NUR 426 Lecture Notes - Lecture 2: Levetiracetam, Carbapenem, Diazepam

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3 Oct 2017
Anti- Seizure Medications
Seizure: sudden discharge of electrical energy from nerve cells
Generalized: begins in one area; rapidly spreads to both hemispheres (loss of consciousness)
Partial: one area of brain focal seizure
Tonic-clonic: muscle contractions; loss of consciousness
Atonic: sudden loss of muscle tone
Status epilepticus: seizures rapidly reoccur
How do categories differ?
Absence succinimides, valproic acid
Myoclonic levetriacetam, topiramate, lamotrigine, valproic acid
Status epilepticus IV benzodiazepines (used to break seizure), IV hydrations, barbiturates
Partial, generalized phenytoin, phenobarbital, valproic acid, lamotrigine
Phenytoin (Dilantin)
Used: Tonic-clonic, complex partial
Pregnancy category D
Adult dose
- 200-1200mg divided
Do not mix with d5w
Narrow therapeutic window (10-15mcg/ml)
IV give at slow rate
- Hypersensitivity, pregnancy
- Heart block
- Stokes-Adams
- Hepatic or renal impairment
Drug interactions
- May interfere with oral contraceptives, warfarin, and glucorticoids
- Increase risk of toxicity with: CNS depressants, alcohol, diazepam, cimetidine, valproic acid
- May decrease effect of phenytoin with taken with carbamazepine, phenobarbital, alcohol
Side effects/adverse effects
- Toxicity: nystagmus, ataxia, slurred speech, alteration in level of consciousness, sedation,
confusion, dizziness
- Life threatening: suicidal thoughts, SJS/TEN, agranulocytosis, aplastic anemia
- CNS: ataxia, diplopia, nystagmus, cognitive impairment/learning
- Derm: rash, hirsutism
- Cardiovascular: hypotension, arrhythmias
- Other: gingival hyperplasia
Nursing implications
- Assessment and monitoring: neuro, mental status, oral, skin, labs: CBC, INR, Ca, Vit D, alk
phos, albumin, glucose
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