13 Drugs for Seizures

Directory Classroom Response System Lecture Note Presentation

Question 1 This phase of a seizure is characterized by alternating contractions and relaxation of the muscles.

Question 1 Choices Absence Clonic Febrile Myoclonic

Question 1 Answer Absence Clonic Febrile Myoclonic

Question 2 The nurse should assess the patient on ethosuximide (Zarontin) for which of the following?

Question 2 Choices Urinary dysfunction Gingival hyperplasia Tremors Depression

Question 2 Answer Urinary dysfunction Gingival hyperplasia Tremors Depression

Question 3 One of the most common adverse effects of antiseizure drugs is:

Question 3 Choices GI upset Spasms Drowsiness Dry mouth

Question 3 Answer GI upset Spasms Drowsiness Dry mouth

Question 4 An overdose of this antiseizure drug may cause severe respiratory depression, CNS depression, coma, and death.

Question 4 Choices Clonazepam (Klonopin) Lorazepam (Ativan) Diazepam (Valium) Phenobarbital (Luminal)

Question 4 Answer Clonazepam (Klonopin) Lorazepam (Ativan) Diazepam (Valium) Phenobarbital (Luminal)

Learning Outcomes Compare and contrast the terms epilepsy, seizures, and convulsions. Recognize possible causes of seizures. Relate signs and symptoms to specific types of seizures. Describe the pharmacological management of acute seizures and epilepsy.

Learning Outcomes Explain the importance of patient drug compliance in the pharmacotherapy of epilepsy and seizures. For each of the drug classes, know representative drug examples and explain their mechanisms of drug action, primary actions, and important adverse effects.

Learning Outcomes Categorize drugs used in the treatment of seizures based on their classifications and mechanisms of action.

All convulsions are seizures, but not all seizures are convulsions. Core Concept 13.1 All convulsions are seizures, but not all seizures are convulsions.

Seizure and Convulsion Not synonymous. Convulsions Involuntary, violent spasms of the large skeletal muscles of the face, neck, arms, and legs. Seizures involve convulsions, other seizures do not.

Many causes of seizure activity are known; a few are not. Core Concept 13.2 Many causes of seizure activity are known; a few are not.

Causes of Seizure Activity Infectious diseases Meningitis Encephalitis Trauma Physical trauma Chemical trauma

Causes of Seizure Activity Metabolic disorders Hypoglycemia Hyponatremia Water intoxication

Causes of Seizure Activity Vascular diseases Respiratory hypoxia Carbon monoxide poisoning Cerebral vascular accidents Shock Cardiac dysrhythmias Pediatric Disorders Febrile seizure. Neoplastic Disease

Core Concept 13.3 Epileptic seizures are typically identified as partial, generalized, and special epileptic syndromes.

Types of Seizures Partial (focal) seizures Small, limited focus Limited portion of the brain. Simple partial seizures Small, limited focus Complex partial seizures (formerly known as psychomotor or temporal lobe seizures) Sensory, motor, or autonomic symptoms

Types of Seizures Some degree of altered or impaired consciousness. Preceded by an aura

Types of Seizures Generalized Seizures Entire brain on both sides Absence seizures (formerly known as petit mal seizures) Atonic seizures are sometimes called drop attacks. stumble and fall for no apparent reason. Lasting for only a matter of seconds, episodes are very short.

Types of Seizures Tonic-clonic seizures (formerly known as grand mal seizures) Most common type of seizure Intense muscle contractions indicate the tonic phase. The clonic phase is characterized by alternating contraction and relaxation of muscles.

Types of Seizures Tonic-clonic seizures (formerly known as grand mal seizures) The seizure usually lasts 1 to 2 minutes, after which the patient becomes drowsy, disoriented, and sleeps deeply.

Special Epileptic Syndromes Febrile seizures Tonic-clonic motor activity lasting for 1 to 2 minutes Rapid return of consciousness. Rapid rise in body temperature 3-month to 5-year old age group.

Special Epileptic Syndromes Myoclonic seizures Large, jerking body movements. Major muscle groups contract quickly Infantile spasms Short-lasting muscle spasms trunk & extremities.

Special Epileptic Syndromes Status epilepticus Medical emergency Repeated occurrence of a seizure. Hypoxia may develop. Hypoglycemia, acidosis, and hypothermia Can cause brain damage and ultimately death.

Special Epileptic Syndromes Status epilepticus Treatment involves the IV administration of antiseizure medications. During seizure activity, steps must be taken to make sure the airway remains open

Concept Review 13.1 What is epilepsy? What is the difference between a seizure and a convulsion? Name and identify signs of the more common types of seizures.

Core Concept 13.4 Effective seizure management involves strict adherence to drug therapy.

Concept Review 13.2 Give the names of traditional and newer drugs used for the management of specific seizure types. Match the drugs with the types of seizures they best control. Which drugs are generally used for a broader range of seizures?

Warnings Food and Drug Administration 2008 Analyzed reports from clinical studies involving patients taking a variety of antiseizure medications, Mostly newer nontraditional drugs Epilepsy, bipolar disorder, psychoses, migraines, and neuropathic pain included in the study.

Warnings Compared to placebo trials, eleven popular antiseizure examples were found to almost double the risk of suicidal behavior and ideation among patients

Core Concept 13.5 Antiseizure pharmacotherapy is directed at controlling the movement of electrolytes across neuronal membranes or affecting neurotransmitter balance.

Goal and Action Suppress neuronal activity just enough to prevent abnormal or repetitive firing. Three general mechanisms by which antiseizure drugs work: Stimulating an influx of chloride ions, neurotransmitter gamma-aminobutyric acid (GABA) Delaying an influx of sodium ions Delaying an influx of calcium ions

Core Concept 13.6 By increasing the effects of GABA in the brain, drugs reduce a wide range of seizure types.

Table 13.2 (continued) Antiseizure Drugs That Potentiate GABA Action

Core Concept 13.7 Hydantoin and related drugs are generally effective in treating partial seizures and tonic-clonic seizures.

Hydanatoins Dampen CNS activity Delay the influx of sodium ions across neuronal membranes. Sodium channels not blocked just made to be less sensitive. Several drugs may also affect the threshold of neuronal firing They may interfere with transduction of the excitatory neurotransmitter glutamate.

First Line Drugs Dilantin(phenytoin) The oldest and most commonly prescribed antiseizure medication First-line drugs in the treatment of status epilepticus. Phenytoin-related drugs share a mechanism similar to the hydantoins

First Line Drugs Examples Carbamazepine (Tegretol), oxcarbazepine (Trileptal), and valproic acid (Depakene, Depakote), which is also available as valproate and divalproex sodium.

Table 13.3 (continued) Hydantoins and Related Drugs

Succinimides generally treat absence seizures. Core Concept 13.8 Succinimides generally treat absence seizures.

Concept Review 13.3 Name three general drug classes introduced by the Drug Snapshot feature at the beginning of this chapter. Identify the various stated chemical categories of antiseizure medications.

Concept Review 13.3 Based on pharmacologic mechanisms, which of the drug examples do not conveniently fit into only one drug class? Which of the drugs control a wide range of seizure types? Which of the drugs have therapeutic applications other than seizure management?