Chapter 15. Seizures. Learning Objectives. Learning Objectives 9/11/2012

Transcription

1 Chapter 15 Seizures Learning Objectives Demonstrate proper procedure for rectal administration of diazepam, and discuss why rectal administration is sometimes necessary for patient having a seizure Discuss benzodiazepines used in the treatment of seizures: Diazepam (Valium) Lorazepam (Ativan) Learning Objectives Discuss other anticonvulsants (nonbenzodiazepines) used in treatment of seizures: Phenytoin (Dilantin) Carbamazepine (Tegretol) Phenobarbital (Luminal) Valproic acid (Depakote) Gabapentin (Neurontin) Lamotrigine (Lamictal) 1

2 Introduction Seizure activity is common emergency that requires prompt management Status epilepticus Continuous seizure activity for 30+ min, or Series of seizures without full recovery of consciousness between seizures Introduction Prolonged seizure activity can lead to brain damage or poor functional status One determinant of outcome is duration Seizure activity is result of chaotic, abnormal, high-frequency firing of neurons Can cause alteration in level of consciousness Introduction Tonic-clonic seizures Altered mental status Abnormal eye movements Incontinence of bowel or bladder 2

3 Maintain adequate airway Provide supplemental O 2 Continually assess breathing Protect patient from injury Attempt to secure venous access Take brief history if possible to identify significant medical history Diabetes with hypoglycemia Known medications Intoxicants Recreational drugs Benzodiazepines Anticonvulsant agents Principal pharmacologic effects are mitigated through gamma-aminobutyric acid (GAMA) When drug binds with GABA receptor, result is inhibition or decrease in activity of the CNS 3

4 Benzodiazepines Diazepam Can be administered rectally Lorazepam (Ativan) Midazolam (Versed) Short half-life Poor choice Equipment needed: Two 3-mL syringes 5F feeding tube Saline flush Water-soluble lubricant Procedure: Observe universal precautions Verify drug order Confirm right patient, right medication, right dose, right route, right time Confirm patient has no allergies to the medication When possible, explain to patient what medication you are giving and why 4

5 Procedure: Draw desired dose of the medication into a 3-mL syringe Attach 5F feeding tube to the 3-mL syringe Into a second 3-mL syringe, draw 1 ml of normal saline to be used as a flush Ensure airway is controlled and patent Place patient on his or her side with knees bent toward the chest Procedure: Apply water-soluble lubricant to tip of catheter Introduce lubricated catheter into the rectum and advance approximately 1 inch Inject diazepam through the catheter, then flush feeding catheter with saline flush Withdraw catheter and dispose properly Record time of drug administration in the PCR Evaluate patient for desired effects of the medication and any adverse effects Major reason patients develop recurrent seizures is failure to achieve appropriate blood plasma concentration in their prescribed medication Possibly from medication noncompliance Must acquire medication history 5

6 Phenytoin (Dilantin) Used to control partial and generalized seizures Prodrug preparations can be administered Inactive or less-active form of a drug that, once administered, is converted to the body in active form of a drug Have fewer side effects Fosphenytoin (Cerebyx) converts to phenytoin after administration Carbamazepine (Tegretol) Used to treat partial and generalized tonic-clonic seizures Stabilizes nerve membranes to decrease abnormal nerve cell firing Phenobarbital (Luminal) Barbiturate Second-line therapy Side effects Sedation Depression Agitation Liver metabolizes and induces hepatic enzymes that cause accelerated metabolism of other medications 6

7 Valproic acid (Depakote) Treats seizures and mood disorders Requires regular monitoring of blood levels to ensure maintenance of therapeutic levels and minimize adverse drug reactions Gabapentin (Neurontin) Well absorbed orally Also used to treat many different neuropathic pain syndromes Treats pain Lamotrigine (Lamictal) Questions? 7