Anticonvulsants

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!

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!