Agents Used to Treat Seizures and Epilepsy Chapter 31

Epilepsy 2 An electrical disorder of the brain that sometimes leads to seizures Definitions Seizure: a brief episode of abnormal electrical activity in the nerve cells Convulsion: spasmodic contractions of involuntary muscles

Symptoms of Epilepsy 3 Abnormal motor function Loss of consciousness Altered sensory awareness Psychic changes

Status Epilepticus 4 Series of tonic-clonic seizures No return to consciousness between seizures Prompt treatment in hospital necessary Life support equipment

Anticonvulsant Therapy 5 Prevent and control seizures Act by decreasing CNS stimulation Drug depends on type of seizure, therapeutic goal, and adverse effects Patient compliance is vital Need to monitor serum levels

Drug Agents Used to Prevent Seizures 6 Barbiturates Hydantoins Succinimides Benzodiazepines

Drug Agents Used to Prevent Seizures (cont’d) Other agents Valproic acid Carbamazepine (Tegretol) Clients often on these medications for life 7

Barbiturates 8 Nonspecific CNS depressants Interferes with impulse transmission in the cortex of the brain Nonselective

Barbiturates Used alone or in combination with other drugs Safe and effective May cause - sedation - hypnosis - respiratory depression 9

Hydantoins 10 Dilantin – oral Fosphenytoin – IV use Preventing and treating partial and generalized tonic-clonic seizures Reduces spontaneous electrical impulses in the brain

Hydantoins (cont’d) Selective action on hyperactive synapses Does not cause sedation or hypnosis Narrow therapeutic range Contraindicated in patients with bradycardia, third degree heart block, or sinoatrial block 11

Hydantoins Adverse effects 12 Hypotension Dysrhythmias Cardiovascular collapse Heart block Drowsiness Weakness Insomnia Confusion Irritability Depression Headache Psychosis If serum too high – coma can result

Succinimides 13 Ethosuximide (Zarontin) – safest in group Used for absence seizures Risk for hematological, hepatic, and renal dysfunction

Benzodiazepines 14 CNS depressants Multiple actions Limits spread of seizure electrical discharges Potential for dependence

Benzodiazepines Examples: - Valium - Klonopin Adverse effects with abrupt withdrawal - convulsions - vomiting - tremor - sweating 15

Anticonvulsants 16 Treatment Start with one drug and add others as needed Check serum drug concentrations as required

Goal of Anticonvulsants 17 Prevent the generation and spread of excessive electrical discharges in the brain Protect the normal cells

Anticonvulsants: Therapeutic Effects 18 Stabilize nerve cells and prevent hyperexcitability Prevent the generation of hyperactive neurons Prevent abnormal impulses from spreading

Anticonvulsants: Side Effects 19 Carbamazepine (Tegretol) Blood dyscrasias Phenytoin (Dilantin) Gum hyperplasia Diazepam (Valium) Respiratory depression and drowsiness

Pediatric Considerations 20 Barbiturates require lower dosages Excessive sedation, confusion, lethargy, or decreased movement Paradoxical reactions Valproic acid (Depakene): do not give with milk Wear a MedicAlert® bracelet

Nursing Considerations 21 Encourage patient to carry medical alert item Educate patients and families about seizure precautions and importance of following drug regime Educate patients regarding drug interactions Educate patients regarding side effects and when to report to provider Monitor appropriate lab values Monitor effectiveness of therapy

To be Covered in Mental Health 22 Sedatives and hypnotics Antianxiety drugs Antidepressants Antipsychotics Substance abuse