ANTICONVULSANTS (HYDANTOINS)

- Used for patients for having seizure

Two types of seizure:

1. Generalized seizure – this involves both side of our brain and then there are three types of generalized seizure
 Tonic –clonic (grand mal) – common type of seizure.
A. Tonic - stiffness of the body
B. Clonic – jerking movement/spasm
 Petit mal/absence seizure – common to pedia. Sx is staring/blank stare
 Atonic/drop attack – sudden fall of patient

2. Focal/Partial seizure – localized

 Simple – the patient is aware when he/she is having seizure. Less than 2mins (affected part is occipital area of
the brain)
 Complex – the patient is unaware (affected part is temporal area of the brain)

s/sx: AUTOMATISM = automatic water symptom, lip smacking, unconscious rubbing of the hands, fidgety, numbness

Nursing Responsibility:

 seizure precaution like oxygen, suction machine in bedside

 IV set access
 give anticonvulsants
 bed side rails to avoid mabagok it ulo
 avoid tight clothing
 never put anything inside the mouth of the patient

Assessment:

 ask the aura – before the seizure ask unusual happening

 time and duration

During seizure:

 Patient’s safety
 Address airway/suction machine
 Do not restrain or ayaw paghigta

After seizure:

 Turn the patient to the sides and allow the patient to rest to prevent the risk of aspiration (there might be over
secretions of saliva)
 Promote flattened airway

Stages of seizure:

1. Prodromal – s/sx happens hours-days before seizure. s/sx like anxiety, anger, GI or bladder problem, depression
2. Aura/Ominous – s/x happens seconds to minutes. s/sx focuses on the senses
3. Ictus – manifests the seizure. Top priority is the safety and airway, document the time and duration
4. Post-Ictus – after seizure, patient falls asleep. When the patient wakes up they will feel dizzy, confused and
temporary memory loss

Normally the duration of seizure is 1-3 minutes. If beyond 5min seizure or multiple seizure, report immediately.
Status Epilepticus – duration of seizure is beyond 5mins or multiple seizure within 5mins

MEDICATION OF SEIZURE

 Hydantoins – anticonvulsant drugs they inhibit the neuromuscular transmission, they can be prescribed either
for long term management (status epilepticus or chronic epilepsy), for short term management (acute isolated
seizure caused by epilepsy)
- Some anticonvulsants are used for the treatment status epilepticus

( notes ppt)

Drug examples:

 Ethotoin (Peganone)
 Fosphenytoin (Cerebyx) - hydantoins
 Phenytoin (Dilantin, Phenytek) – hydantoins, most commonly prescribed anticonvulsants and one of drug of
choice to treat seizure, the enzyme system responsible for the metabolism of phenytoin is saturable, a change in
dose can result in disproportional changes in serum concentration

Normal level of phenytoin is 10-20 microgram per mL

Indications and contraindications: (notes ppt)

Heart block – slow heart rhythm or bradycardic patient

Normal heart rate: 60-100 bpm

Role as Nurses: (notes ppt)

 Assessment (time and duration) and monitoring (s/x of toxicity)

 Check the phenytoin level to check the toxicity
 When administering phenytoin I.V., dilute in normal saline solution because the phenytoin is nag ccrystallized
(dextrose solutions cause a precipitate ); infuse no faster than 50 mg/ minute.
 Monitor vital sign s, blood pressure, and electrocardiogram (ECG) because of the risk of arrythmia during I.V.
administration
 Instruct the patient to avoid any hazardous activity