Antiepileptics: Nursing Pharmacology

Overview

• Antiepileptics, also known as anticonvulsants, are medications primarily used to treat epilepsy and seizures.
• Occasionally used to treat mood disorders.

Classification

• Sodium Channel Blockers
  • Hydantoins: Phenytoin, Fosphenytoin
  • Iminostilbene derivatives: Carbamazepine
  • Valproate derivatives
  • Lamotrigine
• Calcium Channel Blockers
  • Succinimides: Ethosuximide
  • Levetiracetam
• GABA Inhibitors and Analogues
  • Vigabatrin
  • Gabapentin

Mechanism of Action

• Sodium Channel Blockers: Inhibit excitatory neurons by blocking voltage-gated sodium channels, reducing seizure activity.
• Calcium Channel Blockers: Block voltage-gated calcium channels, decrease excitatory neuronal activity.
• GABA Modulators: Increase GABA concentration or mimic GABA, reducing neuronal excitability.

Administration Routes

• Sodium Channel Blockers:
  • Phenytoin: Oral, IV
  • Fosphenytoin: IV, IM
  • Carbamazepine, Valproate, Lamotrigine: Oral, some IV
• Calcium Channel Blockers:
  • Ethosuximide: Oral
  • Levetiracetam: Oral, IV
• GABA Modulators:
  • Vigabatrin, Gabapentin: Oral

Side Effects

• Common Side Effects:
  • Headaches, dizziness, visual disturbances, gastrointestinal issues
• Serious Side Effects:
  • Stevens-Johnson syndrome, toxic epidermal necrolysis, DRESS, hepatotoxicity, blood dyscrasias
  • Suicidal thoughts, CNS depression

Contraindications & Cautions

• Avoid during pregnancy, breastfeeding, and certain cardiac, hepatic, or renal conditions.
• Specific drugs have additional contraindications, like MAOIs interaction with carbamazepine.

Nursing Considerations

• Assessment & Monitoring
  • Assess seizure type, frequency, and duration.
  • Screen for depression, suicidal thoughts, pregnancy.
  • Monitor CBC, liver, and renal function tests.
• Client Education
  • Take medications as prescribed, do not stop abruptly.
  • Use reliable contraception.
  • Report side effects like mood changes or skin rashes immediately.

References

• Mosby's 2021 Nursing Drug Reference
• Pharmacology: A Patient-Centered Nursing Process Approach
• Focus on Nursing Pharmacology
• Saunders Comprehensive Review for the NCLEX-RN Examination
• Lehne's Pharmacology for Nursing Care

Contributors

• Authors and reviewers from the Osmosis team including medical doctors and nursing experts.

Note: Always consult a healthcare professional for medical advice specific to individual health conditions and medication usage.