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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anticonvulsants: Precautions (cont.)
Anticonvulsants: Precautions (cont.)
–
Phenytoin is used cautiously in patients with
hypotension; severe myocardial insufficiency;
hepatic impairment
–
Trimethadione is used with caution in patients
with eye disorders
–
Miscellaneous anticonvulsants are used
cautiously in patients with glaucoma or
increased intraocular pressure; a history of
cardiac, renal, or liver dysfunction; and
psychiatric disorders

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anticonvulsants: Interactions
Anticonvulsants: Interactions
Interacting drug Effect of interaction
Antibiotics/antifungals Increased effect of
anticonvulsant
Tricyclic antidepressants Increased effect of
anticonvulsant
Salicylates Increased effect of
anticonvulsant
Cimetidine Increased effect of
anticonvulsant
Theophylline Decreased serum levels
of anticonvulsant

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anticonvulsants: Interactions (cont.)
Anticonvulsants: Interactions (cont.)
Interacting drug Effect of interaction
Antiseizure medications May increase seizure
activity
Protease inhibitors Increased carbamazepine
levels resulting in toxicity
Oral contraceptives Decreased effectiveness of
birth control, resulting in
breakthrough bleeding or
pregnancy
Analgesics or alcohol Increased depressant effect
Antidiabetic medications Increased blood glucose
levels

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Assessment
Nursing Process: Assessment
•
Preadministration assessment:
–
Obtain vital signs at the time of the initial
assessment to provide baseline data
–
Thorough patient history is necessary to
identify type of seizure disorder
–
Primary health care provider may order
laboratory and diagnostic tests

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Assessment (cont.)
Nursing Process: Assessment (cont.)
•
Ongoing assessment:
–
Carefully document each seizure with regard to
time of occurrence; duration of seizure; psychic or
motor activity occurring before, during, after
seizure
–
Dosage adjustments are based on patient’s
response to therapy, as well as occurrence of
adverse reactions
–
Serum plasma levels of anticonvulsant are
measured regularly to monitor for toxicity

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Diagnoses
Nursing Diagnoses
•
Risk for Injury related to seizure disorder, drowsiness,
ataxia, and vision disturbances
•
Risk for Impaired Skin Integrity related to adverse
reactions (rash)
•
Risk for Infection related to immunosuppression
secondary to drug therapy
•
Impaired Oral Mucous Membranes related to gum
overgrowth secondary to hydantoins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Planning
Nursing Process: Planning
•
Expected outcomes for patient depend on
the type and severity of the seizure but may
include:
–
Optimal response to therapy
–
Support of patient needs related to
management of adverse reactions
–
Understanding of and compliance with
prescribed therapeutic regimen