ANTISEIZURE DRUGS

I. Seizures / Epilepsy
• abnormal or uncontrolled neuronal brain discharges.
• sxs of underlying disease

Causes:
 head trauma
 brain infection
 fluid & electrolyte imbalance
 hypoxia
 stroke
 brain tumors
 high fever in children

II. Categories of Seizures:

A.Partial (Focal) Seizures

• Simple

• Complex

B.Generalized Seizures
• Absence (Petit mal)

• Tonic-Clonic (Grand mal)

• Myoclonic seizures

• Febrile seizures

• Status epilepticus

III. Antiseizure Drugs act by distinct mechanisms:

• increasing effect of GABA , inhibitory neurotransmitter
• delaying the influx of sodium and calcium ions into neurons

4 Major Chemical categories of antiseizure meds:

1. Barbiturates
2. Benzodiazepines
3. Hydantoin & phenytoin-like drugs
4. Succinimides
A.Barbiturates
 phenobarbital (Luminal)
 primidone

MOA : potentiate the effects of GABA

Indic:
 tonic- clonic seizures ,status epilepticus
 adjuncts to anesthesia

SE:
 drowsiness
 dizziness
 hypotension
 resp depression
 drug tolerance
 physical drug dependency & withdrawal syndrome

B.Benzodiazepines
 diazepam (Valium)
 clonazepam (Klonopin)
 lorazepam (Ativan)
 clorazepate (Tranxene)

MOA: intensify GABA action

Indic:
 short -term tx of severe convulsions, status epilepticus
 relieve tension , anxiety & skeletal muscle spasms
SE:
 ataxia
 resp. & cardiac depression
 drug tolerance
 physical drug dependency with withdrawal syndrome

C.Hydantoins
 phenytoin (Dilantin)

MOA: delay influx of sodium ions into neurons

Indic:
 all types of seizure except for absence seizures
 tx dysrhythmias
 Side Effects:
 gingival hyperplasia
 slurred speech
 confusion , headache & depression
 blood dyscrasias
 severe liver toxicity & elevated bld glucose
 alopecia
 hirsutism
 Stevens –Johnson syndrome

MC adverse rxns assoc. with hydantoins, barbiturates & benzodiazepines:

 CNS depression
 confusion, drowsiness
 fatigue, weakness
 constipation, dry mouth, anorexia
 cardiac arrhythmias
 changes in BP
 urinary retention
 loss of libido

D.Succinimides
 ethosuximide (Zarontin)

MOA: delay calcium influx into neurons

Indic: DOC for absence seizures

SE;
 anorexia, N & vomiting
 bld dyscrasia
 Stevens-johnson syndrome

E. Other antiseizure drugs:

1. Valproates
 valporic acid ( Depakene)
 divalproex Na (Depakote)

Indic:
 absence seizures
 mania
  migraine headache

SE:
 GI upset ( N,V, abd cramps, diarrhea & constipation)
 Hepatotoxic
2. Iminostilbenes
 carbamazepine (Tegretol)
 gabapentin (Neurontin)
 lamotrigine
 topiramate

Indic:
 tx seizure DO that have not responded to other convulsants
 trigeminal neuralgia
 DOC for partial seizures

SE;
 Blood dyscrasia
 CNS depression
 GI upset
 Stevens-johnson syndrome

IV. Drugs for Tx of Tonic-Clonic Seizures

 hydantoins
 barbiturates
 benzodiazepines

Drugs for Tx of Absence Seizures

 succinimides
 valproates

Drugs for Tx of Partial (Focal )Seizures

 iminostilbenes
 clorazepate (Tranxene)

V. Interventions for clients on antiseizure meds:

1. Initiate seizure precautions.
2. Discontinue drug at any sign of :
 hypersensitivity rxn
 liver dysfunction
 severe skin rash

3. Take with food to decrease GI irritation

4. If seizure occurs, assess seizure activity (Location & duration)
 5. Protect client from hazards during seizure.
6. Monitor urine output, liver & renal function tests.

7. Monitor for signs of med. toxicity & report to physician.

• Restlessness , visual disturbances
• Gingivitis
• Slurred speech
• Rash
• dizziness

8. Monitor for drug-drug interactions.

• Absorption decreased with use of antacids, calcium preparations &
antineoplastics.
• Used with caution in clients taking
a. anticoagulants & aspirin
b. sulfonamides
c. cimetidine
d. antipsychotic drugs

9. Arrange counseling for women of childbearing age.

VI. Client education;

 Timing of doses
 Do not discontinue drug abruptly.
 Avoid alcohol.
 Avoid OTC meds.
 Wear a Medic-alert bracelet.
 Use caution when driving or performing activities that require alertness.
 Maintain good oral hygiene & use soft toothbrush.
 Instruct client on importance of dental check-ups.
 Instruct on importance of follow-up with periodic bld studies.
 Monitor serum blood glucose levels.
 Urine maybe a harmless pink-red or red-brown color.
 Report sxs of sore throat, bruising & nosebleeds.
 Inform physician if adverse rxns occur.