| Drug and Dosage | Use | Action | Assessment: Side Effects |
|---|---|---|---|
| Carbamazepine (Tegretol)—PO 200 mg twice/day (range: 600–1,200/day in divided doses) | Multiple sclerosis | Decreases synaptic transmission in CNS by affecting sodium channels in neurons | Contraindicated in hypersensitivity, bone marrow depression; drowsiness, ataxia, agranulocytosis, aplastic anemia |
| NURSING IMPLICATIONS: Monitor: complete blood count (CBC), liver function, electrocardiogram (ECG). Therapeutic levels should be 6–12 mcg/mL; take medication as directed around the clock; use sunscreen due to photosensitivity | |||
| Clonazepam (Klonopin)—PO 1.5 mg in 3 doses initially, 0.5–1.0 mg every third day | Absence seizures (petit mal seizures, myoclonic seizures) | Produces anticonvulsant and sedative effects in the CNS; mechanism unknown | Drowsiness, ataxia, behavioral changes |
| NURSING IMPLICATIONS: Give with food; evaluate liver enzymes, CBC, and platelets; avoid abrupt withdrawal—may cause status epilepticus | |||
| Diazepam (Valium)—PO 2–10 mg 2–4 times daily; IM, IV 5–10 mg | All types of seizures Obstetric use: eclampsia | Induces calming effect on limbic system, thalamus, and hypothalamus | Drowsiness, ataxia, paradoxical increase in CNS excitability |
| NURSING IMPLICATIONS: IV may cause phlebitis; give IV injection slowly , because respiratory arrest can occur; inject IM deeply into tissue | |||
| Ethosuximide (Zarontin)—PO 500 mg/day, increase by 250 mg/day until effective | Absence seizures | Depresses motor cortex and reduces CNS sensitivity to convulsive nerve stimuli | GI distress: nausea, vomiting, cramps, diarrhea, anorexia; blood dyscrasias |
| NURSING IMPLICATIONS: Administer with meals; regular CBC ; precautions to avoid injury from drowsiness | |||
| Magnesium salts—IV infusion 4–5 gm | Cirrhosis | Osmotically active in GI tract | Use caution in renal failure; contraindicated in: hypermagnesemia, anuria, heart block |
| NURSING IMPLICATIONS: Monitor: vital signs, seizure precautions, I&O respiratory rate must be 16 before administration | |||
| Magnesium sulfate—IM or IV 1- to 4-gm loading dose, followed by continuous infusion (2–3 gm/hr) | Control seizures in pregnancy, epilepsy; relief of acute constipation; reduces edema, inflammation, and itching of skin; may inhibit preterm contractions | Depresses CNS and smooth, cardiac, and skeletal muscle; promotes osmotic retention of fluid | Flushing, sweating, extreme thirst; complete heart block; dehydration; depressed or absent reflexes, ↓ respirations |
| NURSING IMPLICATIONS: If given IV, monitor vital signs continuously; I&O use with caution in clients with impaired renal functions; observe mother and newborn for signs of toxicity if given near birth; antidote: calcium gluconate | |||
| Phenytoin or diphenylhydantoin (Dilantin) SO4—PO 30–100 mg 3–4 times daily; IM 100–200 mg 3–4 times daily; IV 150–250 mg | Psychomotor epilepsy, convulsive seizures; ventricular arrhythmias | Depresses motor cortex by preventing spread of abnormal electrical impulses | Nervousness, ataxia; gastric distress; nystagmus; slurred speech; hallucinations; gingival hyperplasia |
| NURSING IMPLICATIONS: Give with meals or after meals (pc); frequent and diligent mouth care; advise client that urine may turn pink to red-brown ; teach client signs of adverse reactions; mix IV with normal saline (precipitates with D5W) | |||
| Primidone (Mysoline)—PO 100–250 mg, increase over 10 days (not to exceed 2 gm/day) | Tonic-clonic, focal, or local seizures | Inhibits abnormal brain electrical activity; dose-dependent CNS depression | Excessive sedation or ataxia, vertigo |
| NURSING IMPLICATIONS: Careful neurological, cardiovascular, and respiratory assessment; have resuscitation equipment available | |||
| Valproic acid (Depakene)—PO 15 mg/kg/day, increase up to 60 mg/kg/day | Absence, tonic-clonic, myoclonic, focal, or local seizures | Inhibits spread of abnormal discharges through brain | Nausea, vomiting, diarrhea (disappear over time); drowsiness or sedation if taken in combination with other anticonvulsants |
| NURSING IMPLICATIONS: Assess responses; monitor blood levels; precautions against excessive sedation; discourage alcohol use | |||