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Classification (Antiepileptics)
Phenytoin ( Dilantin)-PO or IV
Carbamazepine (Tegretol)-PO
Valproic Acid (Depakene)-PO or IV
- Action: stabilizes neuronal membranes and limits the spread of seizure activity by affecting the motor cortex
- Uses:
- control grand mal (tonic-clonic) and psychomotor seizures (in all age groups)
- can be used for status epilepticus
- Contraindications:
- hypersensitivity, pregnancy
- Precautions:
- hepatic, hematologic, and respiratory disorders
- sinus bradycardia, sinoartial block, second and third- degree block (Dilantin)
- Side effects:
- Constipation, nausea, vomiting, diarrhea
- headache, drowsiness, somnolence (urge to sleep, long periods of sleep), or insomnia
- blood dyscrasias-(Tegretol)
- cardiac dysrhythmias and gingival hyperplasia-(Dilantin)
- hepatotoxicity-(Valproic acid)
- Nursing implications:
- usually give orally. Administer by deep intramuscular (IM) or intravenous (IV) injection in emergencies.
- Do not mix IV Dilantin with other medications. Give IV Dilantin slowly (do not exceed 50mg/min)
- perform periodic blood studies for therapeutic levels
- check hepatic and renal functions
- teach client to purchase a medic-alert bracelet or carry a medical ID card
- teach client to never abruptly discontinue medication
- with Dilantin, watch for gingival hyperplasia; encourage routine prophylactic dental care, and instruct client to take with meals
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Phenytoin (Dilantin)
- Classification: Antiepileptic
- given PO or IV
- Action: reduces voltage frequency and spread of electrical discharges
- Uses: Control grand mal (tonic-clonic) and psychomotor seizures in all age groups
- Contraindications: hypersensitivity, pregnancy
- Percautions:
- hepatic, hematologic, and respiratory disorders
- sinus brsdycardia, sinoarial block, second and third-degree heart block
- Side effects:
- gingival hyperplasia
- bradycardia
- Constipation, nausea, vomiting, diarrhea
- headache, drowsiness, somnolence, or insomnia
- Nursing implications:
- Noncompliance is frequently responsible for treatment failure
- you need to do drug levels
- teach client to purchase a medic-alert bracelet or carry a medical ID card
- teach client to never abruptly discontinue medication
- While on dilantin watch for gingival hyperplasia; encourage routine prophlactic dental care and instruct client to take with meals
- Do not mix IV dilantin with other medications. Give slowly (do not exceed 50 mg/min)
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Carbamazepine (Tegretol)
- Clasification: Antiepileptic
- given PO
- Action: reduces symptic reaction
- Uses: Control grand mal (tonic-clonic) and psychomotor seizures (in all age groups)
- Contraindications: hypersensitivity, pregnancy
- Percautions:
- hepatic, hematologic, and respiratory disorders
- sinus brsdycardia, sinoarial block, second and third-degree heart block
- Side Effects:
- visual problems, ataxia, vertigo
- Constipation, nausea, vomiting, diarrhea
- headache, drowsiness, somnolence (urge to sleep, prolonged periods of sleep), or insomnia
- Blood dyscrasias (blood disease)
- Nursing inplications:
- Noncompliance is frequently responsible for treatment failure
- you need to do drug levels
- teach client to purchase a medic-alert bracelet or carry a medical ID card
- teach client to never abruptly discontinue medication
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Valproic Acid (Depakene)
- Classification: Antiepileptic
- given PO or IV
- Action: Blocks sodium and calcium channels to prevent neuron firing
- Uses: Control grand mal (tonic-clonic) and psychomotor seizures in all age groups
- Contraindications: hypersensitivity, pregnancy
- Percautions:
- hepatic, hematologic, and respiratory disorders
- sinus brsdycardia, sinoarial block, second and third-degree heart block
- Side effects:
- GI upset
- hepatotoxicity
- Constipation, nausea, vomiting, diarrhea
- headache, drowsiness, somnolence (urge to sleep,prolonged periods of sleep), or insomnia
- Nursing implications:
- Noncompliance is frequently responsible for treatment failure
- you need to do drug levels
- teach client to purchase a medic-alert bracelet or carry a medical ID card
- teach client to never abruptly discontinue medication
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Hydroxyzine (Vistaril)
- Classification: Antianxiety, sedative hypnotic
- given IM or PO
- Action: produces anticholinergic, antihistaminic, analgesic effects; relaxes skeletal muscle; helps control nausea and vomiting
- Uses: Preoperative and postoperative sedation; antiemetic
- Contraindications: third trimester of pregnancy, breastfeeding women, newborns
- Percautions: open-angle glaucoma, prostatic hypertropy, asthma, COPD
- Side effects:
- drowsiness, dry mouth, dizziness, ataxia (lack of cordination of muscle movement), and pain
- with IM injection use Z-track
- Nursing implications:
- offer emotional support; assess motor response; monitor vital signs and fluids and electrolytes; monitor bowel and bladder activity (I & O)
- assess for desired preoperative effects (LOC)
- administer intravenous (IV) medications slowly to avoid life-threatening reactions (severe hypotension, respiratory and cardiac arrest)
- teach client to never abruptly stop medication
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Lorazepam (Ativan)
- Classification: Antianxiety, sedative hypnotic
- given PO, IM, or IV push
- Action: produces muscle relaxation; has anticonvulsant, sedative, antemetic effects; decreased anxiety
- Uses: preoperative sedation, seizures, anxiety
- Contraindications: pregnancy,sleep apnea
- Precautions: clients with suicidal tendencies and substance abuse
- Side effects:
- Central nervous system (CNS) depression
- paradoxical effect (excitement, heightened anxiety)
- physical dependence
- Nursing implications:
- offer emotional support; assess motor response; monitor vital signs and fluids and electrolytes; monitor bowel and bladder activity (I & O)
- assess for desired preoperative effects (LOC)
- administer intravenous (IV) medications slowly to avoid life-threatening reactions (severe hypotension, respiratory and cardiac arrest)
- teach client that oral preparations of ativan should be taken with meals
- teach client to never abruptly stop medication
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Prochlorperazine (Compazine)
- Classification: Antiemetic
- given PO, IM, IV, Rectal
- Action: Blocks dopamine receptors involved in activating the vomiting reflex
- Uses: suppression of nausea and vomiting that are associated with surgery, chemotherapy, and varied noxious stimuli
- Contraindications:
- Hypersensitivity
- glaucoma
- bone marrow depression
- central nervous system (CNS) depression
- Precautions: infants, pregnancy, breastfeeding
- Side effects:
- Drowsiness, hypotension
- Dry mouth, flushing
- Dizziness, fainting
- prolonged use; dystonia (muscle twitching), akathisia (inability to sit still, restlesness), tardive dyskinesia (involentary repetive movements usually appear with long term use), and other extrapyramidal reactions
- Nursing indications:
- assess for cause of nausea and vomiting
- monitor vital signs
- observe for hypersensitivity reactions
- monitor level of hydration
- instruct client about orthostatic hypotension
- avoid skin contact with solution
- instruct client to avoid hazardous or activities requiring mental alertness
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Promethazine (Phenergan)
- Classification: Antiemetic; antihistamine
- given PO, PR, IM, IV
- Action: Blocks histamine receptors in the neuronal pathway, leading from the vestibular apparatus of the inner ear to the vomiting center in the medulla
- Uses: Nausea and vomiting caused by noxious stimuli and motion sickness, virtigo
- Contraindications and Percautions:
- severe central nervous system (CNS) depression, acute asthma
- glaucoma
- gastrointestinal or genitourinary obstruction
- pregnancy, seizure
- Side effects;
- sedation, drowsiness, disorientation
- hypotension
- dry mouth, urinary retention
- confusion
- Nursing indications:
- evaluate client's respiratory status during use of this drug
- teach client to avoid tasks that require mental alertness
- direct client to report tremors or anormal body movement
- long-term therapy, teach client to have complete blood count (CBC) drawn
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Midazolam (Versed)
- Classification: Benzodiazepine
- given PO, IV, IM
- Action: produces unconsciousness and amnesia
- Uses: induction of anesthesia and conscious sedation
- Contraindications:
- shock
- coma
- acute alcohol intoxication
- acute narrow-angle glaucoma
- Precautions:
- can cause dangerous cardiorespiratory effects, including respiratory depression and cardiac arrest
- acute illness
- severe electrolyte imbalance
- Side effects;
- decreased respiratory rate
- tenderness at intramuscular/intravenous (IM/IV) injection site
- hypotension
- Nursing indications:
- administer slowly over 2 or more minutes. Wait another 2 or more minutes for full effects to develop before giving additional doses to avoid cardiorespiratory problems
- unconsciousness develops quickly (within 60 to 80 seconds). Conscious sedation persists for approximately 1 hour
- perform constand cardiac and respiratory monitoring during administration with resuscitative equipment near by
- the client will not remember any postoperative instructions. After outpatient procedures, the client must be accompanied home by a responsible adult
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