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25 Cards in this Set
- Front
- Back
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Convulsion
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a type of seizure involving excessive stimulation of neurons in the brain and characterized by the spasmodic contraction of voluntary muscles
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Epilepsy
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General term used for any group of neurologic disorders characterized by recurrent episodes of convulsive seizures, sensory disturbances, abnormal behavior, loss of consciousness, or any combo of these
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seizure
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excessive stimulation of neurons in the brain leading to a sudden burst of abnormal neuron activity that results in temporary changes in the brain function
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primary/idiopathic epilepsy
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the type of epilepsy that the cause is unknown
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secondary epilepsy
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can be caused by trauma, infection, cerebrovascular disorder, or other illness.
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Partial seizures
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short alteration of consciousness, repetitive unusual movements, psychologic changes, and confusion
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simple seizures
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no impaired consciousness, motor symptoms, hallucinations of sight, hearing, or taste along with somatosensory changes (tingling)
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Complex seizures
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Impaired consciousness, memory impairment, behavioral effects, purposeless behavior, aura, chewing and swallowing movements, unreal feelings, bizarre behavior, tonic, clonic, or tonic-clonic
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Generalized seizures
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most often seen in children and commonly characterized by temporary lapses in consciousness lasting a few seconds. Staring off into space, daydreaming, and inattentive look are common symptoms. May have rythmic movements but not convultions, may have several attacks per day. Involves both cerebral hemispheres, tonic, clonic, myoclonic, atonic, or tonic clonic, and possible infantile spasms, head drop or falling down sensations
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tonic-clonic seizure
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formerly called grand mal seizure this type of epilepsy is characterized by a series of generalized movements of tonic and clonic muscualr contraction
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tonic
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stiffening
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clonic
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rapid, synchronized jerking
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antiepileptic drugs
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(AEDs) most are indicated for the management of all types of epilepsy
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anticonvulsants
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medications that are used to prevent the seizures typically associated with epilepsy.
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Pharmacologic effects of AEDs
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1) They increase the threshold of activity in the area of the brain called the motor cortex (make it harder to excite the nerve cells)
2) act to depress or limit the spread of a seizure discharge form its origin. 3) can decrease the speed of nerve impulse conduction with in a given neuron indirectly affecting the area in the brain responsible for the problem by altering, for ex., the blood supply to that area. The overall effect is to stabalized neurons and keep them from becoming hyperexcited and generalizing excessive nerve impulses to adjacent neurons. |
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Pearl...Dilantin
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can't mix with and sugar, don't exceed 50mg/min, only mix in saline, for tonic-clonic, psychomotor seizures. It decreaes the effect of ginko.
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Status Epilepticus
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Life-threatening emergency
Characterized by generalized tonic-clonic convulsions that occur in succession Hypotension, hypoxia, cardiac dysrhythmias Rx: Valium 5-10 mgs Other drugs – Cerebyx (fosphenytoin), Ativan(lorazepam), Phenobarbitol (Solfoton), and Phenytoin(Dilantin) |
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(phenytoin) Dilantin
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~Narrow therapeutic index
~Inject IV slowly – don’t exceed 50 mgs/min in adults (hypotension, ventricular fibrillation) ~IV dose 15-20 mg/kg ~Very irritating to the vein ~Can only mix in saline ~Replaced by Cerebyx to overcome the short comings of Dilantin ~Adult po – 300-600 mg/day ~For tonic-clinic, psychomotor seizures, convulsions ~Side effects – lethargy, abnormal movements, mental confusion, and cognitive changes. ~Therapeutic levels 10-20mcg/mL ~Toxic levels – nystagmus, ataxia, dysarthria, and encephalopathy ~Long term – gingival hyperplasia, acne, hirsutism, and hypertrophy of the subcutaneous facial tissue resulting in “Dilantin facies” ~Osteoporosis long term ~Highly bound to protein and induces hepatic microsomal enzymes, P-450 system ~Long half-life |
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Phenobarbital (Solfoton)
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Barbiturate
Adult – PO 100-300 mg/day IM/IV – 200-800 mgs followed by 120-240 mg dose every 20 min until seizure is controlled or a total dose of 1-2 g is reached Side effects – sedation most common Therapeutic index – 14-40mcg/mL Long half life Interacts with other drugs because it is a a major induce of hepatic enzymes |
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Carbamazepine (Tegretol)
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~Adult 400-2400 mg/day
~For partial seizures with complex symptoms, tonic-clonic, mixed seizures ~2nd most prescribed in the U.S. ~Autoinduction – process whereby a drug increases its own metabolism over time leading to lower concentrations in the system. |
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(clonazepam) Klonopin
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~Benzodiazepine
~Adult – 4-20 mg/day ~Reduces frequency of absence, generalized clonic-tonic, an myoclonic seizures ~High toxicity ~Adverse effects – drowsiness, ataxia, and personality changes. |
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(clorazepate dipotassium)Tranxene
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~Benzodiazepine – long acting
~Adult 22-90 mg/day ~Partial seizures |
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Ethosuximide (Zarontin)
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~Sucinimide
~Very safe ~Adult – 500 mg/day then adjust ~Absence seizures – childhood ~Side Effects – Nausea and abdominal cramps, drowsiness, anorexia, and headache |
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Valporic acid (Depakote, Depakene)
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~Adult PO 15-60 mg/kg/day divided bid-tid
~Generalized seizures ~Side effects – drowsiness, nausea, vomiting, GI disturbances, tremor, weight gain, and hair loss ~Serious side effects – hepatoxicity and pancreatitis |
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Nursing Interventions (antiepileptic drugs)
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~Give medication at same time of day
~Shake oral solutions, do not crush capsules ~Use 23 gauge, 1 ½ inch needle for deep IM, very caustic to skin ~IVs – Dilantin especially – give slowly, monitor pulse, B/P and respiratory rate, may cause hypotension and ~Ventricular fibrillation. ~Keep a journal of seizure activity |
