Anticonvulsants

 Treats seizures from epilepsy

 Seizures from head injuries
 Petite-mal and Grand-mal
Hydantoins- Dilantin

 most common Rx for seizure control

 90% protein bound
 metabolized by hepatic enzymes
Mechanism of Action

 primary site in motor cortex

 inhibits spread of seizure activity
 some antiarrythmia properties similar to
lidocaine
Therapeutic Use

 Rx of choice for
complex partial
(psychomotor)
 Tonic-clonic
seizures
Drug Interactions

 MANY!!
 All highly protein bound drugs are altered
 coumadin, corticosteroids
 theophyline, thyroid
Adverse Drug Reactions

 CNS - slurred speech, confusion,

drowsiness, ataxia
 GI N/V epigastric pain, anorexia,
gingival hyperplasia
Adverse Drug Reactions
continued

 Cardiac - decreased A/V conduction,

dec.. P, BP, arrest
 Unpredictable- rash, liver necrosis,
thrombocytopenia
Nursing Implications
 Do not give if bradycardic, SA block
 Caution in blood dyscrasias,
hypotensive or cardiac insufficiency
 Caution in renal dysfunction, alcoholism
 Not safe during pregnancy (birth
defects)
 Check serum levels periodically
 Give oral dose with meals to decrease
GI irritation
 Dental care essential
 Do not mix with RX
General teaching

 Do not discontinue
 Avoid hazardous machinery
 Family how to care for pt with seizure
 No OTC, ETOH
 Follow up with MD
Barbiturates

 Limit seizure activity by increasing

threshold for motor cortex stimuli
 Used for partial, tonic-clonic & febrile
seizures
 Dose for seizure control is less than for
hypnotic
 Interacts with MANY Rx
Adverse Reactions

 CNS - dose related - drowsiness,

lethargy, confusion
 GI - N/V
 Laryngospasm, depressed respiration
 hypotension, pupil constriction, oliguria,
circulatory collapse
 anemias
Nursing Implications

 Caution with resp, cardiac, hepatic,

anemia
 Bedrails up for safety (Pad rails)
 Check serum level
 Schedule IV controlled
Iminostilbenes - Tegretol

 Action similar to dilantin - inhibits spread

of seizure activity
 Used for tonic-clonic seizures
 Interacts to induce enzyme activity
Adverse Reactions

 Drowsy, double vision

 Altered blood pressure
 Anticholinergic- urine retention,
constipation, glaucoma
 anemias
Nursing Implications

 Do not give with MAO inhibitors

(hyperpyretic crisis)
 Caution in cardiac, hepatic, renal disease
 Take with meals