recovery of sodium channels from inactivated state

Carbamazepine (Tegretol) Indications

• 1st Drug of Choice for Focal Seizures

• Tonic-Clonic Seizures

• Management for Bipolar Disorder

• Pain relief

Carbamazepine (Tegretol) Adverse Effects

• Nystagmus

• Ataxia

• Bone Marrow Suppression (Leukopenia, Anemia, Thrombocytopenia)

• Rash

• Photosensitivity

Carbamazepine (Tegretol) Nursing Interventions

• Monitor CBC & Platelet levels

• Monitor Serum Blood Levels

• Avoid Grapefruit Juice, warfarin, oral contraceptives, phenytoin, phenobarbital

• Educate on food and drug interactions

• IV solution should be administered over 30 minutes

Carbamazepine (Tegretol) Therapeutic Range

Therapeutic Trough Range: 4-12 mcg/mL

Valproate (Depakote) MOA

Enhances GABA action

Valproate (Depakote) Indications

• All seizure types

• Migraine

• Bipolar disorder

Valproate (Depakote) Adverse Effects

• Hepatotoxicity

• Pancreatitis

Valproate (Depakote) Nursing Interventions

• Take with food

• Monitor LFTs

• Avoid in liver dysfunction

• Highly teratogenic

Oxcarbazepine (Oxtellar XR) MOA

Decreases Na+ entry into the cell

Oxcarbazepine (Oxtellar XR) Indications

Focal seizures

Oxcarbazepine (Oxtellar XR) Adverse Effects

• Dizziness

• Drowsiness

• Hyponatremia

• Stevens-Johnson syndrome

Oxcarbazepine (Oxtellar XR) Nursing Interventions

• Monitor renal function

• XR: swallow whole

• Decreases effectiveness of oral contraceptives

Topiramate (Topamax) MOA

Blocks Na+, Ca++, glutamate; Enhances GABA

Topiramate (Topamax) Indications

Focal + tonic-clonic seizures

Topiramate (Topamax) Adverse Effects

• Dizziness

• Weight loss

• Cognitive effects

• Metabolic acidosis

• Kidney stones

Topiramate (Topamax) Nursing Interventions

• Monitor for suicide risk

• Monitor metabolic acidosis

Gabapentin (Neurontin) MOA

Enhances GABA release

Gabapentin (Neurontin) Indications

Focal seizures; Neuropathic pain (off-label)

Gabapentin (Neurontin) Adverse Effects

• Dizziness

• Fatigue

• Peripheral edema

Gabapentin (Neurontin) Nursing Interventions

• Can take with or without food

• Take at bedtime

• DO NOT stop abruptly

Levetiracetam (Keppra) MOA

Unknown

Levetiracetam (Keppra) Indications

Myoclonic, focal, tonic-clonic seizures

Levetiracetam (Keppra) Adverse Effects

• Drowsiness

• Neuropsychiatric symptoms

Levetiracetam (Keppra) Nursing Interventions

• Monitor CBC

• Monitor renal & liver function

• IV over 15 minutes