alden- drug of choice for each type of seizure (1)
TRANSCRIPT
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Alden Paul P. Mendoza
DRUG OF CHOICE FOR EACH TYPE OF SEIZURE
Seizures are symptoms of an abnormality in the nerve cells of the brain. They are brief periods of abnormal electrical activity in
these nerve centers. [Clayton]
There are various types and names of seizures. The International Classification of Seizures describes two categories of seizure:
Generalized and Partial. [Kee]
Generalized Seizures
o affect both hemispheres of the brain
1. Tonic-Clonic (Grand Mal) Seizures
most common form of seizure
DRUGS OF CHOICE:
Phenytoin
DRUG CLASSIFICATION /
INDICATION
MECHANISM OF
ACTION
DOSE ROUTE
FREQUENCY
SIDE EFFECTS CONTRAINDICATIONS NURSING
RESPONSIBILITIES
Brand name:
Dilantin
Generic Name:
Phenytoin
Dilantin is
indicated for the
control of tonic-
clonic ( grand
mal) and
psychomotor(
temporal lobe)
seizures.
Decreases seizure
activity by
increasing efflux
or
decreasinginflux
of sodium ions
across cell
membranes in
the motor cortex
duringgeneration
of nerve
Adults and elderly:
Status epilepticus:
IV: loading
dose:15-20 mg/kg
in a single or
divided
dose,followed by
100-150 mg/dose
at 30-minute
intervals up to a
maximum of
Drowsiness.
Dizziness.
Fatigue.
Lack of
coordination.
Loss of appetite.
Inability to
concentrate or
speak clearly.
Nervousness.
Hypersensitivity to
phenytoin, other
hydantoins, or any
component;heart
block; sinus
bradycardia
Obtain data relating
to the six cardinal
signs of
cardiovascular
disease to be used as
a baseline for
subsequent
evaluation of
response
therapy.Record date
relating to any GI
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yellowish color to
skin or eyes,
palpitations.
Valproate
DRUG CLASSIFICATION /
INDICATION
MECHANISM
OF ACTION
DOSE ROUTE
FREQUENCY
SIDE EFFECTS CONTRAINDICATIONS NURSING
RESPONSIBILITIES
Brand
name:
Valproic
acid
Generic
Name:
valproat
e
Sole and
adjunctivetherapy insimple (petitmal) andcomplex
absenceseizures
DepakoteER:
Treatment ofepilepsy inchildren > 10
yr;treatment ofacute manicor mixedepisodesassociatedwith bipolar
disorder,with orwithoutpsychotic
features Adjunctive
therapy withmultiple
seizuretypes,including
absenceseizures
- It
probably
blocks
high-
frequency
,
repetitive
neuronal
firing by
blocking
voltage-
dependen
t sodium
channels.
- It may
augment
the action
of GAD
(glutamicacid
decarboxy
lase), a
GABA-
synthesizi
ng
enzyme.
- At high
levels, it
restrictsGABA-T
ADULTS
Dosage isexpressed asvalproic acidequivalents. Initial
dose is 1015mg/kg/day PO,
increasing at 1-wkintervals by 510
mg/kg/day untilseizures arecontrolled or side
effects precludefurther increases.Maximumrecommendeddosage is 60mg/kg/day PO. Iftotal dose > 250
mg/day, give individed doses.
Acute
mania orbipolar
disorder:Initially, 25mg/kg/dayPO once
daily. Dose
tiredness
dizziness
nausea
vomiting
tremor
hair loss
weight gain
behavioral
changes
(depression in
adults,
irritability in
children)
Contraindicat
ed withhypersensitivity to valproicacid, hepaticdisease or
significanthepatic
impairment. Use
cautiouslywith children< 18 mo;
children < 2yr, especiallywith multipleantiepileptics,congenitalmetabolicdisorders,
severeseizuresaccompaniedby severe
mentalretardation,organic braindisorders
(higher riskof developingfatal
hepatotoxicity);
Give drug
with food ifGI upsetoccurs;substitutionof the
enteric-coated
formulationalso may be
of benefit;have patientswallow SR
tablet whole;do not cut,crush, orchew.
WARNING:Reducedosage,
discontinue,or substituteotherantiepileptics
gradually;abruptdiscontinuation of all
antiepilepticsmayprecipitate
absenceseizures.
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DepakoteER:
Treatment ofbipolarmania
Depakote,DepacoteER:
Prophylaxisof migraineheadaches
Divalproex,sodiumvalproate
injection:Treatment ofcomplexpartialseizures as
monotherapyor with otherantiepileptics
Unlabeled
uses:Adjunct insymptommanagement
ofschizophrenia, treatmentof aggressive
outbursts inchildren with
attention-deficithyperactivitydisorder,organic brainsyndrome
.
(GABA
transamin
ase), an
enzyme
that
speeds
the
degradation of
GABA.
It acts against
T-type calcium
currents like
those
implicated in
the spike-wave
activity of
absence
seizures. (This
action is not as
apparent as
with
ethosuximide,
however.)
should beincreased
rapidly toachieve thelowest
therapeuticdose.Maximum
dose 60mg/kg/dayPO(DepakoteER only).
Bipolar
mania: 750mg POdaily individeddoses; do
not exceed60mg/kg/day(Divalproex
DR tabletsonly).
Migraine:250 mg PO
bid; up to1,000mg/dayhas been
used(Divalproex
DRtablets);500 mg ERtablet oncea day.
PEDIATRIC
PATIENTS > 10YR
pregnancy(fetal neural
tube defects;do notdiscontinue
to preventmajorseizures;
discontinuingsuchmedication islikely toprecipitatestatus
epilepticus,hypoxia andrisk to bothmother andfetus);
lactation.
BLACK BOXWARNING:
Arrange forfrequentLFTs;
discontinuedrugimmediately
withsignificanthepaticimpairment,suspected orapparent
significanthepaticimpairment;continueLFTs to
determine ifhepaticimpairmentprogresses
in spite ofdrugdiscontinuation.
WARNING:Arrange forpatient tohave platelet
counts,bleeding
timedetermination beforetherapy,periodically
duringtherapy, andprior to
surgery.
Monitorpatient
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10-15mg/kg/dayPO.
PEDIATRIC
PATIENTS
Use
extremecaution.Fatalhepatotoxic
ity hasoccurred.Children 10
yr;treatment ofacute manic
or mixedepisodesassociated
with bipolardisorder,with orwithoutpsychoticfeatures
Adjunctivetherapy withmultipleseizuretypes,including
absenceseizures
Depakote
ER:Treatment ofbipolarmania
Depakote,DepacoteER:Prophylaxis
of migraineheadaches
Divalproex,sodiumvalproateinjection:Treatment of
complexpartialseizures as
monotherapyor with otherantiepileptics
voltage-
dependen
t sodium
channels.
- It may
augment
the action
of GAD
(glutamic
acid
decarboxy
lase), a
GABA-
synthesizi
ng
enzyme.
- At high
levels, it
restrictsGABA-T
(GABA
transamin
ase), an
enzyme
that
speeds
the
degradati
on ofGABA.
It acts against
T-type calcium
currents like
those
implicated in
the spike-wave
activity of
absence
seizures. (This
action is not as
seizures arecontrolled or side
effects precludefurther increases.Maximum
recommendeddosage is 60mg/kg/day PO. If
total dose > 250mg/day, give individed doses.
Acutemania orbipolar
disorder:Initially, 25mg/kg/day
PO oncedaily. Doseshould beincreased
rapidly toachieve thelowesttherapeuticdose.Maximumdose 60
mg/kg/day
PO(DepakoteER only).
Bipolarmania: 750mg PO
daily individeddoses; donot exceed
60
mg/kg/day(Divalproex
tremor
hair loss
weight gain
behavioral
changes(depression in
adults,
irritability in
children)
with children< 18 mo;
children < 2yr, especiallywith multiple
antiepileptics,congenitalmetabolic
disorders,severeseizuresaccompaniedby severemental
retardation,organic braindisorders(higher riskof developingfatal
hepatotoxicity);pregnancy
(fetal neuraltube defects;do notdiscontinue
to preventmajorseizures;discontinuing
suchmedication is
likely toprecipitatestatusepilepticus,hypoxia and
risk to bothmother andfetus);lactation.
have patientswallow SR
tablet whole;do not cut,crush, or
chew. WARNING:
Reduce
dosage,discontinue,or substituteotherantiepilepticsgradually;
abruptdiscontinuation of allantiepilepticsmayprecipitate
absenceseizures.
BLACK BOX
WARNING:Arrange forfrequentLFTs;
discontinuedrugimmediatelywith
significanthepatic
impairment,suspected orapparentsignificanthepatic
impairment;continueLFTs to
determine ifhepaticimpairment
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Unlabeleduses:
Adjunct insymptommanagement
ofschizophrenia, treatment
of aggressiveoutbursts inchildren withattention-deficithyperactivity
disorder,organic brainsyndrome
.
apparent as
with
ethosuximide,
however.)
DR tabletsonly).
Migraine:250 mg PObid; up to
1,000mg/dayhas been
used(DivalproexDRtablets);500 mg ERtablet oncea day.
PEDIATRICPATIENTS > 10
YR
10-15
mg/kg/dayPO.
PEDIATRICPATIENTS
Use
extremecaution.Fatalhepatotoxic
ity hasoccurred.Children