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CNS – Antiepileptic Drugs

CNS – Antiepileptic Drugs. Compare and contrast the terms seizure, convulsion and epilepsy. Discuss the indications for antiepileptic therapy (AED). Compare and contrast the first line drugs of choice for AED.

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CNS – Antiepileptic Drugs

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  1. CNS – Antiepileptic Drugs • Compare and contrast the terms seizure, convulsion and epilepsy. • Discuss the indications for antiepileptic therapy (AED). • Compare and contrast the first line drugs of choice for AED. • Discuss the nursing process related to the care of the patient receiving AEDs in acute and chronic situations.

  2. CNS – Antiepileptic DrugsInternational Classification of Seizures • Partial Seizures – short alterations of consciousness; repetitive unusual movements (chewing or swallowing); psychologic changes; confusion • Simple Seizures – No impaired consciousness; motor symptoms of face, arm or legs; hallucinations of sight, hearing, or taste; tingling sensation; ANS changes; personality changes • Complex Seizures – Impaired consciousness; memory impairment; behavioral effects; purposeless behaviors; aura, unreal feelings, bizarre behavior • Generalized Seizures – Temporary lapses in consciousness; staring off into space; rhythmic movements of eyes, head, or hands; may have tonic, clonic, myoclonic, atonic, or tonic-clonic seizures; brief loss of consciousness without confusion; head drop or falling down symptoms

  3. CNS – Antiepileptic DrugsSyndrome of CNS Dysfunction • Convulsion – Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal and facial muscles. Postictal state • Seizures – Brief episode of abnormal electrical activity in the nerve cells of the brain -- detected on EEG • Epilepsy – Chronic, recurrent pattern of seizures

  4. CNS Antiepileptic Drugs /Anticonvulsant Drugs Terms overlap and are used interchangeably to achieve the goal of maintaining a reasonable quality of life. • Antiepileptic Drugs: management of all types of epilepsy, not just convulsions (AED Therapy) • Anticonvulsant Drugs: used to prevent the seizures typically associated with epilepsy.

  5. CNS – Antiepileptic DrugsMechanism of Action • ION Theory – movement of K+, Na+, Ca+, Mg+: Stabilizes neurons: • from becoming hyperexcited • prevents excessive impulses to adjacent neurons 1. Increase threshold of activity in the motor cortex Makes it more difficult to excite; reduces response 2. Depress the seizure discharge from its origin Suppress transmission of impulsesfrom one nerve to the next 3. Decrease the speed of nerve impulse conduction within a given neuron

  6. CNS – Antiepileptic DrugsIndications • Prevention or control of seizure activity • Long-term maintenance treatment of epilepsy • Acute treatment of convulsions and status epilepticus • Status epilepticus: common seizure disorder – • life-threatening emergency characterized by tonic-clonic convulsions that occur in succession. • Loss of consciousness, hypotension, hypoxia, cardiac dysrhythmias – brain damage and death may quickly result • Once controlled, long term therapy is begun to prevent future seizures • Brain Surgery - Head injuries = prophylactic AED Therapy

  7. CNS – Antiepileptic DrugsContraindications • Known drug allergy • Pregnancy – consider risks to mother & infant if untreated

  8. CNS – Antiepileptic DrugsDrugs of First Choice

  9. CNS – Antiepileptic Drugs

  10. CNS – Antiepileptic DrugsBenzodiazepines • Actions • Not fully understood • May enhance the inhibitory effects of GABA in postsynaptic clefts between nerve cells • Uses • Diazepam (Valium), clonazepam (Klonopin), clorazepate (Tranxene), lorazepam (Ativan) • Diazepam - drug of choice for status epilepticus • must be given intravenously -- slowly • never mixed with any other medication • Therapeutic outcomes • Reduced frequency of seizures, reduced injuries • Minimal adverse effects from therapy

  11. CNS – Antiepileptic DrugsHydantoins • Actions – mechanism unknown • phenytoin (Dilantin) – most commonly used • ethotoin (Peganone) • fosphenytoin (Cerebyx) • Uses • Anticonvulsants used to control tonic-clonic seizures • CAUTION: • Phenytoin must be administered slowly • Do not mix with other medications in the same syringe • Dilute only with 0.9% NaCl to avoid precipitation • Infuse slowly <150mg/min • CAUTION: toxicity may cause nystagmus • CAUTION: infiltration causes sloughing of tissue • Therapeutic outcomes • Reduced frequency of seizures, reduced injuries • Minimal adverse effects from therapy

  12. CNS – Antiepileptic DrugsCarbamazepine • Actions -- carbamazepine (Tegretol) • Blocks up the reuptake of norepinephrine • Decreases release of norepinephrine and rate of dopamine and GABA turnover • Mechanisms of action as anticonvulsant are unknown • Uses • Used in combination with other anticonvulsants to control tonic-clonic seizures • Not effective for myoclonic or absence seizures • Should not be given with grapefruit – increased levels of the AED • Therapeutic outcomes • Reduced frequency of seizures, reduced injuries • Minimal adverse effects from therapy

  13. CNS – Antiepileptic Drugs Succinimides • Actionsethosuximide (Zarontin), methsuximide (Celontin) • Mechanism of action unknown • Uses • To control absence (petit mal) seizures • Therapeutic outcomes • Reduced frequency of seizures, reduced injuries • Minimal adverse effects from therapy

  14. CNS – Antiepileptic DrugsTopiramate • Actions topiramate (Topomax) • Mechanisms of action are unknown • May prolong blockade of sodium channels, enhance activity of GABA, and antagonize certain neurotransmitter receptors • Uses • Used in combination with other anticonvulsants to control tonic-clonic seizures • Prevention of migraine headaches • Therapeutic outcomes • Reduced frequency of seizures and injuries • Minimal adverse effects from therapy

  15. CNS – Antiepileptic DrugsPrimidone • Actionsprimidone (Mysoline) • Metabolized into phenobarbital and PEMA - both active anticonvulsants • Exact anticonvulsant mechanism of action is unknown • Uses • Used in combination with other anticonvulsants to treat tonic-clonic seizures • Therapeutic outcomes • Reduced frequency of seizures and injuries • Minimal adverse effects from therapy

  16. CNS – Antiepileptic DrugsGabapentin • Actionsgabapentin (Neurontin) • Mechanisms of action are unknown • Does not appear to enhance GABA • Uses • Used in combination with other anticonvulsants to control partial seizures • Therapeutic outcomes • Reduced frequency of seizures • Minimal adverse effects from therapy • Also used for pain reduction – shingles, peripheral neuropathy – nerve pain

  17. CNS – Antiepileptic DrugsNursing Implications • Nurses may play an important role in diagnosis and treatment • Comprehensive history – allergies/medication reconciliation • Describe seizures – precipitating events, duration/frequency, intensity of the seizure activity, postictal behavior – observe & record • Safety – positioning – assist pt during seizure, proper supplies • Medication administration guidelines – specific for IV meds • Lab values – check therapeutic blood levels on admission • Patient and family support: discuss lifestyle and feelings with patient

  18. CNS – Antiepileptic DrugsPatient Education • Medication: • adherence to prescribe regimen • Do not Stop Abruptly – Life Time Treatment - Rebound Convulsions • Medic Alert Bracelet • Protective environment • Driving – physician prescription/State laws • Sedating effects of the drugs – may decrease with time • Avoid alcohol & cigarettes • Photosensitivity with certain AEDs – sunscreen & protective clothing • Avoid stimulants • Oral hygiene – hyperplasia

  19. CNS – Antiepileptic DrugsReview • When caring for a patient with epilepsy who was hospitalized and successfully treated for status epilepticus, a precaution that the nurse institutes includes: • a. placing oxygen and suction equipment at the bedside. • b. assigning an assistant to stay with the patient at all times. • c. keeping an airway available to insert as needed. • d. instructing the patient to stay in bed and call for assistance to go to the bathroom.

  20. CNS – Antiepileptic DrugsReview • A nurse witnesses a patient with a seizure disorder as he suddenly jerks his arms and legs with tonic-clonic type movement, falls to the floor, temporary loss of consciousness, which he regains immediately. The type of seizure demonstrated by this patient and that the nurse documents is: • a. atonic seizure • b. myoclonic seizure • c. complex partial seizure with automatisms • d. generalized seizure

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