Anticonvulsants
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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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Study Plan Lessons
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
EKG (ECG) Course Introduction
ABGs Nursing Normal Lab Values
Care of the Pediatric Patient
Coronary Artery Disease Concept Map
Electrical A&P of the Heart
Respiratory A&P Module Intro
ABG (Arterial Blood Gas) Interpretation-The Basics
Computed Tomography (CT)
COPD Concept Map
Electrolytes Involved in Cardiac (Heart) Conduction
Magnetic Resonance Imaging (MRI)
Magnetic Resonance Imaging (MRI)
Nursing Care and Pathophysiology for Sickle Cell Anemia
Adult Vital Signs (VS)
CT & MR Angiography
Nursing Care and Pathophysiology for Disseminated Intravascular Coagulation (DIC)
Nasal Disorders
Nursing Care and Pathophysiology for Disseminated Intravascular Coagulation (DIC)
Pediatric Vital Signs (VS)
Respiratory Acidosis (interpretation and nursing interventions)
Thrombocytopenia
Cardiovascular Angiography
Preload and Afterload
Respiratory Alkalosis
Congestive Heart Failure Concept Map
Echocardiogram (Cardiac Echo)
Performing Cardiac (Heart) Monitoring
Hypertension (HTN) Concept Map
Pulmonary Function Test
Electroencephalography (EEG)
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology for Asthma
02.02 Cardiomyopathy for CCRN Review
Leukemia
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Lymphoma
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Respiratory Terminology
Oncology Important Points
Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Lung Cancer
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Heart (Cardiac) and Great Vessels Assessment
Intracranial Pressure ICP
Nursing Care and Pathophysiology for Pulmonary Edema
Cerebral Perfusion Pressure CPP
Cerebral Perfusion Pressure CPP
02.08 Cardiac Catheterization & Acute Coronary Syndrome for CCRN Review
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Grief and Loss
Dementia and Alzheimers
Acute Coronary Syndrome (ACS)
Immunology Module Intro
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Sickle Cell Anemia
Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
Aneurysm & Dissection
Nursing Care and Pathophysiology for Heart Failure (CHF)
Hemoglobin (Hbg) Lab Values
Iron Deficiency Anemia
Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
Sinus Bradycardia
Nursing Care and Pathophysiology for Anaphylaxis
Cardiopulmonary Arrest
Hematocrit (Hct) Lab Values
Nursing Care and Pathophysiology for Anaphylaxis
Sinus Tachycardia
Meds for Alzheimers
Pacemakers
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Hypertensive Emergency
Supraventricular Tachycardia (SVT)
Fibromyalgia
Migraines
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2nd Degree AV Heart Block Type 1 (Mobitz I, Wenckebach)
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3rd Degree AV Heart Block (Complete Heart Block)
Cholesterol (Chol) Lab Values
Nursing Care and Pathophysiology of Hypertension (HTN)
Leukemia
Pulmonary Embolism
Acute Respiratory Distress
Cardiac (Heart) Disease in Pregnancy
Nursing Care and Pathophysiology for Cardiomyopathy
Respiratory Structure & Function
ACLS (Advanced cardiac life support) Drugs
Fever
Respiratory Trauma Module Intro
Seizure Causes (Epilepsy, Generalized)
Increased Intracranial Pressure
Nursing Care and Pathophysiology for Pulmonary Embolism
Anti-Platelet Aggregate
Respiratory Procedures Module Intro
Electrical Activity in the Heart
Nursing Care and Pathophysiology for Meningitis
Respiratory Terminology
Thrombin Inhibitors
Thrombolytics
Blood Plasma
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Acute Otitis Media (AOM)
07.06 Increased Intracranial Pressure (ICP) for CCRN Review
Dystocia
Acute Bronchitis
Bronchiolitis and Respiratory Syncytial Virus (RSV)
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Asthma
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AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Bicarbonate (HCO3) Lab Values
Bronchiolitis and Respiratory Syncytial Virus (RSV)
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Cardiac Anatomy
Cardiac Labs – What and When to Use Them 2 – Live Tutoring Archive
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Cerebral Palsy (CP)
CHF Treatment Nursing Mnemonic (UNLOAD FAST)
Chronic Obstructive Pulmonary Disease (COPD) for Certified Emergency Nursing (CEN)
Chronic Obstructive Pulmonary Disease (COPD) Case Study (60 min)
Nursing Care and Pathophysiology for Heart Failure (CHF)
Congestive Heart Failure (CHF) Labs
Congestive Heart Failure Concept Map
COPD (Chronic Obstructive Pulmonary Disease) Labs
COPD Concept Map
COPD Exacerbation for Progressive Care Certified Nurse (PCCN)
COPD management Nursing Mnemonic (COPD)
Coronary Artery Disease Concept Map
Cystic Fibrosis (CF)
Dementia Nursing Mnemonic (DEMENTIA)
Diagnostic Criteria for Lupus Nursing Mnemonic (SOAP BRAIN MD)
EKG Basics – Live Tutoring Archive
Furosemide (Lasix) Nursing Considerations
Head and Spinal Cord Trauma for Certified Emergency Nursing (CEN)
Heart (Cardiac) Failure Module Intro
Heart (Cardiac) Failure Therapeutic Management
Heart Failure for Certified Emergency Nursing (CEN)
Heart Failure 2 – Live Tutoring Archive
Heart Failure (Acute Exacerbations, Chronic) for Progressive Care Certified Nurse (PCCN)
Heart Failure – Right Sided Nursing Mnemonic (HEAD)
Heart Failure Case Study (45 min)
Heart Failure-Left-Sided Nursing Mnemonic (CHOP)
Heart Failure-Origin Nursing Mnemonic (Left – Lung|Right – Rest)
Hematocrit (Hct) Lab Values
Hematologic Disorders for Certified Emergency Nursing (CEN)
Hemoglobin (Hbg) Lab Values
Hypertension for Certified Emergency Nursing (CEN)
Hypertension (HTN) Concept Map
Hypertension (Uncontrolled) and Hypertensive Crisis for Progressive Care Certified Nurse (PCCN)
Hypertension – Nursing care Nursing Mnemonic (DIURETIC)
Hypertension- Complications Nursing Mnemonic (The 4 C’s)
Hypertensive Crisis Case Study (45 min)
Increased Intracranial Pressure (ICP) for Certified Emergency Nursing (CEN)
Intracranial Pressure ICP
Leukemia
Leukemia – Signs and Symptoms Nursing Mnemonic (ANT)
Leukemia Case Study (60 min)
Lymphoma
Management of Lyme Disease Nursing Mnemonic (BAR)
MI Surgical Intervention
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Myocardial Infarction (MI) Case Study (45 min)
Noncardiac Pulmonary Edema for Certified Emergency Nursing (CEN)
Nursing Care and Pathophysiology for Anemia
Nursing Care and Pathophysiology for Aortic Aneurysm
Nursing Care and Pathophysiology for Arterial Disorders
Nursing Care and Pathophysiology for Asthma
Nursing Care and Pathophysiology for Cardiomyopathy
Nursing Care and Pathophysiology for Heart Failure (CHF)
Nursing Care and Pathophysiology for Lyme Disease
Nursing Care and Pathophysiology for Thrombophlebitis (clot)
Nursing Care and Pathophysiology for Valve Disorders
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Nursing Care and Pathophysiology of Endocarditis and Pericarditis
Nursing Care and Pathophysiology of Hypertension (HTN)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Myocarditis
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care Plan (NCP) for Activity Intolerance
Nursing Care Plan (NCP) for Acute Bronchitis
Nursing Care Plan (NCP) for Acute Pain
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Care Plan (NCP) for Alzheimer’s Disease
Nursing Care Plan (NCP) for Anaphylaxis
Nursing Care Plan (NCP) for Anemia
Nursing Care Plan (NCP) for Angina
Nursing Care Plan (NCP) for Aortic Aneurysm
Nursing Care Plan (NCP) for Arterial Disorders
Nursing Care Plan (NCP) for Asthma
Nursing Care Plan (NCP) for Asthma / Childhood Asthma
Nursing Care Plan (NCP) for Bronchiolitis / Respiratory Syncytial Virus (RSV)
Nursing Care Plan (NCP) for Bronchoscopy (Procedure)
Nursing Care Plan (NCP) for Cardiomyopathy
Nursing Care Plan (NCP) for Cellulitis
Nursing Care Plan (NCP) for Cerebral Palsy (CP)
Nursing Care Plan (NCP) for Chronic Obstructive Pulmonary Disease (COPD)
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Congestive Heart Failure (CHF)
Nursing Care Plan (NCP) for Cystic Fibrosis
Nursing Care Plan (NCP) for Decreased Cardiac Output
Nursing Care Plan (NCP) for Dementia
Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)
Nursing Care Plan (NCP) for Emphysema
Nursing Care Plan (NCP) for Guillain-Barre
Nursing Care Plan (NCP) for Heart Valve Disorders
Nursing Care Plan (NCP) for Hypertension (HTN)
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) for Impaired Gas Exchange
Nursing Care Plan (NCP) for Leukemia
Nursing Care Plan (NCP) for Lung Cancer
Nursing Care Plan (NCP) for Lyme Disease
Nursing Care Plan (NCP) for Lymphoma (Hodgkin’s, Non-Hodgkin’s)
Nursing Care Plan (NCP) for Migraines
Nursing Care Plan (NCP) for Myocardial Infarction (MI)
Nursing Care Plan (NCP) for Neutropenia
Nursing Care Plan (NCP) for Otitis Media / Acute Otitis Media (AOM)
Nursing Care Plan (NCP) for Pericarditis
Nursing Care Plan (NCP) for Pulmonary Embolism
Nursing Care Plan (NCP) for Respiratory Failure
Nursing Care Plan (NCP) for Restrictive Lung Diseases
Nursing Care Plan (NCP) for Sickle Cell Anemia
Nursing Care Plan (NCP) for Skin cancer – Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma
Nursing Care Plan (NCP) for Spinal Cord Injury
Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)
Nursing Care Plan (NCP) for Thrombocytopenia
Nursing Care Plan (NCP) for Thrombophlebitis / Deep Vein Thrombosis (DVT)
Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Care Plan (NCP) for Alzheimer’s Disease
Nursing Care Plan (NCP) for Angina
Nursing Care Plan (NCP) for Aortic Aneurysm
Nursing Care Plan (NCP) for Arterial Disorders
Nursing Care Plan (NCP) for Asthma
Nursing Care Plan (NCP) for Bronchiolitis / Respiratory Syncytial Virus (RSV)
Nursing Care Plan (NCP) for Cardiomyopathy
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Congestive Heart Failure (CHF)
Nursing Care Plan for Coronary Artery Disease (CAD)
Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)
Nursing Care Plan for Fibromyalgia
Nursing Care Plan (NCP) for Heart Valve Disorders
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care Plan (NCP) for Leukemia
Nursing Care Plan (NCP) for Lymphoma (Hodgkin’s, Non-Hodgkin’s)
Nursing Care Plan (NCP) for Myocardial Infarction (MI)
Nursing Care Plan for Myocarditis
Nursing Care Plan for Nasal Disorders
Nursing Care Plan (NCP) for Neutropenia
Nursing Care Plan for Pulmonary Edema
Nursing Care Plan for Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Nursing Care Plan (NCP) for Sickle Cell Anemia
Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)
Nursing Case Study for Head Injury
Nursing Case Study for Pediatric Asthma
Obstruction for Certified Emergency Nursing (CEN)
Obstructive Sleep Apnea for Progressive Care Certified Nurse (PCCN)
Pacemakers
Pain Management and Procedural Sedation for Certified Emergency Nursing (CEN)
Pain Management for the Older Adult – Live Tutoring Archive
Pain Management Meds – Live Tutoring Archive
Pain (Acute, Chronic) for Progressive Care Certified Nurse (PCCN)
Palliative Care for Progressive Care Certified Nurse (PCCN)
Parasympathomimetics (Cholinergics) Nursing Considerations
Asthma
Pediatric Bronchiolitis Labs
Platelets (PLT) Lab Values
Pleural Effusion for Certified Emergency Nursing (CEN)
Preload and Afterload
Pulmonary Embolism for Progressive Care Certified Nurse (PCCN)
Pulmonary Embolus for Certified Emergency Nursing (CEN)
Pulmonary Hypertension for Progressive Care Certified Nurse (PCCN)
Pulmonary Hypertension for Certified Emergency Nursing (CEN)
Red Blood Cell (RBC) Lab Values
Red Cell Distribution Width (RDW) Lab Values
Respiratory Acidosis (interpretation and nursing interventions)
Respiratory Distress Syndrome for Certified Emergency Nursing (CEN)
Respiratory Failure (Acute, Chronic, Failure to Wean) for Progressive Care Certified Nurse (PCCN)
Respiratory Infections (Pneumonia) for Progressive Care Certified Nurse (PCCN)
Sodium and Potassium Imbalance for Certified Emergency Nursing (CEN)
Spinal Cord Injury
Spinal Cord Injury Case Study (60 min)
Steroids – Side Effects Nursing Mnemonic (6 S’s)
Systemic Lupus Erythematosus (SLE)
Thrombocytopenia
Thromboembolic Disease- Deep Vein Thrombosis (DVT) for Certified Emergency Nursing (CEN)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Troponin I (cTNL) Lab Values
Valvular Heart Disease for Progressive Care Certified Nurse (PCCN)
Vascular Disease for Progressive Care Certified Nurse (PCCN)
Vascular Disease – Deep Vein Thrombosis Nursing Mnemonic (HIS Leg Might Fall off)
Venous Disorders (Chronic venous insufficiency, Deep venous thrombosis/DVT)
Warfarin (Coumadin) Nursing Considerations