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ANTICONVULSANTS

PHARMACOLOGIC PROFILE
General Use
Anticonvulsants are used to decrease the incidence and severity of seizures due various etiologies.
Some anticonvulsants are used parenterally in the immediate treatment of seizures. It is
not uncommon for patients to require more than one anticonvulsant to control seizures on a
long-term basis. Many regimens are evaluated with serum level monitoring. Several anticonvulsants
also are used to treat neuropathic pain.

General Action and Information
Anticonvulsants include a variety of agents, all capable of depressing abnormal neuronal discharges
in the CNS that may result in seizures. They may work by preventing the spread of seizure
activity, depressing the motor cortex, raising seizure threshold, or altering levels of neurotransmitters,
depending on the group. See individual drugs.
Contraindications
Previous hypersensitivity.
Precautions
Use cautiously in patients with severe hepatic or renal disease; dose adjustment may be required.
Choose agents carefully in pregnant and lactating women. Fetal hydantoin syndrome may
occur in offspring of patients who receive phenytoin during pregnancy.
Interactions
Barbiturates stimulate the metabolism of other drugs that are metabolized by the liver, decreasing
their effectiveness. Hydantoins are highly protein-bound and may displace or be displaced by
other highly protein-bound drugs. Lamotrigine, tiagabine, and topiramate are capable of interacting
with several other anticonvulsants. For more specific interactions, see individual drugs.
Many drugs are capable of lowering seizure threshold and may decrease the effectiveness of anticonvulsants,
including tricyclic antidepressants and phenothiazines.
NURSING IMPLICATIONS
Assessment
● Assess location, duration, and characteristics of seizure activity.
● Toxicity and Overdose: Monitor serum drug levels routinely throughout anticonvulsant
therapy, especially when adding or discontinuing other agents.
Potential Nursing Diagnoses
● Risk for injury (Indications) (Side Effects).
● Deficient knowledge, related to disease process and medication regimen (Patient/Family
Teaching).
Implementation
● Administer anticonvulsants around the clock. Abrupt discontinuation may precipitate status
epilepticus.
● Implement seizure precautions.
Patient/Family Teaching
● Instruct patient to take medication every day, exactly as directed.
● May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness
until response to medication is known. Do not resume driving until physician gives clearance
based on control of seizures.
● Advise patient to avoid taking alcohol or other CNS depressants concurrently with these medications.
● Advise patient to carry identification describing disease process and medication regimen at all
times.
General Action and Information
Anticonvulsants include a variety of agents, all capable of depressing abnormal neuronal discharges
in the CNS that may result in seizures. They may work by preventing the spread of seizure
activity, depressing the motor cortex, raising seizure threshold, or altering levels of neurotransmitters,
depending on the group. See individual drugs.
Contraindications
Previous hypersensitivity.
Precautions
Use cautiously in patients with severe hepatic or renal disease; dose adjustment may be required.
Choose agents carefully in pregnant and lactating women. Fetal hydantoin syndrome may
occur in offspring of patients who receive phenytoin during pregnancy.
Interactions
Barbiturates stimulate the metabolism of other drugs that are metabolized by the liver, decreasing
their effectiveness. Hydantoins are highly protein-bound and may displace or be displaced by
other highly protein-bound drugs. Lamotrigine, tiagabine, and topiramate are capable of interacting
with several other anticonvulsants. For more specific interactions, see individual drugs.
Many drugs are capable of lowering seizure threshold and may decrease the effectiveness of anticonvulsants,
including tricyclic antidepressants and phenothiazines.
NURSING IMPLICATIONS
Assessment
● Assess location, duration, and characteristics of seizure activity.
● Toxicity and Overdose: Monitor serum drug levels routinely throughout anticonvulsant
therapy, especially when adding or discontinuing other agents.
Potential Nursing Diagnoses
● Risk for injury (Indications) (Side Effects).
● Deficient knowledge, related to disease process and medication regimen (Patient/Family
Teaching).
Implementation
● Administer anticonvulsants around the clock. Abrupt discontinuation may precipitate status
epilepticus.
● Implement seizure precautions.
Patient/Family Teaching
● Instruct patient to take medication every day, exactly as directed.
● May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness
until response to medication is known. Do not resume driving until physician gives clearance
based on control of seizures.
● Advise patient to avoid taking alcohol or other CNS depressants concurrently with these medications.
● Advise patient to carry identification describing disease process and medication regimen at all
times.
Evaluation/Desired Outcomes
● Decrease or cessation of seizures without excessive sedation.

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