1. Anticonvulsants drugs used to manage seizure disorders2. Anticonvulsants categories Hydantoins

Carboxylic acid derivativesSuccinimidesOxazolidinedionesBarbituratesBenzodiazepines

3. Anticonvulsants Lorazepam(Ativan)

Lorazepam (Ativan), is the drug of choice for status epilepticus

4. Adverse Reactions ofAnticonvulsants

CNS:somnolence (sleepiness), nystagmusGI: gingival hyperplasia (gum tissue overgrowth)

5. benzodiazepines are used cautiously during pregnancy6. Hydantoins Include: ethotoin (Peganone), fosphenytoin (Cerebyx), and **phenytoin (Dilantin)

s/e hypotension,drowsiness, sedation,gingival hyperplasia (Dilantin only),blood dyscrasias,elevated glucose

7. Phenytoin (Dilantin) most commonly prescribed anticonvulsant-orally w/ meals and parenterally by IV route; -IM route may cause pain and muscle damage-IV diluted in NS b/c dextrose causes medication to crystalize (precipitate)-Rapid IV administration cause hypotension and dysrhythmias-decreases the effectiveness of some birth control pillstube feedings may interfere w/ the absorption of orally administered-if on continuous tube feedings higher doses of the drug may be necessary -soft bristled toothbrush (may have bleeding due to gingivitis and gingival hyperplasia)-urine to turn a harmless pinkish-red or reddish-brown color-monitor serum glucose levels often in clients with diabetes mellitus

8. Succinimides Include: ethosuximide (Zarontin), and methsuximide (Celontin)Used for partial seizures and absence seizuresCBC and liver function tests should be monitoreds/e gingival hyperplasia (gum overgrowth)

9. Barbiturates phenobarbital (Luminal), amobarbital (Amytal), mephobarbital (Mebaral)Use with extreme caution with valproic acid, may cause phenobarbital toxicitys/e somnolence, respiratory depression,

10. Carboxylic Acid Derivatives acid (Depakene, Depacon), divalproex sodium (Depakote)-Also referred to as valproates-Used for epilepsy, migraine headache, mania-Use with extreme caution with phenobarbital (Luminal) may cause phenobarbital toxicity-s/e blood dyscrasias, hepatotoxicity (monitor CBC & liver enzymes)

11. Oxazolidinediones trimethadione (Tridone), paramethadione (Paradione)12. Benzodiazepines lonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium, Diastat), lorazepam (Ativan)

-sedation, drowsiness,blood dyscrasias13. Carbamazepine (Tegretol) for epilepsy, bipolar disorder, trigeminal and postherpetic neuralgia14. Gabapentin (Neurontin) - used for partial seizures (adults) and postherpetic neuralgia

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15. Nursing Considerations started low and gradually increased over a few weeks-Plasma serum levels of anticonvulsants are measured regularly to monitor for toxicity-taken for life-Status epilepticus may result from abrupt discontinuation -orazepam (Ativan) or diazepam (Valium) may cause respiratory depression-avoid alcohol and over the counter medications-caution when driving or performing activities that require alertness-follow-up healthcare visits w/ periodic blood studies related to determining toxicity-report symptoms of bruising, and nosebleeds, which may indicate a blood dyscrasia-may cause nausea and vomiting so stress importance of adequate nutritional intake

16. Therapeutic Serum Range for CommonAnticonvulsants

Carbamezepine (Tegretol): 3-14 mcg/mLClonazepam (Klonopin): 20-80 ng/mLEthosuximide (Zarontin): 40-100 mcg/mLPhenobarbital (Luminal): 15-40 mcg/mLPhenytoin (Dilantin): 10-20 mcg/mL

17. Monitor for signs and symptoms of liverdysfunction for clients on carbamazepine(Tegretol)

dark urine, clay colored stools, unusual bleeding,

18. Parkinsonism tremors, rigidity, and bradykinesia (slow movement)19. Antiparkinsonism Drugs either supplement the dopamine in the brain or block excess acetylcholine (ACh) so

that better transmission of nerve impulses occur20. Antiparkinsonism drugs include Dopaminergic agents

Cholinergic blocking drugsCatechol-O-methyltransferase inhibitorsNon-ergot dopamine receptor agonists

21. Dopaminergic Drugs affect the dopamine content in the bloodlevodopa, carbidopa (Lodosyn), amantadine (Symmetrel), and carbidopa/levodopacombination (Sinemet)

22. Dopaminergic Drugs AKA MAOIs MAOIs, selegiline (Eldepryl, Zelapar) and rasagiline (Azilect) should not be used withthe opioid meperidine (Demerol) because of antimetabolite conversion stupor,rigidity, and hyperthermia

23. Amantadine (Symmetrel) lightheadedness, dizziness,orthostatic hypotension ( B/P and P),24. Carbidopa/levodopa (Sinemet, Parcopa,

Carbilev)dizziness, dark sweat or urine,

25. Rasagiline (Azilect) Do not administer with demerol26. Selegeline (Eldepryl, Emsam, Zelapar) - agonist (helper) for levodopa/carbidopa in the treatment of PD

Do not administer with demerol27. Adverse Reactions of Cholinergic

Blocking Drugs (Anticholinergics)dry mouth, blurred vision, dizziness, orthostatic hypotension ( B/P and pulse),urinaryretention,

28. Cholinergic Blocking Drugs(Anticholinergics)

glaucoma,prostatic hypertrophy,myasthenia gravis,

29. Cholinergic Blocking Drugs(Anticholinergics)

Benztropine (Cogentin)Biperiden (Akineton) Diphenhydramine (Benadryl)

30. COMT Inhibitors Tolcapone is a potent COMT inhibitor associated with liver damage and liver failureTolcapone (Tasmar) -liver failure

31. Dopamine Receptor Agonists Apomorphine (Apokyn) is used for "on-off" phenomenon; antiemetic therapy must beinitiated with this drug due to vomiting-nausea, vomiting,postural hypotension, abnormal involuntary movements,Apomorphine (Apokyn)profound hypotension, nausea, vomiting

32. Antiparkinsonism DrugsNursing Considerations

Antiparkinsonism drugs if effective should severity of symptoms-Parlodel interferes with oral contraceptives, another method of birth control should be usedOffer frequent sips of water, ice chips, or hard candy- chronic constipation-diet high in fiber and fluids-Monitor liver function tests:persistent nausea, fatigue, lethargy, anorexia, jaundice, dark urine, claycolored stools, unusual bleeding, pruritus, and RUQ tenderness-rise slowly from a sitting or lying position,-neuroleptic malignant-like syndrome may occur: muscular rigidity, elevated body temperature, andmental changes-Avoid the use of alcoholInstruct the client taking levodopa to avoid vitamin B6 (pyridoxine), this vitamin may interfere with theaction of levodopa (found in whole grains, fortified cereals, liver, and green vegetables)

33. "On-Off" Phenomenon is when the therapeutic effects of the drug have decreased and the adverse effects have increased-associated with long term levodopa treatment-Low doses of the drug, reserving the drug for severe cases, or the use of a drug holiday (off drug for 5-14days) may be prescribed

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