Alden- Drug of Choice for Each Type of Seizure (1)

8/11/2019 Alden- Drug of Choice for Each Type of Seizure (1)

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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

Documents

Alden- Drug of Choice for Each Type of Seizure (1)