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28 Cards in this Set

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- Disorder of recurrent seizures

- Anticonvulsants prevent and control most epileptic seizures

- Goal of drug therapy is to reduce seizure activity with lowest level of drug

- Start 1 at a time, slowly increase dose, may need multiple drugs


Disorganized, rapid-firing, electrical activity

Generalized seizures - produced by the entire brain

1. Grand Mal - unconsciousness, convulsions, muscle rigidity

2. Absence - Brief loss of consciousness

3. Myoclonic - Sporadic (isolated), jerking movements

4. Clonic - Repetitive, jerking movements

5. Tonic - Muscle stiffness, rigidity

6. Atonic - Loss of muscle tone

Generalized Seizures: First Line Generations

Mechanism of Action: Generally unknown

Cause a decrease in voltage, frequency, and spread of electrical impulses

Side Effects: ataxia, dizziness, drowsiness, loss of coordination

Adverse Effects: Bleeding

Examples: Dilantin (phenytoin), Tegretol (carbamepine), Depakote (valproic acid)

Note: Can't stop abruptly, no alcohol consumption

Anticonvulsants: First Line Specifics

Phenytoin (Dilantin)

- Narrow therapeutic index, teratogenic

Side Effects: hyperplasia of gums, diplopia, hypotension

Adverse Effect: Neutropenia, aplastic anemia (Low WBCs and RBCs)

Interactions: Increase Effects of anticoagulants, decrease absorption with antacids

Anticonvulsants: First Line Specifics


- Used for bipolar disorder and alcohol withdrawal

Adverse Effects: Neutropenia, thrombocytopenia (low platelets)

No grapefruit juice - causes increased levels of the drug

Anticonvulsants: First Line Specifics

Valproic Acid (Depakote)

Mechanism of Action: attributed to increased GABA (calming effect)

Adverse Effects: hepatotoxicity, pancreatitis

Anticonvulsants: First Line for Absence Seizures

Mechanism of Action: Depresses motor cortex and increases the CNS threshold to stimuli

Side Effects: GI (anorexia, n/v), sensitivity to light, drowsiness

Adverse Effects: Pancytopenia (Low blood cells)

Example: Zarontin (ethosuximide)

Note: Also use valproic acid (Depakote) for absence seizures

Anticonvulsants: Second Line: Benzodiazepines

Mechanism of Action: Potentiate GABA, generally useful for all seizures

Side Effects: ataxia, GI distress, sedation

Adverse Effects: Severe CNS depression

Examples: clonazepam, diazepam, lorazepam (Ativan)

Note: Do not stop abruptly, Antagonist: Romazicon (for when patient stops breathing - risk they will start seizing again)

Anticonvulsants: Second Line: Barbiturates

Mechanism of Action: Nonspecific CNS depressant. Potentiates GABA. Useful for all seizures.

Side Effects: Sedation, GI distress, drowsiness

Adverse Effects: Respiratory depression

Examples: phenobarbitol

Note: May cause physical dependence


Tricyclic (TCA), SSRIs, Atypical, MAOIs

Take 2-8 weeks to work

Antidepressants: Tricyclic (TCAs)

Mechanism of Action: Inhibit reuptake of NE, dopamine, and serotonin

Side Effects: Sedation, blurry vision, dry mouth

Adverse Effects: Arrythmias

Example: Elavil (amitriptyline)

Note: Effective but sedating - give at bedtime

Antidepressants: SSRIs

Mechanism of Action: Prevent serotonin reuptake, thus increasing the amount of serotonin

Side Effects: Insomnia, GI, tremors, decreased sexual activity

Adverse Effects: Serotonin Syndrome --> toxicity

Examples: Zoloft (sertraline), Prozac (fluoxetine), Celexa (citalopram)

Note: Most commonly prescribed

Antidepressants: Atypical

Mechanism of Action: Unique, work differently by changing dopamine, NE, serotonin

Side Effects: Dizziness, headaches

Adverse Effects: Seizures

Examples: Bupropion (Wellbutrin), trazadone (Desyrel), venlafaxine (Effexor)

Note: Wellbutrin may be marketed as Zyban for smoking cessation

Antidepressants: Monoamine Oxidase Inhibitors (MAOIs)

Mechanism of Action: Inhibit monoamine oxidase (MAO) from removing NE, serotonin, and dopamine from the brain

Side Effects: Multiple

Adverse Effects: food and drug interactions

Examples: Parnate, Nardil

Note: diet restrictions, HTN results when mixed with certain foods, avoid food high in tyramine (processed meat, aged cheese, red wine, pickled foods)

Nursing Process for Antidepressants

Obtain med/drug history

Monitor drug levels

Monitor client's response

Educate and monitor for side effects

Pediatric: May increase risk for suicidal thoughts, may suppress growth (Effexor)

Pregnancy considerations: Category C or D



-zepam -alprazolam

SSRIs and venlafaxine (Effexor)

-Milder side effects

Antipsychotics: Generalized Therapy

Mechanism of Action: Block Dopamine receptors. Impulse transmission decreases. CNS relaxes.

Side effects: Many. Sedation, agitation, tremors, blurry vision

Adverse effects: Multiple on CNS, ANS, and cardiac. Tardive dyskinesia, Neuroleptic Malignant Syndrome

What to monitor for in antipsychotics

Extrapyramidal symptoms (EPS)

- Tardive dyskinesia (TD) - tongue rolling/protrusion, sucking/smacking of lips, abnormal facial or body movement

- More common in long term use

Neuroleptic Malignant Syndrome

- Rare dysfunction of autonomic nervous system

- Increase in HR and RR, high fever 105-106

Antipsychotics: Mood Stabilizers

Mechanism of Action: Alters NE and serotonin synthesis, used for bipolar

Side Effects: Dizzinesss, sedation, headache

Adverse Effects: Toxicity, Increase in reflexes, HR, HTN, Decreased LOC

Examples: Lithium, Abilify

Note: Teratogenic, Narrow therapeutic window, Maintain hydration, avoid alcohol


Signs and symptoms, not disease itself

Tremors, slow movement

-Imbalance of dopamine and acetylcholine

For therapy:

-Acetylcholine needs to be blocked, more dopamine is needed

Focus on parasympathetic nervous system

Parkinsonism medications



- levadopa

- carbidopa-levadopa

Dopamine Agonists

- amantadine

MAO-B inhibitor

- selegiline

COMT inhibitor

- entacapone

Parkinsonism: Dopaminergics: Levodopa

- Most effective

- Can cross the blood-brain barrier

- Short half-life

- Need to take the drug 3-4 times a day

Side effects: dyskinesia, orthostatic hypotension, cardiac dysrhythmias, and psychosis

Parkinsonism: Domaminergics: Carbidopa - Levodopa

2 medications in 1

Allows more conversion of dopamine

1:10 ratio 1 part carbidopa to 10 parts levodopa

Side effects: dystonic movement (involuntary abnormal movement), and psychotic behavior

Parkinsonism: Dopamine Agonists: Amantadine

Given in early treatment, delays the need for levodopa

Effective in drug-induced parkinsinism also, with fewer side effects than anticholinergics

Parkinsonism: Dopamine Agonists: Bromocriptine

Used in early treatment for Parkinsinism

Can be given with levodopa therapy

Side effect: amnesia

Parkinsonism: MAO-B inhibitor: Selegiline

Inhibits the catabolic enzymes of dopamine

It Increases the action of dopamine

Given in the early phase of Parkinson's disease

When used less levodopa is needed

Side effects: confusion, dry mouth

Parkinsonism: COMT inhibitor: Entacapone

Inhibits the COMT enzyme

the concentration of levodopa is increased

Used in combination with levodopa-carbidopa

When used less levodopa is needed

Side Effects: dyskinesia, dystonia, headache

Alzheimer's Agents

Thought to be the result of deficient Ach

Medication therapy aimed at preventing breakdown of Ach in CNS

Palliative, not curative

Acetylcholinesterase (AChE) Inhibitors

Prevent the breakdown of Ach

Mild: Aricept, Exelon

Mild/Moderate: Namenda

Side Effects: Increased parasympathetic action