1. 13
Drugs for Seizures

2. Directory
Classroom Response System
Lecture Note Presentation

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

4. Question 1 Choices
Absence
Clonic
Febrile
Myoclonic

5. Question 1 Answer
Absence
Clonic
Febrile
Myoclonic

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

7. Question 2 Choices Urinary dysfunction Gingival hyperplasia Tremors
Depression

8. Question 2 Answer Urinary dysfunction Gingival hyperplasia Tremors
Depression

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

10. Question 3 Choices
GI upset
Spasms
Drowsiness
Dry mouth

11. Question 3 Answer
GI upset
Spasms
Drowsiness
Dry mouth

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

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

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

15. 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.

16. 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.

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

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

19. 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.

20. 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.

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

22. Causes of Seizure Activity
Metabolic disorders
Hypoglycemia
Hyponatremia
Water intoxication

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

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

25. 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

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

27. 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.

28. 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.

29. 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.

30. 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.

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

32. 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.

33. 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

34. 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.

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

37. 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?

38. 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.

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

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

41. 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

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

44. Table 13.2 (continued) Antiseizure Drugs That Potentiate GABA Action

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

46. 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.

47. 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

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

50. Table 13.3 (continued) Hydantoins and Related Drugs

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

53. 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.

54. 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?