Term
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Definition
- sudden and involuntary contraction of muscles, often with loss of consciousness
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Term
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Definition
disturbance in brain’s electrical activity, often causing convulsion, though not necessarily. |
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Term
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Definition
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Term
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Definition
- from known causes, eg high fevers, elec imbalances, hypoglycemia, brain tumors, etc; best to treat underlying condition
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Term
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Definition
- = most common, from local brain area with specific symptoms; can cause a simple seizure (consciousness impaired/changed), motor seizure, or somatosensory seizure, etc. Depends on area of brain. There is not a loss of consciousness.
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Term
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Definition
- loss of consciousness with or without convulsions.
- tonic-clonic or myoclonic
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Term
Tonic Clonic and Myoclonic Genrealized Seizures |
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Definition
§ Tonic-clonic = alternating bt tonic (contraction) and clonic (relaxation) and abnormal behavior
§ Myoclonic = sudden forceful contractions |
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Term
1. ethotoin
2. fosphenytoin
3. phenytoin (Dilantin) |
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Definition
hydantoin anticonvulsants |
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Term
1. valproic acid (Depakote) |
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Definition
carboxylic acid derivitive anticonvulsant |
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Term
carboxylic acid derivitive anticonvulsant |
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Definition
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Term
1. ethosuximide
2. methsuximide |
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Definition
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Term
1. clonazepam (Klonipin)
2. clorazepate
3. diazepam (Valium, Diastat)
4. lorazepam (Ativan) |
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Definition
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Term
1. acetazolamide
2. carbamazepine (Tegretol)
3. felbamate
4. gabapentin (Neurontin)
5. lamotrigine (Lamictal)
6. levetiracetam
7. magnesium
8. oxcarbazepine
9. pregabalin (Lyrica)
10. primidone
11. tiagabine
12. topiramate (Topamax)
13. zonisamide |
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Definition
Miscellaneous anticonvulsants |
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Term
General action of ALL anticonvulsants |
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Definition
depresses abnormal nerve impulses in CNS |
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Term
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Definition
stabilize hyperexcitability postsynaptically in motor cortex |
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Term
carboxylic acid derivitive action |
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Definition
increase GABA to stabilize sell membranes |
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Term
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Definition
depress motor cortex, making higher threshold for nerve reaction to convulsive stimuli |
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Term
Action of oxazolidinediones |
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Definition
decrease repetitive synaptic transmissions |
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Term
Actions of benzodiazepines and barbituates |
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Definition
elevate seizure threshold by decreasing post synaptic excitability |
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Term
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Definition
a. Prevention of seizures after trauma, neurosurgery, or brain tumors
b. seizure disorders
c. neuropathic pain
d. bipolar
e. anxiety disorder
f. lorazepam is drug of choice for status epilepticus – though lasts only about an hour, so must give with longer lasting anticonvulsant like phenytoin |
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Term
CNS Adverse reactions of anticonvulsants |
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Definition
i. drowsiness, somnolence
ii. weakness
iii. dizziness
iv. headache
v. nystagmus
vi. ataxia
vii. slurred speech |
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Term
GI adverse reactions of anticonvulsants |
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Definition
i. N/V
ii. anorexia
iii. C/D
iv. gingival hyperplasia (overgrowth of gums) |
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Term
Other adverse reactions to anticonvulsants (besides CNS and GI) |
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Definition
i. rash, pruritus, urticaria
ii. urinary frequency
iii. serious skin reactions like Steven-Johnsons syndrome assoc with lamogrigine (Lamictal)
iv. Some assoc with hematologic changes like pancytopenia, leucopenia, aplastic anemia, thrombocytopenia (carbamezepine, felbamate, trimethadione) |
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Term
Contraindications of phenytoin (Dilantin) |
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Definition
i. sinus bradycardia
ii. sinoatrial block
iii. Adams-Stokes syndrome
iv. 2nd and 3rd degree AV block
v. pregnancy and lactation (cat D) |
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Term
Contraindications of ethoin (Peganone)
What type of drug is ethoin? |
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Definition
i. hepatic abnormalities
A HYDANTOIN |
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Term
Contraindications of oxazolidineediones |
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Definition
i. associated with serious adverse reactions and fetal malformations
ii. Only used when less toxic drugs are not effective |
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Term
contraindicatinos of succinimides |
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Definition
i. bone marrow depression
ii. hepatic or renal impairment
iii. associated with higher rate of lupus |
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Term
contraindications of carbamazepine |
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Definition
i. do not give within 14 days of MAOI
ii. bone marrow depression
iii. hepatic or renal impairment
iv. pregnancy (cat D) |
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Term
contraindications of valproic acid (Depakote) |
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Definition
i. renal impairment
ii. pregnancy (cat D) – increased risk for birth defects |
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Term
contraindication of oxcarbazepine (Trileptal) |
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Definition
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Term
Use of anticonvulsants in pregnancy |
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Definition
anticonvulsants in pregnancy associated with birth defects; sometimes anticonvulsants NOT DCed in pregnancy bc possible status epilepticus. If no serious threat to pregnant women, will DC during pregnancy. |
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Term
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Definition
i. kidney disease
ii. neuro disorders
iii. pulmonary disease
iv. hyperactive children |
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Term
precautions benzodiazepines |
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Definition
i. kidney disease
ii. neuro disorders
iii. pregnancy (cat D)
iv. psychoses
v. acute narrow glaucoma
vi. elderly
vii. debilitated |
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Term
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Definition
i. kidney disease
ii. neuro disorders
iii. hypotension
iv. severe myocardial insufficiency
v. hepatic impaiment
phenytoin can also cuase hemo changes, leading to increased risk of infetions, increased bleeding, etc; signs of infection and bleeding, etc must be reported immediately |
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Term
Precautions trimethadione |
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Definition
i. kidney disease
ii. neuro disorders
iii. eye disorders like retinal or optic nerve disease (can cause vidual disturbances) |
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Term
Precautions of miscellaneous anticonvulsant drugs |
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Definition
i. kidney disease
ii. neuro disorders
iii. glaucoma or increased IOP
iv. Hx of cardiac, renal, or liver dysfunction
v. psychiatric disorders |
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Term
precautions of valproic acid |
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Definition
i. kidney disease - increased risk for failure
ii. neuro disorders
iv. increased risk for pancreatitis |
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Term
anticonvulsant + antibiotics/antifungals |
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Definition
increased effect of anticonvulsant |
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Term
anticonvulsant and tricyclics |
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Definition
increased effect of anticonvulsnat |
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Term
anticonvulsants and cimetidine |
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Definition
à increased effect of anticonvulsant |
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Term
anticonvulsant and theophyline |
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Definition
decreased serum levels of anticonvulsant |
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Term
anticonvulsant with antiseizure meds |
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Definition
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Term
carbamezapine (Tegratol) + protease inhibitors |
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Definition
à increase carbamezapine to toxic levels |
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Term
anticonvulsants with oral contraceptives |
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Definition
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Term
anticonvulsants with CNS depressants like alcohol, analgesics |
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Definition
a. increases depressant effect |
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Term
anticonvulsants with antidiabetic meds |
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Definition
increased blood glucose levels |
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Term
Preassessment for anticonvulsant admin |
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Definition
a. Thorough history, including hx of head trauma
b. Observations of friends/family – description, frequency, length, LOC, triggers and presence of aura (feeling that precedes a seizure)
c. Family history of seizures
d. recent drug tx
e. Vitals for baseline
f. Review lab orders e.g. EECG, MRI, CBC, hep/renal fnx etc |
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Term
Ongoing assessment for anticonvulsant admin |
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Definition
a. Dosage/drug type may frequently changes initially based on therapeutic response and adverse reactions
b. Blood tested for toxicity
c. If hospitalized, watch seizures closely and document descriptions as much as possible to help PCP dx type of seizures and tx effect |
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Term
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Definition
- constant seizure activity lasting longer than 5 minutes
- can be caused by missing a dose, even pt on a small dose
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Term
Implementation
Admin of hydantoins |
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Definition
i. Phenytoin is most common (Dilantin) bc relatively less toxic
ii. However, some can’t metab phenytoin, so pts must be monitored for toxicity
iii. Signs of phenytoin toxicity are slurred speech, ataxia (uncoordinated muscle movements), lethargy, dizziness, N/V
iv. When oral, give with food to avoid GI upset
v. When parenteral, IV preferred over IM bc can harm/hurt muscle
vi. NURSING ALERT – when admin phenytoin, closely monitor for signs of toxicity (slurred speech, ataxia, lethargy, dizziness, N/V, nystagmus, mental changes). Phenytoin bt 10-20 mcg/mL is optimal, greater than 20 associated with toxicity. |
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Term
Admin of Barbituate (phenobarbitol) for epilepsy to an elderly person |
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Definition
i. causes CNS depression
ii. in ELDERLY, can cause marked excitement, depression and confusion. Monitor elderly closely for unusual reactions |
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Term
Implementation/Admin of benzodiazepines for epilepsy |
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Definition
i. dose individualized
ii. IV lorazepam can quickly control seizures, but effect is short
iii. diazepam can precipitate when mixed with other drugs, don’t do this
iv. LIFESPAN ALERT – apnea and cardiac arrest can occur when diazepam given to older adults, very ill and those with limited pulm capacity. Watch these pts closely for oversedation. May need lower dose. |
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Term
“Risk for Injury rt seizure disorder, drowsiness and ataxia” |
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Definition
a. drowsiness common adverse reactions, esp. early in tx
b. Assis pt until stable
c. Careful with oral admin, bc drowsi pt could choke; assess swallowing first with water; if unable to swallow, notify PCP ASAP for different route |
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Term
“Risk for Impaired Skin Integrity rt adverse reaction to drug” |
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Definition
a. phenytoin, lamotrigine and the barbiturates can produce a severe and potentially fatal hypersensitivity rash
b. notify PCP immediately
c. Closely examine areas and describe
d. If itchy, keep nails short and give antiseptic cream (may open skin); avoid use of soap (drying)
e. NURSING ALERT – tell PCP immediately; Certain types of rashes necessitate permanent DC. |
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Term
“Risk for Infection rt immunosupression secondary to drug therapy” |
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Definition
a. Be alert for pancytopenia signs: sore throat, fever, malaise, bleeding from mucos membranes, epistaxis (nose bleeding) and easy bruising
b. carbamazepine can cause aplastic anemia and agranulocytosis
c. succinimides also toxic
d. Should be routine labs taken like CBC and differentials
e. Looking for bone marrow suppression (resulting in pancytopenia); if apparent, probably DCed
f. Protect pt from injury and trauma (bleeding) bc of low platelets.
g. Also protect from infection
h. NURSING ALERT – phyenytoin can cause hemo changes like aplastic anemia, leucopenia, thrombocytopenia; immediately report to PCP signs of thrombocytopenia (low platelets) which means more bleeding or leucopenia (signs of infection) |
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Term
“Impaired Oral Mucous Membranes rt gum overgrowth secondary to hydantoins” |
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Definition
a. long-term hydantoins can cause gingivitis and gingival hyperplasia
b. periodically inspect mouth, teeth, gums and report changes to PCP
c. Oral care very important |
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Term
“Disturbed Sensory Perception: Visual rt adverse drug reactions” |
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Definition
a. Assist pt with ambulation
b. ensure safe environment
c. May want dimmer light if sensitive to light
d. May be photosensitive, so wear protection until know |
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Term
General education for ALL anticonvulsants |
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Definition
a. Some pts, when under contoll, may start missing doses; explain that pt must never miss dose
b. Blood levels of anticonvulsant will be monitored
c. Don’t put anything into mouth of person having a seizure
d. Do not do anything hazardous while drowsy
e. Driving privileges can be reinstated once controlled
f. Avoid alcohol unless approved
g. Med ID
h. Do not use OTC without approval
i. Keep record of seizures and take with to appointments |
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Term
Education specific to hydantoins |
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Definition
i. inform dentist and other PCPs
ii. good oral care necessary
iii. Take with food to lessen GI upset
iv. Thoroughly shake suspension form just before use
v. Do not take discolored capsules
vi. Notify if:
1. rash
2. bleeding
3. swollen or tender gums
4. yellow skin or eyes
5. fever
6. sore throat
7. unusual bleeding/bruising
8. persistant headache
9. malaise
10. pregnancy |
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Term
Education specific to succinimides |
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Definition
i. Take with food or milk if GI upset
ii. Notify PCP if:
1. rash
2. joint pain
3. fever
4. sore throat
5. unusual bleeding/bruising
6. drowsiness
7. dizziness
8. blurred vision
9. pregnancy
- "You can take with food/milk, but you might die with a full stomach"
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Term
Education specific to oxazolidinediones |
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Definition
- can cause photosensitivity. Protective measures needed until tolerance determined
- Do not become pregnant with trimethadione bc or risk of serious birth defects
- Notify PCP if:
1. visual disturbances
2. excesss drowsiness or dizziness
3. sore throat
4. fever
5. rash
6. malaise
7. easy bruising
8. epitaxis or bleeding tendencies
9. pregnancy
10. trimethadione can cause serious birth defects |
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Term
what kind of drug is trimethadione? |
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Definition
an oxazolidinedione anticonvulsant |
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Term
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Definition
Tegertol, an anticonvulsant |
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Term
What are signs of phenytoin toxicity? What serum levels are associated with toxicity of phenytoin? What are therepeutic levels |
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Definition
slurred speech, ataxia, lethargy, dizziness, N/V
20 mcg/mL
Tx levels are 10-20 although below 10 can be effective |
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Term
Which barbituate is commonly used to treat convulsive disorders? |
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Definition
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Term
Diazepam and elderly, very ill and those with limited pulmonary capacity |
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Definition
Apneea and cardiac arrest can occur when diazepam given to older adults, very ill and those with limited pulm capacity. Watch these pts closely for oversedation. May need lower dose. |
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Term
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Definition
hydantoins
carboxylic acid derivative
oxazolidinediones
succinimides
bezodiazepines
miscellaneous
barbituate
Having convulsions or seizures breaks my brain |
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Term
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Definition
i. Phenytoin is most common (Dilantin) bc relatively less toxic
ii. However, some can’t metab phenytoin, so pts must be monitored for toxicity
iii. Signs of phenytoin toxicity are slurred speech, ataxia (uncoordinated muscle movements), lethargy, dizziness, N/V |
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Term
General assessments of seizures |
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Definition
Describe
Frequency
Length
Aura?
LOC
Triggers |
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Term
trimethadione and pregnancy |
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Definition
Do not become pregnant with trimethadione bc or risk of serious birth defects |
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Term
Drug of choice for status epilepticus w/ one caveat |
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Definition
lorazepam
short term control, so must be given with another longer lasting anti-convulsant |
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Term
a precaution of carbamazepine (Tegratol) |
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Definition
Can cause aplastic anemia and agranulocytosis |
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Term
Major precautions/contraindication of the succinimides |
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Definition
- They are particularly toxic
- Are contraindicated in those with bone marrow depression (and hepatic/renal impoairment)
- Associated with greater risk of lupus erythematosis
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Term
Which general category of drugs can cause bone marrow suppression? |
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Definition
Anticonvulsants can suppress blod cell production, resulting in pancytopenia, which means lower platelets, lower WBCs and lower RBCs, leading to increased risk of infection, bleeding, etc |
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Term
phenytoin induced hemologic changes |
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Definition
phyenytoin can hemo changes like aplastic anemia, leucopenia, thrombocytopenia
Must be reported immediatey: signs of infection (leucopenia) and excess bleeding (thrombocytopenia) |
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Term
What kind of drug is trimethadione and what is it's most serious reaction? |
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Definition
An oxazolidinedione
Can cuase serious birth defects |
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Term
Which class of drugs can cause photosensitivity? |
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Definition
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Term
Adverse reactions to oxazolidinediones that must be reported: |
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Definition
visual disturbances
excess drowsiness/dizziness/malaise
Signs indicating hemotologic changes
Signs of infection
sore throat
fever
skin rash
Signs of bleeding
easy bruising
epistaxis
bleeding tendencies |
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Term
Which anticonvulsants can cause a severe and potentially fatal hypersensitivity rash? |
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Definition
phenytoin (Dilantin)
lamotrigine (Lamictal)
barbituate (Phenobarbitol) |
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Term
Which hydantoin can cause hemotologic changes resulting in icreased infection and bleeding? |
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Definition
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Term
Which anticonvulsants cause visual disturbances? |
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Definition
valproic acid - diplopia
oxcarbazepine (Trileptal) - diplopia
benzodiazepines
Diamox (a misc = acetazolamide)
trimethodione
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Term
What conditions require precautious use of all types of anticonvulsants? |
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Definition
Kidney disease
Neurological disorders |
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Term
When phenytoin given parenterally, which form is preferred and why? |
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Definition
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Term
which anticonvulsnats have potential to cause severe potentially fatal rash? |
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Definition
phenytoin
lamotringine (Lamictal) also used for bipolar?
phenobarbitol |
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Term
diazepam admin in older adult, very ill and those with limited pulmonary capacity |
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Definition
can cause apnea and cardiac arrest
monitor for over sedation and report |
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