{"id":384,"date":"2019-11-19T16:58:43","date_gmt":"2019-11-19T16:58:43","guid":{"rendered":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/chapter\/8-10-anticonvulsants\/"},"modified":"2021-12-07T11:26:14","modified_gmt":"2021-12-07T11:26:14","slug":"8-10-anticonvulsants","status":"publish","type":"chapter","link":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/chapter\/8-10-anticonvulsants\/","title":{"raw":"8.10 Anticonvulsants","rendered":"8.10 Anticonvulsants"},"content":{"raw":"
\n\nMedications used for seizures are called anticonvulsants or antiseizure drugs. Antiseizure drugs stabilize cell membranes and suppress the abnormal electric impulses in the cerebral cortex. These drugs prevent seizures but do not provide a cure. Antiseizure drugs are classified as CNS depressants. There are many types of medications used to treat seizures such as phenytoin, phenobarbital, benzodiazepines, carbamazepine, valproate, and levetiracetam.[footnote]McCuistion, L., Vuljoin-DiMaggio, K., Winton, M, & Yeager, J. (2018). Pharmacology: A patient-centered nursing process approach.<\/em> pp. 227-305. Elsevier.[\/footnote]<\/sup>\n\nThere are three main pharmacological effects of antiseizure medications. First, they increase the threshold of activity in the motor cortex, thus making it more difficult for a nerve to become excited. Second, they limit the spread of a seizure discharge from its origin by suppressing the transmission of impulses from one nerve to the next. Third, they decrease the speed of the nerve impulse conduction within a given neuron.\n\nSome drugs work by enhancing the effects of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), which plays a role in regulating neuron excitability in the brain.[footnote]Lilley, L., Collins, S., & Snyder, J. (2020). Pharmacology and the Nursing Process.<\/em> pp. 246-272. Elsevier.[\/footnote]<\/sup> Gabapentin, although structurally similar to GABA and classified as an anticonvulsant, is commonly used to control chronic neuropathic pain. Neuropathic pain is defined by the International Association for the Study of Pain as \u201cpain caused by a lesion or disease of the somatosensory nervous system.\u201d[footnote]Murnion B. P. (2018, June 1). Neuropathic pain: current definition and review of drug treatment. Australian prescriber, 41<\/em>(3), 60\u201363. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6003018\/<\/a>[\/footnote]<\/sup> An example of neuropathic pain is tingling or burning in the lower extremities that often occurs in patients with diabetes.\n

Phenytoin<\/h2>\nPhenytoin, which was discovered in 1938, was the first anti-seizure medication and is still being used to control seizures.[footnote]McCuistion, L., Vuljoin-DiMaggio, K., Winton, M, & Yeager, J. (2018). Pharmacology: A patient-centered nursing process approach.<\/em> pp. 227-305. Elsevier.[\/footnote]<\/sup>\n\nMechanism of Action<\/strong>\n\nPhenytoin improves evidence of seizures by interfering with sodium channels in the brain, resulting in a reduction of sustained high-frequency neuronal discharges.\n\nIndications for Use<\/strong>\n\nPhenytoin is indicated for the treatment of tonic-clonic (grand mal) and psychomotor (temporal lobe) seizures and for the prevention and treatment of seizures occurring during or following neurosurgery.\n\nNursing Considerations Across the Lifespan<\/strong>\n\nPhenytoin should not be administered to pregnant women because it will cause harm to the fetus. When given intravenously, there is a Black Box Warning that the rate of administration should not exceed 50 mg per minute in adults and 1 to 3 mg\/kg\/min (or 50 mg per minute, whichever is slower) in pediatric patients because of the risk of severe hypotension and cardiac arrhythmias. Careful cardiac monitoring is needed during and after administering intravenous phenytoin.\n\nPhenytoin has a narrow therapeutic drug level, usually between 10-20 mcg\/ml, so serum drug monitoring is required. Serum levels of phenytoin sustained above the therapeutic range may produce confusional states referred to as delirium, psychosis, or encephalopathy. Accordingly, at the first sign of acute toxicity, serum levels should be immediately checked.\n\nAbrupt discontinuation can cause status epilepticus, so in the event of an allergic or hypersensitivity reaction, rapid substitution of alternative therapy may be necessary.\n\nUse with caution in patients with renal or hepatic impairment. Elderly patients may require dosage adjustment.\n\nThere are many potential drug interactions with phenytoin. Read drug label information before administering. Phenytoin is extensively bound to plasma proteins and is prone to competitive displacement. Phenytoin is metabolized by hepatic cytochrome P450 enzymes, so it is susceptible to inhibitory drug interactions, which may produce significant increases in circulating phenytoin concentrations and enhance the risk of drug toxicity.\n\nAdverse\/Side Effects<\/strong>\n\nSerious and sometimes fatal dermatologic reactions, including toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS), have been reported with phenytoin treatment. The onset of symptoms is usually within 28 days, but can occur later. Phenytoin should be discontinued at the first sign of a rash.\n\n[pb_glossary id=\"2375\"]Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)[\/pb_glossary]<\/strong> has been reported in patients taking antiepileptic drugs, including phenytoin. Some of these events have been fatal or life threatening. DRESS typically presents with fever, rash, lymphadenopathy, and\/or facial swelling, in association with other organ system involvement. These findings should be immediately reported to the provider. Acute hepatotoxicity has been reported with phenytoin. These events may be part of the spectrum of DRESS or may occur in isolation.\n\nHematopoietic complications, some fatal, have occasionally been reported in association with administration of phenytoin. These have included thrombocytopenia, leukopenia, granulocytopenia, agranulocytosis, and pancytopenia with or without bone marrow suppression.\n\nThe most common adverse reactions encountered with phenytoin therapy are nervous system reactions and are usually dose-related. Reactions include nystagmus, ataxia, slurred speech, decreased coordination, somnolence, and mental confusion.[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. \u00a0[\/footnote]<\/sup>\n\nPatient Teaching & Education<\/strong>\n\nPatients should be advised to take medications as directed and that doses should be evenly spaced throughout the day.\u00a0 It may take several weeks to obtain the desired medication effect.\u00a0 Abrupt withdrawal of medication may cause status epilepticus.\u00a0 Patients should avoid alcohol and other CNS depressants while taking anticonvulsant drug therapy.\u00a0 Additionally, diabetic patients should monitor their blood glucose levels carefully.\n\nNow let's take a closer look at the medication grid for phenytoin in Table 8.10a.[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. <\/span>[\/footnote]<\/span>\n\nTable 8.10a Phenytoin Medication Grid\n\n\n\n\n
Class\/Subclass<\/strong><\/th>\nPrototype\/Generic<\/strong><\/th>\nAdministration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nAdverse\/Side Effects<\/strong><\/th>\n<\/tr>\n
Anticonvulsant<\/th>\nphenytoin<\/a><\/td>\nCareful cardiac monitoring is needed during and after administering intravenous phenytoin\n\nFor IV infusions, an in-line filter (0.22 to 0.55 microns) should be used. Cannot be given with D5W due to preciptiation and no faster than 50 mg\/minute in adults\n\nMonitor serum drug levels\n\nContraindicated with patient with heart block\n\nUse cautiously in patients with hepatic or renal impairment\n\nTaper dose; do not stop abruptly<\/td>\nDecrease or prevent seizure activity<\/td>\nCardiovascular risk associated with rapid IV infusion\n\nDiscontinue and notify the provider if a rash occurs\n\nNotify the provider immediately if fever, rash, lymphadenopathy, and\/or facial swelling occur\n\nCardiovascular: arrhythmia and hypotension\n\nCNS: Nystagmus, ataxia, slurred speech, decreased coordination, somnolence, and mental confusion\n\nGI: Constipation, gingival hyperplasia, and hepatotoxicity\n\nHematology: Thrombocytopenia, pancytopenia, and agranulocytosis<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Levetiracetam<\/h2>\nLevetiracetam is indicated as adjunctive therapy in the treatment of partial onset seizures in patients 12 years of age and older with epilepsy. It is generally well tolerated.\n\nMechanism of Action<\/strong>\n\nThe exact mechanism of action is unknown. This medication may interfere with sodium, calcium, potassium, or GABA transmission.[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. \u00a0[\/footnote]<\/sup>\n\nIndications for Use<\/strong>\n\nLevetiracetam is used for partial onset seizures in patients with epilepsy.\n\nNursing Considerations Across the Lifespan<\/strong>\n\nPlasma levels can gradually decrease during pregnancy and should be monitored closely. Safety and effectiveness in pediatric patients 12 years of age and older have been established.\n\nLevetiracetam immediate release and solution can be used in patients as young as 1 month.\n\nLevetiracetam should not be stopped abruptly or withdrawal seizures may occur. Use with caution in patients with renal impairment.\n\nAdverse\/Side Effects<\/strong>\n\nBehavioral abnormalities including psychotic symptoms, suicidal ideation, irritability, and aggressive behavior have been observed; monitor patients for psychiatric signs and symptoms.\n\nThe most common adverse reactions are somnolence and irritability. Advise patients not to drive or operate machinery until they have gained sufficient experience on levetiracetam.\n\nThis drug can cause anaphylaxis or angioedema after the first dose or at any time during treatment. Serious dermatological reactions, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), have been reported, as well as coordination difficulties and hematologic abnormalities.\n\nPatient Teaching & Education<\/strong>\n\nMedications should be taken as directed and may cause increased dizziness and somnolence.\u00a0 Patients, family, and caregivers should also monitor carefully for suicidality during medication therapy.\n\nNow let's take a closer look at the medication grid for levetiracetam in Table 8.10b.[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. \u00a0[\/footnote]<\/sup>\n\nTable 8.10b Levetiracetam Medication Grid\n\n\n\n\n
Class\/Subclass<\/strong><\/th>\nPrototype\/Generic<\/strong><\/th>\nAdministration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nAdverse\/Side Effects<\/strong><\/th>\n<\/tr>\n
Anticonvulsant<\/th>\nlevetiracetam<\/a><\/td>\nTaper dose; do not stop abruptly or seizures may occur\n\nMonitor plasma levels for pregnant women\n\nUse cautiously if renal impairment<\/td>\nDecrease seizure activity<\/td>\nBehavioral\/mood changes (psychotic symptoms, suicidal ideation, irritability, and aggressive behavior)\n\nAnaphylaxis or angioedema\n\nSomnolence, fatigue, and irritability\n\nSerious skin conditions\n\nCoordination difficulties\n\nHematopoietic abnormalities<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n \n

Gabapentin<\/h2>\nGabapentin is indicated as an adjunct treatment for partial seizures, but is most commonly used to treat neuropathic pain.[footnote]Lilley, L., Collins, S., & Snyder, J. (2020). Pharmacology and the Nursing Process.<\/em> pp. 246-272. Elsevier.[\/footnote]<\/sup>\n\nMechanism of Action<\/strong>\n\nThe exact mechanism of action is unknown. It is structurally similar to GABA, but does not act on GABA receptors or influence GABA.\n\nIndications for Use<\/strong>\n\nGabapentin is used for partial seizures and neuropathic pain.\n\nNursing Considerations Across the Lifespan<\/strong>\n\nThis drug can cause harm to the fetus of pregnant women.\n\nGabapentin use in pediatric patients with epilepsy 3 to 12 years of age is associated with the occurrence of central nervous system related adverse events. The most significant of these can be classified into the following categories: 1) emotional lability (primarily behavioral problems); 2) hostility, including aggressive behaviors; 3) thought disorder, including concentration problems and change in school performance; and 4) hyperkinesia (primarily restlessness and hyperactivity).\n\nIn elderly patients, peripheral edema and ataxia tended to increase in incidence with age. Fall precautions should be considered.\n\nAntiepileptic drugs should not be abruptly discontinued because of the possibility of increasing seizure frequency.\n\nAdverse\/Side Effects<\/strong>\n\nAntiepileptic drugs, including gabapentin, increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and\/or any unusual changes in mood or behavior.\n\nDrug Reaction with Eosinophilia and Systemic Symptoms (DRESS), also known as multiorgan hypersensitivity, has been reported in patients taking antiepileptic drugs, including gabapentin. Some of these events have been fatal or life threatening. DRESS typically, although not exclusively, presents with fever, rash, and\/or lymphadenopathy, in association with other organ system involvement. If these symptoms occur, they should be immediately reported to the provider.\n\nGabapentin may cause dizziness, somnolence, and other symptoms and signs of CNS depression. Patients should be advised neither to drive a car nor to operate other complex machinery until they have gained sufficient experience on gabapentin to gauge whether or not it affects their mental and\/or motor performance adversely.[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. \u00a0[\/footnote]<\/sup>\n\nPatient Teaching & Education<\/strong>\n\nPatients receiving gabapentin therapy should take medication as directed and be careful to not exceed dosage recommendations.\u00a0 Patients should not take gabapentin within 2 hours of antacid medications.\u00a0 Additionally, gabapentin may cause increased drowsiness and dizziness.\u00a0 Patients, family, and caregivers should also monitor for suicidality.\n\nNow let's take a closer look at the medication grid for gabapentin in Table 8.10c.[footnote]This work is a derivative of\u00a0Daily Med<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a>\u00a0in the\u00a0public domain<\/a>.\u00a0\u00a0[\/footnote]<\/sup>\n\nTable 8.10c Gabapentin Medication Grid\n\n\n\n\n
Class\/Subclass<\/strong><\/th>\nPrototype\/Generic<\/strong><\/th>\nAdministration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nAdverse\/Side Effects<\/strong><\/th>\n<\/tr>\n
Anticonvulsant<\/th>\ngabapentin<\/a><\/td>\nAdminister first dose at bedtime to decrease dizziness and drowsiness\n\nMonitor for worsening depression, suicidal thoughts or behavior, and\/or any unusual changes in mood or behavior\n\nTaper dose; do not stop abruptly<\/td>\nDecreased neuropathic pain or seizures<\/td>\nIncreased suicidal ideation\n\nImmediately report fever, rash, and\/or lymphadenopathy\n\nCNS depression: dizziness, somnolence, and ataxia<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n
\n
\n

Critical Thinking Activity 8.10\n\"Image<\/h2>\n<\/header>\n
\n\nA 70-year-patient in a long-term care center has diabetes and has been prescribed gabapentin for neuropathic pain.\n\n1. The patient states, \u201cI have never had a seizure. Why has the doctor prescribed an antiseizure medication for me?\u201d What is the nurse\u2019s best response?\n\n2. The nurse plans to implement additional fall precautions for this patient. Why are additional fall precautions needed?\n\n3. What potential adverse effects should the nurse plan to monitor? What adverse effects would require immediate notification of the provider?\n\nNote: Answers to the Critical Thinking activities can be found in the \"Answer Key\" sections at the end of the book.\n\n<\/div>\n<\/div>\n<\/div>","rendered":"
\n

Medications used for seizures are called anticonvulsants or antiseizure drugs. Antiseizure drugs stabilize cell membranes and suppress the abnormal electric impulses in the cerebral cortex. These drugs prevent seizures but do not provide a cure. Antiseizure drugs are classified as CNS depressants. There are many types of medications used to treat seizures such as phenytoin, phenobarbital, benzodiazepines, carbamazepine, valproate, and levetiracetam.[1]<\/sup><\/a><\/sup><\/p>\n

There are three main pharmacological effects of antiseizure medications. First, they increase the threshold of activity in the motor cortex, thus making it more difficult for a nerve to become excited. Second, they limit the spread of a seizure discharge from its origin by suppressing the transmission of impulses from one nerve to the next. Third, they decrease the speed of the nerve impulse conduction within a given neuron.<\/p>\n

Some drugs work by enhancing the effects of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), which plays a role in regulating neuron excitability in the brain.[2]<\/sup><\/a><\/sup> Gabapentin, although structurally similar to GABA and classified as an anticonvulsant, is commonly used to control chronic neuropathic pain. Neuropathic pain is defined by the International Association for the Study of Pain as \u201cpain caused by a lesion or disease of the somatosensory nervous system.\u201d[3]<\/sup><\/a><\/sup> An example of neuropathic pain is tingling or burning in the lower extremities that often occurs in patients with diabetes.<\/p>\n

Phenytoin<\/h2>\n

Phenytoin, which was discovered in 1938, was the first anti-seizure medication and is still being used to control seizures.[4]<\/sup><\/a><\/sup><\/p>\n

Mechanism of Action<\/strong><\/p>\n

Phenytoin improves evidence of seizures by interfering with sodium channels in the brain, resulting in a reduction of sustained high-frequency neuronal discharges.<\/p>\n

Indications for Use<\/strong><\/p>\n

Phenytoin is indicated for the treatment of tonic-clonic (grand mal) and psychomotor (temporal lobe) seizures and for the prevention and treatment of seizures occurring during or following neurosurgery.<\/p>\n

Nursing Considerations Across the Lifespan<\/strong><\/p>\n

Phenytoin should not be administered to pregnant women because it will cause harm to the fetus. When given intravenously, there is a Black Box Warning that the rate of administration should not exceed 50 mg per minute in adults and 1 to 3 mg\/kg\/min (or 50 mg per minute, whichever is slower) in pediatric patients because of the risk of severe hypotension and cardiac arrhythmias. Careful cardiac monitoring is needed during and after administering intravenous phenytoin.<\/p>\n

Phenytoin has a narrow therapeutic drug level, usually between 10-20 mcg\/ml, so serum drug monitoring is required. Serum levels of phenytoin sustained above the therapeutic range may produce confusional states referred to as delirium, psychosis, or encephalopathy. Accordingly, at the first sign of acute toxicity, serum levels should be immediately checked.<\/p>\n

Abrupt discontinuation can cause status epilepticus, so in the event of an allergic or hypersensitivity reaction, rapid substitution of alternative therapy may be necessary.<\/p>\n

Use with caution in patients with renal or hepatic impairment. Elderly patients may require dosage adjustment.<\/p>\n

There are many potential drug interactions with phenytoin. Read drug label information before administering. Phenytoin is extensively bound to plasma proteins and is prone to competitive displacement. Phenytoin is metabolized by hepatic cytochrome P450 enzymes, so it is susceptible to inhibitory drug interactions, which may produce significant increases in circulating phenytoin concentrations and enhance the risk of drug toxicity.<\/p>\n

Adverse\/Side Effects<\/strong><\/p>\n

Serious and sometimes fatal dermatologic reactions, including toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS), have been reported with phenytoin treatment. The onset of symptoms is usually within 28 days, but can occur later. Phenytoin should be discontinued at the first sign of a rash.<\/p>\n

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)<\/strong> has been reported in patients taking antiepileptic drugs, including phenytoin. Some of these events have been fatal or life threatening. DRESS typically presents with fever, rash, lymphadenopathy, and\/or facial swelling, in association with other organ system involvement. These findings should be immediately reported to the provider. Acute hepatotoxicity has been reported with phenytoin. These events may be part of the spectrum of DRESS or may occur in isolation.<\/p>\n

Hematopoietic complications, some fatal, have occasionally been reported in association with administration of phenytoin. These have included thrombocytopenia, leukopenia, granulocytopenia, agranulocytosis, and pancytopenia with or without bone marrow suppression.<\/p>\n

The most common adverse reactions encountered with phenytoin therapy are nervous system reactions and are usually dose-related. Reactions include nystagmus, ataxia, slurred speech, decreased coordination, somnolence, and mental confusion.[5]<\/sup><\/a><\/sup><\/p>\n

Patient Teaching & Education<\/strong><\/p>\n

Patients should be advised to take medications as directed and that doses should be evenly spaced throughout the day.\u00a0 It may take several weeks to obtain the desired medication effect.\u00a0 Abrupt withdrawal of medication may cause status epilepticus.\u00a0 Patients should avoid alcohol and other CNS depressants while taking anticonvulsant drug therapy.\u00a0 Additionally, diabetic patients should monitor their blood glucose levels carefully.<\/p>\n

Now let’s take a closer look at the medication grid for phenytoin in Table 8.10a.[6]<\/sup><\/a><\/span><\/p>\n

Table 8.10a Phenytoin Medication Grid<\/p>\n\n\n\n\n
Class\/Subclass<\/strong><\/th>\nPrototype\/Generic<\/strong><\/th>\nAdministration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nAdverse\/Side Effects<\/strong><\/th>\n<\/tr>\n
Anticonvulsant<\/th>\nphenytoin<\/a><\/td>\nCareful cardiac monitoring is needed during and after administering intravenous phenytoin<\/p>\n

For IV infusions, an in-line filter (0.22 to 0.55 microns) should be used. Cannot be given with D5W due to preciptiation and no faster than 50 mg\/minute in adults<\/p>\n

Monitor serum drug levels<\/p>\n

Contraindicated with patient with heart block<\/p>\n

Use cautiously in patients with hepatic or renal impairment<\/p>\n

Taper dose; do not stop abruptly<\/td>\n

Decrease or prevent seizure activity<\/td>\nCardiovascular risk associated with rapid IV infusion<\/p>\n

Discontinue and notify the provider if a rash occurs<\/p>\n

Notify the provider immediately if fever, rash, lymphadenopathy, and\/or facial swelling occur<\/p>\n

Cardiovascular: arrhythmia and hypotension<\/p>\n

CNS: Nystagmus, ataxia, slurred speech, decreased coordination, somnolence, and mental confusion<\/p>\n

GI: Constipation, gingival hyperplasia, and hepatotoxicity<\/p>\n

Hematology: Thrombocytopenia, pancytopenia, and agranulocytosis<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Levetiracetam<\/h2>\n

Levetiracetam is indicated as adjunctive therapy in the treatment of partial onset seizures in patients 12 years of age and older with epilepsy. It is generally well tolerated.<\/p>\n

Mechanism of Action<\/strong><\/p>\n

The exact mechanism of action is unknown. This medication may interfere with sodium, calcium, potassium, or GABA transmission.[7]<\/sup><\/a><\/sup><\/p>\n

Indications for Use<\/strong><\/p>\n

Levetiracetam is used for partial onset seizures in patients with epilepsy.<\/p>\n

Nursing Considerations Across the Lifespan<\/strong><\/p>\n

Plasma levels can gradually decrease during pregnancy and should be monitored closely. Safety and effectiveness in pediatric patients 12 years of age and older have been established.<\/p>\n

Levetiracetam immediate release and solution can be used in patients as young as 1 month.<\/p>\n

Levetiracetam should not be stopped abruptly or withdrawal seizures may occur. Use with caution in patients with renal impairment.<\/p>\n

Adverse\/Side Effects<\/strong><\/p>\n

Behavioral abnormalities including psychotic symptoms, suicidal ideation, irritability, and aggressive behavior have been observed; monitor patients for psychiatric signs and symptoms.<\/p>\n

The most common adverse reactions are somnolence and irritability. Advise patients not to drive or operate machinery until they have gained sufficient experience on levetiracetam.<\/p>\n

This drug can cause anaphylaxis or angioedema after the first dose or at any time during treatment. Serious dermatological reactions, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), have been reported, as well as coordination difficulties and hematologic abnormalities.<\/p>\n

Patient Teaching & Education<\/strong><\/p>\n

Medications should be taken as directed and may cause increased dizziness and somnolence.\u00a0 Patients, family, and caregivers should also monitor carefully for suicidality during medication therapy.<\/p>\n

Now let’s take a closer look at the medication grid for levetiracetam in Table 8.10b.[8]<\/sup><\/a><\/sup><\/p>\n

Table 8.10b Levetiracetam Medication Grid<\/p>\n\n\n\n\n
Class\/Subclass<\/strong><\/th>\nPrototype\/Generic<\/strong><\/th>\nAdministration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nAdverse\/Side Effects<\/strong><\/th>\n<\/tr>\n
Anticonvulsant<\/th>\nlevetiracetam<\/a><\/td>\nTaper dose; do not stop abruptly or seizures may occur<\/p>\n

Monitor plasma levels for pregnant women<\/p>\n

Use cautiously if renal impairment<\/td>\n

Decrease seizure activity<\/td>\nBehavioral\/mood changes (psychotic symptoms, suicidal ideation, irritability, and aggressive behavior)<\/p>\n

Anaphylaxis or angioedema<\/p>\n

Somnolence, fatigue, and irritability<\/p>\n

Serious skin conditions<\/p>\n

Coordination difficulties<\/p>\n

Hematopoietic abnormalities<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Gabapentin<\/h2>\n

Gabapentin is indicated as an adjunct treatment for partial seizures, but is most commonly used to treat neuropathic pain.[9]<\/sup><\/a><\/sup><\/p>\n

Mechanism of Action<\/strong><\/p>\n

The exact mechanism of action is unknown. It is structurally similar to GABA, but does not act on GABA receptors or influence GABA.<\/p>\n

Indications for Use<\/strong><\/p>\n

Gabapentin is used for partial seizures and neuropathic pain.<\/p>\n

Nursing Considerations Across the Lifespan<\/strong><\/p>\n

This drug can cause harm to the fetus of pregnant women.<\/p>\n

Gabapentin use in pediatric patients with epilepsy 3 to 12 years of age is associated with the occurrence of central nervous system related adverse events. The most significant of these can be classified into the following categories: 1) emotional lability (primarily behavioral problems); 2) hostility, including aggressive behaviors; 3) thought disorder, including concentration problems and change in school performance; and 4) hyperkinesia (primarily restlessness and hyperactivity).<\/p>\n

In elderly patients, peripheral edema and ataxia tended to increase in incidence with age. Fall precautions should be considered.<\/p>\n

Antiepileptic drugs should not be abruptly discontinued because of the possibility of increasing seizure frequency.<\/p>\n

Adverse\/Side Effects<\/strong><\/p>\n

Antiepileptic drugs, including gabapentin, increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and\/or any unusual changes in mood or behavior.<\/p>\n

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), also known as multiorgan hypersensitivity, has been reported in patients taking antiepileptic drugs, including gabapentin. Some of these events have been fatal or life threatening. DRESS typically, although not exclusively, presents with fever, rash, and\/or lymphadenopathy, in association with other organ system involvement. If these symptoms occur, they should be immediately reported to the provider.<\/p>\n

Gabapentin may cause dizziness, somnolence, and other symptoms and signs of CNS depression. Patients should be advised neither to drive a car nor to operate other complex machinery until they have gained sufficient experience on gabapentin to gauge whether or not it affects their mental and\/or motor performance adversely.[10]<\/sup><\/a><\/sup><\/p>\n

Patient Teaching & Education<\/strong><\/p>\n

Patients receiving gabapentin therapy should take medication as directed and be careful to not exceed dosage recommendations.\u00a0 Patients should not take gabapentin within 2 hours of antacid medications.\u00a0 Additionally, gabapentin may cause increased drowsiness and dizziness.\u00a0 Patients, family, and caregivers should also monitor for suicidality.<\/p>\n

Now let’s take a closer look at the medication grid for gabapentin in Table 8.10c.[11]<\/sup><\/a><\/sup><\/p>\n

Table 8.10c Gabapentin Medication Grid<\/p>\n\n\n\n\n
Class\/Subclass<\/strong><\/th>\nPrototype\/Generic<\/strong><\/th>\nAdministration <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nAdverse\/Side Effects<\/strong><\/th>\n<\/tr>\n
Anticonvulsant<\/th>\ngabapentin<\/a><\/td>\nAdminister first dose at bedtime to decrease dizziness and drowsiness<\/p>\n

Monitor for worsening depression, suicidal thoughts or behavior, and\/or any unusual changes in mood or behavior<\/p>\n

Taper dose; do not stop abruptly<\/td>\n

Decreased neuropathic pain or seizures<\/td>\nIncreased suicidal ideation<\/p>\n

Immediately report fever, rash, and\/or lymphadenopathy<\/p>\n

CNS depression: dizziness, somnolence, and ataxia<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

\n
\n
\n

Critical Thinking Activity 8.10
\n\"Image<\/h2>\n<\/header>\n
\n

A 70-year-patient in a long-term care center has diabetes and has been prescribed gabapentin for neuropathic pain.<\/p>\n

1. The patient states, \u201cI have never had a seizure. Why has the doctor prescribed an antiseizure medication for me?\u201d What is the nurse\u2019s best response?<\/p>\n

2. The nurse plans to implement additional fall precautions for this patient. Why are additional fall precautions needed?<\/p>\n

3. What potential adverse effects should the nurse plan to monitor? What adverse effects would require immediate notification of the provider?<\/p>\n

Note: Answers to the Critical Thinking activities can be found in the “Answer Key” sections at the end of the book.<\/p>\n<\/div>\n<\/div>\n<\/div>\n

  1. McCuistion, L., Vuljoin-DiMaggio, K., Winton, M, & Yeager, J. (2018). Pharmacology: A patient-centered nursing process approach.<\/em> pp. 227-305. Elsevier. ↵<\/a><\/li>
  2. Lilley, L., Collins, S., & Snyder, J. (2020). Pharmacology and the Nursing Process.<\/em> pp. 246-272. Elsevier. ↵<\/a><\/li>
  3. Murnion B. P. (2018, June 1). Neuropathic pain: current definition and review of drug treatment. Australian prescriber, 41<\/em>(3), 60\u201363. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6003018\/<\/a> ↵<\/a><\/li>
  4. McCuistion, L., Vuljoin-DiMaggio, K., Winton, M, & Yeager, J. (2018). Pharmacology: A patient-centered nursing process approach.<\/em> pp. 227-305. Elsevier. ↵<\/a><\/li>
  5. This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. \u00a0 ↵<\/a><\/li>
  6. This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. <\/span> ↵<\/a><\/li>
  7. This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. \u00a0 ↵<\/a><\/li>
  8. This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. \u00a0 ↵<\/a><\/li>
  9. Lilley, L., Collins, S., & Snyder, J. (2020). Pharmacology and the Nursing Process.<\/em> pp. 246-272. Elsevier. ↵<\/a><\/li>
  10. This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. \u00a0 ↵<\/a><\/li>
  11. This work is a derivative of\u00a0Daily Med<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a>\u00a0in the\u00a0public domain<\/a>.\u00a0\u00a0 ↵<\/a><\/li><\/ol><\/div>
    definition<\/span>