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182 Cards in this Set
- Front
- Back
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Clonic
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spasms that alternate between contraction and relaxation
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Convulsion
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tonic–clonic type of seizure characterized by spasmodic contractions of involuntary muscles |
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Epilepsy
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disease where the patient has repetitive seizures
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Malignant hyperthermia
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rare but life-threatening complication of anesthesia characterized by hypercarbia, metabolic acidosis, skeletal muscle rigidity, fever, and cyanosis
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Muscle spasm:
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sudden, involuntary, painful muscle contraction that occurs with musculoskeletal trauma or inflammation
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Seizure
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brief episode of abnormal electrical activity in nerve cells of the brain that may or may not be accompanied by visible changes in appearance or behavior
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Tonic
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muscle spasms with sustained contraction
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Tonic–clonic
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most common type of seizure; often referred to as a major motor seizure
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Tonic phase
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sustained contraction of skeletal muscles; abnormal postures, such as opisthotonos; and absence of respirations, during which the person becomes cyanotic
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Clonic phase
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rapid rhythmic and symmetric jerking movements of the body
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Spasticity
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caused by nerve damage in the brain and spinal cord, it is a permanent condition that may be painful and disabling; involves increased muscle tone or contraction and stiff, awkward movements
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Status epilepticus
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repeated seizures or a seizure that lasts at least 30 minutes; may be convulsive, nonconvulsive, or partial |
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Seizures
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may occur as single events in response to hypoglycemia, fever, electrolyte imbalances, overdoses of numerous medications (e.g., amphetamine, cocaine, isoniazid, lidocaine, lithium, methylphenidate, antispasmodics, theophylline), and withdrawal from alcohol or sedative–hypnotic drugs.
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Partial seizures
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begin in a specific area of the brain and often indicate a localized brain lesion such as birth injury, trauma, stroke, or tumor. They produce symptoms ranging from simple motor and sensory manifestations to more complex abnormal movements and bizarre behavior. Movements are usually automatic, repetitive, and inappropriate to the situation, such as chewing, swallowing, or aversive movements (automatisms).
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simple partial seizures
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consciousness is not impaired; in complex partial seizures, the level of consciousness is decreased. |
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Drugs Used to Treat Seizure Disorders
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Barbiturates
Benzodiazepines Gamma-aminobutyric acid (GABA) structural analogs Hydantoins Iminostilbenes Sulfonamides |
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Other Antiepileptic Drugs (AEDs)
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Carboxylic acid derivatives
Functionalized amino acids Mineral electrolytes Phenyltriazine derivatives Pyrrolidine derivatives Sulfamate-substituted monosaccharides Triazole derivatives |
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Phenobarbital (Luminal)
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Barbiturates Prototype
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Diazepam (Valium)
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Benzodiazepines Prototype
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Gabapentin (Neurontin)
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Gamma-aminobutyric acid (GABA) structural analogs Prototype
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Phenytoin (Dilantin)
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HydantoinsPrototype
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Carbamazepine (Tegretol)
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IminostilbenesPrototype
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Acetazolamide (Diamox)
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Sulfonamides Prototype
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Valproic acid (Depakene, Depakene Syrup)
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Carboxylic acid derivatives Prototype
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Lacosamide (Vimpat)
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Functionalized amino acids Prototype
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Magnesium sulfate Lamotrigine (Lamictal) |
Mineral electrolytesPrototype
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Lamotrigine (Lamictal)
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Phenyltriazine derivativesPrototype
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Levetiracetam (Keppra)
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Pyrrolidine derivatives
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Topiramate (Topamax)
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Sulfamate-substituted monosaccharides
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Rufinamide (Banzel)
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Triazole derivativesPrototype
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Phenobarbital
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____________, like all barbiturates, is absorbed rapidly through the gastrointestinal (GI) tract, usually within 1 hour. The oral drug has an onset of action of 30 to 60 minutes and a duration of 10 to 16 hours. The IV form begins to act in 5 minutes and lasts for 4 to 6 hours. ____________ has a half-life of 50 to 140 hours. The drug takes approximately 2 to 3 weeks to reach therapeutic serum levels and 3 weeks to reach a steady-state concentration. It is also lipid bound, which means that it crosses the placenta and is present in breast milk. ____________ is metabolized in the liver and excreted by the renal system.
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Phenobarbital
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____________ depresses the CNS by inhibiting the conduction of impulses in the ascending reticular activating system, thus depressing the cerebral cortex and cerebellar function.
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phenobarbital
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Prescribers order oral ____________ as a sedative and antiepileptic agent in the treatment of generalized tonic–clonic and partial seizures.
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phenobarbital
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Sudden withdrawal of the medication places the patient at risk for status epilepticus. The FDA has issued a BLACK BOX WARNING ♦ for ____________ . Patients who take phenobarbital are at risk for suicidal ideation.
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primrose
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Oil of____________ increases the effects of phenobarbital.
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phenobarbital
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The nurse assesses for increases in CNS activity consistent with paradoxical excitation, as noted most often in the elderly. It is essential to assess respiratory problems such as hypoventilation, apnea, respiratory depression, laryngospasm, bronchospasm, and circulatory collapse, particularly in patients receiving parenteral ____________ .
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Phenobarbital(Luminal)
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Generalized tonic–clonic and partial seizures
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Phenobarbital
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* Assess for bradycardia, hypotension, and syncope
* Assess the serum drug level for signs of toxicity or inadequate seizure treatment * Assess for changes in the integumentary system indicative of the onset of Stevens-Johnson syndrome |
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Drugs That Increase the Effects of Phenobarbital
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Alcohol, chloramphenicol, diazepam, monoamine oxidase inhibitors Gabapentin, valproic acid Mephobarbital, primidone |
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benzodiazepines
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Drugs belonging to this class have a broad range of uses; they may act as antidepressants, antiepileptics, or skeletal muscle relaxants. The____________ potentiate the effects of GABA by increasing the attraction to the receptor sites.
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diazepam
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For the IV drug, the onset of action is 1 to 5 minutes, with a peak of 30 minutes and a duration of 15 to 60 minutes. For the oral drug, the onset of action of 30 to 60 minutes, with a peak of 1 to 2 hours and a duration of 3 hours. For the IM drug, the onset of action is generally within 15 to 30 minutes, with a peak of 30 to 45 minutes and a duration of 3 hours. For the rectal drug, the onset is rapid, with a peak of 1.5 hours and a duration of 3 hours. Its half-life, which is longer in newborns and the elderly, is 20 to 80 hours.
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diazepam
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The exact mechanism of action of____________ is unknown. However, authorities believe that the drug acts primarily on the limbic system and reticular formation to produce skeletal muscle relaxation. It potentiates the effect of GABA by increasing the attraction of the medication to the receptor sites.
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diazepam
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IV ____________ is an adjunctive skeletal muscle relaxant administered for the treatment of severe recurrent convulsive seizures and status epilepticus. Oral diazepam is an adjunctive agent used for seizure disorders.
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diazepam
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CNS adverse effects of____________ include depression, disorientation, restlessness, and confusion. In the first 2 weeks of treatment, paradoxical excitatory reactions may occur. The most serious cardiovascular adverse effect is cardiovascular collapse with bradycardia and hypotension.
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diazepam
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When preparing____________ , the nurse does not mix the drug in plastic bags or tubing or combine it with other solutions. During administration, it is important to monitor pulse, blood pressure, and respiration. During parenteral administration, it is necessary to administer oxygen as well as to put the patient on bedrest for 3 hours. The nurse injects the IV form of the drug slowly into a large vein at 1 mL/min—over at least 3 minutes in children—never intra-arterially or into small veins. Intra-arterial administration results in arterial spasm.
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diazepam
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When administering____________ for a seizure disorder, the goal of therapy is to control seizure activity. When administering drug for status epilepticus, the goal is to eliminate the seizure activity.
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Diazepam(Valium)
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Status epilepticus
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Drugs That Increases the Effect of Diazepam
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Alcohol, omeprazole Cimetidine, disulfiram, and hormonal contraceptives |
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Drugs That Decrease the Effects Diazepam
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Theophylline, ranitidine
Decrease pharmacological effects |
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Herbs and Foods That Increase the Effect of Diazepam
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Kava Valerian Grapefruit juice |
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diazepam
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Do not use alcohol or smoke. Alcohol is more potent when combined with ____________ . Smoking may constrict blood vessels, resulting in reduced elimination of the drug.
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Patient Teaching Guidelines for Diazepam
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Use two types of contraceptives if you are a woman of childbearing age and are sexually active. Ask your prescriber about safety and central nervous system (CNS) depression. Protect yourself from falls. Do not drive or operate machinery if you have CNS depression. Wear a medical alert bracelet or necklace stating that you have a seizure disorder and naming the medications you take. |
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Gabapentin
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____________ reaches its peak in 1 hour. Metabolism occurs in the liver and elimination takes place in the urine. The drug crosses the placenta and may enter the breast milk.
Its antiepileptic action is related to its ability to inhibit postsynaptic responses and block post-tetanic potentiation. |
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gabapentin
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Prescribers order ____________ as an adjunctive treatment for partial seizures.
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gabapentin
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The most common adverse effects of____________ are associated with CNS depression and include dizziness, somnolence, insomnia, and ataxia. Other reported adverse effects are pruritus, dry mouth, dyspepsia, nausea, vomiting, and suicidal ideation.
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Ginkgo biloba
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The herb ____________ decreases the effect of the drug, gabapentin
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gabapentin
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The nurse ensures that ____________ is taken orally. People may take the drug with food to prevent GI upset.
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gabapentin
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The nurses assesses for the absence of partial seizures, the most important therapeutic effect. It is also necessary to assess changes in mood and personality in patients receiving____________ , as with all antiepileptic medications, because suicidal ideation is the result of CNS depression. The nurse assesses for CNS depression that could affect patient safety. |
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phenytoin (Dilantin)
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The oldest and most widely used AED, it is often the initial drug of choice, especially in adults. In addition to using it to treat seizure disorders, prescribers sometimes order it for cardiac dysrhythmias.
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Phenytoin
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____________ is highly bound (90%) to plasma proteins, and only the free drug (the fraction not bound to plasma albumin) is therapeutically active. The oral preparation, absorbed by the GI tract, has a slow onset of action, with a peak of 2 to 12 hours and a duration of 6 to 12 hours. The IV preparation has an onset of action of 1 to 2 hours with a rapid peak and a duration of 12 to 24 hours. The drug is metabolized by the liver and excreted in the urine.
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Phenytoin
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____________ stabilizes the neuronal membrane by delaying the influx of sodium ions into the neurons and preventing the excitability caused by excessive stimulation.
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Phenytoin(Dilantin)
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Generalized tonic–clonic and some partial seizures Prevention and treatment of seizures occurring during or after neurosurgery |
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phenytoin
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Clinicians use____________ to control tonic–clonic seizures, psychomotor seizures, and nonepileptic seizures. They also use it to prevent seizure activity in patients during and following neurosurgery and brain injury.
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Phenytoin
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Patients should not switch between generic and trade name formulations because of differences in absorption and bioavailability.
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phenytoin
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The most common adverse effects of ____________ affect the CNS (e.g., ataxia, drowsiness, lethargy) and GI tract (e.g., nausea, vomiting). Gingival hyperplasia,an overgrowth of gum tissue, is also common, especially in children. Long-term use may lead to an increased risk of osteoporosis because of its effect on vitamin D metabolism. Serious reactions are uncommon but may include allergic reactions, hepatitis, nephritis, bone marrow depression, and mental confusion.
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Drugs That Increase the Effects of Phenytoin
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Alcohol, amiodarone, chloramphenicol, omeprazole, ticlopidine
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Drugs That Decrease the Effects of Phenytoin
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Enteral feedings Decrease ____________ absorption
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phenytoin
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Absorption of folic acid, calcium, and vitamin D is decreased with the administration of ____________ .
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phenytoin
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The injectable solution is highly irritating to tissues. Therefore, when giving the drug intravenously, it is necessary to use special techniques.
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Carbamazepine
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____________ is administered orally and absorbed by the GI tract. The onset of action is slow in both the oral and oral extended-release preparations. The regular oral preparation peaks in 4 to 5 hours, whereas the extended-release preparation peaks in 3 to 12 hours. The half-life of the drug is 12 to 17 hours. It is metabolized by the liver and excreted in the feces and urine. It crosses the placenta and enters breast milk.
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Patient Teaching Guidelines for Phenytoin
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Take the drug as prescribed and do not stop taking it abruptly. Take the medication with food to prevent gastric upset. Have serum drug levels checked as ordered by your prescriber. Maintain good oral hygiene (regular brushing and flossing) to prevent gum disease. Have regular dental check-ups. Use contraception if you are of childbearing age and are sexually active. Wear a medical alert bracelet or necklace, stating that you have a seizure disorder and naming the medications you take. |
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carbamazepine
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The mechanism of action of____________ is not understood, but its antiepileptic activity may be related to inhibition of polysynaptic responses that block post-tetanic potentiation. Like the tricyclic antidepressants, the drug affects sodium channels within the cortical neurons. It has the ability to decrease action potential of the cell by inhibiting the influx of sodium into the cell.
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carbamazepine
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Clinicians use ____________ to tprevent partial seizures with complex symptoms, as in patients with psychomotor and temporal lobe epilepsy. Prescribers order the drug for generalized tonic–clonic and mixed seizures, either partial or generalized. Patients who have uncontrolled seizures or CNS depression on other AEDs use it commonly.
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Carbamazepine(Tegretol)
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Partial Generalized tonic–clonic Mixed seizures |
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Carbamazepine
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____________ may have serious adverse effects. The FDA has issued a BLACK BOX WARNING ♦ for ____________ concerning aplastic anemia and agranulocytosis. Other adverse effects include heart block, Stevens-Johnson syndrome, respiratory depression, hepatitis, massive hepatic cellular necrosis with total loss of intact liver tissue, and suicidal ideation.
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carbamazepine
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The herb Ginkgo biloba decreases the effect of the drug.
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carbamazepine
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It is essential that ____________ not be administered within 14 days of use of a monoamine oxidase inhibitor. The nurse should tell patients never to crush or chew extended-release tablets. When the nurse administers____________ suspension, he or she never mixes the preparation with other liquid medications because a precipitate may develop. The nurse ensures that the medication is taken with food to prevent GI upset.
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carbamazepine
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The nurse assesses the patient for absence of partial, tonic–clonic, and mixed seizures.
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Drugs That Increase the Effects of Carbamazepine
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Erythromycin, troleandomycin, cimetidine, danazol, isoniazid, propoxyphene, verapamil Lithium Isoniazid |
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Drugs That Decrease the Effects of Carbamazepine
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Barbiturates Phenytoin, primidone |
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carbamazepine,
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There is a risk of aplastic anemia with the administration of ____________ and hematologic assessments are most important. The nurse also assesses the integumentary system for Stevens-Johnson syndrome. It is also important that he or she assess hepatic function to check for hepatic adverse effects, including hepatic failure. In addition, to prevent toxicity, the nurse assesses serum levels as ordered. |
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acetazolamide (Diamox)
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The sulfonamide diuretic ____________ controls fluid secretion in the CNS. It is an adjuvant medication useful in the treatment of seizures.
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Acetazolamide
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___________ is absorbed by the GI tract. For regular tablets, the onset of action is 1 hour, the peak is 2 to 4 hours, and the duration of action is 6 to 12 hours. For sustained-release tablets, the onset of action is 2 hours, the peak is 3 to 6 hours, and the duration of action is 6 to 12 hours. The half-life of the drug is 5 to 6 hours. ____________ is concentrated in the red blood cells, plasma, and kidneys. The drug is excreted by the kidneys and eliminated in the urine. It crosses the placenta._
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Patient Teaching Guidelines for Carbamazepine
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Take the medication with food. Do not chew or crush extended-release tablets. Do not stop taking the medication abruptly. Avoid alcohol, sleep agents, or over-the-counter medications. Have hematological testing as ordered by your prescriber. Use contraceptives if you are of childbearing age and are sexually active. Wear medical alert bracelet or necklace stating that you have a seizure disorder and naming the medications you take. Report symptoms of bruising or bleeding immediately to your prescriber. |
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Acetazolamide(Diamox)
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Absence and tonic–clonic seizures
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acetazolamide
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The antiepileptic action of ____________ is unclear, but it is thought to inhibit CNS carbonic anhydrase to decrease neuronal excitability.
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acetazolamide
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The adverse effects of____________ include excessive diuresis, Stevens-Johnson’s syndrome, CNS depression, aplastic anemia, leukopenia, thrombocytopenia, hypokalemia, asymptomatic hyperuricemia, and hyperchloremic acidosis.
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acetazolamide
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To prevent GI upset, the nurse ensures that the drug is taken with food. Crushing or chewing of regular tablets is permissible, but patients must swallow sustained-release tablets whole. It is necessary to store the oral preparation in a container with a tight-fitting lid at 59°F to 86°F.
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Patient Teaching Guidelines for Acetazolamide
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Take the medication with food to prevent gastric upset. Have annual eye examinations to assess intraocular pressure. Report any changes in weight, unusual bruising or bleeding, pain, or rash to your prescriber. |
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valproic acid
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The onset of action for oral ____________ varies, and it reaches its peak in serum in 1 to 4 hours. Parenteral ____________ has a rapid onset of action, reaching a peak in 1 hour. The drug is metabolized by the liver and excreted by the kidneys. It crosses the placenta and enters breast milk. See Figure 52.1 for the site of action of the carboxylic acid derivatives.
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valproic acid
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The action of ____________ is not understood, but it is thought to produce antiepileptic activity by increasing GABA effects, thus decreasing electrical activity.
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valproic acid
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Clinicians use____________ alone or in combination with other AEDs for the treatment of simple and complex absence seizures, and prescribers also order the drug for the treatment of seizures related to Lennox-Gastaut syndrome.
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valproic acid
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The most life-threatening adverse effects associated with____________ are pancreatitis and hepatic failure. Other significant adverse effects include altered bleeding time, thrombocytopenia, bruising, and hemorrhage. The most common GI adverse effects are nausea, vomiting, indigestion, diarrhea, and abdominal cramps. CNS adverse effects include sedation, tremor, emotional upset, weakness, and suicidal ideation.
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valproic acid
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The FDA has issued several BLACK BOX WARNINGS ♦ for ____________ . The first instructs patients to discontinue valproic acid at any sign of pancreatitis. The development of this condition is life threatening. The second points out that ____________ is a teratogenic medication. Women of childbearing age should not take the drug without using two forms of birth control. The third instructs the patient to check for signs of bleeding or bruising.
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valproic acid
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Certain medications interact with____________ , decreasing or increasing its effects (Box 52.12). Serum levels of phenobarbital, primidone, ethosuximide, diazepam, lamotrigine, and zidovudine may increase when these drugs are combined with valproic acid. The herb Ginkgo biloba decreases the effect of the drug.
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valproic acid
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The nurse dilutes the vial in 5% dextrose, 0.9% sodium chloride, or lactated Ringer’s solution for IV administration. The reconstituted medication is stable for 24 hours and does not need to be refrigerated. Infusion should occur over 1 hour, no faster than 20 mg/min. IV administration is permissible only for 14 days, and a switch to an oral preparation is necessary. When administering Depakote to children, the nurse may open the tablets and sprinkle the contents on applesauce or pudding. |
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Valproic acid(Depakene capsules); Sodium valproate (Depakene syrup, Depacon injection); Divalproex sodium (Depakote enteric-coated tablets)
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Absence, mixed, and complex partial seizures
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Drugs That Increase the Effects of Valproic Acid
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Alcohol, central nervous system (CNS) depressants Chlorpromazine, cimetidine, erythromycin, |
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Drugs That Decrease the Effects of Valproic Acid
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Carbamazepine, charcoal, rifampin Phenytoin |
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Patient Teaching Guidelines for Valproic Acid
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Keep follow-up appointments for serum blood levels, platelet counts, bleeding and clotting times, liver function, and renal function. Use two types of birth control if you are a woman of childbearing age and are sexually active. Notify your prescriber if you become pregnant. Do not operate machinery with central nervous system (CNS) depression. You may have sedation, tremors, emotional upset, weakness, or suicidal ideation. Know the signs and symptoms of pancreatitis, such as upper abdominal pain and nausea and vomiting, which often begins or worsens after eating. If you have diabetes, be aware that this medication interferes with ketones. Report any unusual bleeding or bruising. |
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Lacosamide
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____________ is rapidly absorbed. The oral preparation reaches its peak in 1 to 4 hours, and the IV preparation reaches its peak at the end of the infusion. The half-life of the medication is 13 hours. The drug is metabolized by the liver and excreted in the urine. It crosses the placenta and may enter the breast milk. |
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lacosamide
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The mechanism of action of____________ is not fully understood. The drug inhibits the voltage-sensitive sodium channels, producing stabilization of the neuronal membrane and inhibition of the repetitive firing of the neuron.
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lacosamide
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Indications for oral ____________ include the treatment of partial-onset seizures. Clinicians use the IV drug on a short-term basis when oral administration is prohibited.
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lacosamide
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The adverse effects of____________ include a prolonged PR interval, dizziness, ataxia, diplopia, somnolence, suicidal ideation, headache, nausea, and vomiting.
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lacosamide
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It is important that____________ not be combined with any medication that prolongs the PR interval. Patients should not take this drug in combination with alcohol.
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Patient Teaching Guidelines for Lacosamide
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Report any mood changes to the prescriber. Keep follow-up appointments to monitor drug response and assessment of adverse effects. Do not drink alcohol because of the increased risk of central nervous system (CNS) depression. If you are a woman of childbearing age and are sexually active, use contraceptives. |
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lacosamide
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The nurse may give IV____________ in 0.9% sodium chloride, 5% dextrose, or lactated Ringer’s solution. The period of infusion is 30 to 60 minutes. Administration of____________ should not occur in the same IV line with other medications. The preparation is stable at room temperature for 24 hours.
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lacosamide
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The nurse assesses the patient for CNS depression and diminished partial-onset seizure activity. The greatest risks associated with ____________are suicidal ideation and cardiac conduction abnormalities. The nurse assesses the patient for sudden personality changes, signs of aggression, and severe nausea and vomiting. During parenteral administration, the nurse assesses for signs of a prolonged PR interval. |
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magnesium sulfate
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It is important to understand the use and administration of the mineral electrolyte,____________, due to the fetal neuroprotection it can prove to pregnant women. This medication provides the opportunity to improve neurodevelopmental outcomes in infants by delaying preterm birth and decreasing maternal seizure risk.
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Lamotrigine (Lamictal)
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____________ is used for adjunctive therapy in the treatment of partial seizures, administered orally. It is absorbed by the GI tract with a rapid onset of action. ____________ is metabolized by the liver and excreted in the urine. It crosses the placenta and enters the breast milk. The medication is 55% protein bound and has a 25- to 30-hour half-life.
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lamotrigine
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The action of____________ is not well understood. It is thought to reduce the release of glutamate, an excitatory neurotransmitter, in the brain. The neurotransmitter is sensitive to sodium channels, thus decreasing seizure activity.
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lamotrigine
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Adverse effects of ____________ include dizziness, drowsiness, headache, ataxia, blurred or double vision, nausea and vomiting, and weakness. The FDA has issued a BLACK BOX WARNING ♦ related to the potential development of serious dermatologic reactions. Because a serious skin rash may occur, especially in children,____________ should be administered cautiously to children younger than 16 years of age and should be discontinued at the first sign of skin rash in an adult.
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Drugs That Increase the Effects of Lamotrigine
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Valproic acid
Significantly increases plasma concentration |
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Drugs That Decrease the Effects of Lamotrigine
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Carbamazepine, fosphenytoin,
oral contraceptives, phenobarbital, primidone, phenytoin Decrease serum concentration |
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Lamotrigine
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The nurse should assess for the lack of generalized, myoclonic, and absence seizures. The nurse assesses the integumentary system daily for the onset of skin eruptions. He or she also questions the patient about ophthalmological changes. |
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Herbs and Foods That Decrease the Effect of Lamotrigine
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Gingko biloba Oil of primrose |
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Levetiracetam (Keppra)
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____________ s an AED that is effective in the treatment of a wide variety of seizure disorders. In a retrospective study, Gamez-Leyva, Aristin, Fernandex, and Pascual (2009) found that IV ____________ was effective in patients with status epilepticus. Of note, these patients had not responded well to benzodiazepines.
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Levetiracetam
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____________ is administered orally or intravenously and is rapidly absorbed, reaching its peak in 1 hour. It is 10% protein bound with minimal hepatic metabolism. It is excreted in the urine and has a 7.1-hour half-life. The half-life in older adults is 9.6 hours.
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Levetiracetam
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____________ is chemically unrelated to other AEDs, and its mechanism of action is unknown. It inhibits abnormal neuronal firing but does not affect normal neuronal excitability or function.
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levetiracetam
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Clinicians use ____________ as adjunctive therapy for partial-onset and generalized tonic–clonic seizures.
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levetiracetam
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Common adverse effects of____________ include drowsiness, dizziness, and fatigue. Others include decreases in red and white blood cell counts, double vision, amnesia, anxiety, ataxia, emotional lability, hostility, nervousness, paresthesia, pharyngitis, and rhinitis.
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Patient Teaching Guidelines for Lamotrigine
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Call your prescriber if a skin rash develops. Use protection from sunlight. Do not operate machinery if you have central nervous system (CNS) depression. Use contraceptives if you are of childbearing age and are sexually active. Schedule eye examinations annually. Do not stop the medication abruptly. |
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levetiracetam
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The nurse assesses the patient for symptoms of partial-onset and generalized tonic–clonic seizures, which should be absent. The nurse assesses the patient for ocular changes, CNS depression, and hematological changes. |
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Topiramate (Topamax)
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____________ is a sulfamate-substituted monosaccharide that was identified during a research project to develop a new antidiabetic agent. One study found that topiramate provides neurostabilizing effects by attenuating the excitability of brain neuronal pathways
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Topiramate
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____________ is absorbed in the GI tract and produces peak plasma levels about 2 hours after oral administration. The average half-life is about 21 hours, and steady-state concentrations are reached in about 4 days with normal renal function. The drug is 20% bound to plasma proteins.____________ is not extensively metabolized and is primarily eliminated via the kidneys.
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52.18 Patient Teaching Guidelines for Levetiracetam
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Take the medication as prescribed and do not crush or chew extended-release tablets. Do not stop taking the medication abruptly. Use contraceptives if you are of childbearing age and are sexually active. Schedule eye examinations annually. Do not operate machinery if you have central nervous system (CNS) depression. |
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topiramate
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The mechanism of action of____________ is not understood, but the antiepileptic action may be related to the blockage of sodium channels in neurons with sustained depolarization. This action increases GABA activity at the receptors, potentiating the inhibition of the neurotransmitters blocking excitatory neurotransmitters at the neuron receptor sites.
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topiramate
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Clinicians use____________ as monotherapy in partial-onset or primary generalized tonic–clonic seizures as well as in adjunctive therapy for partial-onset or primary generalized seizures. Lennox-Gastaut syndrome is also an indication. In addition, prescribers order the medication as a preventive for migraine headaches.
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topiramate
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Adverse effects of____________ include CNS effects such as ataxia, somnolence, dizziness, and nystagmus as well as GI adverse effects such as nausea and dyspepsia. Renal stones may develop. Other adverse effects are increased intraocular pressure, weight loss, and fatigue.
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Topiramate
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has a very bitter taste. To prevent patients from tasting the bitterness, the nurse instructs them never to chew the medication. In addition, the nurse notes that it is necessary to store topiramate in a tightly closed container at 59°F to 86°F.
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Topiramate: Lennox-Gastaut
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Patients are without symptoms of partial or generalized seizures. Those with____________ syndrome have no seizure activity. The nurse assesses the patient for pain or discomfort related to kidney stones. The patient should have an annual eye examination to determine the onset of increased intraocular pressure. |
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Rufinamide (Banzel)
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____________ is structurally unrelated to other AEDs. It produced antiepileptic effects in several animal studies including seizures induced by maximal electroshock
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Drugs That Increase the Effects of Topiramate
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Alcohol Carbonic anhydrase inhibitors |
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Drugs That Decrease the Effects of Topiramate
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Carbamazepine, phenytoin, valproic acid
Decrease serum levels |
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Patient Teaching Guidelines for Topiramate
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Take the medication as prescribed. Do not stop taking the medication abruptly. Use two types of contraceptives if you are of childbearing age and are sexually active. Do not operate machinery with central nervous system (CNS) depression. Drink six to eight 8-ounce glasses of water per day to decrease risk of renal stone development. |
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Rufinamide
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____________is absorbed slowly by the GI tract. Peak plasma concentrations occur between 4 and 6 hours. The drug is metabolized extensively without active metabolites. It is excreted by the kidneys. ____________decreases seizure activity by prolonging the inactive sodium channels in the cortical neurons. |
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rufinamide
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Clinicians use ____________ in the treatment of seizures in patients with Lennox-Gastaut syndrome.
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rufinamide
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The most common adverse effects of ____________include fatigue, headache, somnolence, vomiting, and flu-like symptoms. Contraindications include short QT syndrome, severe hepatic impairment, pregnancy, and lactation. |
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Drugs That Increase the Effect of Rufinamide
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Valproic acid
Increases plasma concentration |
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Drugs That Decrease the Effect of Rufinamide
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Primidone Carbamazepine, ethinyl estradiol, and norethindrone Phenobarbital, phenytoin |
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Patient Teaching Guidelines for Rufinamide
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Take the medication with food. Take the medication as prescribed. Do not stop taking the medication abruptly. Use two types of contraceptives if you are of childbearing age and are sexually active. |
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rufinamide
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To increase drug absorption, the nurse ensures that is taken ____________ with food. It is acceptable to crush or split the medication for ease of administration.
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Carisoprodol (Soma)
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____________ is a centrally acting skeletal muscle relaxant. It is chemically related to meprobamate, which inhibits multineuronal spinal reflexes.
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Carisoprodol (Soma)
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CARBAMATE DERIVATIVES protoype
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carisoprodol
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The onset of action of____________ is 30 minutes, with a peak in 1 to 2 hours and a duration of 4 to 6 hours. The half-life is 8 hours. The drug is metabolized in the liver by the enzyme CYP2C19 and excreted in the urine. It crosses the placenta and is present in breast milk.
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carisoprodol
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The action of____________ is not known, but animal studies have shown that the drug inhibits interneuronal activity in the descending reticular formation and spinal cord. It does not act directly to relax the skeletal muscles.
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carisoprodol
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Clinicians us____________ e in the relief of discomfort associated with acute painful musculoskeletal conditions in which relief was not attained by rest, physical therapy, or alternative measures.
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carisoprodol
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CNS adverse effects of____________ include dizziness, drowsiness, vertigo, ataxia, tremor, agitation, and irritability. Initially, after the first, second, third, or fourth dose, patients may exhibit an allergic or idiosyncratic reaction with rash, erythema multiforme, pruritus, eosinophilia, hypotension, bronchospasm, vision and speech alterations, and the most severe adverse effect, anaphylactoid shock.
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carisoprodol |
The nurse administers ____________ with food to prevent GI upset, giving the last dose of medication at bedtime. It is necessary to store the mediation in a container with a tight-fitting lid.
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carisoprodol
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The nurse assesses the musculoskeletal area for relief of pain and spasms associated with the musculoskeletal injury.
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carisoprodol
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The nurse assesses the integumentary system for signs and symptoms of an idiosyncratic reaction after the fourth to fifth doses of ____________ . It is also important to observe for visual changes, speech difficulties, bronchospasm, hypotension, and anaphylaxis. ____________ is habit forming and should not be stopped abruptly. Abrupt withdrawal results in headache, nausea, insomnia, and abdominal cramping.
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baclofen (Lioresal)
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____________ is an agonist-specific inhibitor to GABAB receptors located in the spinal cord. It restricts the influx of calcium to reduce the presynaptic neurotransmitter release in the excitatory spinal pathways
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baclofen (Lioresal)
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GABA derivative PROTOTYPE
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baclofen
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Oral____________ begins to act in 1 hour, peaks in 2 hours, and lasts 4 to 8 hours. It is metabolized in the liver and excreted in urine; its half-life is 3 to 4 hours. Intrathecal baclofen has an onset of action of 30 to 60 minutes, peaks in 4 hours, and like oral baclofen, has a duration of action 4 to 8 hours. The drug crosses the placenta and enters the breast milk.
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baclofen
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The exact mechanism of action of____________ is unknown. It appears to reduce impulse transmissions from the spinal cord to the skeletal muscle, thus decreasing muscle spasms.
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baclofen
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Clinicians use____________ to alleviate signs and symptoms of spasticity in patients with multiple sclerosis. It is particularly effective against flexor spasms, concomitant pain, and muscular rigidity. Other indications include the treatment of spinal cord injuries and other diseases of the spinal cord.
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Patient Teaching Guidelines for Carisoprodol
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Do not operate machinery with central nervous system (CNS) depression. Do not combine with other CNS depressants or alcohol. Take the medication with food. Do not combine with over-the-counter cold remedies without approval from the prescriber. Do not stop the medication abruptly. Know the idiosyncratic effects of the drug and how to maintain safety when CNS effects are evident. Report signs and symptoms of idiosyncratic adverse effects. |
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baclofen
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The most common adverse effects of ____________are transient drowsiness, dizziness, weakness, fatigue, confusion, headache, insomnia, hypotension, and urinary frequency. Elevated blood sugar may occur, requiring the administration of an oral hypoglycemic agent. Contraindications include known hypersensitivity to the drug and skeletal muscle spasms resulting from rheumatic disorders. |
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baclofen
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When ____________ is combined with alcohol or other CNS depressants, patients experience increased CNS depression.
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baclofen
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Administration of ____________is oral or intrathecal. The nurse starts with a low dose that he or she increases slowly, using the smallest dose possible to achieve muscle tone without adverse effects. If the benefits of the medication are not evident during a trial period, then the medication is withdrawn gradually. Intrathecal administration involves an implantable pump. It is best to consult the manufacturer’s literature concerning the pump instructions and initiation of long-term infusions. |
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Baclofen
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Do not stop taking the drug abruptly; Abrupt discontinuation may cause hallucinations or other serious side effects. Avoid alcohol and other central nervous system (CNS) depressants. Do not take if you are pregnant or breast feeding. Do not operate machinery. Report painful or frequent urination, constipation, headache, insomnia, or confusion. |
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Dantrolene sodium
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____________ is a drug administered for spasticity related to multiple sclerosis, cerebral palsy, spinal cord injury, and stroke.
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HYDANTOIN DERIVATIVES
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HYDANTOIN DERIVATIVES PROTOTYPE
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dantrolene
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Oral ____________ is absorbed by the GI tract, reaching a peak in 4 to 6 hours. The duration of action is 8 to 10 hours, and the half-life is 9 hours. IV ____________ has a rapid onset of action with a peak in 5 hours, a duration of action of 6 to 8 hours, and a half-life of 4 to 8 hours. The drug is metabolized by the liver and excreted in the urine. ____________ crosses the placenta and enters the breast milk.
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Dantrolene
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____________ interferes with the release of calcium from the sarcoplasmic reticulum to relax skeletal muscle. It does not interfere with neuromuscular transmission or affect the surface membrane of the skeletal muscle.
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Dantrolene
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____________ controls spasticity caused by upper motor neuron disorders, such as spinal cord injury, cerebrovascular accident, cerebral palsy, and multiple sclerosis. Clinicians may use it to prevent and manage malignant hyperthermia, a rare but life-threatening complication of anesthesia characterized by hypercarbia, metabolic acidosis, skeletal muscle rigidity, fever, and cyanosis.
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dantrolene
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The FDA has issued a BLACK BOX WARNING♦ stating that the patient should have liver function tests and that ____________ be discontinued at the first indication of hepatic impairment.
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Cyclobenzaprine hydrochloride (Flexeril
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____________ is a centrally acting skeletal muscle relaxant administered on a short-term basis for the relief of muscle spasm.
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Cyclobenzaprine
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____________ s administered orally and is well absorbed by the GI tract. The onset of action is 1 hour, with a peak in 3 to 8 hours, and the duration of action is 12 to 24 hours. The half-life is 1 to 3 days. The drug is highly protein bound. It is metabolized in the liver to inactive metabolites and is excreted in the urine, with some eliminated in the feces. ____________ crosses the placenta and is excreted in the breast milk.
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Patient Teaching Guidelines for Dantrolene
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Do not alter positions when experiencing dizziness. Report gastrointestinal (GI) upset and eat small frequent meals. Avoid alcohol and other central nervous system (CNS) depressants. Report severe diarrhea, headache, and anorexia. |
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cyclobenzaprine
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The mechanism of action of____________ is not known, but it appears to produce relaxation by acting at the brainstem and spinal cord to depress motor activity.
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cyclobenzaprine
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Clinicians use____________ as an adjunctive to other measures such as physical therapy to relieve muscle spasm
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cyclobenzaprine
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Common adverse effects of ____________are drowsiness, dizziness, and anticholinergic effects (e.g., dry mouth, constipation, urinary retention, tachycardia). Contraindications include known hypersensitivity to the drug. Other contraindications include acute myocardial infarction, dysrhythmia, heart block, conduction disturbances, heart failure, and hyperthyroidism. Caution is necessary with urinary retention, increased intraocular pressure, and mild hepatic impairment. |
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6 Patient Teaching Guidelines for Cyclobenzaprine
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Avoid alcohol and other central nervous system (CNS) depressants. Do not operate machinery with CNS depression. Report effectiveness of therapy to prescriber. |
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Tizanidine hydrochloride (Zanaflex)
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____________ is a centrally acting alpha2-adrenergic agonist administered for acute and intermittent management of increased muscle tone with spasticity.
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Tizanidine
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____________ is absorbed rapidly in the GI tract. The medication has on onset of action in 30 to 60 minutes, peak in 1 to 2 hours, and duration of action in 3 to 6 hours. It is metabolized by the liver with a 2.7- to 4.2-hour half-life, and the drug is excreted in the urine.____________ crosses the placenta and enters the breast milk.
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Tizanidine
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____________ is a centrally acting alpha2-adrenergic agonist that produces antispasmodic effect as a result of indirect depression of postsynaptic reflexes by blocking the excitatory actions of spinal interneurons.
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tizanidine
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Clinicians use____________ as indicated for use in patients who have acute and intermittent management of increased muscle tone associated with spasticity.
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tizanidine
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Common adverse effects of ____________ include drowsiness, dizziness, constipation, dry mouth, and hypotension. Hypotension may be significant and occur at usual doses. The drug may also cause psychotic symptoms, including hallucinations. Contraindications include hypersensitivity to the medication. Other contraindications include use of fluvoxamine and ciprofloxacin. |
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Patient Teaching Guidelines for Tizanidine
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Do not alter positions when experiencing dizziness. Do not operate machinery. Report unusual sensory effects such as hallucinations or delusions. |
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tizanidine
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The nurse assesses the patient for a reduction of skeletal muscle spasms and decreased muscle tone. The nurse assesses patients for somnolence, sedation, dizziness, and hallucinations. He or she also assesses the cardiovascular patient’s status for bradycardia and hypotension. In addition, it is necessary to assess the patient’s liver and renal function |
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tizanidine
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The administration of alcohol, baclofen, or CNS depressants with____________ can increase the patient’s susceptibility to symptoms of depression. Hormonal contraceptives may increase the plasma concentration of ____________ . Administration with other alpha2-agonists may have hypotensive effects. Kava and valerian may decrease the effect of the drug.
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