ANTIEPILEPTICS (AEDs)
Epilepsy
 A general term for any of a group of neurologic
disorders characterized by recurrent episodes of
convulsive seizures, sensory disturbances, abnormal
behavior, loss of consciousness, or any combination
of these.
Select Prototype Medications
 Barbiturates:
 Phenobarbital (Luminal)
 Primidone (Mysoline)
 Hydantoins: phenytoin (Dilantin)
 Benzodiazepines:
 Diazepam (Valium)
 Lorazepam (Ativan)
 Carbamazepine (Tegretol)
 Ethosuximide (Zarontin)
 Valproic acid (Depakote)
 Gabapentin (Neurontin)
Other Medications:
 Lamotrigine (Lamictal)
 Oxcarbazepine (Trileptal)
Expected Pharmacological Action
AEDs control seizure disorders by various mechanisms, which
include:
 Slowing the entrance of sodium and calcium back into the
neuron and, thus extending the time it takes for the nerve
to return to its active state.
 Suppressing neuronal firing, which decreases seizure
activity and prevents propagation of seizure activity into
other areas of the brain.
 Decreasing seizure activity by enhancing the inhibitory
effects of gamma butyric acid (GABA)
Therapeutic Uses
Side/Adverse effect
Side/Adverse effect
Side/Adverse effect
Side/Adverse effect
Side/Adverse effect
Side/Adverse effect
Side/Adverse effect
Contraindications/Precautions
The following medications are in Pregnancy Risk Category D.
 Barbiturates are contraindicated in clients with
intermittent porphyria.
 Phenytoin are contraindicated in clients with sinus
bradycardia, sinoatrial blocks, second- and third-degree AV
block, or Stokes-Adams syndrome.
 Carbamazepine is contraindicated in clients with bone
marrow suppression or with bleeding disorders.
 Valproic acid is contraindicated in clients with liver
disorders.
Interactions
Interactions
Nursing Administration
 Monitor therapeutic plasma levels. Be aware of therapeutic
levels for medications prescribed. Notify the provider of
results.
 Advise clients taking antiepileptic medications that treatment
provides for control of seizures, not cure of disorder.
 Encourage clients to keep a seizure frequency diary to monitor
effectiveness of therapy.
 Advise clients to take medications as prescribed and not to
stop medications without consulting the provider. Sudden
cessation of medication may trigger seizures.
 Advise clients to avoid hazardous activities (driving, operating
heavy machinery) until seizures are fully controlled.
 Advise clients who are traveling to carry extra medication to
avoid interruption of treatment in locations where their
medication is not available.
 Advise clients of childbearing age to avoid pregnancy, because
medications may cause birth defects and congenital
abnormalities.
 Advise the client that phenytoin doses must be individualized.
Dosing usually starts twice a day and can be switched to once a
day dosing with an extended-release form when maintenance
dose has been established.
 Advise clients that phenytoin has a narrow therapeutic range,
and strict adherence to the medication regimen is imperative to
prevent toxicity or therapeutic failure.
Nursing Evaluation of Medication
Effectiveness
Depending on therapeutic intent, effectiveness may be
evidenced by:
 Absence or decreased occurrence of seizures
 Ability to perform ADLs
 Absence of injury