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Ppt chapter 18

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Information about Ppt chapter 18

Published on October 15, 2014

Author: stanbridge

Source: slideshare.net

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1. Chapter 18 Drugs Treating Seizure Disorders Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question • The following are symptoms of which disorder/disease: loss of consciousness with muscle twitching and mild alterations in consciousness with repetitive blinking? – A. Epilepsy – B. Seizures – C. Parkinson disease – D. Delirium

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer • B. Seizures • Rationale: These symptoms are the classic presentation of seizure activity.

4. Epilepsy • Epilepsy is a brain disorder. • Seizures are loss of consciousness with generalized muscle twitching or mild alterations in consciousness with repetitive blinking. • Patients with patterns of seizures who are diagnosed with epilepsy are treated with antiepileptic drugs. • The three main ways that antiepileptic drugs work are – Decreasing the rate at which sodium flows into the Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins cell – Inhibiting calcium flow rate into the cell through specific channels – Increasing the effect of the neuroinhibitor gamma-aminobutyric acid (GABA)

5. Physiology • Action potentials within neurons are initiated by an influx of sodium into the cell. • Influx of calcium through specialized voltage-dependent channels also plays a role in creating an action potential. • When the cell fires, there is a release of neurotransmitters into the synaptic cleft. • The neurotransmitter glutamate produces excitation. • GABA normally acts as a counterbalance to glutamate, preventing hyperexcitation. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

6. Physiology of Neurotransmitters Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

7. Pathophysiology • When a group of neurons exhibits coordinated, high-frequency discharge, it is termed a focus. • The causes of a focus include head trauma, tumor growth, hypoxia, and inherited birth defects. • When the activity from a focus spreads to other areas of the brain, causing other neurons to join in the hyperactivity, seizures result. • Seizures may result from either high levels of glutamate or low levels of GABA. • Partial seizures occur when focus activity is limited to an area of the brain. • When the focus activity is within both hemispheres, generalized seizure symptoms occur. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

8. Antiepileptic Drugs that Decrease Sodium Influx • Control seizures by decreasing sodium influx into the cells. • Prototype drug: phenytoin (Dilantin) Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

9. Phenytoin: Core Drug Knowledge • Pharmacotherapeutics – Used to control partial and generalized seizures • Pharmacokinetics – Peak 1.5 to 3 hours. At low doses, the half-life is less than at the therapeutic dose. • Pharmacodynamics – The primary site of action is the motor cortex. – Reversibly binds to sodium channels while they are in the inactive state Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

10. Phenytoin: Core Drug Knowledge (cont.) • Contraindications and precautions – Bradycardia and heart block • Adverse effects – Nystagmus, ataxia, dysarthria, slurred speech, mental confusion, tremor, and gingival hyperplasia • Drug interactions – Numerous drugs interact with phenytoin Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

11. Phenytoin: Core Patient Variables • Health status – Assess allergies and any cardiac conditions. • Life span and gender – Pregnancy Category D drug • Lifestyle, diet, and habits – Alcohol intake and nutritional status • Environment – Assess environment where the drug will be given. – Oral given in any environment Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

12. Phenytoin: Nursing Diagnoses and Outcomes • Disturbed Sensory Perception related to adverse effects of drowsiness and sedation – Desired outcome: The patient will not experience adverse effects to the degree that sensory perception is altered enough to impair quality of life. • Risk for Injury related to the adverse effects of drowsiness and sedation – Desired outcome: The patient will not sustain any injury while taking phenytoin. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

13. Phenytoin: Nursing Diagnoses and Outcomes (cont.) • Altered Oral Mucous Membrane related to the adverse effect of gingival hyperplasia – Desired outcome: The patient will demonstrate knowledge of optimal oral hygiene and experience no deterioration in dental health. • Risk for Injury related to adverse effects of blood dyscrasias – Desired outcome: The patient will return for follow-up blood work while taking phenytoin and will have no life-threatening blood disorders. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

14. Phenytoin: Planning and Interventions • Maximizing therapeutic effects – Monitor blood levels of the drug. – Titrate the dose upward gradually. • Minimizing adverse effects – Monitor blood levels—narrow therapeutic range. – Administer IV push phenytoin no faster than 50 mg/minute in adults or 1 to 3 mg/kg/minute in neonates. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

15. Phenytoin: Teaching, Assessment, and Evaluations • Patient and family education – Ensure proper administration of medication. – Take medication with food to decrease GI upset. – Notify the physician of adverse effects. • Ongoing assessment and evaluation – Ongoing assessments include monitoring patients closely for therapeutic responses, seizure control, and adverse effects to drug therapy. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question • What condition places the patient at greater risk for toxicity to phenytoin? – A. Alcoholism – B. Sinus bradycardia – C. Obesity – D. Malnutrition

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer • D. Malnutrition • Rationale: Malnutrition causes a greater amount of free, active drug in the blood because less protein albumin is available for binding.

18. Antiepileptic Drugs that Decrease Calcium Influx • Prototype drug: ethosuximide (Zarontin) Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

19. Ethosuximide: Core Drug Knowledge • Pharmacotherapeutics – Used to treat absence (petit mal) seizures • Pharmacokinetics – Administered: oral. Metabolism: liver. Excreted: kidneys. Peak: 3 to 7 hours. T½: 30 to 60 hours. • Pharmacodynamics – Inhibiting the influx of calcium ions Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

20. Ethosuximide: Core Drug Knowledge (cont.) • Contraindications and precautions – Hypersensitivity • Adverse effects – Drowsiness, dizziness, lethargy, nausea, and blood dyscrasias • Drug interactions – Known to interact with some of the other antiepileptic drugs Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

21. Ethosuximide: Core Patient Variables • Health status – Assess allergies, history of renal or hepatic dysfunction. • Life span and gender – Pregnancy Category C drug • Environment – Assess environment where the drug will be given. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

22. Ethosuximide: Nursing Diagnoses and Outcomes • Imbalanced nutrition: Less than Body Requirements related to adverse GI drug effects of anorexia, abdominal complaints, nausea, and vomiting – Desired outcome: The patient will not experience major nutritional imbalances while receiving ethosuximide. • Risk for Injury from falls related to CNS adverse effects of ethosuximide – Desired outcome: The patient will not sustain an injury while receiving ethosuximide. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

23. Ethosuximide: Nursing Diagnoses and Outcomes (cont.) • Risk for Injury from blood dyscrasias related to adverse effects of ethosuximide – Desired outcome: The patient will not experience major changes in his or her complete blood cell counts. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

24. Ethosuximide: Planning and Interventions • Maximizing therapeutic effects – Monitor drug levels at the start of therapy and when changing dosage. • Minimizing adverse effects – Assess CBC, UA, and LFT. – Taper dose gradually if need to discontinue the drug. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

25. Ethosuximide: Teaching, Assessment, and Evaluations • Patient and family education – Teach patients to take the drug with milk or food if GI upset occurs. – Notify the provider of adverse effects. • Ongoing assessment and evaluation – Ongoing assessments include monitoring patients closely for therapeutic responses, seizure control, and adverse effects of drug therapy. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

26. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question • Ethosuximide is used to treat __________ seizures. – A. Absence – B. Grand mal – C. Generalized – D. Febrile

27. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer • A. Absence • Rationale: Ethosuximide is used to treat absence (petit mal) seizures.

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