Seizure 7.
Lacosamide
- is a sudden, temporary and uncontrolled
electrical disturbance in the brain.
- It can cause changes in your behavior,
movements or feelings, and in levels of
consciousness.
Types of seizures
1. Focal seizures
- Result from abnormal electrical activity in
one area of your brain. Focal seizures can
occur with or without loss of consciousness.
2. Generalized seizures
- Seizures that appear to involve all areas of
the brain are called generalized seizures.
Epilepsy
- a chronic neurological disorder in which brain
activity becomes abnormal, causing seizures
or periods of unusual behavior, sensations,
and sometimes loss of awareness.
 Having a single seizure doesn't mean you have
epilepsy. At least two unprovoked seizures are
generally required for an epilepsy diagnosis.
Convulsion
- convulsion is a type of seizure
- is an episode in which you experience rigidity
and uncontrolled muscle spasms along with
altered consciousness.
- The spasms cause jerky motions that
generally last a minute or two.
 If you’ve had convulsions, it doesn’t necessarily
mean you have epilepsy.
 Epilepsy is a chronic neurologic condition.
 Convulsions can be a reaction to a single medical
event or a part of a medical condition.
Drugs for treating Partial Seizures
Sample Medications
1. Carbamazepine
2. Clorazepate
3. Ezogabine
4. Felbamate
5. Oxcarbazepine
6. Gabapentin
GROUP 2 : Azuelo,Cano Pacheco, Inoc, Pareja, Tejano
8. Lamotrigine
9. Levetiracetam
Therapeutic action:
- stabilize nerve membrane
● direct
- altering sodium and calcium channels
● indirect
- increase GABA
- inhibitory neurotransmitter
- monotherapy
- adjuctive therapy
Pharmacokinetics
- Absorb in the GI tract with a peak level of 38
minutes, 1-2 hours, 4-6 hours or 6-8 hours
depends on the kind of medication
- it is widely distributed in the whole body and
it cross the placenta
- it is metabolized in the liver and excreted in
urine with a half life of 5-7 hours, 6.3 hours,
7-11 hours, 20-23 hours, 25-26 hours, or 30-
100 hours depending on the drug.
Indication:
- use to treat patients with partial seizures
(simple partial seizures or complex partial
seizures
Contraindication:
- Patients who are Allergy to prevent
hypersensitivity
- Bone marrow suppression
- Severe hepatic dysfunction
- Pregnant or lactating women
- Men considering fathering a child because
these drugs could decrease fertility and it
could increase birth defects in offspring
Caution
- for patients with Renal and Hepatic
dysfunction, which could alter with the
metabolism and excretion of the drug;
Patients with Renal stone, which could
exacerbate by the effects of some of these
agents
Adverse effects
- Drowsiness
- Fatigue
- Weakness
 - Confusion methsuximide - reserved for treatment of seizure
- Headache refractory to other agents because its associated with
- Insomnia more severe adverse effects.
- Nausea
- Vomiting Pharmacokinetics
- Anorexia A- GI tract, reach peak level 1-7hrs
- Upper respiratory infection D- cross the placenta and enter breast milk
- Toxic to the liver M- liver
- Severe liver failure E - Urine
 ethosuximide- half-life is 30 hours in children;
- Aplastic anemia
60 hours in adult
- Rash
 Methsuximide- 2.6-4 hours
- Abuse medication and alcohol
- Loss of vision
Contraindications:
- allergy to Succinimides
 All these drugs have a BLACK BOX WARNING and
- Patient with intermittent porphyria
could increase potential suicidal when on these
- Patient with renal or hepatic diseases
drugs.
- Pregnancy and lactation
DRUG TO DRUG INTERACTION
these drugs should not be taken with: Drug-drug interaction
o Alcohol and other CNS depressants -using succinimides with primidone cause a increased
in a serum level of primidone
- increase CNS depression
o Hormonal Contraceptives
Adverse Effects:
- lower the effect if combined with rufinamide;
o NCS
consider a barrier contraceptive if needed.
- depression, drowsiness, fatigue, ataxia,
insomnia, headache, blurred vision
Nursing considerations
o GI activity
- Assess for the contraindication and cautions
- Nausea vomiting, anorexia, weight loss, GI
- Get baseline data and physical assessment
pain, constipation
- Assess for skin color and lesions, level of
o Bone marrow suppression, potential fatal
orientation, affect, and reflexes
pancytopenia,
- Assess for brain, renal and liver function
o Dermatological reaction
- Monitor results of laboratory tests such as
- Pruritus, urticaria, alopencia, Steve-Johnson
urinalysis and CBC with differential to identify
Syndrome
changes I n bone marrow function
Nursing Considerations:
- Monitor the patient
Classification: Succinimides
- Appropriate dose adjustment
Action:
Classification: Hydantoins
- most frequently used for treating absence
- Less sedating
seizure, a form of generalized seizure.
- Suppress the normal electrical activity in the - Drug of choice for px who are not willing to
brain tolerate drowsiness

Indication: Sample Medication

- ethosuximide and methsuximide are - ethotoin (Preganone)
indicated for control of absence seizure. - fosphenytoin (Cerebyx)
- phenytoin (Dilantin)
ethosuximide - should be tried 1st
Action

GROUP 2 : Azuelo,Cano Pacheco, Inoc, Pareja, Tejano

 - stabilize nerve membrane throughout CNS - Pregnant women/ Lactating women
by directly influencing ionic channels,
thereby decreasing excitability and Adverse Effects
hyperexcitability to stimulation. - CNS effects related to: CNS suppression
(weakness, fatigue, drowsiness, dizziness and
Pharmacokinetics paresthesia (tingling or pricking sensation;
A: GI tract damage to peripheral nerves))
D: passes to the placenta
M: liver
E: urine Valporic Acid
- reduces abnormal electrical activity in the
Indications brain
- ttt fro tonic clonic and psychomotor seizures - Used to treat: epilepsy, bipolar disorder, and
- status epilepticus prevents migraine
- ttt for seizure after neurosurgery - May increase GABA activity at inhibitory
C/I and Cautions: receptors
- allergy
- pregnancy/lactation Indications
- elderly - Migraine Prevention
- impaired renal or liver function - Absence seizures, partial seizure, &
- diabetic generalized seizures
- CV problems
Adverse effects Contraindications
- Depression, confusion, drowsiness, lethargy, - Pregnant Women (Category X)
fatigue, constipation, severe liver toxicity,
bone marrow suppression, gingival Pharmacokinetics:
hyperplasia, Frank-malignant lymphoma Mode: Oral & IV
A: GI tract
Drug to Drug Interaction M: Liver
Do not combine with: E: Urine
o Alcohol - increase CNS depression
o Evening primrose - increase risk for seizure  Peak levels: 1 - 4 hours
o ginkgo - could cause serious adverse effects  Half life: 6 - 16 hours

Nursing Considerations Adverse Effects

- monitor cardiovascular status
- be aware of name confusion (Cerebyx,
celebrex, celexa, xanax)
Other Drugs for ttt of absence seizures:
- Acetazolamide (Diamox)
- Valporic Acid (Depakene)
- Zonisamide (Zonegram)
Contraindications
- Known allergy to any component of the drug
- (For Sulfonamides) known allergy to
antibacterial Sulfonamides and Thizide
diuretics (Hypertension control) to avoid
hypersensitivity
- Hepatic/ Renal Impairment
- Liver toxicity
Drug to drug interactions
- increase serum levels
Potential toxicity of:
- Phenobarbital (ttt of types of epilepsy)
- Ethosuximide (ttt of absence seizures)
- Diazepam (Benzodiazepine: calming effect)
- Primidone (ttt of partial and generalized
seizures and essential tremors)
- Zidovudine
- Phenytoin (anti seizure meds; prevents tonic-
clonic seizures and focal seizures) may cause
breakthrough seizures
- Carbamazepine (Anticonvulsant meds; ttt of
epilepsy and nueropathic pain) Increase
zonisamide levels and toxicity

GROUP 2 : Azuelo,Cano Pacheco, Inoc, Pareja, Tejano

Zonisamide (sulfonamide) - Most frequently used anxiolytic drugs
- Inhibits voltage-sensitive sodium and calcium - Used to prevent anxiety without causing
channels much sedation
- Stabilizes the nerve cell membranes and
modulating calcium-dependent presynaptic Sample medications:
release of excitatory neurotransmitters 1. Alpazoram
- Px should be well hydrated 2. Chlorodiazepoxide
3. Clonazepam
Contraindications 4. Chlorazepate
- Risk for precipitating seizures 5. Diazepam
- Risk of renal calculi (Kidney stones) 6. Estazolam
development 7. Flurazepam
8. Lorazepam
Pharmacokinetics 9. Midazolam
Mode: Oral 10. Oxazepam
A: GI tract 11. Quazepam
E: Unchanged in Urine 12. Temazepam
13. Triazolam
- Peak levels: 2 - 6 hours
- Half life: 63 hours Pharmacokinetics
Adverse Effects - Peak levels: 30 mins – 2 hours
- Bone marrow suppression A - Well absorbed from the GI tract
- Renal calculi development (kidney stones) D – passes the placenta
- GI upset M - Liver
E – urine
Acetazolamide (sulfonamide)
- Alters electrolyte movement Contraindications:
- Stabilizes nerve cell membranes - Allergy to benzodiazepines
- Ttt of Glaucoma; epilepsy; altitude sickness; - Acute narrow glaucoma
periodic paralysis; idiopathic intracranial - Shock
hypertension; heart failure - Coma
- Acute alcoholic intoxication
Pharmacokinetics: - Pregnant
Mode: Oral, IM & IV
A: GI tract  Use with caution in elderly or deliberated patients
E: Unchanged in Urine
Actions
- Half life: 2.5 - 6 hours - Act in the limbic system and RAS to make
GABA more important
Adverse Effects - Causing interference with neuron firing
- Rash Indications
- Dermatological changes - Anxiety disorders, alcohol withdrawal,
hyperexcitability and agitation and
Drug to drug interactions preoperative relief of anxiety and tension
- increase serum levels of quinidine (anti- Adverse Effects
arrhythmic agent in the heart); tricyclic o Nervous system
antidepressants; & amphetamines (CNS - Sedation, drowsiness, lethargy, blurred
stimulants) vision, headaches,
- Increase salicytate toxicity when giver o GI conditions
salicytes - Dry mouth, constipation, nausea, vomiting
o Cardiovascular Problems
Classification: Benzodiazepines

GROUP 2 : Azuelo,Cano Pacheco, Inoc, Pareja, Tejano

 - Arrythmias, palpitations, and respiratory - Respiratory depression and laryngospasm
difficulties. - Rash, serum sickness, Stevens – Johnson
o Hematological conditions syndrome
- Blood dyscrasias
o Genitourinary effects Drug to Drug Interaction
- Urinary retention and hesitancy, loss of libido - Increased CNS depression if taken with
and change in sexual functioning alcohol, antihistamines and other
tranquilizers
Drug to Drug Interaction - Altered response to phenytoin if combined
- If taken with other CNS depressants or with barbiturates
alcohol it may cause CNS depression. - Barbiturates + MIO = increased serum levels
- Action increases when taken with: - Enzyme induction in liver decreases
cimetidine, disulfiram effectiveness of barbiturates
- Action is decreased if given with theophylline - Px. Should be monitored closely if
or ranitidine barbiturates are given with
1. Oral anticoagulants
Classification: Barbiturates 2. Digoxin
- Sedative-hypnotic drug 3. Tricyclic antidepressants
- Greater chances od sedation and adverse 4. Corticosteroids
effects 5. Oral contraceptive estrogens
Sample medications:
1. Amobarbital
2. Butobarbital
3. Pentobarbital
4. Phenobarbital
5. Secobarbital

Pharmacokinetics
- Peak levels : 20 – 60 mins
A – Absorbed Well
M - Liver
E – Urine

 Longer acting = metabolized slower &

excreted to a greater degree of unchanged in
the urine

Contraindications
- Allergy to Barbiturates
- Previous history of addiction
- Latent or manifested porphyria
- Respiratory distress or severe respiratory
dysfunction
- Pregnancy and lactating women
- Acute or chronic pain

Adverse Effects
- Drowsiness, somnolence, lethargy, ataxia,
vertigo, a feeling of hangover
- Nausea, vomiting, constipation, diarrhea,
epigastric pain
- Bradycardia, hypotension, syncope

GROUP 2 : Azuelo,Cano Pacheco, Inoc, Pareja, Tejano