66 Questions
What percentage of patients with seizures do medications control, if properly prescribed and taken?
70% to 80%
Why are medications selected for controlling seizures based on the type of seizure being treated?
To match the medication's mechanism of action with the type of seizure
When might changing to another medication be necessary for seizure control?
If seizure control is not achieved or if toxicity makes it impossible to increase the dosage
What factors may necessitate the adjustment of seizure medication?
Weight changes, increases in stress, or concurrent illness
What are the three categories of anticonvulsant medication side effects?
Idiosyncratic/allergic disorders, acute toxicity, chronic toxicity
What can long-term use of phenytoin lead to?
Gingival hyperplasia
What is the half-life of phenobarbital?
53 to 118 hours
What type of seizures is phenobarbital used for?
Generalized tonic-clonic and partial seizures
Who may experience greater sedation from phenobarbital due to altered absorption and excretion?
Older adults
What are the adverse effects of phenobarbital?
CNS depression, respiratory problems, Stevens-Johnson syndrome
How does phenobarbital depress the central nervous system?
By inhibiting impulse conduction
What is the route of absorption for phenobarbital?
Gastrointestinal tract
How long does it take for phenobarbital to reach therapeutic serum levels?
2-3 weeks
Who may require lower doses of phenobarbital?
Patients with renal or hepatic impairment
What is the primary use of phenobarbital?
Sedative and antiepileptic agent
What is the effect of phenobarbital on impulse conduction?
Inhibition
What is a key consideration for the administration of IV diazepam?
Injecting slowly into a large vein
For which conditions is gabapentin approved?
Partial seizures and postherpetic neuralgia pain
What requires monitoring in patients with impaired liver function receiving gabapentin?
Elevated liver enzymes
What is a key nursing consideration for diazepam administration?
Monitoring pulse, blood pressure, and respiration
What is a contraindication for combining diazepam with other solutions?
Mixing in plastic bags or tubing
What requires dosage adjustment for gabapentin?
Renal impairment based on creatinine clearance
What is a key aspect of patient teaching for diazepam?
Advice on alcohol use and contraception
What should be monitored during diazepam administration for seizure disorder?
Cardiovascular changes, CNS response, and alterations in elimination patterns
What is a key consideration for combining opioids with benzodiazepines or CNS depressants?
FDA warns about serious adverse effects
What is a key aspect of gabapentin's pharmacokinetics?
Dosage adjustments based on creatinine clearance
What is a key difference in the goals of diazepam therapy for seizure disorder and status epilepticus?
The desired outcome and response
What is gabapentin approved for in addition to partial seizures?
Postherpetic neuralgia pain
What is the maximum rate of intravenous administration for phenobarbital to prevent intraarterial injection complications?
60 mg/minute
Which therapeutic effect of phenobarbital is evidenced by decreased brain waves on EEG?
Decreased seizure activity
What is a potential adverse effect of phenobarbital?
Paradoxical excitation
What are the patient teaching guidelines for phenobarbital related to?
Long-term administration
What is the primary mechanism of action of benzodiazepines like diazepam?
Potentiation of GABA effects
For what conditions is diazepam used as an adjunctive agent?
Seizure disorders
In which patient populations are dosage adjustments for diazepam necessary?
Older adults, patients with renal or hepatic impairment, and those with critical illness
What is a potential adverse effect of diazepam related to the central nervous system?
CNS depression
What are the contraindications for diazepam?
Narrow-angle glaucoma
What may interactions with medications and herbs do to diazepam's effects?
Decrease its effects
Which medication is used to control tonic–clonic seizures, psychomotor seizures, and nonepileptic seizures?
Phenytoin
What is a common adverse effect of long-term use of phenytoin?
Increased risk of osteoporosis
What is a contraindication to phenytoin?
Hypersensitivity to hydantoins
What is a caution needed in older adults regarding phenytoin?
Renal or hepatic impairment causing drug displacement
What is a key consideration for the administration of injectable solution of phenytoin?
Highly irritating to tissues, special techniques needed for IV administration
What is the route of administration for carbamazepine?
Oral
What is the primary use of carbamazepine?
Preventing partial seizures with complex symptoms
What is a caution needed for pregnant and breastfeeding women regarding carbamazepine?
Crosses the placenta and enters breast milk
What is the mechanism of action of phenytoin?
Delays sodium influx
What is an effect of carbamazepine on liver enzymes?
Induces liver enzymes to increase metabolism
What should be monitored during phenytoin administration?
Absence of seizures and presence of hypersensitivity reactions
What is a patient teaching guideline for phenytoin?
Using the drug as prescribed
Which medication is used to control tonic–clonic seizures, psychomotor seizures, and nonepileptic seizures?
Phenytoin
What caution is needed in older adults when administering phenytoin?
Altered albumin levels
What can IV administration of phenytoin lead to?
Cardiovascular collapse
What is a common adverse effect of phenytoin?
CNS and GI tract issues
What is a contraindication to phenytoin?
Hypersensitivity to hydantoins
Which medication interacts with phenytoin, affecting its effectiveness and absorption of folic acid, calcium, and vitamin D?
Phenobarbital
What is highly irritating to tissues and requires special techniques for IV administration?
Injectable solution of phenytoin
What does the nurse assess for in patients taking phenytoin?
Therapeutic and adverse effects
What are the patient teaching guidelines for phenytoin?
Taking the drug as prescribed, maintaining good oral hygiene, and using contraception
What is the onset of action of carbamazepine?
Slow
What does carbamazepine induce to increase metabolism?
Liver enzymes
Where does carbamazepine cross and require caution in pregnant and breastfeeding women?
Placenta and breast milk
What is dementia characterized by?
A permanent decrease in intellectual functioning
What is the most common cause and type of dementia?
Alzheimer's disease
What is associated with the transmission of impulses between nerve cells in the brain?
Acetylcholine
What does Alzheimer's disease result in?
A continuous decline in thinking, behavioral, and social skills
Study Notes
Phenytoin and Carbamazepine: Pharmacological Aspects and Nursing Implications
- Phenytoin stabilizes neuronal membrane by delaying sodium influx, used to control tonic–clonic seizures, psychomotor seizures, and nonepileptic seizures
- Caution needed in older adults due to altered albumin levels, renal or hepatic impairment causing drug displacement
- IV administration of phenytoin can lead to cardiovascular collapse, requiring careful monitoring
- Common adverse effects of phenytoin include CNS and GI tract issues, long-term use may lead to increased risk of osteoporosis
- Contraindications to phenytoin include hypersensitivity to hydantoins, caution in patients with specific conditions
- Several medications interact with phenytoin, affecting its effectiveness and absorption of folic acid, calcium, and vitamin D
- Injectable solution of phenytoin is highly irritating to tissues, special techniques needed for IV administration
- Nurse assesses for therapeutic and adverse effects, including absence of seizures and presence of hypersensitivity reactions
- Patient teaching guidelines for phenytoin include taking the drug as prescribed, maintaining good oral hygiene, and using contraception
- Carbamazepine is administered orally, with slow onset of action, and induces liver enzymes to increase metabolism
- Mechanism of action of carbamazepine is not fully understood, used to prevent partial seizures with complex symptoms
- Like phenytoin, carbamazepine crosses the placenta and enters breast milk, requiring caution in pregnant and breastfeeding women
Test your knowledge of antiepileptic medications with this quiz covering the uses, administration, and nursing implications of phenobarbital, diazepam, phenytoin, and carbamazepine. Explore the pharmacological aspects and nursing considerations for these important drugs used to manage seizures and related conditions.
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