Question

Drugs for Seizure Disorders

You are the pediatric nurse caring for Missy, an 8-year-old girl who has been diagnosed with epilepsy. Missy will be hospitalized for at least 3 more days. Missy has been prescribed carbamazepine. You have been assigned to develop the initial teaching plan for Missy and her parents. How will you best prepare to answer these questions?

1. Does the patient need to follow the time frame established for administration of the drugs used in her treatment?

2. How can Missy and her parents assist the healthcare team in determining how her seizures can best be treated?

3. What are the action, side effects, and precautions needed for carbamazepine?

Answer 1

EPILEPSY

It is a abnormal , sudden, excessive discharge of electrical activity within the brain.

It is a chronic seizure and indicates brain or CNS irritation

Types of seizure

1. Generalized:- tonic- clonic, absence , myoclonic and atonic

2. Partial:- simple and complex partial

ASSESSMENT

1. Time of onset, precipitating events and behaviors before and after seizure.

2. Child history related to seizures

3. Monitor for apnea or cyanosis

4. Loss of motor activity

5. Ask for aura to the child (sigh of impending epilepsy or seizure)

6. Post seizure- child is disoriented and sleepy.

MANAGEMENT

1. DRUG THERAPY- phenobarbital, diphenylhydantoin , carbamazepine ,diazepam , sodium valproate , ethosuximide.

2. Diet therapy – ketogenic diet

3. Surgical management- neurosurgery in some case.

4. Nursing management

Priority

a. Prevention and control of seizure activity

b. Prevent child from injury

c. Maintaining airway and respiratory functions

d. Positive self esteem

e. Providing education disease progress , prognosis, and treatment need.

f. Reduce anxiety and fear

PATIENT TEACHING PLAN

1. Instruct the child to wear medical identification

2. Place a water proof mattress or pad on bed.

3. Instruct child to swim with companion.

4. Wear helmet and padding while engaged in cycling or skateboarding etc

5. Wear a medical alert bracelet.

6. Tell parent about the importance of life long medication and need for follow up

7. Tell parent about the need of child like physical ,emotional and cultural need (play therapy , friends , study etc)

8. Clear doubts regarding hospitalization some child have misconception that every who goes to hospital will “die”.

9. Reduce the anxiety and fear regarding the seizure that there is proper treatment of the epilepsy you just have to keep patience.

10. Encourage for the self care activity.

11. Emphasize on the IMPORTANCE of well balanced diet

12. Encourage the parents to learn CPR.

13. Teach about the medication and its frequency.

14. Don’t discontinue the drug.

ANSQ1. Yes timely administration is important in the case of epilepsy to avoid any complication

Missing one dose may likely to have a chance of episode of seizure , so adherence to the regimen to important for prevention of onset of seizures or side effect.

ANSQ2. Patient teaching can help in the assistance to the health care system by following instruction , closely assessment of the child , making distance from risk factor with increase the risk of seizure , taking medication on time , follow diet plan if any, timely reporting of sign of seizures.

AN3Q CARBAMEZAPINE

These are drug which used to seizure disorder that have not responded to other anticonvulsants and used to treat trigeminal neuralgia.

MECHANISM OF ACTION

Normally, sodium moves into the neuron cell by the sodium channel in the cell membrane. Carbamazepine halt seizure by closing the or blocking the sodium channel and it prevent the entry of the sodium into the cell. Keeping the sodium out the cell may slow the nerve impulse transmission, thus slowing the rate at which neuron fire.

SIDE EFFECT

Drowsiness , dizziness, nausea , vomiting, dry mouth, constipation, diarrhea, rash, visual abnormalities, bloody dyscrasis , agranulocytosis, headache

Any many more side effect according to system wise , above one are the main side effects

DOSAGE

child(upto age of 6yrs ) - 10 to 20 mg/kg/day in 2 to 3 divided doses

children(6 to 12yr) intial 100mg and maximum 1000mg in a day , divide into 2 , 3 0r 4 dose

adut dose- intial 200mg and maximum is 1600mg in a day , divided into 3 or 4 dose

PRECAUTIONS

1. Avoid using carbamazepine in patient with a history of hepatic porphyria ( enzyme deficiency in liver) because it may prompt an acute attack.

2. Use cautiously in the patient with impaired hepatic functions.

3. Monitor closely for adverse side effects, such as DRESS multiorgan hypersentivity

4. Monitor child electrolyte level especially sodium level to assess the hyponatremia

5. Monitor for WBC and platelets count for first 2cmonths . decreased count indicates the bone marrow depression

6. Withdrawal the medication gradually to minimize the risk of seizures.

7. Urge the patient to wear sunscreen and protective clothing to prevent photosentivity.

8. Warn the patient about possible side effects.

9. Tell patient to report about sign of bleeding , rash and ulcers.

10. Periodic monitor blood carbamezapine level to assess for therapeutic and toxic levels

( blood level of 6 to 12 mcg/ml is optimal  anticonvulsant effects )

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