Drug Class - Anticonvulsants

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What are anticonvulsants used for?: to decrease the incidence and severity of seizures due to various etiologies

some are used parenterally in the immediate treatment of seizures...sometimes more than one is used on a long-term basis
How are many anticonvulsant regimens monitored?: serum level monitoring
Anticonvulsants contain a variety of agents and all are capable of depressing normal neuronal discharges in the CNS that may result in _______.: seizures
Depending on the group of anticonvulsants, they may do the following?: prevent the spread of seizure
activity
depress motor cortex
raise seizure threshold
alter levels of neuro-
transmitters
The only contraindication is _______.: hypersensitivity
Use cautiously in which 2 diseases? (dosage adjustment may be required): renal
hepatic
Choose agents carefully in pregnant and lactating women.: okay
What syndrome may occur in offspring of patients who receive phenytoin during pregnancy?: fetal hydantoin
What is fetal hydantoin syndrome (FHS)?: Synonyms
Meadow syndrome
congenital hydantoin
syndrome
Dilantin syndrome
fetal Dilantin syndrome
fetal phenytoin syndrome
hydantoin syndrome

Summary:
Multiple abnormalities in infants whose mothers were treated for epilepsy with hydantoin anticonvulsants during pregnancy. The abnormalities include disorders of growth and mental development, dysmorphic facies, and osteoarticular, cardiovascular, and other anomalies. Neoplasms complicate some cases.

Major Features
Head and neck: Microcephaly, brachycephaly, midfacial hypoplasia, wide fontanels, metopic ridging, and mild micrognathia.
Ears: Low-set deformed ears.
Eyes: Blepharoptosis, mild hypertelorism, and strabismus,
Nose: Short nose with a broad depressed bridge and epicanthal folds.
Mouth and oral structures: Cupid's bow of the upper lip and occasional cleft lip/and or palate.
Neck: Short neck with mild webbing.
Thorax: Widely spaced nipples
Abdomen: Umbilical or inguinal hernia.
Hand and foot: Finger-like thumbs, aplasia or hypoplasia of the distal phalanges, supernumerary phalangeal epiphyses, and clubfoot. Dermatoglyphic abnormalities consist of abnormal palmar creases.
Skin appendages: Coarse hair, hirsutism, low hairline, and nail hypoplasia.
Cardiovascular system: Variable coarctation of the aorta, endocardial cushion defect, double outlet right ventricle, ventricular septal defect, atrial septal defect, and bicuspid pulmonic valve.
Gastrointestinal system: Intestinal malrotation.
Hematopoietic system: Hemorrhagic complications.
Growth and development: Growth and mental retardation.
Etiology and pathogenesis: Teratogenic and potential carcinogenic effects of phenytoin and related hydantoin anticonvulsants.
Additional features: Neuroblastoma, mesenchymoma, and Wilms tumor have been reported in some infants.
Name 5 groups of anticonvulsants?: barbituates
benzodiazepines
hydantoins
valproates
miscellaneous
Which group of the 5 stimulates metabolism of other drugs that are metabolized by the liver, decreasing their effectiveness?: barbituates
Which group of anticonvulsants are highly protein-bound and may displace or be displaced by other highly protein-bound drugs.: hydantoins
Which 3 of the miscellaneous drugs are capable of interacting with several other anticonvulsants?: lamotrigine
tiagabine
topiramate
What other 2 drug classifications are capable of lowering seizure threshold and may decrease the effectiveness of anticonvulsants?: tricyclic antidepressants
phenothiazines
What 3 things should be assessed while patient is on anticonvulsants?: location of seizure activity
duration of seizure activity
characteristics of seizure
activity
TOXICITY AND OVERDOSE: What should be monitored routinely throughout anticonvulsant therapy, especially when adding or discontinuing other agents?: serum drug levels
Potential Nursing Diagnoses? (2): Injury, risk for
Knowledge deficit, related to
medication regimen
Administer anticonvulsants around the clock. Abrupt discontinuation may precipitate _____ ______. Implement seizure precautions.: status epilepticus
Explain Seizure First Aid? (online source): During a seizure, we first ask that everyone involved stay calm and keep the child safe. Time the seizure with a watch or clock, as most seizures seem to be a lot longer than they really are. If the seizure lasts longer than five minutes, EMS needs to be called. Notice what the seizure looks like so you can give a good description to the paramedics and the childâ€™s doctor. Please DO NOT place anything in the childâ€™s mouth. They cannot swallow their tongue. If possible, gently lay the child on his side. Lastly, let the seizure run its course. Do not try to restrain the child. After the seizure is over, allow them to rest and completely recover from the seizure. Again, if the seizure does not stop after five minutes, 911 should be called. If there are any other unusual or concerning circumstances surrounding the seizure, also consider consulting medical personnel.
Explain Seizure Precautions: These are some general precautions for children with a history of seizures or epilepsy. Discourage your child from climbing higher than 10 feet. Do not let your child take a tub bath alone, as some children have drowned in the bath during a seizure. If they are too old for supervision, they should take a shower and leave the door unlocked. There should be no unsupervised swimming; they should swim with other swimmers who are strong enough to rescue them. As with all children, children with epilepsy should wear a helmet when riding a bike or rollerblades. If your child is old enough to drive, they should not drive unless they have been seizure free for six months and you have contacted the physician. While there canâ€™t be a universal rule applicable to every possible situation and person, older children and adults also need to take reasonable precautions or restrictions with more dangerous activities, such as operating heavy machinery and playing contact sports.

Despite the above precautions, children with epilepsy should be encouraged to lead as normal a life as possible. Using common sense, there is no reason that people with epilepsy cannot participate fully in the vast majority of activities that life offers.
Seizures are divided into generalized and partial seizures. What are generalized seizures?: Generalized seizures are caused by abnormal electrical activity that occurs over the entire brain simultaneously. This group of seizures affect the level of awareness and muscle movement of all extremities.
Name 5 generalized seizures?: absence
atonic
myoclonic
tonic-clonic
tonic
Explain absence seizures? Hint: absence is staring: also known as â€œpetit malâ€. They are described as staring spells. At times they are difficult to distinguish from normal daydreaming spells. These seizures typically start in childhood and are often outgrown by adolescence, although adults can occasionally also have absence seizures. They can happen dozens of times a day but are very brief, usually lasting just a few seconds, so they are not always noticed. The child may get a dazed look on their face, have some eye blinking or head bobbing and not respond to any type of stimulus. After the seizure is over, the child usually continues his previous activity as if nothing happened. An EEG is very helpful with diagnosing this type of seizure. Patients usually respond very well to medication.
Explain myoclonic seizures? Hint: myo is muscle: These are characterized by sudden brief jerks of a single muscle or muscle group. You may see a sudden jerk of the hand or arm that will cause them to drop or knock things over. It may appear as if they have been startled. You may see the head or body suddenly bend forward or backward. At times the jerk can be so strong that the child can be thrown to the ground. These seizures are not the same thing as the periodic muscle spasms one often experiences when falling asleep.
Explain atonic seizures? Hint: atonic, a is without; tonic, tone: These are also very sudden brief seizures, but they involve loss of all muscle tone. The child will suddenly go limp and fall to the ground. There is significant risk of head injury during the fall. So, many children with this seizure type wear helmets for protection.
Explain tonic seizures? Hint: tonic - stiff tone: These seizures involve stiffening of parts of the body or the entire body, sometimes causing the child to fall down. Unlike tonic-clonic seizures, there is no progression to a clonic phase
Explain tonic-clonic seizures? Hint: tonic-clonic - grand mal: Also known as â€œgrand malâ€, these are very intense and can often be very frightening to witness. They generally start with a tonic phase with stiffening of the entire body. The eyes may roll back in the head, the back arches, and arms and legs stiffen. The muscles in the chest can also stiffen so it may appear that the person is not breathing and you may see blue around the lips. There may be an increase in saliva or â€œfoaming at the mouthâ€. The clonic part is described as rhythmic jerking of the entire body. Once the seizure is over, they may feel worn out and may even sleep for a period of time. They may also experience some confusion.
What are partial seizures?: also called focal, are those seizures that begin in one part of the brain instead of all over. Depending on which lobe of the brain the seizure comes from will determine the way the seizure looks. Partial seizures can be classified based on either the symptoms of the seizure or the part of the brain where they start.
Name two types of partial seizures?: simple partial
complex partial
What are simple partial seizures?: Simple partial seizures are noted for staying in just one area of the brain and not interfering with the level of consciousness. Depending on the area of the brain affected, these seizures could be expressed as shaking of a small part of the body, an unusual tingling or numbness of a localized body part, or even an unusual smell, visual hallucination, or ill-defined feeling. Simple partial seizures are often also called â€œaurasâ€. Regardless of the specific symptom, in all simple partial seizures, the person remains completely aware and alert during the seizure.
What are complex partial seizures?: A complex partial seizure happens when the abnormal electrical activity involves parts of the brain that affect level of consciousness. Thus, the critical feature of the complex partial seizure is that the person has altered consciousness, so that he may be confused or staring unresponsively. There may also be subtle, repetitive and stereotypical movements of the face or extremities (automatisms). Although complex partial seizures can look similar to absence seizures, they usually last longer, typically 1-2 minutes. In addition, unlike absence seizures, complex partial seizures often are preceded by an aura and are followed by a state of sleepiness. Sometimes a complex partial seizure can start in just one area and spread throughout the entire brain, resulting in a generalized tonic-clonic seizure. This type is known as complex partial with secondary generalization.
Which lobes are affected by seizures?: frontal
temporal
parietal
occipital
Explain frontal lobe seizures?: These seizures are usually very short and often occur during sleep. They may be described as twitching or a funny feeling in the face, a finger or leg. The person may be aware all of this is happening (simple partial seizure). Sometimes the head will turn to one side, and the arm on that same side will stiffen. In other cases, very bizarre or complicated movements of the entire body can occur. The seizure may spread causing awareness to be affected and jerking of extremities may happen.
Explain temporal lobe seizures?: This type usually involves complex partial seizures with staring and repetitive movements that seem to happen without purpose. These movements are called automatisms. There may also be a complaint of a funny feeling around the mouth, be unable to speak, and have increased saliva and twitching of the mouth. You may also see twitching, jerking, or stiffening on one side of the body. At the beginning of the seizure, they may experience a funny smell, a sensation of fear or a funny feeling in the stomach or chest.
Explain parietal lobe seizures?: There may be a feeling of electricity or tingling sensation that may start in a certain area, or may spread. They may complain that one part of the body feels like it is moving. Sometimes there is a feeling of sinking, choking or nausea, or pain.
Explain occipital lobe seizures?: These classically begin with visual problems, such as seeing flashes of light or hallucinations. Often the child will complain that they canâ€™t see and have rapid eye blinking. The loss of vision is temporary and will return after the seizure is over.
Patient/Family teaching tips?: Take medication every day

May cause drowsiness so don't drive until response to
medication is determined

Avoid alcohol or other CNS depressants concurrently with these medications

Carry ID describing disease process and medication regimen at all times
Effectiveness of therapy can be demonstrated by?: decrease or cessation of seizures without excessive sedation
Name 2 barbituates?: pentobarbital Nembutal

phenobarbital {Ancalixir}, Luminal, Solfoton
Name 3 benzodiazepines?: clonazepam Klonopin, {Rivotril}, {Syn-Clonazepam)

clorazepate {Apo-Clorazepate}, Gen-XENE, {Novo-Clopate}, Tranxene, Tranxene-SD

diazepam {Apo-Diazepam}, Diastat, {Diazemuls}, Dizac, D-Val, {Novodipam}, {PMS-Kiazepam}, Valium, {Vivol}
Name 1 hydantoin?: phenytoin
Dilantin, Diphenylhydantoin, DPH, Phenytek

fosphenytoin Cerebyx
Name 3 valproates?: divalproex sodium Depakote, Depakote ER, {Epival}

valproate sodium Depacon

valproic acid Depakene
Name 9 miscellaneous anticonvulsants?: acetazolamide Diamox

carbamazepine {Apo-Carbamazepine}, Atretol, Carbatrol, Epitol, {Novo-Carbamaz}, Tegretol, {Tegretol CR}, Tegretol-SR, Teril

gabapentin Neurontin

lamotrigine Lamictal

levetiracetam Keppra

oxcarbazepine Trileptal

tiagabine Gabatril

topiramate Topamax

zonisamide Zonegran

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Deck Info

Number of cards 43