Category / Classification of Drugs:
Antiepileptic Drugs (AEDs)
Generic name / common suffix:
carbamazepine (Mazepine®)
ethosuximide (Zarontin®)
fosphenytoin (Cerebyx®)
gabapentin (Neurontin®)
lamotrigine (Lamictal®)
levetiracetam (Keppra®)
oxcarbazepine (Trileptal®)
phenobarbital
phenytoin
valproic acid
Indications – main uses:
Prevention or control of seizure activity
Long-term maintenance therapy for chronic, recurring seizures
Acute treatment of convulsions and status epilepticus
Mechanism of action:
Exact Mechanism of action is not known but includes:
Reducing a nerve's ability to be stimulated
Suppressing transmission of impulses from one nerve to the next
Decreasing the speed of nerve impulse conduction within a neuron
Therapeutic objectives:
To control or prevent seizures while maintaining a reasonable quality of life
To minimize adverse effects and drug-induced toxicity
Antiepileptic drug (AED) therapy is usually lifelong
Contraindications:
Known drug allergies
Individual drug-specific contraindications may apply
Main side effects:
Numerous adverse effects; vary per drug
Long-term therapy with phenytoin (Dilantin®) may cause gingival hyperplasia, acne, hirsutism,
and Dilantin facies.
Individual drug-specific side effects may apply
Monitoring parameters:
Serum drug concentrations must be measured for some AEDs.
Therapeutic drug monitoring is essential.
Regular monitoring of therapeutic drug levels and patient response.
Complete blood count (CBC) and liver function studies for some drugs.
Health teaching:
Teach patients to keep a journal to monitor:
Response to AED
Seizure occurrence and descriptions
Adverse effects
Instruct patients to wear a medical alert tag or ID.
AEDs should not be discontinued abruptly.
Instruct patients to follow driving recommendations.
Teach patients that therapy is long term and possibly lifelong (not a cure).
Educate on the importance of taking oral AEDs regularly and with meals to reduce GI upset.
Provide guidance on the administration of IV AEDs and monitoring vital signs.
Emphasize avoiding extravasation of fluids and using only normal saline with IV phenytoin
(Dilantin).