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33 Cards in this Set
- Front
- Back
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What is happening within the brain when a seizure is occurring?
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A sudden discharge of EXCESSIVE electrical disharge from the nerve cells within the brain
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Define the term epilepsy
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A collection of various syndromes all of which are characterized by seizures
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What are causes of seizures?
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Primary have no underlying cause. Secondary result of trauma, infection, CVA or illness
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Describe how seizures are treated: depression of CNS or increasing GABA
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CNS depression: inhibits impulse conduction in the ascending RAS, depresses cerebral cortex, alters cerebellular function... GABA: potentiates the effects f GABA which acts as an inhibitory neurotransmitter that acts to stabilize the nerve membrane.
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Define a generalized and partial seizure. Which type includes multiple areas of the brain? Which one only includes part of the brain and originates from one site or focus?
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Generalized seizures begin in one area of the brain & rapidly spread through both hemispheres. Partial seizures or "focal seizures" involve one area of the brain and does not spread throughout the brain.
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Define status epileptics. Why is diazepam a benzodiazepine effective in treating status epiplepticus?
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Status elipepticus starts out as pratial or generalized seizures and then develops into a "Pattern of no recovery between attacks" Diazepam has a very quick onset and long half life, making it an adjunct drug of choice for status epileptics/
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Describe a tonic-clonic seizure or grand mal seizure. Is this a generalized or partial seizure?
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Tonic-clonic is a generalized seizure described as having tonic-clonic muscle contractions, loss of consciousness and a recovery period characterized by confusion and exhaustion.
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Are convulsions always present when a seizure is occurring?
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Convulsions are spasmodic contractions of voluntary muscle & are NOT always present during a seizure.
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Petit mal seizures are common in what age population?
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Children and frequently disappear at puberty.
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What would you teach a patient who is being prescribed antiepileptic agents?
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Timing of doses is very important. Do not stop taking suddenly. Common side effects are fatique, weakness, drowsiness, headaches, difficulty sleeping, GI upset, loss of appetite, diarrhea or constipation. Adverse effects that need to be reported include skin rash, severe N/V, impaired coordination, yellowing of eyes or skin, fever, sore throat, personality changes, and unusual bleeding or bruising.
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Contrast simple partial and complex partial seizures
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Simple partial - single muscle movement or sensory alteration. Complex partial - complex sensory changes and motor changes
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Why is it important for a nurse to observe and record the characteristics of a seizure?
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It helps to identify the TYPE of seizure the patient is having.
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Why is AED therapy a difficult task?
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The side effects make it a difficult task to maintain seizure control while limiting the adverse side effects.
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Why is monotherapy an advantage in AED therapy?
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Can allow higher serum concentrations and fewer side effects resulting in better control.
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Explain the reason why "rescue drugs" are used and their therapeutic action. The influx of what electrolyte causes brain damage during a seizure?
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During seizures there can be an excessive amount of calcium into cells which causes neuronal destruction of brain tissue which leads to brain damage. Calcium channel blockers may be given to prevent brain damage.
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What classes of drugs are used to treat seizures-grand mal and petit mal? Are they CNS depressants or CNS stimulants?
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hydantonions, barbiturates, benzodiazapines. This is done by blocking channels in the cell membranes or by altering receptor sites. These are CNS depressants causing sedation.
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What is an advantage to using the hydatoins?
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The chemical class is less sedating than the other classes.
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Prototype Hydantoins
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Phenytoin (Dilantin) is one of the first line drugs used for many seizures. Side effects: drowsiness, dizziness, blood dyscarasias, SEVERE LIVER TOXICITY, folic acid defieciency, ataxiz, vein irritation, gingival hyperplasia. Has very NARROW therapuetic index. Do not stop suddenly as can cause status epilepticus. Fosphenytoin (Cerebyx) similar to Dilantin but does not irritate tissue like dilanitn.
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Prototype Barbiturate
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Phenobarbital allows for once a day dosing with a 79 hour half-life. Can increase toxicity. Used for treatment for various seizures, acute convulsions, sedative, pre-anesthetic and short term tx of insomnia. Adverse effects: Somnolence, lethargy, nervousness, hallucinations, dizziness, hypotension, N/V, constipation, respiratory depression & tissue necrosis at injection site. Diazapam (Valium)- has very quick onset and long half life. Used to treat anxietym preoperative, acute alcohol withdrawl, muscle relaxant, adjunct with status epilepticus and recurrent convulsive seizures. Adverse effects: drowsiness/sedation, lethargy, disorientation, dysrhthymias and paradoxial excitement.
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Prototype Succinimides (Petit Mal)
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Ethosuximde (Zarontin) used to treat abscent seizures. CNS depressant effects, GI effects, bone marrow suppresion, dermatological reactions (Steven Johnson Syndrome) Methsuximide (Celontin) is reserved for use with seizures that are more resistant to tx due to more adverse side effects.
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Prototypes for Partial Seizures
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Carbamazepine (Tegretol) 2nd most prescribed after Phenytoin. Undergoes "autoinduction" a process where the drug speeds up its own metabolism over time leading to lower concentrations. Adverse effects: CNS effecys, blood dyscrasias & Stevens Johnson syndrome. Gabapentin (Neurontin) treats partial seizures and neuropathic pain. Do NOT discontinue abruptly can lead to seizures. Increases GABA which is an inhibitory neuro transmitter to the CNS. Requires weekly/biweekly CBC and liver function tests due to aplastic anemiaand liver failure side effects.
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Why does dilantin interact with so many other drugs?
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Dilantin interacts with so many drugs due to P450 system (hepatic microsomal enzymes involved with drug metabolism.
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Why should dilantin not be stopped suddenly?
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May cause status epilepticus
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It is highly bound to plasma proteins? What effects can this cause when giving with other protein bound agents? ,
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Yes, highly bound to plasma proteins.
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What are adverse effects associated with dilantin?
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Severe liver toxicity, gingival hyperplasia
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Patient Teaching for Dilantin:
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Do not stop suddenly. Interacts with many drugs, drug levels must be monitored. Therapuetic levels is 5-20ug/dl
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What consideration needs to be addressed for patients who are on Dilantin orally and need to be kept NPO for surgery?
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may need to change from oral route to IV route per MD order
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Fosphenytoin (cerebyx) is similar to what agent? Are they interchangeable agents?
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Dilantin. no theyare not interchangable because they do not have the same dosing.
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Why is once a day dosing an advantage to Phenobarbital?
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Helps with compliance.
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Why is diazepam (valium) often a drug of choice to treat status epilepticus
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has a very quick onset and long half life making it an adjunct drug of choice
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What class of drug is used to treat absence seizures? (petit mal)
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Succinimides
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Explain "autoinduction" that can occur with carbamazepine
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process where the drug speeds up its own metabolism over time leading to a lower drug concentration. Usually occurs within first 2 months.
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What other indication is gabapentin (neurontin) used for besides treatment of partial seizures? What type of pain is it used to treat?
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Effective with partial seizures and to treat nueropathic pain.
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