CHAPTER 13 Antiepileptic Agents Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Table 13 -1 Antiepileptic Drugs of Choice Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Epilepsy • Seizure – Brief episode of abnormal electrical activity in the brain • Convulsion – Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal and facial muscles • Epilepsy – Chronic, recurrent pattern of seizures Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Epilepsy (cont'd) • Primary (idiopathic) – Cause cannot be determined – More than 50% of epilepsy cases • Secondary – Distinct cause identified • Trauma, infection, cerebrovascular disorder Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Classification of Epilepsy • Partial seizures – Simple seizures – Complex seizures • Generalized seizures • Unclassified seizures • Status epilepticus Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Box 13 -1 International Classification of Seizures Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Antiepileptic Agents • Also known as Antiepileptic Drugs (AEDs) • Goals of therapy – To control or prevent seizures while maintaining a reasonable quality of life – To minimize side effects and drug-induced toxicity • AED therapy is usually lifelong • Combination of agents may be used Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Antiepileptic Agents • Single-drug therapy started before twodrug and multiple-drug therapy is tried • Serum drug concentrations must be measured Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Mechanism of Action AED therapy must: – Prevent generation and spread of excessive electrical discharge from abnormally functioning nerve cells – Protect surrounding normal cells Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Mechanism of Action (cont'd) • Exact mechanism of action not known • AEDs thought to alter movement of sodium, potassium, and calcium ions across nerve cells in the brain – Reduce nerve’s ability to be stimulated – Suppress transmission of impulses from one nerve to the next – Decrease the speed of nerve impulse conduction within a neuron Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Mechanism of Action (cont'd) • Overall effect – Neurons are stabilized – Neuron hyperexcitability is decreased – The spread of excessive nerve impulses is decreased Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Antiepileptic Agents: Indications • Prevention or control of seizure activity • Long-term maintenance therapy for chronic, recurring seizures • Acute treatment of convulsions and status epilepticus Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Antiepileptic Agents • Numerous side effects—vary per agent • Side effects often cause the need to change choice of medication Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Antiepileptic Agents • Barbiturates, such as phenobarbital (Solfoton) • carbamazepine (Tegretol) • valproic acid (Depakote) • felbamate (Felbatol) • Hydantoins, such as phenytoin (Dilantin) Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Antiepileptic Agents (cont'd) • Succinimides, such as ethosuximide (Zarontin) • Benzodiazepines (clonazepam and clorazepate) • gabapentin (Neurontin) • lamotrigine (Lamictal) • Several other miscellaneous agents Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Nursing Implications • Assessment, including – Health history, including current medications – Drug allergies – Liver function studies, CBC – Baseline vital signs Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Nursing Implications • Oral agents – Take regularly, same time each day – Take with meals to reduce GI upset – Do not crush, chew, open extended-release forms Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Nursing Implications • Intravenous forms – Follow manufacturer’s recommendations for IV delivery—usually given slowly – Monitor VS during administration – Avoid extravasation of fluids – Use only NORMAL SALINE with IV phenytoin Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Nursing Implications • Teach patients to keep a journal to monitor: – Response to AED – Seizure occurrence and descriptions – Side effects • A medical alert tag or ID should be worn • AEDs should not be discontinued abruptly • Driving may be impaired until drug levels stabilize Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Nursing Implications • Patients need to know that therapy is long term and possibly lifelong, not a cure Mosby items and derived items © 2005, 2002 by Mosby, Inc.
Nursing Implications • Monitor for therapeutic effects – Seizure activity is decreased or absent • Monitor for side effects – Mental status changes, mood changes, changes in LOC or sensorium – Eye problems, visual disorders – Sore throat, fever (blood dyscrasias may occur with hydantoins) – Many others Mosby items and derived items © 2005, 2002 by Mosby, Inc.
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