Anticonvulsants
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Included In This Lesson
Outline
Overview
I. Overview
A. Management
1. Epilepsy
2. Convulsions
II. Mechanism of Action
A. Alter movement of Na, K, Ca & Mg ions
B. Stabilized & cell membranes & make cells less responsive
C. Decrease excitability & responsiveness of brain neurons
III. Types
A. Status epileptics
1. Diazepam
2. Fosphenytoin
3. Lorazepam
4. Phenobarbital
5. Phenytoin
B. Antiepileptics
1. Carbamazepine
2. Valproic acid
3. Clonazepam
4. Levetiracetam
5. Pregabalin
6. Oxcarbazepine
7. Lamotrigine
IV. Indications
A. Prevention or control of seizure activity
B. Maintenance therapy for chronic recurring seizures
C. Acute treatment of convulsions
D. Status epilepticus
E. Epilepsy
V. Contraindications
A. Drug allergy
B. Pregnancy
VI. Interactions
A. Carbamazepine
1. Grapefruit juice
a. Increase levels
2. Warfarin
a. Decrease in half-life
B. Valproic acid
1. Barbiturates
a. Increase CNS depression
C. Gabapentin
1. Antacids
a. Decrease levels
VII. Side Effects
A. Carbamazepine
1. Agranulocytosis
a. Bone marrow suppression
i. Aplastic anemia
ii. Agranulocytosis
iii. Thrombocytopenia
2. Stevens-Johnson syndrome
3. Dysrhythmias
4. Thrombophlebitis
B. Valproic acid
1. Pancreatitis
2. Weight gain
3. Thrombocytopenia
C. Levetiracetam / Oxcarbazepine / Lamotrigine
1. Somnolence
2. Headache
3. Dizziness
D. Gabapentin / Pregabalin
1. Peripheral edema
2. N/V/D
3. Visual changes
Nursing Points
Therapeutic Management
Successful control of a seizure disorder hinges on selecting the appropriate drug class and drug dosage, the patient complying with the treatment regimen, and limiting toxicity.
Patient Education
Serum drug concentrations are useful guidelines in assessing the effectiveness of therapy. Maintaining serum drug levels within therapeutic ranges helps not only to control seizures but also to reduce adverse effects.
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Transcript
Welcome back and today we are going to discuss anticonvulsants.
Anticonvulsants are used to treat or manage convulsions (seizures) and epilepsy. They accomplish this by altering the movement of sodium, potassium, calcium, and magnesium. This adjustment of electrolytes stabilizes cell membranes in the brain and decrease excitability in the neurons. When you think of seizures or epilepsy, think of over-excitement in the brain – too much going on at once. Anticonvulsants calm things down. Think if anticonvulsants as melatonin when you can’t turn your brain off to go to bed.
There are various types of anticonvulsants. During a seizure, there can be a lack of oxygen to the brain. The longer the seizure, the longer the damage caused by the lack of oxygen. Status epilepticus is a term for seizures greater than 5 mins and are considered medical emergencies – these require the one types of medications shown here (with your top two being benzodiazepines – diazepam and lorazepam). Now, once the emergency has passed the focus is then using maintenance medications (the list to your right). These meds cover many drug classes with the overall goal of altering the brain’s electrolytes therefore calming excitability. Neurologists are commonly consulted to manage anticonvulsants as there are many drugs with many serious side effects. I’ve had many patients on carbamazepine and valproic acid with a goal of control or limiting their seizure activity so they can function in life. As mentioned earlier, the goal is acute treatment and control of convulsions (seizures) and epilepsy. We again are trying to decrease the excitability in the brain which is causing things to go haywire (things are too exciting). Have you seen someone during a seizure episode? It’s all excitement – violent movements and jerking, it can be quite scary. As a caregiver, they goal to support safety and airway, with a goal of termination of the episodes as fast as possible. The longer the episodes, the longer the damage. Contraindications include allergies and pregnancy (as some drugs have serious side effects that could harm the baby). Although risks and benefits must of evaluated – as multiple seizures will ultimately cause hypoxia and cause fetal harm as well. Typically a neurologist or fetal medicine provider will determine the safest course of action with a pregnant patient’s anticonvulsant options. Interactions are individualized and vary. Carbamazepine with taken with grapefruit juice will cause increases in anticonvulsant medication levels due to its rapid metabolism. This drug also interacts with warfarin, with it decreasing in the drug’s half-life (the drug leaves the body faster than expected). Now valproic acid with used with barbiturates will increase CNS depression – remember we are slowing things down, barbituates also slow things down. Lastly, we have gabapentin. Which when used with antacids will decrease medication levels. Now the level of seizure control is based on therapeutic levels so if those are altered, more seizures will occur – which is a bad thing!
There are various types of anticonvulsants. During a seizure, there can be a lack of oxygen to the brain. The longer the seizure, the longer the damage caused by the lack of oxygen. Status epilepticus is a term for seizures greater than 5 mins and are considered medical emergencies – these require the one types of medications shown here (with your top two being benzodiazepines – diazepam and lorazepam). Now, once the emergency has passed the focus is then using maintenance medications (the list to your right). These meds cover many drug classes with the overall goal of altering the brain’s electrolytes therefore calming excitability. Neurologists are commonly consulted to manage anticonvulsants as there are many drugs with many serious side effects. I’ve had many patients on carbamazepine and valproic acid with a goal of control or limiting their seizure activity so they can function in life. As mentioned earlier, the goal is acute treatment and control of convulsions (seizures) and epilepsy. We again are trying to decrease the excitability in the brain which is causing things to go haywire (things are too exciting). Have you seen someone during a seizure episode? It’s all excitement – violent movements and jerking, it can be quite scary. As a caregiver, they goal to support safety and airway, with a goal of termination of the episodes as fast as possible. The longer the episodes, the longer the damage. Contraindications include allergies and pregnancy (as some drugs have serious side effects that could harm the baby). Although risks and benefits must of evaluated – as multiple seizures will ultimately cause hypoxia and cause fetal harm as well. Typically a neurologist or fetal medicine provider will determine the safest course of action with a pregnant patient’s anticonvulsant options. Interactions are individualized and vary. Carbamazepine with taken with grapefruit juice will cause increases in anticonvulsant medication levels due to its rapid metabolism. This drug also interacts with warfarin, with it decreasing in the drug’s half-life (the drug leaves the body faster than expected). Now valproic acid with used with barbiturates will increase CNS depression – remember we are slowing things down, barbituates also slow things down. Lastly, we have gabapentin. Which when used with antacids will decrease medication levels. Now the level of seizure control is based on therapeutic levels so if those are altered, more seizures will occur – which is a bad thing!
Carbamazepine side effects are plentiful and include agranulocytosis (which is a reduction in WBCs), bone marrow suppression, anemia, and thrombocytopenia. It also includes Steven-Johnson syndrome (flu-like symptoms followed by blisters), dysrhythmia (sinus tachycardia), and thrombophlebitis.
Side effects for valproic acid include pancreatitis, weight gain, and thrombocytopenia. If your patient has a baseline pancreatic disease or dysfunction, this drug clearly wouldn’t be the first choice. Now I had a patient with a history of chronic pancreatitis who was on this drug. I week later his amylase and lipase were sky-high. Of course, his neurologist changed his anticonvulsant medication. The goal is indeed seizure control but we don’t want other organs failing either.
Now levetiracetam, oxcarbazepine, and lamotrigine all have the same side effects: somnolence, headache, and dizziness – all neurological based. While gabapentin and pregabalin have side effects such as edema, N/V/D and visual changes.
Priority Nursing Concepts for a patient receiving anticonvulsant medications include cellular regulation and pharmacology.
Alright, let’s recap. Anticonvulsants will alter electrolytes in the brains in order to decrease excitability in neurons. Types of drugs are based on whether the provider is treating status epilepticus or general seizure control – they cover many drug classes. Indications are to treat and control seizure activity, status epilepticus and epilepsy. Contraindications are allergy and pregnancy based, as some medication can cause fetal harm. Interactions are drug-specific and include grapefruit juice, warfarin, antacids, and barbituates (depending on the drug). Always remember – the longer the seizures, the longer the damage. The goal is to control here. Now you know all there is to know about anticonvulsants. Now go out and be your best self and happy nursing!
Priority Nursing Concepts for a patient receiving anticonvulsant medications include cellular regulation and pharmacology.
Alright, let’s recap. Anticonvulsants will alter electrolytes in the brains in order to decrease excitability in neurons. Types of drugs are based on whether the provider is treating status epilepticus or general seizure control – they cover many drug classes. Indications are to treat and control seizure activity, status epilepticus and epilepsy. Contraindications are allergy and pregnancy based, as some medication can cause fetal harm. Interactions are drug-specific and include grapefruit juice, warfarin, antacids, and barbituates (depending on the drug). Always remember – the longer the seizures, the longer the damage. The goal is to control here. Now you know all there is to know about anticonvulsants. Now go out and be your best self and happy nursing!
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Pharmacology for Nursing (MedMaster)
The Pharmacology Course is a one-stop-shop for all things medication related! We’ll talk you through how to be successful in pharmacology and how to be safe when administering meds. We break down the most common and most important medication classes into easy-to-understand sections. We even walk you through how to conquer the often intimidating med math and drug calculations! When you finish this course you’ll be able to confidently and safely administer medications to your patients!
Course Lessons
0 - Pharmacology Course Introduction
Pharmacology Course Introduction
1 - NCLEX Must Knows
12 Points to Answering Pharmacology Questions
54 Common Medication Prefixes and Suffixes
Therapeutic Drug Levels (Digoxin, Lithium, Theophylline, Phenytoin)
Essential NCLEX Meds by Class
6 Rights of Medication Administration
Pharmacodynamics
Pharmacokinetics
The SOCK Method – Overview
The SOCK Method – S
The SOCK Method – O
The SOCK Method – C
The SOCK Method – K
2 - Math for Meds
Basics of Calculations
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
Oral Medications
Injectable Medications
IV Infusions (Solutions)
Complex Calculations (Dosage Calculations/Med Math)
Interactive Pharmacology Practice
Interactive Practice Drip Calculations
Pediatric Dosage Calculations
3 - Disease Specific Medications
Disease Specific Medications
4 - Antianxiety Agents
Antianxiety Meds
Benzodiazepines
Alprazolam (Xanax) Nursing Considerations
Lorazepam (Ativan) Nursing Considerations
Midazolam (Versed) Nursing Considerations
Diazepam (Valium) Nursing Considerations
Buspirone (Buspar) Nursing Considerations
Antianxiety Meds
5 - Antiarrhythmics
ACLS (Advanced cardiac life support) Drugs
Amiodarone (Pacerone) Nursing Considerations
Adenosine (Adenocard) Nursing Considerations
Procainamide (Pronestyl) Nursing Considerations
6 - Anticoagulants & Thrombolytics
Anti-Platelet Aggregate
Clopidogrel (Plavix) Nursing Considerations
Coumarins
Warfarin (Coumadin) Nursing Considerations
Thrombin Inhibitors
Enoxaparin (Lovenox) Nursing Considerations
Heparin (Hep-Lock) Nursing Considerations
Thrombolytics
Alteplase (tPA, Activase) Nursing Considerations
Streptokinase (Streptase) Nursing Considerations
7 - Anticonvulsants
Anticonvulsants
Carbamazepine (Tegretol) Nursing Considerations
Divalproex (Depakote) Nursing Considerations
Gabapentin (Neurontin) Nursing Considerations
Lamotrigine (Lamictal) Nursing Considerations
Levetiracetam (Keppra) Nursing Considerations
Phenytoin (Dilantin) Nursing Considerations
8 - Antidepressants
Antidepressants
Bupropion (Wellbutrin) Nursing Considerations
MAOIs
Selegiline (Eldepyrl) Nursing Considerations
SSRIs
Escitalopram (Lexapro) Nursing Considerations
Fluoxetine (Prozac) Nursing Considerations
Paroxetine (Paxil) Nursing Considerations
Sertraline (Zoloft) Nursing Considerations
TCAs
Amitriptyline (Elavil) Nursing Considerations
9 - Antidiabetic Agents
Antidiabetic Agents
Glipizide (Glucotrol) Nursing Considerations
Metformin (Glucophage) Nursing Considerations
Insulin
Insulin – Rapid Acting (Novolog, Humalog) Nursing Considerations
Insulin – Short Acting (Regular) Nursing Considerations
Insulin – Intermediate Acting (NPH) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin – Long Acting (Lantus) Nursing Considerations
10 - Antihistamines
Histamine 1 Receptor Blockers
Diphenhydramine (Benadryl) Nursing Considerations
Promethazine (Phenergan) Nursing Considerations
Histamine 2 Receptor Blockers
Cimetidine (Tagamet) Nursing Considerations
Famotidine (Pepcid) Nursing Considerations
Ranitidine (Zantac) Nursing Considerations
11 - Antihypertensives
Renin Angiotensin Aldosterone System
Sympatholytics (Alpha & Beta Blockers)
Atenolol (Tenormin) Nursing Considerations
Metoprolol (Toprol XL) Nursing Considerations
Propranolol (Inderal) Nursing Considerations
ACE (angiotensin-converting enzyme) Inhibitors
Captopril (Capoten) Nursing Considerations
Enalapril (Vasotec) Nursing Considerations
Lisinopril (Prinivil) Nursing Considerations
Angiotensin Receptor Blockers
Losartan (Cozaar) Nursing Considerations
Calcium Channel Blockers
Amlodipine (Norvasc) Nursing Considerations
Diltiazem (Cardizem) Nursing Considerations
Nifedipine (Procardia) Nursing Considerations
Verapamil (Calan) Nursing Considerations
Cardiac Glycosides
Digoxin (Lanoxin) Nursing Considerations
12 - Anti-Infectives
Anti-Infective – Aminoglycosides
Gentamicin (Garamycin) Nursing Considerations
Anti-Infective – Antifungals
Metronidazole (Flagyl) Nursing Considerations
Nystatin (Mycostatin) Nursing Considerations
Anti-Infective – Antitubercular
Isoniazid (Niazid) Nursing Considerations
Rifampin (Rifadin) Nursing Considerations
Anti-Infective – Antivirals
Acyclovir (Zovirax) Nursing Considerations
Anti-Infective – Carbapenems
Meropenem (Merrem) Nursing Considerations
Anti-Infective – Fluoroquinolones
Ciprofloxacin (Cipro) Nursing Considerations
Levofloxacin (Levaquin) Nursing Considerations
Anti-Infective – Glycopeptide
Vancomycin (Vancocin) Nursing Considerations
Anti-Infective – Lincosamide
Clindamycin (Cleocin) Nursing Considerations
Anti-Infective – Macrolides
Erythromycin (Erythrocin) Nursing Considerations
Azithromycin (Zithromax) Nursing Considerations
Anti-Infective – Penicillins and Cephalosporins
Amoxicillin (Amoxil) Nursing Considerations
Ampicillin (Omnipen) Nursing Considerations
Cefaclor (Ceclor) Nursing Considerations
Cefdinir (Omnicef) Nursing Considerations
Cephalexin (Keflex) Nursing Considerations
Anti-Infective – Sulfonamides
Trimethoprim-Sulfamethoxazole (Bactrim) Nursing Considerations
Anti-Infective – Tetracyclines
Tetracycline (Panmycin) Nursing Considerations
13 - Antipsychotics
Atypical Antipsychotics
Chlorpromazine (Thorazine) Nursing Considerations
Antipsychotics
Haloperidol (Haldol) Nursing Considerations
Quetiapine (Seroquel) Nursing Considerations
Olanzapine (Zyprexa) Nursing Considerations
14 - Autonomic Nervous System Meds
Autonomic Nervous System (ANS)
Methylphenidate (Concerta) Nursing Considerations
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Dobutamine (Dobutrex) Nursing Considerations
Dopamine (Inotropin) Nursing Considerations
Carbidopa-Levodopa (Sinemet) Nursing Considerations
Parasympathomimetics (Cholinergics) Nursing Considerations
Neostigmine (Prostigmin) Nursing Considerations
Parasympatholytics (Anticholinergics) Nursing Considerations
Atropine (Atropen) Nursing Considerations
Benztropine (Cogentin) Nursing Considerations
Diphenoxylate-Atropine (Lomotil) Nursing Considerations
15 - Bronchodilators & Respiratory Drugs
Guaifenesin (Mucinex) Nursing Considerations
Bronchodilators
Albuterol (Ventolin) Nursing Considerations
Montelukast (Singulair) Nursing Considerations
Salmeterol (Serevent) Nursing Considerations
16 - Diuretics
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Furosemide (Lasix) Nursing Considerations
Hydrochlorothiazide (Hydrodiuril) Nursing Considerations
Spironolactone (Aldactone) Nursing Considerations
Mannitol (Osmitrol) Nursing Considerations
17 - GI Meds
Bisacodyl (Dulcolax) Nursing Considerations
Bismuth Subsalicylate (Pepto-Bismol) Nursing Considerations
Lactulose (Generlac) Nursing Considerations
Loperamide (Imodium) Nursing Considerations
Metoclopramide (Reglan) Nursing Considerations
Ondansetron (Zofran) Nursing Considerations
Pancrelipase (Pancreaze) Nursing Considerations
Sucralfate (Carafate) Nursing Considerations
Proton Pump Inhibitors
Omeprazole (Prilosec) Nursing Considerations
Pantoprazole (Protonix) Nursing Considerations
18 - Hormone & Immune Related Drugs
Epoetin Alfa
Epoetin (Epogen) Nursing Considerations
Glucagon (GlucaGen) Nursing Considerations
Iodine Nursing Considerations
Levothyroxine (Synthroid)
Propylthiouracil (PTU) Nursing Considerations
Cyclosporine (Sandimmune) Nursing Considerations
19 - Lipid Lowering Drugs
HMG-CoA Reductase Inhibitors (Statins)
Atorvastatin (Lipitor) Nursing Considerations
20 - Mineral and Electrolyte Drugs
Magnesium Sulfate
Magnesium Sulfate in Pregnancy
Magnesium Sulfate (MgSO4) Nursing Considerations
Calcium Acetate (PhosLo) Nursing Considerations
Calcium Carbonate (Tums) Nursing Considerations
Ferrous Sulfate (Iron) Nursing Considerations
Alendronate (Fosamax) Nursing Considerations
21 - Mood Stabilizers
Mood Stabilizers
Lithium (Lithonate) Nursing Considerations
22 - Non-Opioid Analgesics
Acetaminophen (Tylenol) Nursing Considerations
Phenazopyridine (Pyridium) Nursing Considerations
NSAIDs
ASA (Aspirin) Nursing Considerations
Celecoxib (Celebrex) Nursing Considerations
Ibuprofen (Motrin) Nursing Considerations
Indomethacin (Indocin) Nursing Considerations
Ketorolac (Toradol) Nursing Considerations
Naproxen (Aleve) Nursing Considerations
23 - OB Meds
Tocolytics
Terbutaline (Brethine) Nursing Considerations
Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations
Meds for Postpartum Hemorrhage (PPH)
Methylergonovine (Methergine) Nursing Considerations
Oxytocin (Pitocin) Nursing Considerations
Prostaglandins in Pregnancy
Rh Immune Globulin in Pregnancy
Lung Surfactant for Newborns
Eye Prophylaxis for Newborn
Phytonadione (Vitamin K) for Newborn
Hepatitis B Vaccine for Newborns
24 - Opioid Analgesics
Opioids
Opioid Analgesics in Pregnancy
Butorphanol (Stadol) Nursing Considerations
Codeine (Paveral) Nursing Considerations
Fentanyl (Duragesic) Nursing Considerations
Hydrocodone-Acetaminophen (Vicodin, Lortab) Nursing Considerations
Hydromorphone (Dilaudid) Nursing Considerations
Meperidine (Demerol) Nursing Considerations
Methadone (Methadose) Nursing Considerations
Morphine (MS Contin) Nursing Considerations
Nalbuphine (Nubain) Nursing Considerations
Oxycodone (OxyContin) Nursing Considerations
25 - Sedatives / Hyponotics
Sedatives-Hypnotics
Barbiturates
Phenobarbital (Luminal) Nursing Considerations
Pentobarbital (Nembutal) Nursing Considerations
Anesthetic Agents
Propofol (Diprivan) Nursing Considerations
Lidocaine (Xylocaine) Nursing Considerations
26 - Steroids
Corticosteroids
Betamethasone and Dexamethasone in Pregnancy
Cortisone (Cortone) Nursing Considerations
Dexamethasone (Decadron) Nursing Considerations
Fluticasone (Flonase) Nursing Considerations
Methylprednisolone (Solu-Medrol) Nursing Considerations
27 - Vasodilators
Hydralazine
Hydralazine (Apresoline) Nursing Considerations
Nitro Compounds
Nitroglycerin (Nitrostat) Nursing Considerations
Nitroprusside (Nitropress) Nursing Considerations
28 - Vasopressors
Vasopressin
Epinephrine (EpiPen) Nursing Considerations
Norepinephrine (Levophed) Nursing Considerations
Vasopressin (Pitressin) Nursing Considerations
29 - Medications By Class
ACLS (Advanced cardiac life support) Drugs
Anti-Infective – Aminoglycosides
Anti-Infective – Carbapenems
Anti-Infective – Macrolides
Anti-Infective – Fluoroquinolones
Anti-Infective – Sulfonamides
Anti-Infective – Tetracyclines
Anti-Infective – Antifungals
Anti-Infective – Antivirals
Anti-Infective – Lincosamide
Thrombolytics
Anticonvulsants
Antidiabetic Agents
Sympatholytics (Alpha & Beta Blockers)
Anti-Infective – Antitubercular
Anti-Infective – Glycopeptide
Bronchodilators
Opioids
Barbiturates
Anesthetic Agents
30- Antineoplastics
Antineoplastics
Alkylating Agents
Antimetabolites
Anti Tumor Antibiotics
Plant Alkaloids Topoisomerase and Mitotic Inhibitors
31 – Medication Infusion
Patient Controlled Analgesia (PCA)
Epidural
Insulin Drips
