Nclex Review: Seizure Meds

Nclex Review: Seizure Meds

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NCLEX Chapter 15: Drugs for Seizur...

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Chapter 15: Drugs for Seizures

23 terms quizlette30417710 Preview Seizures NCLEX 12 terms murkacatPreview Anticon 10 terms kar A patient receives phenytoin (Dilantin) for partial seizures.Which medication will require a higher-than-normal dosage when taken by the patient during this therapy?

• Tiagabine (Gabritril)
• Lamotrigine (Lamictal)
• Gabapentin (Neurontin)
• Phenobarbital (Luminal)

B A normal dosage of lamotrigine is unlikely to be effective against partial seizures when administered with phenytoin, because these medications are metabolized by the same hepatic enzymes, resulting in decreased effectiveness of the lamotrigine. For the lamotrigine to be therapeutically effective, the dosage must be increased when the drug is administered concurrently with phenytoin.The nurse prepares a female patient who takes phenobarbital (Luminal) and oral contraceptives for discharge. Which intervention is the nurse's priority before discharge?

• Planning for regular exercise in a safe setting
• Making a medication reminder sign for the home
• Instructing the patient to get help before climbing

stairs

• Helping the patient plan another form of birth control

C Because phenobarbital can cause lethargy, drowsiness, and dizziness, the nurse instructs the patient to get help when climbing stairs to help prevent injury. The nurse instructs the patient to continue precautions to maintain safety until the full effects of the drug are known. Of secondary importance, the nurse instructs the patient to use an alternative form of birth control, because the effect of the oral contraceptives is blunted with concomitant administration of phenobarbital. The nurse instructs the patient to plan exercise, because the lethargy from this medication can contribute to deconditioning. The nurse also instructs the patient to post a sign as a reminder to take phenobarbital once a day to maintain adherence to therapy.The patient is receiving IV antiepileptic therapy. Which parenteral antiepileptic drug is effective against generalized seizures?

• Phenytoin (Dilantin)
• Fosphenytoin (Cerebyx)
• Phenobarbital (Luminal)
• Valproic acid (Depakene)

D Valproic acid is indicated in all its forms for generalized seizures, including tonic- clonic, absence, and myoclonic seizures. Phenytoin, fosphenytoin, and phenobarbital are parenteral antiepileptic medications, effective in the treatment of partial seizures and, secondarily, generalized tonic-clonic seizures.

What information should the nurse provide to a patient who will self-administer an antiepileptic agent for the first time at home?

• Report any vision or hearing problems with

levetiracetam (Keppra).

• Stir phenobarbital (Luminal) elixir into a cold

carbonated beverage.

• Have a complete blood count monthly while taking

carbamazepine (Tegretol).

• Administer pregabalin (Lyrica) every morning on an

empty stomach.C The nurse instructs the patient taking carbamazepine to have complete blood counts as directed, usually every month at first, because iminostilbenes can cause bone marrow suppression. Patients taking levetiracetam are told to report changes in mood or behavior or motor difficulties. Patients taking phenobarbital are instructed to mix the elixir with fruit juice, milk, or water but not a carbonated beverage. The nurse instructs the patient taking pregabalin to take the medication in 2 or 3 doses and to avoid sudden withdrawal of the medication.The nurse finds a patient on the floor who is unresponsive but exhibiting spasms of the trunk and flexion of the arm alternating with periods of relaxation. Which finding should the nurse include in the nursing documentation?

• Patient on floor as a result of loss of consciousness
• Patient fallen to floor, exhibiting tonic convulsions
• Patient exhibiting arm flexion with trunk spasms
• Patient fallen to floor as a result of tonic-clonic seizure

C The nurse documents an objective description of the event by stating that the patient is exhibiting arm flexion and trunk spasms and therefore that the patient is experiencing a type of generalized seizure involving tonic-clonic convulsive activity. The nurse does not know how the patient got to the floor; however, the facts that the patient was found on the floor and is unresponsive should be documented. The nurse avoids documenting that the patient fell, fell because of the convulsions, or first lost consciousness, because the nurse did not witness the sequence of events.A patient who needs an antiepileptic medication for tonic-clonic seizures is unresponsive. Which antiepileptic medication(s) should the nurse avoid administering to this patient? (Choose all that apply.)

• Tiagabine (Gabitril)
• Phenytoin (Dilantin)
• Topiramate (Topamax)
• Gabapentin (Neurontin)
• ethosuximide (Zarontin)
• Phenobarbital (Luminal)

A, C, D, E

Because the patient is unresponsive, the nurse avoids administering medications by mouth, because doing so exposes the patient to an increased risk of aspiration.Until the level of consciousness improves and the patient can swallow, the nurse should not administer tiagabine, topiramate, gabapentin, or ethosuximide, which are available for oral administration only. In addition, tiagabine, gabapentin, and ethosuximide are not indicated therapy for tonic-clonic seizures. Topiramate, phenytoin, and phenobarbital are suitable for tonic-clonic seizures, but only phenytoin and phenobarbital, which may be administered intravenously, are indicated for an unresponsive patient.After the nurse administers lidocaine for ventricular tachycardia, the patient experiences status epilepticus.Which medication could be administered to treat both problems?

• Diazepam (Valium)
• Phenytoin (Dilantin)
• Phenobarbital (Luminal)
• Carbamazepine (Tegretol)

B Diazepam is a first-line therapy for the initial control of generalized convulsive status epilepticus; however, because the patient is also experiencing ventricular tachycardia, phenytoin may be a better choice of antiepileptic agent because it is indicated for both conditions. Once the patient's condition has stabilized, maintenance therapy may include phenytoin; however, oral phenytoin is not indicated as maintenance antidysrhythmic therapy. Phenobarbital is indicated for status epilepticus; but, because of its side effect profile, it has been replaced clinically by diazepam and phenytoin. Carbamazepine is not indicated for status epilepticus.

The nurse prepares to administer carbamazepine (Tegretol) to a patient receiving temazepam (Restoril).Which risk to the patient is increased by the concomitant administration of these medications?

• Inability to have sound sleep
• Incidence of absence seizures
• Carbamazepine toxicity
• Circulatory collapse

C Concomitant administration of carbamazepine with a benzodiazepine such as temazepam increases the risk of carbamazepine toxicity because both medications are metabolized in the liver through cytochrome P450 enzymes. As a result, the enzyme supply is exhausted, impairing the removal of these drugs from the blood. This can cause higher circulating drug levels for longer periods, thereby increasing the risk of toxicity for both drugs. The patient is more likely to experience deep, prolonged sleep rather than poor sleep and should be less likely to experience generalized seizures. The patient is likely to experience hypotension after the administration of both agents; however, circulatory collapse is less likely.A patient's pharmacotherapy includes valproic acid (Depakene), and the prescriber wants to add carbamazepine (Tegretol). After the new medication is added, which phenomenon is the nurse most likely to observe in the patient?

• Less amnesia after a convulsion
• Increased number of convulsions
• Changes in nature of convulsions
• Improved level of consciousness

C Concomitant administration of carbamazepine with a benzodiazepine such as temazepam increases the risk of carbamazepine toxicity because both medications are metabolized in the liver through cytochrome P450 enzymes. As a result, the enzyme supply is exhausted, impairing the removal of these drugs from the blood. This can cause higher circulating drug levels for longer periods, thereby increasing the risk of toxicity for both drugs. The patient is more likely to experience deep, prolonged sleep rather than poor sleep and should be less likely to experience generalized seizures. The patient is likely to experience hypotension after the administration of both agents; however, circulatory collapse is less likely.What is the best diagnostic study with which to determine the type of seizure activity while the patient is experiencing the seizure?

• Electroencephalogram (EEG)
• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET)

A The EEG is the best diagnostic study with which to determine the type of seizure a patient is having while experiencing the seizure, because an EEG detects electrical discharges in the brain and records them as waves on a tracing.Electrical activity associated with seizures is excessive and disorganized, but the waves are correlated with different neurologic conditions. CT, MRI, and PET do not detect electrical activity in the brain.Which information should be given to the client taking phenytoin (Dilantin)?

• Taking the medication with meals will increase its

effectiveness.

• The medication can cause sleep disturbances
• More frequent dental appointments will be needed for

special gum care.

• The medication decreases the effects of oral contra-

ceptives.

• More frequent dental appointments will be needed for special gum care.

Gingival hyperplasia is a side effect of phenytoin. The client will need more frequent dental visits.Answers A, B, and D do not apply to the medication; therefore, they are incorrect.

The nurse is teaching a patient who is newly diagnosed with epilepsy about her disease. Which statement made by the nurse best describes the goals of antiepilepsy medication therapy?

• "With proper treatment we can completely eliminate

your seizures."

• "Our goal is to reduce your seizures to an extent that

helps you live a normal life."

• "Epilepsy medication does not reduce seizures in most

patients."

• "These drugs will help control your seizures until you

have surgery."

• "Our goal is to reduce your seizures to an extent that helps you live a normal

life." Epilepsy is treated successfully with medication in a majority of patients. However, the dosages needed to completely eliminate seizures may cause intolerable side effects. Neurosurgery is indicated only for patients in whom medication therapy is unsuccessful.The nurse is preparing to give ethosuximide (Zarontin).The nurse understands that this drug is only indicated for which seizure type?

• Tonic-clonic
• Absence
• Simple partial
• Complex partial
• Absence

Absence seizures are the only indication for ethosuximide. The drug effectively eliminates absence seizures in approximately 60% of patients and effectively controls 80% to 90% of cases.The nurse is conducting discharge teaching related to a new prescription for phenytoin (Dilantin). Which statements are appropriate to include in the teaching for this patient and his family? Select all that apply.

• "Be sure to call the clinic if you or your family notice

increased anxiety or agitation."

• "You may have some mild sedation. Do not drive until

you know how this drug will affect you."

• "This drug may cause easy bruising. If you notice this,

call the clinic immediately."

• "It is very important to have good oral hygiene and

visit your dentist regularly."

• "You may continue to have wine with your evening

meals but only in moderation."

A, B, D

Patients receiving an antiepileptic drug are at increased risk for suicidal thoughts and behavior beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these immediately. Mild sedation can occur in patients taking phenytoin even at therapeutic levels.Carbamazepine(Tegretol), not phenytoin, increases the risk for hematologic effects, such as easy bruising.Phenytoin causes gingival hyperplasia in about 20% of patients who take it. Dental hygiene is important.Patients receiving phenytoin should avoid alcohol and other central nervous system depressants because they have an additive depressant effect.