Ppt chapter030

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Introduction to Clinical Pharmacology

Chapter 30-Anticonvulsants


Anticonvulsants: ActionsAnticonvulsants: Actions

• Benzodiazepines and barbiturates inhibit uptake of GABA at receptors

• Hydantoins stabilize hyperexcitability postsynaptically in motor cortex of brain

• Oxazolidinediones decrease repetitive synaptic transmission of nerve impulses

• Succinimides depress motor cortex creating higher threshold before nerves react to convulsive stimuli


Anticonvulsants: UsesAnticonvulsants: Uses

• Used prophylactically to prevent seizures following trauma, neurosurgery, or tumor

• Used in treatment of:

– Seizures of all types; neuropathic pain; biopolar disorders; anxiety disorders


Anticonvulsants: Adverse Reactions Anticonvulsants: Adverse Reactions • Central nervous system reactions:

Drowsiness; weakness; dizziness; headache; somnolence; nystagmus; ataxia; slurred speech

• Gastrointestinal reactions: Nausea; vomiting; anorexia; constipation; diarrhea; gingival hyperplasia

• Other: Skin rashes; pruritus; urticaria; urinary frequency; serious skin reactions; hematologic changes


Anticonvulsants: Contraindications Anticonvulsants: Contraindications • Contraindicated in patients : Hypersensitive

to the drugs

– Phenytoin is contraindicated in patients with sinus bradycardia; sinoatrial block; Adams-Stokes syndrome; second and third-degree atrioventricular (AV) block; during pregnancy and lactation

– Ethotoin (Pegatone) is contraindicated in patients with hepatic abnormalities

change "patient" to "client"


Anticonvulsants: Contraindications (cont’d)Anticonvulsants: Contraindications (cont’d)

– Succinimides are contraindicated in patients with bone marrow depression or hepatic or renal impairment

– Carbamazepine is contraindicated in patients with bone marrow depression or hepatic or renal impairment and during pregnancy

– Valproic acid (Depakote) is not administered to patients with renal impairment or during pregnancy



Anticonvulsants: Precautions Anticonvulsants: Precautions

• Used cautiously in patients with: Liver or kidney disease and neurologic disorders

– Barbiturates are used with caution in patients with pulmonary disease and in hyperactive children

– Benzodiazepines are used cautiously during pregnancy and in patients with psychoses; acute narrow-angle glaucoma; elderly or debilitated patients



Anticonvulsants: Precautions (cont’d)Anticonvulsants: Precautions (cont’d)

– Phenytoin is used cautiously in patients with hypotension; severe myocardial insufficiency; hepatic impairment

– Trimethadione is used with caution in patients with eye disorders

– Miscellaneous anticonvulsants are used cautiously in patients with glaucoma or increased intraocular pressure; a history of cardiac, renal or liver dysfunction; and psychiatric disorders

change "patient' to "client"


Anticonvulsants: InteractionsAnticonvulsants: InteractionsInteractant Drug Effect of Interaction

Antibiotics/antifungals Increased effect of the anticonvulsant

Tricyclic antidepressants Increased effect of the anticonvulsant

Salicylates Increased effect of the anticonvulsant

Cimetidine Increased effect of the anticonvulsant

Theophylline Decreased serum levels of the anticonvulsant


Anticonvulsants: Interactions (cont’d)Anticonvulsants: Interactions (cont’d)Interactant Drug Effect of Interaction

Antiseizure medications May increase seizure activity

Protease inhibitors Increased carbamazepine levels resulting in toxicity

Oral contraceptives Decreased effectiveness of birth control, resulting in breakthrough bleeding or pregnancy

Analgesics or alcohol Increased depressant effect

Antidiabetic medications Increased blood glucose levels


Nursing Process: Assessment Nursing Process: Assessment

• Preadministration assessment:

– Obtain vital signs at the time of the initial assessment to provide baseline data

– Thorough patient history is necessary to identify type of seizure disorder

– Primary health care provider may order laboratory and diagnostic tests



Nursing Process: AssessmentNursing Process: Assessment

• Ongoing assessment:

– Carefully document each seizure with regard to time of occurrence, duration of seizure, psychic or motor activity occurring before, during, after seizure

– Dosage adjustments are based on patient’s response to therapy, as well as occurrence of adverse reactions

– Serum plasma levels of anticonvulsant are measured regularly to monitor for toxicity



Nursing Process: Planning Nursing Process: Planning

• Expected outcomes for patient depend on the type and severity of the seizure but may include:

– optimal response to therapy

– Support of patient needs related to management of adverse reactions

– Understanding of and compliance with prescribed therapeutic regimen



Nursing Process: Implementation Nursing Process: Implementation

• Promoting an optimal response to therapy:

– Make notation on the care plan, as well as informing all health care team members of the importance of the drug

– Barbiturates:

•Monitor patient carefully during administration of barbiturate, taking blood pressure and observing respirations frequently

Delete"by"change "patient" to "client"


Nursing Process: ImplementationNursing Process: Implementation

• Promoting an optimal response to therapy (cont’d):

– Benzodiazepines:

•Dosage of benzodiazepines is highly individualized, increase the dosage cautiously to avoid adverse reactions, particularly in elderly and debilitated patient

•Do not mix diazepam with other drugs

change "patient" to "client"Reworded 2nd bullet (deleted" the nurse must not mix")




– Hydantoins:

•Monitor serum concentrations of drug on regular basis to detect signs of toxicity

– Oxazolidinediones:

•Used when less toxic drugs are not effective in controlling seizure disorder




– Succinimides:

•Effective in controlling partial seizures, these drugs are given with food to prevent GI upset

– Miscellaneous anticonvulsants:•Drug is absorbed rapidly when taken

orally, should not be chewed but swallowed whole



• Monitoring and managing patient needs:

– Risk for injury:

•The nurse should assist the patient with all ambulatory activities

•Use caution when giving an oral preparation as aspiration of tablet, capsule, or liquid may occur if patient experiences drowsiness

•Test swallowing ability of patient by offering small sips of water before giving drug




• Monitoring and managing patients needs (cont’d):

– Risk for impaired skin integrity:

•Carefully examine all affected areas and provides an accurate description

•Be alert for signs of pancytopenia, such as sore throat, fever, general malaise, bleeding of the mucous membranes, epistaxis, easy bruising

•Routine laboratory tests, such as complete blood counts and differential counts, should be performed periodically




• Monitoring and managing patient needs (cont’d):

– Impaired oral mucous membranes:

•Periodically inspect mouth, teeth, gums of patients in a hospital or long-term clinical setting

– Disturbed sensory perception: visual

•Patient should stay out of sun if possible and wear sunscreens and protective clothing as needed until individual effects of drug are known



Nursing Process: ImplementationNursing Process: Implementation• Educating the patient and family:

– When patient receives diagnosis of epilepsy, nurse must assist patient and family to adjust to diagnosis

– Instruct family members in care of patient before, during, and after seizure

– Explain importance of restricting some activities until seizures are controlled by drugs

– Assist patient to look for other modes of transportation in order to continue typical activities or employment

– The nurse reviews adverse drug reactions associated with the prescribed anticonvulsant with the patient and family members




• Educating the patient and family (cont’d):

– Hydantoins:

•Inform dentist and other primary health care providers of use of this drug

•Brush and floss teeth after each meal and make periodic dental appointments for oral examination and care





•Take medication with food to reduce GI upset

•Thoroughly shake phenytoin suspension immediately before use

•Do not take capsules that are discolored





•Notify primary health care provider if any of the following occurs: Skin rash; bleeding; swollen or tender gums; yellowish discoloration of the skin or eyes; unexplained fever; sore throat; unusual bleeding or bruising; persistent headache; malaise; or pregnancy





– Succinimides:

•If GI upset occurs, take drug with food or milk

•Notify primary health care provider if any of the following occurs: Skin rash; joint pain; unexplained fever; sore throat; usual bleeding or bruising; drowsiness; dizziness, blurred vision; or pregnancy



Nursing Process: ImplementationNursing Process: Implementation• Educating the patient and family (cont’d):

– Oxazolidinediones:

•Determine: Protective measures when exposed to ultraviolet light, sunlight

•Notify primary care provider if following reactions occur: Visual disturbances; excessive drowsiness; dizziness; sore throat; fever; skin rash; pregnancy; malaise; easy bruising; epistaxis; bleeding tendencies

change "patient" to "client"Pluralize "measure"


Nursing Process: Evaluation Nursing Process: Evaluation

• Therapeutic effect is achieved and convulsions are controlled

• No injury is evident

• Adverse reactions are identified, reported, and managed successfully through appropriate nursing interventions

• Patient verbalizes the importance of complying with the prescribed treatment regimen

• Patient verbalizes an understanding of treatment modalities and the importance of continued follow-up care

• Patient and family demonstrate an understanding of the drug regimen



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Ppt chapter030

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