mosby items and derived items © 2007, 2005, 2002 by mosby, inc., an affiliate of elsevier inc....

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

CHAPTER 13CHAPTER 13

Antiepileptic DrugsAntiepileptic Drugs


EpilepsyEpilepsy

SeizureSeizure Brief episode of abnormal electrical activity in the nerve cells Brief episode of abnormal electrical activity in the nerve cells

of the brainof the brain ConvulsionConvulsion

Involuntary spasmodic contractions of any or all voluntary Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal and facial muscles throughout the body, including skeletal and facial musclesmuscles

EpilepsyEpilepsy Chronic, recurrent pattern of seizuresChronic, recurrent pattern of seizures


Epilepsy (cont’d)Epilepsy (cont’d)

Primary (idiopathic)Primary (idiopathic) Cause cannot be determinedCause cannot be determined More than 50% of epilepsy casesMore than 50% of epilepsy cases

SecondarySecondary Distinct cause identifiedDistinct cause identified

• Trauma, infection, cerebrovascular disorderTrauma, infection, cerebrovascular disorder


Classification of EpilepsyClassification of Epilepsy

Partial seizuresPartial seizures Simple seizuresSimple seizures Complex seizuresComplex seizures

Generalized seizuresGeneralized seizures Unclassified seizuresUnclassified seizures Status epilepticusStatus epilepticus



Also known as anticonvulsantsAlso known as anticonvulsants Goals of therapyGoals of therapy

To control or prevent seizures while maintaining a To control or prevent seizures while maintaining a reasonable quality of lifereasonable quality of life

To minimize adverse effects and drug-induced To minimize adverse effects and drug-induced toxicitytoxicity

AED therapy is usually lifelongAED therapy is usually lifelong Combination of drugs may be usedCombination of drugs may be used


Antiepileptic Drugs (cont’d)Antiepileptic Drugs (cont’d)

Single-drug therapy started before two-drug Single-drug therapy started before two-drug or multiple-drug therapy is triedor multiple-drug therapy is tried

Serum drug concentrations must be Serum drug concentrations must be measuredmeasured


Mechanism of ActionMechanism of Action

AED therapy must:AED therapy must: Prevent generation and spread of excessive Prevent generation and spread of excessive

electrical discharge from abnormally functioning electrical discharge from abnormally functioning nerve cellsnerve cells

Protect surrounding normal cellsProtect surrounding normal cells


Mechanism of Action (cont’d)Mechanism of Action (cont’d)

Exact mechanism of action not knownExact mechanism of action not known AEDs thought to alter movement of sodium, AEDs thought to alter movement of sodium,

potassium, and calcium ions across nerve cells in the potassium, and calcium ions across nerve cells in the brainbrain Reduce nerve’s ability to be stimulatedReduce nerve’s ability to be stimulated Suppress transmission of impulses from one nerve to the Suppress transmission of impulses from one nerve to the

nextnext Decrease the speed of nerve impulse conduction within a Decrease the speed of nerve impulse conduction within a

neuronneuron


Mechanism of Action (cont’d)Mechanism of Action (cont’d)

Overall effectOverall effect Neurons are stabilizedNeurons are stabilized Neuron hyperexcitability is decreasedNeuron hyperexcitability is decreased The spread of excessive nerve impulses is The spread of excessive nerve impulses is

decreaseddecreased


Antiepileptic Drugs:Antiepileptic Drugs:IndicationsIndications

Prevention or control of seizure activityPrevention or control of seizure activity Long-term maintenance therapy for chronic, Long-term maintenance therapy for chronic,

recurring seizuresrecurring seizures Acute treatment of convulsions and status Acute treatment of convulsions and status

epilepticusepilepticus Other usesOther uses



Numerous adverse effects—vary per drugNumerous adverse effects—vary per drug Adverse effects often cause the need to Adverse effects often cause the need to

change choice of medicationchange choice of medication



Barbiturates, such as phenobarbital (Solfoton)Barbiturates, such as phenobarbital (Solfoton) carbamazepine (Tegretol)carbamazepine (Tegretol) valproic acid (Depakote)valproic acid (Depakote) felbamate (Felbatol)felbamate (Felbatol) Hydantoins, such as phenytoin (Dilantin)Hydantoins, such as phenytoin (Dilantin)



Succinimides, such as ethosuximide Succinimides, such as ethosuximide (Zarontin)(Zarontin)

Benzodiazepines (clonazepam and Benzodiazepines (clonazepam and clorazepate)clorazepate)

gabapentin (Neurontin)gabapentin (Neurontin) lamotrigine (Lamictal)lamotrigine (Lamictal) pregabalin (Lyrica)pregabalin (Lyrica) Several other miscellaneous drugsSeveral other miscellaneous drugs


Nursing ImplicationsNursing Implications

Assessment, includingAssessment, including Health history, including current medicationsHealth history, including current medications Drug allergiesDrug allergies Liver function studies, CBCLiver function studies, CBC Baseline vital signsBaseline vital signs


Nursing Implications (cont’d)Nursing Implications (cont’d)

Oral drugsOral drugs Take regularly, same time each dayTake regularly, same time each day Take with meals to reduce GI upsetTake with meals to reduce GI upset Do not crush, chew, open extended-release formsDo not crush, chew, open extended-release forms If patient is NPO for a procedure, contact If patient is NPO for a procedure, contact

physician regarding AED dosagephysician regarding AED dosage


Nursing Implications (cont’d)Nursing Implications (cont’d)

Intravenous formsIntravenous forms Follow manufacturer’s recommendations for IV Follow manufacturer’s recommendations for IV

delivery—usually given slowlydelivery—usually given slowly Monitor vital signs during administrationMonitor vital signs during administration Avoid extravasation of fluidsAvoid extravasation of fluids Use only NORMAL SALINE with IV phenytoinUse only NORMAL SALINE with IV phenytoin


Nursing Implications (cont’d) Nursing Implications (cont’d)

Teach patients to keep a journal to monitor:Teach patients to keep a journal to monitor: Response to AEDResponse to AED Seizure occurrence and descriptionsSeizure occurrence and descriptions Adverse effectsAdverse effects

A medical alert tag or ID should be wornA medical alert tag or ID should be worn AEDs should not be discontinued abruptlyAEDs should not be discontinued abruptly Driving may be impaired until drug levels stabilizeDriving may be impaired until drug levels stabilize



Patients need to know that therapy is long Patients need to know that therapy is long term and possibly lifelong, not a cureterm and possibly lifelong, not a cure



Monitor for therapeutic effectsMonitor for therapeutic effects Seizure activity is decreased or absentSeizure activity is decreased or absent

Monitor for adverse effectsMonitor for adverse effects Mental status changes, mood changes, changes in LOC or Mental status changes, mood changes, changes in LOC or

sensoriumsensorium Eye problems, visual disordersEye problems, visual disorders Sore throat, fever (blood dyscrasias may occur with Sore throat, fever (blood dyscrasias may occur with

hydantoins)hydantoins) Many othersMany others

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