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77 Cards in this Set

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A siezure can be defined as a symptom of an abnormal and excessive _________ discharge in the ______.
electrical
brain
What is the most common cause of recurring and chronic seizures?
Epilepsy
Epileptic seizures are generally iodiopathic? T or F
TRUE.
The common causes of seizure activity are: head injuries, brain tumors, ____ and ____
Temperature elevations and poisoning (alcohol or drugs)
What is the MOST frequent cause of a seizure?
Failure to take medications to control previously diagnosed seizure activity.
Seizures can be grouped into two broad categories
Generalized and Focal

...based on clinical presentation and EEG.
What sort of treatment options are available for the individual suffering from seizure disorders?
Medication for epileptic seizures.
Surgery and dietary treatment are sometimes used to control symptoms.
What is the goal for treatment?
To supress or reduce the number of seizures.
Anticonvulsants work by ______ or ______ the abnormal discharges of the CNS.
Depressing or slowing
How are pts usually started on their medications?
2 STEPS:

- P arenteral therapy
- O ral therapy when seizure activity under control.
The 4 Major Classes of Anticonvulsants are:
1. Barbituates
__________
2. Hydantoins
3. Succinimides
Benzodiazepines
What determines the type of anticonvulsant that the pt would take?
Trial and error, mostly.

Where one drug fails? Another might work
Barbituates are CNS stimulants? T or F
FALSE

They are depressants and used for their sedative effect on the brain.
Barbituates act primarily on the _____. They _______ nerve impulses that go to the cerebral cortex.
Brainstem
Reduce
What sort of affect do barbituates have on the respiratory system?
They depress it.
They slow the activity of nerves and muscles.
BARBITUATES

What does it mean when a barbituate is said to raise the seizure threshold?
The level of electrical activity that must be produced before a seizure will occur is raised.
BARBITUATES

Barbituates are:
a. short-acting
b. long-acting
c. Intermediate-acting
d. A, C
e. A, B, C
Answer: e. A, B, C
Long-acting barbituates are typically used to control and prevent seizures of which type?
M iscellaneous seizures (caused by tetanus, fever & drugs)
E pilepticus, status. (sometimes)
G rand Mal seizures
What is status epilepticus?
A series of grand mals occuring one after another.
Elders and weakened pts tend to be more sensitive to barbituates? T or F
TRUE.

'Hangover', confusion and delirium also more likely.
Elder --> Low Dose.
BARBITUATES

In an adverse reaction, elders tend to experience worsening brain disorder symptoms. T or F
TRUE.
BARBITUATES

S/S of Adverse Reactions?
- H epatitis w/Jaundice
- U nusual bleeding/bruising.
- U ticaria (hives)
- P aradoxical restessness/excitement
BARBITUATES

What may happen to the platelet count of pt experiencing an adverse reaction to barbituates?
It will decrease.
BARBITUATES

An increased tolerance or withdrawal symptoms upon D/C'ing barbituates anticonvulsants can always be considered normal in a pt. T or F
FALSE.

Pt could be experiencing an adverse reaction.
BARBITUATES

S/S of an Overdose?
S low, shallow respirations
T achycardia
S hock
C oma
BARBITUATES

A pt showing signs of areflexia may be experiencing:
a. Nothing.
b. an adverse reaction
c. an overdose
d. a common symptom
C.
An Overdose.
BARBITUATES

Death tends to result from ______.
Cardiorespiratory failure.

The drug will overly depress the CNS.
BARBITUATES

What sort of effect does the barbituate have on anticoagulants, cortifosteroids and digitalis preparations? Why?
They reduce their activity because they increase metabolism.
BARBITUATES

MAO I's decrease the depressant effect of barbituates? T or F
FALSE.

The increase the effect.
When barbituates are mixed with alcohol, antihistamines, benzodiazepines, methotrimeprazine, narcotics and tranqs, an ______ effect is produced.
Additive
BARBITUATES

What is the generic name for Luminal Phenobarbital?
Phenobarbital.
BARBITUATES

It is ok to administer barbituates to a pt in pain? T or F
FALSE.

Barbituates tend to worsen pain
BARBITUATES

Barbituates may be given to pt's with a history of abuse and addiction?
FALSE.
BARBITUATES

Why should you exercise caution when giving barbituates parentally?
Injecting into an artery or tissue may cause serious ischemia. Gangrene could also result.
BENZODIAZEPINES

Benzodiazepones are CNS depressants?
T or F
TRUE
BENZODIAZEPINES

Benzodiazepines act on the _____ and ________ system of the brain, suppressing the electiical discharge.
Hypothalmus and limbic
BENZODIAZEPINES

Benzodiazepines treat ______ motor seizures.
Minor
What sort of anticonvulsant is used to treat Lennox-Gastaut syndrome?
Benzodiazepines
BENZODIAZEPINES

Name 3 Benzodiazepines that are approved for use as anti-convulsants?
GENERIC TRADE
Clonazepam Klonapin
Clorazepate Tranxene
Diazepam Valium
BENZODIAZEPINES

Diazepam is administed by what route?
Intravenously.
Which benzodiazepine is the drug of choice for status epilepticus?
Diazepam.
Clonazepam is used to treat grand mal seizures in elders? T or F
FALSE
It's used to treat petit mal seizures in children.
By which route is clonezepam administered to children?
Orally
Chronic use of this benzodiazepine may result in impaired physical or mental function in the developing child.
Clonazepam
Clorazeoate is used with oher anti-epileptics to control ______ seizures.
Partial
Benzodiazepines are also given to pt's who have failed to respond to this anticonvulsant.
Succinimides
BENZODIAZEPINES

A flushed pt with low b/p, sob, blurred vision, sweating and confusion could be suffering from:
a. an overdosage.
b. an adverse reaction.
c. a common side effect
B. Adverse Reaction.
BENZODIAZEPINES

S/S of Adverse Reaction
Paradoxical reaction
Anorexia
Bitter taste and dry mouth
Heartburn
Burning eyes

....and itchy skin with a rash
BENZODIAZEPINES

A pt who appears tired, weak comes down the hall. They appear to be somewhat confused and have an unsteady stance. This pt is demonstrating signs of:

a. an overdosage.
b. an adverse reaction.
c. a common side effect
a. Overdosage.
BENZODIAZPINES

Somesimes, a combination of benzodiazepines and other anti-convulsants can provoke additional seizures. T or F
TRUE
BENZODIAZEPINES

Benzodiazepines can be used during pregnancy? T of F
F

They may produce neonatal depression and congenital malformations
BENZODIAZEPINES

Which pts should be carefully monitored while on Benzodiazepines?
- Geriatrics
- Weak Patients
- Children
- Pt's with decreased liver function
What does the liver do to benzodiazepines?
Changes benzodiazepines into long-acting forms.
The pt taking benzodiazepines is at increased R/F.
- increased sedation
- liver damage
Why would the pt taking benzodiazepines experience increased sedation?
The drug remains in the body longer.
If stopped too quickly, benzodiazepines can produce this type of seizure?
Status Epilepticus
A pt with a respiratory problem and taking benzodiazepines has been noticed drooling.
Is this abnormal?
Not necessarily.

Benzodiazepines may cause drooling or increased secretions in pt's with abnormal respiratory problems.
What is the onset of action for the benzodiazepines? ___ to ___ minutes with effects that last __ to __ hours.
- 30 to 60 minutes
- 7 to 8 hours
Hydantoines act primarily on the ___ ____ where they stop the seizure activity by increasing or decreasing ___ ___ movement along the cortex during the generation of nerve impulses
- Motor Cortex
- Sodium ion
Hydantoins treat which type of seizure?
Grand Mal and psycho motor seizures
Hydantoins are sometimes used to treat status epilepticus, migraine and trgeminal neuralgia? T or F
True.

They also treat nonepileptic psychotic patients.
You notice a pt staring forward with slurred speech, low b/p and unresponsive pupils. This could be signs of:
a. Common Side Effects
b. Adverse Reactions
c. Overdose.
C. Overdose.

They pt may also have 'nystagmus' (twitchy eyeballs)
What special recommendations should be given for hydantoine oral suspension and PO-route drugs?
Shake well and don't freeze.

Chewable tablets should not be used for once a day treatment.
What type of administration route is dangerous with hydantoine?
SubQ or perivascular injections.

...because of high alkalinity of the solution.
When given by IV route, Hydantoins must be administered very slowly
TRUE
Pts taking hydantoins at R/F for toxicity. Why?
They metabolize the drug at higher rates and are R/F:
Good oral hygiene should be emphasized for hydantoins. Why?
Gingival hyperplagia.
Gum overgrowth is a typical findng with us of hydantoins.
Nystagmus, lupus erythematosus, gingival hyperplagia, hepatitis with jaundice and lymph node hyperplasia are the s/s of an adverse reaction for which anticonvusalnt?
Hydrantoin.
In PO hydrantoin therapy, a capsule labeled 'prompt' means what?
The capsule is to be given 2-3x a day.
In Hydrantoin oral therapy, a capsule labeled 'extended' means that the capsule should be given ____.
Once a day.
Name two hydantoins medications?
GENERIC TRADE
Fosphenytoin Cerebyx
Phenytoin Dilantin
Succinimides _____ the seizure threshhold in the cortex and basal ganglia.
Elevate
Succinimides control this type of seizure
Petite Mal
Succinimides + other anti-convulsant can result in either an increases __________ or an increased ______.
1. Sex drive
2. frequency of grand mal seizures.
S/S of Succinimide Adverse Reaction
Systemic lupus erythematosus
Mental slowness.
Blood cell changes.
Muscular Weakness.
A pt taking succinimides has what appears to be pink urine. This is:
a. normal.
b. an infection
c. an adverse reaction
d. a common side effect
A. Normal.

Succinimides may make urine appear pink, red or reddish-brown.
Name a Succinimide drug.
GENERIC TRADE
Phensuximide
Ethosuximide Zarontin