30 Questions
What percentage of patients with seizures do medications control seizures in, if properly prescribed and taken?
70% to 80%
Why are medications selected for controlling seizures?
Based on the type of seizure being treated and the effectiveness and safety of the medications
What percentage of patients with focal seizures may not demonstrate improvement with any prescribed medication or may be unable to tolerate the side effects of medications?
30%
When is changing to another medication necessary in controlling seizures?
If seizure control is not achieved or if toxicity makes it impossible to increase the dosage
Why are medication levels in the blood monitored?
Because the rate of drug absorption varies among patients
What determines the starting dose and the rate at which the dosage is increased for seizure control medication?
The occurrence of side effects
What is the half-life range of phenobarbital?
53 to 118 hours
Which organ system can be affected by drug toxicity manifestations?
Any organ system
What is the long-term effect of phenytoin use?
Gingival hyperplasia
What type of seizures is phenobarbital used for?
Generalized tonic-clonic and partial seizures
What effect does phenobarbital have on the central nervous system?
Inhibits impulse conduction
Who may require lower doses of phenobarbital?
Older adults
What is the maximum rate of intravenous administration for phenobarbital?
60 mg/minute
Which condition is diazepam contraindicated for?
Narrow-angle glaucoma
What is the primary aim of phenobarbital's therapeutic effects?
Decrease brain waves on EEG
What is the primary mechanism of action of diazepam?
Primarily affects the limbic system and reticular formation
For which condition is phenobarbital used as a therapeutic agent?
Seizure disorders
What are the adverse effects of phenobarbital?
Paradoxical excitation and integumentary changes
What is the mechanism of action of phenytoin?
Delaying sodium influx to stabilize neuronal membrane
Why is caution needed in older adults when administering phenytoin?
Altered albumin levels and renal or hepatic impairment may cause drug displacement
What is a common adverse effect of long-term phenytoin use?
Increased risk of osteoporosis
What is a contraindication to phenytoin?
Hypersensitivity to hydantoins
How is carbamazepine administered?
Orally
What caution is needed for pregnant and breastfeeding women when taking carbamazepine?
Due to crossing the placenta and entering breast milk
What is a key consideration for the administration of IV diazepam?
It should be injected slowly into a large vein
What is a specific goal of diazepam therapy for status epilepticus?
To terminate the seizure activity
For which conditions is gabapentin approved?
Partial seizures and postherpetic neuralgia pain
What requires dosage adjustments for gabapentin?
Renal impairment based on creatinine clearance
What should be monitored in patients with impaired liver function receiving gabapentin?
Elevated liver enzymes
What is a key concern in combining opioids with benzodiazepines or CNS depressants?
Serious adverse effects
Study Notes
QSEN Alert: Safety
- FDA warns about serious adverse effects from combining opioids with benzodiazepines or CNS depressants
- Diazepam should not be mixed in plastic bags or tubing and should not be combined with other solutions
- Diazepam administration requires monitoring of pulse, blood pressure, respiration, and oxygen administration, along with bed rest for 3 hours
- IV form of diazepam should be injected slowly into a large vein, not intra-arterially or into small veins
- Goals of diazepam therapy for seizure disorder and status epilepticus differ
- Nurse assesses for cardiovascular changes, CNS response, and alterations in elimination patterns with diazepam administration
- Patient teaching guidelines for diazepam include advice on alcohol use, contraception, CNS depression, and seizure disorder identification
- Gabapentin is approved for partial seizures and postherpetic neuralgia pain
- Gabapentin's pharmacokinetics, action, and off-label uses
- Dosage adjustments for gabapentin in patients with renal impairment based on creatinine clearance
- Patients with impaired liver function require monitoring for elevated liver enzymes but not a dosage adjustment for gabapentin
- Common adverse effects, contraindications, and nursing implications for gabapentin administration
Test your knowledge on medication safety with this quiz covering topics such as FDA warnings on opioid and benzodiazepine combinations, administration guidelines for diazepam, and considerations for gabapentin use in patients with renal or liver impairment.
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