Antiepileptic Drugs

ACTIONS

Stabilizes neuronal membranes, and limits the spread of seizure activity by affecting the motor cortex.

USES

• Control grand mal (tonic-clonic) and psychomotor seizures (in all age groups).

• Can be used for status epilepticus.

CONTRAINDICATIONS

• Hypersensitivity

• Pregnancy (teratogenic effects)

PRECAUTIONS

• Hepatic, hematologic, and respiratory disorders

• Sinus bradycardia, sinoatrial block, second- and third-degree block (Dilantin)

SIDE EFFECTS

• ^**Constipation, nausea, vomiting—Valproic acid^**

• Headache, drowsiness, somnolence, or insomnia

• Blood dyscrasias, ^**visual disturbances, ataxia, vertigo—Tegretol^**

• Cardiac dysrhythmias, hypotension, ^**gingival hyperplasia, rash—Dilantin^**

• Hepatotoxicity, pancreatitis—Valproic acid

NURSING IMPLICATIONS

1. Usually give orally. Administer by deep intramuscular (IM) or intravenous (IV) injection in emergencies. ^*Do not mix IV Dilantin with other medications.^* Give IV Dilantin slowly (do not exceed 50 mg/min).

2. ^*Perform periodic blood studies for therapeutic levels.^*

3. Check hepatic and renal functions.

4. ^‡Teach patient to purchase a Medic-Alert bracelet or carry a medical ID card.^‡

5. ^‡Teach patient to never abruptly discontinue medication.^‡

6. ^‡With Dilantin, watch for gingival hyperplasia; encourage routine prophylactic dental care, and instruct patient to take with meals.^‡

7. ^*Do not give Tegretol with grapefruit juice.^*

Hydroxyzine (Vistaril) and Lorazepam (Ativan) Preoperative and Postoperative Sedation

CLASSIFICATION

Antianxiety, sedative hypnotic

ACTIONS

• Vistaril: Produces anticholinergic, antihistaminic, analgesic effects; relaxes skeletal muscles; helps control nausea and vomiting.

• Ativan: Produces muscle relaxation; has anticonvulsant, sedative, antiemetic effects; decreases anxiety, status epilepticus.

USES

• Vistaril: Preoperative and postoperative sedation; antiemetic

• Ativan: Preoperative sedation, seizures, anxiety, status epilepticus

CONTRAINDICATIONS

• Ativan: Pregnancy, sleep apnea

• Vistaril: Third-trimester-pregnancy, breast-feeding women, newborns

PRECAUTIONS

• Vistaril: Open-angle glaucoma, prostatic hypertrophy, asthma, COPD

• Ativan: Patients with suicidal tendencies and substance abuse

SIDE EFFECTS

• Vistaril: ^**Sedation,^** anticholinergic effects (dry mouth), GI upset

• Ativan: Central nervous system (CNS) depression, paradoxical effect (excitement, heightened anxiety), physical dependence

NURSING IMPLICATIONS

1. Offer emotional support; ^*assess motor response; monitor vital signs and fluids and electrolytes; monitor bowel and bladder activity.^*

2. Assess for desired preoperative effects.

3. ^‡Teach patient that oral preparations of Ativan should be taken with meals.^‡

4. ^*Administer intravenous (IV) medications slowly to avoid life-threatening reactions^{* †}(severe hypotension, respiratory and cardiac arrest).^†

5. ^‡Teach patient to never abruptly discontinue oral medications.^‡

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