Chapter 16 Drugs Used for Seizure Disorders

seizure: violent and sudden contractions or tremors of muscle groups may lose consciousness caused by abnormal electrical activity in brain neurons epilepsy: brain disorder, clusters of nerve cells signal abnormally, brief changes in electrical function, sometimes there are seizures, muscles spasms and loss of consciousness in epilepsy seizures recur, person has permanent brain injury or defect children and young adults commonly affected no cure for seizure disorders, drugs can control them though

when controlled, epilepsy does NOT affect learning and activities of daily living Causes of epilepsy: brain injury before, during or after birth problems with brain development before birth mom having injury or infection while pregnant head injury poor nutrition brain tumor childhood fevers poison (lead/alcohol) infection (meningitis, encephalitis) stroke

3 major types of seizures: Partial seizure: only part of brain is involved, a body part may jerk. Person may have hearing/vision problem or stomach discomfort. Does NOT lose consciousness Generalized tonic-clonic seizure (grand mal): has 2 phases. In tonic phase person loses consciousness, person falls to floor, body is rigid because all muscles contract at once. Clonic phase follows, muscle groups contract and relax, this causes jerking/twitching. Urinary/fecal incontinence may occur. Deep sleep is common afterwards. Confusion and headache may occur upon waking up Generalized absence seizure(petit mal): usually lasts a few seconds, loss of consciousness, twitching of eyelids and staring. NO first aid necessary, should guide person away from dangers.

Anti-Convulsant Therapy Anti-convulsants are used to prevent or reduce seizures Main goal of therapy is to reduce frequency of seizures, and to reduce injury from seizures May take several drugs to find right one or right combo of drugs to control seizure activity Drugs control seizures by: Inhibiting processes that excite neurons Enhancing processes that inhibit the neurons Preventing the seizures from spreading to other neurons

Delegation Guidelines for Anti-Convulsant Therapy: Some drugs are given parenterally. Because you do NOT give parenteral dose forms, they are not included in this chapter. Should a nurse delegate the administration of such to you, you must: - remember that parenteral dosages are often very different from dosages for other routes - refuse the delegation. Make sure to explain why. Do NOT just ignore the request. Make sure the nurse knows that you cannot give drug and why

Assisting With the Nursing Process: Anti-convulsant drugs Benzodiazepines: action unknown, may inhibit neurotransmission Assisting With the Nursing Process: ASSESSMENT: observe speech pattern, degree of alertness, orientation to person, time, place PLANNING: see table 16-1 (p.214) for oral and rectal dose forms IMPLEMENTATION: see table 16-1 for “Adult Dose Range” Rapidly discontinuing these drugs after long-term use may cause symptoms similar to alcohol withdrawal. Signs and symptoms may not occur for several days after it’s discontinued. Usually withdrawn over 2-4 weeks EVALUATION: report and record: - sedation, drowsiness, dizziness, blurred vision, fatigue, lethargy: provide for safety - behavior disturbances (aggression, agitation): provide for safety - sore throat, fever, jaundice, weakness: may signal changes in red or white blood cells - anorexia, nausea, vomiting, jaundice: may signal liver toxicity

Assisting With the Nursing Process: Anti-convulsant drugs….. Hydantoins: action unknown Assisting With the Nursing Process: ASSESSMENT: measure blood glucose, observe persons speech pattern, degree of alertness, orientation to person, place, time PLANNING: : see table 16-1 (p.214) for oral dose forms IMPLEMENTATION: see table 16-1 for “Adult Dose Range”, give the drug with food or milk to reduce stomach irritation, if oral suspension is ordered shake the container well. Use oral syringe to measure EVALUATION: report and record: - nausea, vomiting, indigestion: give with food/milk - sedation, drowsiness, dizziness, blurred vision, fatigue and lethargy: provide for safety - confusion: provide for safety - Gum over-growth: provide good oral hygiene (brushing, flossing) - hyperglycemia: measure blood glucose - sore throat, fever, jaundice, weakness: may signal changes in white/red blood cells - anorexia, nausea, vomiting, jaundice: may signal liver toxicity - rash, itching: may signal allergic reaction, notify nurse at once

Assisting With the Nursing Process: Anti-convulsant drugs….. Succinimides: used to control generalized absence (petit mal) seizures Assisting With the Nursing Process: ASSESSMENT: observe persons speech pattern, degree of alertness, orientation to person, place, time PLANNING: : see table 16-1 (p.214) for oral dose forms IMPLEMENTATION: see table 16-1 for “Adult Dose Range EVALUATION: report and record: - nausea, vomiting, indigestion: give with food/milk - sedation, drowsiness, dizziness, blurred vision, fatigue and lethargy: provide for safety

Assisting With the Nursing Process: Anti-convulsant drugs….. carbamazepine (Tegretol): blocks re-uptake and release of norepinephrine, also affects dopamine, often used with other anti-convulsants Assisting With the Nursing Process: ASSESSMENT: measure blood pressure both supine/standing, measure weight daily, measure intake/output, observe persons speech pattern, degree of alertness, orientation to person, place, time PLANNING: : see p.215 for oral dose forms IMPLEMENTATION: see pg. 216 for “Adult Dose Range” EVALUATION: report and record: - nausea, vomiting, drowsiness, dizziness: provide for safety - hypertension, orthostatic hypotension: provide for safety - dyspnea, edema: measure intake/output - kidney toxicity: check urine color - sore throat, fever, jaundice, weakness: may signal changes in white/red blood cells - anorexia, nausea, vomiting, jaundice: may signal liver toxicity - rash, itching: may signal allergic reaction, tell nurse at once

Assisting With the Nursing Process: Anti-convulsant drugs….. gabapentin (Neurontin): usually used with other anti-convulsants to reduce frequency of partial seizures Assisting With the Nursing Process: ASSESSMENT: observe persons speech pattern, degree of alertness, orientation to person, place, time PLANNING: : see p.216 for oral dose forms IMPLEMENTATION: see pg. 216 for “Adult Dose Range” EVALUATION: report and record: - sedation, drowsiness, dizziness, blurred vision: provide for safety - speech, alertness and orientation to person, time and place, observe for changes

Assisting With the Nursing Process: Anti-convulsant drugs….. lamotrigine (Lamictal): stabilizes neuron membranes, inhibits the release of some excitatory neurotransmitters, used in combo with other anti-convulsants to treat partial and generalized seizures Assisting With the Nursing Process: ASSESSMENT: observe persons speech pattern, degree of alertness, orientation to person, place, time PLANNING: : see p.216 for oral dose forms IMPLEMENTATION: see pg. 216 for “Adult Dose Range” EVALUATION: report and record: - nausea, vomiting, drowsiness, indigestion: give drug with food or milk - sedation, drowsiness, dizziness, blurred vision: provide for safety - rash, itching: slower increase in dose adjustment may solve problem, also may signal allergic reaction, tell nurse at once. Do NOT give next dose until approved by nurse

Assisting With the Nursing Process: Anti-convulsant drugs….. levetiracetam (Keppra): used in combo with other anti-convulsants to treat partial seizures Assisting With the Nursing Process: ASSESSMENT: observe persons speech pattern, degree of alertness, orientation to person, place, time PLANNING: : see p.217 for oral dose forms IMPLEMENTATION: see pg. 217 for “Adult Dose Range” EVALUATION: report and record: - weakness, drowsiness, dizziness: provide for safety - speech, alertness, and orientation to person, time and place: observe for changes

Assisting With the Nursing Process: Anti-convulsant drugs….. oxcarbazepine (Trileptal): stabilizes neurons, prevents repeated firing of electrical impulses thought to produce seizures. Used alone or with other drugs to prevent partial seizures Assisting With the Nursing Process: ASSESSMENT: observe persons speech pattern, degree of alertness, orientation to person, place, time PLANNING: : see p.217 for oral dose forms IMPLEMENTATION: see pg. 217 for “Adult Dose Range” EVALUATION: report and record: - confusion, poor coordination, drowsiness, dizziness: provide for safety - speech, alertness, and orientation to person, time and place: observe for changes - nausea, headache, lethargy, confusion, reduced level of consciousness, weakness: signs of low sodium

Anti-convulsant drugs….. phenobarbital (Luminal): long acting barbituate (Ch.15) Prevents spread of seizure activity. Used in combination with other drugs to treat partial and generalized seizures. Drug has sedative effects, used when non-sedating anti-convulsants do NOT control seizures Assisting With the Nursing Process: ….see Ch. 14 p. 182 and table 14-5

Assisting With the Nursing Process: Anti-convulsant drugs….. primidone (Mysoline): drug is related to barbiturates, used in combo with other anti-convulsants to treat partial and generalized seizures Assisting With the Nursing Process: ASSESSMENT: observe persons speech pattern, degree of alertness, orientation to person, place, time PLANNING: : see p.217 for oral dose forms IMPLEMENTATION: see pg. 217/218 for “Adult Dose Range” EVALUATION: report and record: - sedation, drowsiness, dizziness, blurred vision, provide for safety - sore throat, fever, jaundice, weakness: may signal changes in white/red blood cells

Assisting With the Nursing Process: Anti-convulsant drugs….. tiagabine (Gabitril): used in combo with other anti-convulsants to treat partial seizures Assisting With the Nursing Process: ASSESSMENT: observe persons speech pattern, degree of alertness, orientation to person, place, time PLANNING: : see p.218 for oral dose forms IMPLEMENTATION: see pg. 218 for “Adult Dose Range” EVALUATION: report and record: - sedation, drowsiness, dizziness: provide for safety - speech, alertness, memory loss, orientation to person, time, and place: observe for changes

Assisting With the Nursing Process: Anti-convulsant drugs….. topiramate (Topamax): used in combo with other anti-convulsants to treat: - partial and generalized seizures - migraines Assisting With the Nursing Process: ASSESSMENT: observe persons speech pattern, degree of alertness, orientation to person, place, time. Measure weight, measure intake/output, ask about headaches PLANNING: : see p.218 for oral dose forms IMPLEMENTATION: see pg. 218 for “Adult Dose Range” EVALUATION: report and record: - sedation, drowsiness, dizziness: provide for safety - speech, alertness, and orientation to person, time and place: observe for changes - decreased sweating, over-heating: may occur with vigorous activity or exposure to warm or hot temperatures

Assisting With the Nursing Process: Anti-convulsant drugs….. valproic acid (Depakene): action is not known, used to treat partial and general seizures and migraines Assisting With the Nursing Process: ASSESSMENT: observe persons speech pattern, degree of alertness, orientation to person, place, time PLANNING: : see p.219 for oral dose forms IMPLEMENTATION: see pg. 219 for “Adult Dose Range” EVALUATION: report and record: - sedation, drowsiness, dizziness: provide for safety - nausea, vomiting, drowsiness, dizziness: give the drug with food/milk - sore throat, fever, jaundice, weakness: may signal changes in white/red blood cells - anorexia, nausea, vomiting, jaundice: may signal liver toxicity - abdominal pain, nausea, vomiting, anorexia: symptoms of pancreatitis

Assisting With the Nursing Process: Anti-convulsant drugs….. zonisamide (Zonegran): used in combo with other anti-convulsants to treat partial seizures Assisting With the Nursing Process: ASSESSMENT: observe persons speech pattern, degree of alertness, orientation to person, place, time PLANNING: : see pg. 219 for oral dose forms IMPLEMENTATION: see pg. 219 for “Adult Dose Range” EVALUATION: report and record: - sedation, drowsiness: provide for safety - speech, alertness, orientation to person, time and place: observe for changes - back pain, abdominal pain, pain on urination: may signal kidney problems - sore throat, fever, jaundice, weakness: may signal changes in white/red blood cells - rash, itching: slower increases in dosage adjustment may resolve problem. Rash/itching may signal allergic reaction, notify nurse at once