Question

SS, a 26-year-old woman, takes phenytoin 100 mg t.i.d. to control grand mal seizures. SS and her husband are contemplating starting a family. SS complains of frequent "upset stomach" and "bleeding gums" when brushing her teeth and is questioning if other anticonvulsants are more appropriate than phenytoin. 1. List the different classifications of anticonvulsant medications noted on your drug list and briefly explain how they work. Describe a situation in which each could be prescribed. 2. Detail assessment criteria important before administering anticonvulsants. 3. Explain nursing interventions (not patient teaching, what interventions are appropriate for the RN when administering these medications).

Answer 1

1. Classification of Anticonvulsant medication:

Drug name	Action	Indication
Valporte	Inhibits GABA transaminase	Tonic clonic generalized seizure, partial seizure, Myoclonic seizure.
Carbamazepine	Act on ion channels and inactivates sodium channels	Tonic-clonic generalized seizure, focal seizure.
Phenytoin	Inactivates the sodium channels across the neural membranes	Tonic-clonic seizure, focal seizure, status epilepticus.
Ethosuximide	inhibition of calcium channel function	absence seizure
Phenobarbital	GABA agonist and inhibit GABA action.	Tonic clonic generalized seizure, focal seizure.
Gabapentin	Inhibits calcium channel across the neural membrane	focal seizure
Vigabatrin	inhibits the transaminase of GABA transferase	Refractory focal seizure
Topiramate	Block sodium channels	Generalized tonic-clonic generalized seizure,
Tiagabine	inhibits GABA reuptake	focal seizure

2. Nursing Assessment Criteria:

• Assess the onset, duration, and frequency of seizure episodes.
• Assess patient allergic to drugs.
• Assess the physical status and function of the patient.
• Monitor the lab values.
• Assess the level of understanding of the patient.

3. Nursing Intervention:

• Monitor the patient before administration of anticonvulsant medication
• Follow safety measures while administering medication
• Monitor intake and output.
• Maintain oral care
• Evaluate the outcome of the medication.

4. Teaching points for patients:

patient teaching points	Rationale
Educate about the antiseizure activity	To know about the seizure episodes and to follow safety measures.
Explain about anticonvulsant medication.	to know the importance of medication.
educate to monitor the lab values	It helps to adjust the dose of medication.
Educate about the drug interaction with other medication	To prevent unnecessary complications.