Assignment I: Antiseizure medications
Written assignment part I:
1.	What is the difference between older and more recent Antiseizure medications?
“Older, more toxic drugs are being are being replaced by newer drugs with better adverse effect profiles that maintain better control of seizures” (Abrams, Pennington, Lammom, p. 197)
2.	What are advantages and disadvantages between monotherapy and comboterapy for seizure disorders?
Advantages (monotherapy):
Fewer adverse side effects
		Fewer drug-drug interactions
Lower cost
Usually greater pt. compliance
Disadvantages:
Sometimes monotherapy is ineffective, so another drug must be added
3.	List strategies for the prevention and treatment of status epilepticus:
Prevention:
	Do not abruptly discontinue seizure medications
	Do not change brands
Treatment:
	(IV) Benzodiazepine- usually lorazepam 
	Afterwards…a long acting drug is given to prevent recurrence such as phenytoin 
   	Or fosphenytoin 
Written assignment part II:
1.	Name characteristics and effects of phenytoin:pro-type, oldest and most widely used AED
Treatment of seizure disorders
Sometimes used to treatment cardiac dysrythmias
Generalized tonic-clonic
Some partial seizures
Carbamazepine: 
Trigeminal neuralgia
Glossopharyngeal neuralgia
Seizures 
Bipolar disorder
Metabolized in the liver
Contraindicated in pts with bone marrow depression
Narrow therapeutic range
Diazepam: pro-type benzodiazepines
	Anti-anxiety
	Hypnotic
	Anticonvulsant
	Muscle spasms
	Acute alcohol withdrawal
	More commonly prescribed due to their greater therapeutic effects and rapid onset          
	Given concurrently with antipsychotic, antidepressants, and mood stabilizers
2.	Identify the implications for the use of Antiseizure medications in children, older adults, patients with renal impairment, patients with hepatic impairment, and with critical illness.
Children:
Rates of metabolism and excretion are increased (children require higher dose per Kg)
Older adults:
Have multiple medical conditions that require multiple drugs, which decrease protein binding, liver, and kidney function.
Patients with renal impairment:
	Protein binding is decreased and the amount of free active drug is higher 
	than in patients with normal renal, function.
Patients with hepatic impairment:
	Most ADEs are metabolized in the liver, and may accumulate in the 
	presence of liver disease or impaired liver function thus should be used 
	cautiously.
	Dose should be reduced or given at less frequent interval in those with 
	hepatic impairment.
Patients with critical illnesses:
	Continuing AED medications may complicate drug therapy given for 
	Other conditions because of adverse effects and potential drug-drug 
	interactions.
Clinical correlation assignment part III:
1.	Write a discharge patient teaching plan for a patient with a new prescription for Phenytoin:
•	Do not switch from a generic Dilantin, or vice versa, w/o discussing w/ the prescribing clinician. 
•	Ask your clinician if you should take (or give a child) supplements of folic acid, calcium, vit D, or vit. K these supplements may help to prevent some adverse effects of Phenytoin.
•	Brush and floss your teeth and have regular dental care to prevent or delay a gum disorder called gingival hyperplasia.
•	If you have diabetes, you may need to check your blood sugar more often or take a higher dose of your antidiabetic medication. Phenytoin may inhibit the release of insulin and increase blood sugar.
•	Notify your clinician if you develop a skin rash, severe nausea and vomiting, swollen glands, bleeding, swollen or tender gums, yellowish skin or eyes, joint pain, unexplained fever, sore throat, unusual bleeding or bruising, and if you become pregnant.
•	If you are taking a liquid suspension, do not use regular tsp. because they hold varying amounts of medications 
Web Assignment Part IV 
	1. Identify types and potential causes of seizures at www.medicinenet.com. 
On the same website, identify factors that influence choice of seizure

		Different kinds of seizures 
Seizures are placed into two different major categories, which are then broken down further. Within with these two different groups there are more than 30 different known types. The two main classifications are focal and generalized seizures. Focal seizures are often referred to as partial seizures. However, some cannot be placed into either group because they do not the follow the typical pattern of either group.
	Focal Seizures (partial)
A focal seizure occurs in a specific area of the brain. It is common for the name of focal seizures to be given based on the specific area of the brain that is affected. Focal seizures are broken down based on the level of the person’s consciousness. A person experiencing a simple focal seizure does not experience any level of impaired consciousness. A complex seizure occurs when the person’s level of consciousness is decreased. With complex and focal seizures, people may experience an unusual sensation that occurs before they seize know as aura.
Generalized seizures
The origin of generalized seizures is unknown and they occur due to an abnormal bilateral neuronal activity of the brain. Symptoms associated with generalized seizures include decreased consciousness, falling, or muscle spasms. There are several different types of generalized seizures. An absence seizure is characterized by spacing out and/or twitching of the muscles. Tonic seizures present with muscle rigidity and abnormal postures such as opisthotonos. A clonic seizure causes rapid rhythmic bilateral and symmetric jerking movements. When the upper body is affected, it is called a myoclonic seizure. An atonic seizure causes muscle atrophy. Tonic-Clonic seizures often referred to as a grand mal seizures are a combination of stiffening, and abnormal body movements that is accompanied by a decreased level of consciousness.
Febrile Seizures
Febrile seizures occur in children in response to an alarming high fever. This form of seizure is not highly associated with the development of epilepsy. However, there is correlation between a family history of epilepsy and the development of epilepsy.
Potential causes of seizures
A of any sort disturbance in neuron activity can result in a seizure. Conditions or incidences that are linked to the cause of seizures are localized brain lesion, birth injury, trauma, stroke, tumor, chemical imbalances, infection, or genetic abnormalities. In some cases, the cause of seizures is unknown. 
	Factors that influence choice of seizure
Seizures are classified by the symptoms that they cause and symptoms are different depending on the area of the brain that is affected. 		

References 
Abrams, A.C., Pennington, S.S., Lammon, C.B. (2009). Clinical drug therapy: 
	Rationales for nursing practice 9th ed. Philadelphia: Wolter Kluwer, 
	Lippincott Williams & Wilkins. 
MedicineNet.( 2012). Epilepsy (Seizure Disorder).http://www.medicinenet.com/
	seizure/article.htm.