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Agents Used to Treat Seizures and Epilepsy
Chapter 31
Epilepsy
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An electrical disorder of the brain that sometimes leads to seizures
DefinitionsSeizure: a brief episode of abnormal electrical activity in the nerve cells
Convulsion: spasmodic contractions of involuntary muscles
Symptoms of Epilepsy
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Abnormal motor functionLoss of consciousnessAltered sensory awareness
Psychic changes
Status Epilepticus
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Series of tonic-clonic seizuresNo return to consciousness between seizures
Prompt treatment in hospital necessary
Life support equipment
Anticonvulsant Therapy
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Prevent and control seizuresAct by decreasing CNS stimulation
Drug depends on type of seizure, therapeutic goal, and adverse effects
Patient compliance is vitalNeed to monitor serum levels
Drug Agents Used to Prevent Seizures
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BarbituratesHydantoinsSuccinimidesBenzodiazepines
Drug Agents Used to Prevent Seizures
(cont’d)
Other agentsValproic acidCarbamazepine (Tegretol)
Clients often on these medications for life
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Barbiturates
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Nonspecific CNS depressants
Interferes with impulse transmission in the cortex of the brain
Nonselective
BarbituratesUsed alone or in combination with other drugs
Safe and effectiveMay cause - sedation - hypnosis - respiratory depression
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Hydantoins
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Dilantin – oral Fosphenytoin – IV usePreventing and treating partial and generalized tonic-clonic seizures
Reduces spontaneous electrical impulses in the brain
Hydantoins
(cont’d)Selective action on hyperactive synapses
Does not cause sedation or hypnosis
Narrow therapeutic rangeContraindicated in patients with bradycardia, third degree heart block, or sinoatrial block
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Hydantoins Adverse effects
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HypotensionDysrhythmiasCardiovascular collapse
Heart blockDrowsinessWeakness Insomnia
ConfusionIrritabilityDepressionHeadachePsychosis If serum too high – coma can result
Succinimides
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Ethosuximide (Zarontin) – safest in group
Used for absence seizuresRisk for hematological, hepatic, and renal dysfunction
Benzodiazepines
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CNS depressantsMultiple actionsLimits spread of seizure electrical discharges
Potential for dependence
Benzodiazepines
Examples: - Valium - KlonopinAdverse effects with abrupt withdrawal
- convulsions - vomiting - tremor - sweating
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Anticonvulsants
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TreatmentStart with one drug and add others as needed
Check serum drug concentrations as required
Goal of Anticonvulsants
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Prevent the generation and spread of excessive electrical discharges in the brain Protect the normal cells
Anticonvulsants: Therapeutic Effects
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Stabilize nerve cells and prevent hyperexcitabilityPrevent the generation of
hyperactive neuronsPrevent abnormal
impulses from spreading
Anticonvulsants: Side Effects
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Carbamazepine (Tegretol)Blood dyscrasias
Phenytoin (Dilantin)Gum hyperplasia
Diazepam (Valium)Respiratory depression and drowsiness
Pediatric Considerations
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Barbiturates require lower dosages
Excessive sedation, confusion, lethargy, or decreased movement
Paradoxical reactionsValproic acid (Depakene): do not give with milk
Wear a MedicAlert® bracelet
Nursing Considerations
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Encourage patient to carry medical alert item
Educate patients and families about seizure precautions and importance of following drug regime
Educate patients regarding drug interactions
Educate patients regarding side effects and when to report to provider
Monitor appropriate lab valuesMonitor effectiveness of therapy
To be Covered in Mental Health
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Sedatives and hypnoticsAntianxiety drugsAntidepressantsAntipsychoticsSubstance abuse