Drug Management Of Seizure Disorders
This quiz includes anti-convulsant drugs for seizure disorders.
- 1.Hydantoins are Anti-convulsants. Phenytoin (Dilantin) and Fosphenytoin (used for status epilepticus (IV)) What is true of Dilantin?
- A.
Used for status epilepticus (IV) (a persistent state of seizure)
- B.
Taken orally, occasionally IV
- C.
For partial or generalized seizures
- D.
Is most commonly used
- E.
Therapeutic blood levels 10-20, dose varies widely between individuals
- 2.Anti-convulsants: Hydantoins: Phenytoin (Dilantin): Adverse Effects:
- A.
Few Sedative effects
- B.
Gingival Hyertrophy (GUMS) 20-30% (brush teeth carefully and floss daily)
- C.
Cardiac: depresses pacemaker activity in heart. Cardiac monitoring with IV form, Contraindicated in bradycardia, heart block, CV collapse possible with IV
- D.
GI: Anorexia, nausea, vomiting, pain
- E.
Skin: rash, Steven Johnson Syndrome, lupus, excess hair growth, coarsening of features
- 3.Anticonvulsants: Hydantoins: Phenytoin (Dilantin). Dilantin Toxicity symptoms:
- A.
Ataxia (lack of muscle coordination) and nystagmus (involuntary eye movement)
- B.
Double vision, lethargy, slurred speech
- C.
N/v
- D.
Hypotension
- E.
Hypersensitivity (first 3-8 weeks) includes rash, fever, lymph node enlargement (can be fatal)
- 4.Nursing interventions: Anti-convulsants: Hydantoins: Dilantin:
- A.
Monitor for adverse effects
- B.
Monitor blood levels: therapeutic 10-20
- C.
Patient education (purpose, dose, important of compliance, adverse reactions)
- D.
Many drug interactions
- 5.Anti-convulsants: Barbiturates: Phenobarbital
- A.
Used for febrile seizures
- B.
Used for partial seizures
- C.
Used for tonic-clonic seizures (affects the whole brain)
- D.
May be used in combo with dilantin or as part of multi-drug regimen
- 6.Anti-convulsants: Barbiturates: Phenobarbital: Adverse reactions
- A.
CNS Depression, Sedation
- B.
Resp Depression- Contraindicated in resp disorders
- C.
Hypersensitivity
- D.
GI upset and pain
- E.
Blood dyscrasias
- 7.Carbamazepine (Tegretol) is the second most common prescribed anticonvulsant. It is structurally related to tricyclic antidepressants. It can also be used with combinations of Dilantin or Phenobarbital. Uses:
- A.
Partial and tonic clonic seizures
- B.
Neuropathic pain management
- C.
Schizophrenia
- D.
Bipolar disorder
- 8.Carbamazepine (Tegretol) Adverse effects:
- A.
CNS Depression: Restlessness, irritability, agitation, dizzy, confused, ataxia (lack of muscle coordination), encephalopathy (disorder or disease of the brain)
- B.
Renal: Renal Failure, urinary frequency, water retention (stimulates ADH)
- C.
Visual Changes
- D.
Toxicity similar to Dilantin ( bone marrow depression, hepatic dysfuction, visual changes)
- E.
Numerous drug interactions
- 9.Anticonvulsants: Bezodiazepines include:Diazepam (Valium) IV, IMLorazepam (Ativan) IV.
- A.
Terminate Status Epilepticus (state of persistent seizure)
- B.
Need close medical supervision
- C.
Resuscitation equipment should be available
- 10.Anti-convulsant drug implications
- A.
Drug initiations Titrating up based on effectiveness, blood levels, toxic effects Change to another drug if not effective or tolerated
- B.
Patient Education- Importance of Compliance
- C.
Duration of Therapy- May be withdrawn if seizure - free 2 years (12-36% recurrence)
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