Action: Anticonvulsants are divided into the barbiturates, benzodiazepines, hydantoins, succinimides, and miscellaneous products. Hydantoins act by inhibiting the spread of seizure activity in the motor cortex. Succinimides act by inhibiting spike and wave information; they also decrease amplitude, frequency, duration, and spread of discharge in seizures.
Uses: Hydantoins are used in generalized tonic-clonic seizures, status epilepticus, and psychomotor seizures. Succinimides are used for absence (petit mal) seizures. Barbiturates are used ub generalized tonic-clonic and cortical focal seizures.
Side effects / Adverse reactions: Bone marrow depression is the most life-threatening adverse reaction associated with hydantoins or succinimides. The most common side effects are GI symptoms. Other common side effects for hydantoins are gingival hyperplasia and CNS effects sych as nystagmus, ataxia, slurred speech, and mental confusion.
Contraindications: Hypersensitive reactions may occur, and allergies should be identified before these products are given.
Precautions: Persons with renal or hepatic disease should be watched closely.
Interactions: Decreased effects of estrogens, oral contraceptives (hydantoins).
Possible nursing diagnoses:
» Risk for injury [uses]
» Noncompliance [teaching]
» Sleep pattern disturbance [adverse reactions]
» Renal studies, including BUN, creatinine, serum uric acid, urine creatinine clearance before and during therapy
» Blood studies: RBC, Hct, Hgb, reticulocyte counts qwk for 4 weeks then qmo
» Hepatic studies: AST, ALT, bilirubin, creatinine
» Mental status, including mood, sensorium, affect, behavioral changes, if mental status changes, notify prescriber
» Eye problems, including need for opthalmic exam before, during, and after treatment (slit lamp, fundoscopy, tonometry)
» Allergic reactions, including red, raised rash; if this occurs, drug should be discontinued
» Blood dyscrasia, including fever, sore throat, bruising, rash, jaundice
» Toxicity, including, bone marrow depression, nausea, vomiting ataxia, diplopia, cardiovascular collapse, Stevens-Johnson syndrome
» With food, milk, to decrease GI symptoms
» Good oral hygiene is important for hydantoins
» Therapeutic response, including decreased seizure activity; document on patients chart
» To carry emergency ID stating drugs taken, condition, prescriber’s name, phone number
» To avoid drinking, other activities that require alertness
Selected Generic Names
Valproate/Valproic acid, Divalproex sodium