NUR 426 Lecture Notes - Lecture 2: Levetiracetam, Carbapenem, Diazepam
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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
• Contraindicated
- 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
(chronic)
• 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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