ANTI CONVULSANT DRUGS PHARMACOLOGY

1. IMTIAZ AHMED
NURSING LECTURER
Murshid SONAM

2. By the completion of this section the learners will be able
to:
1. Discuss the classification of seizures & its types.
2. Identify classification of anti convulsants with its drugs
example.
3. Discuss the mechanism of action, indication, side
effects & category of anti convulsant drugs.
4. Explain the nursing interventions, including client
teaching related to the use of anti-convulsants.

3.  Seizures occur when abnormal electrical
signals are being rapidly fired for neurons in
the brain.
 This can happen throughout the brain
affecting both sides (generalized seizure) or
being located in a specific area of the brain
(partial or focal seizure).
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4. Partial Seizures: (involves only one hemisphere of the
brain)
1. Simple partial seizures: consciousness not impaired
2. Complex partial Seizures: consciousness impaired.
Generalized Seizures: (involves both hemisphere of
the brain)

6.  Anti convulsants also known as anti epileptic or
anti seizure drugs.
 Anti convulsant drugs can effectively control
most epileptic seizures.
 It also work by calming hyperactivity in
the brain also these drugs are used to
treat epilepsy, prevent migraines, and as a mood
stabilizer.
 These drugs do not treat the underlying disorder.
 Long term administration is usually required.

7. 1. Hydantoins
2. Benzodiazepines
3. Barbiturates
4. Succinimides

8. 1. Hydantoins:
Indication: Are primarily used in treating generalized
tonic-clonic (Grand Mal) seizures.These are some times
also used to prevent or treat seizures during or after
neuro surgery.
Drugs Include: Phenytoin (Dilantin), mephenytoin
(Mesantoin), Fosphenytoin, Ethotoin.
2. Benzodiazepines:
Indication: these are effective in treatment of absence
seizures as well as other seizures disorder.
Drugs Include: Clonazepam (Klonopin), Clorazenate,
Lorazepam & diazepam (Valium).

9. 3. Barbiturates:
Indication: This medication is used alone or with
other medications to control seizures.
Drug Includes: Phenobarbital, Mephobarbital
4. Succinimides:
Indication: the succinimides are group of chemically
related drugs that are of particular use in the
treatment of absence seizures.
Drug Includes: Ethosuximide, Methsuximide,
phensuximide

10. Others Drugs includes:
 Carbamazepine (Tegretol)
 Valporic acid (Depakote, Depakene)
 Gabapentin (Neurontin)
 Topiramate (Topamax)
 Felbamate (Felbatol)
 Magnesium sulfate
 Lamotringine (Lamictal)

11.  Generic Name: Phenytoin.
 Trade Name: Dilantin.
 Classification: Hydantoins
MOA: This medicine works by slowing down impulses in the
brain that cause seizures.
Indication: Phenytoin are primarily used in treating
generalized seizures. Phenytoin does not treat all types of
seizures.
Route: Oral, IM, IV
Common Adverse Effects: Dizziness, confusion, insomnia,
slurred speech, N/V, Rashes, Hepatotoxicity.

12. Nursing Intervention of Phenytoin:
 Phenytoin should be diluted in 0.9% Normal Saline
only as it is only compatible in Saline.
 To prevent arrhythmias and hypotension. It should be
well diluted and given slowly with cardiac monitor.
Rapid IV administration may cause cardiovascular
arrest.
 Monitor patient for gingival hyperplasia. Patient
should be encouraged to practiced good oral hygiene.

13. Classification: Benzodiazepines
Indication: Used to treat a variety of seizure disorder
including absence & myoclonic seizures.
Common Adverse Effect: CNS depression, Behavioral
changes, confusion, anorexia, muscular weakness &
increased salivation.
Nursing Intervention:
 Should be used with caution in patient chronic
respiratory disorders.
 Patient should advice not to involve in hazardous task
since drug may cause dizziness & drowsiness.

14.  Generic Name: Phenobarbital
 Trade Name: Luminal
 Classification: Barbiturates
Indication: It is used to treat insomnia and as a
sedative to relieve the symptoms of anxiety or
tension. It is also used for the control of certain types
of seizures. It works by slowing down the brain and
nervous system.
Route: Oral
Adverse Effects: CNS & Respiratory depression,
Hepatoxicity, nausea & vomiting.

15.  Generic name: Ethosuximide
 Trade name: Zarontin
 Classification: Succinimides
Indication: This medicine is used along with other
medications by controlling the abnormal electric
activities in the brain that occur during seizures.
Route: Oral
Adverse Effects: Nephrotoxicity, Hepatoxicity, Nausea,
Vomiting, Drowsiness & Dizziness.

16.  Generic Name: Carbamazepine
 Trade Name: Tegretol
 Classification: Other
MOA: It works by decreasing nerve impulses that
cause seizures and pain.
Indication: used for the treatment of certain types
of seizures (partial, tonic clonic), nerve pain (such
as trigeminal neuralgia).
Adverse Effects: Blood abnormalities, nausea,
vomiting, dizziness, drowsiness, Hepatoxicity.

17.  Generic Name: Valproic acid.
 Trade Name: Valproate Sodium
 Classification: Other
Indication: This medicine used to treat absence seizures and
to prevent Migraine headache, also treat anxiety.
MOA: It increase brain levels of GABA, a substance which
inhibit electrical impulse transmission in nerve cells.
Side Effects:
Diarrhea, dizziness, drowsiness, hair loss, blurred/double
vision, ringing in the ears, shakiness (tremor),
unsteadiness, weight changes, CNS depression.

18.  Generic Name: Lamotringine
 Trade Name: Lamictal
 Classification: Other
Indication: Lamotringine is used with combination of other
anti convulsant (i.e:Valporic Acid) in the treatment of partial
seizures in adult also to treat generalized tonic clonic,
absence & myoclonic seizures.
SideEffects:
Dizziness, visual disturbance, skin rash, sedation, Nausea/
vomiting & upset stomach.

19.  Observe for therapeutic effects of the drug.
 Observe the adverse effects and also teach the client
about it.
 Teach the client not to stop drug abruptly. Gradually
taper off the dose may reduce the chance of withdrawal
effects.
 Do not change brands or dosage without physician's
consultation.
 Regular follow ups
 Lab investigations i.e:Valproic acid can cause serious
liver damage so check LFT’s.

20.  Anticonvulsant drugs work on the central nervous
system, they may add to the effects of alcohol and
other drugs e.g: antihistamines.
 Safety precautions: driving, use machines,
coagulation disorders (PT, APTT).
 To promote compliance, educate the patient the
importance of taking anti seizure drugs exactly as
prescribe.

21.  Teach the patient to maintain seizure frequency chart.
 Phenytoin decreases the effect of birth control pills,
teach the patient accordingly.
 Monitor liver functions with drugs as it cause liver
damage.
 Advice the patient to take Valporate with meals to
reduce gastric upset.
 Give drugs I. V during status epilepticus to have the
desired effects.
 Monitor plasma drug level as means of encouraging and
evaluating compliance.

22. Retrieved From:
 https://reference.medscape.com/drug/zarontin-ethosuximide-343007
 https://www.webmd.com/drugs/2/drug-4582-7217/lamotrigine-
oral/lamotrigine-oral/details
 https://medlineplus.gov/druginfo/meds/a682007.html
 https://www.drugs.com/phenytoin.html
 https://www.webmd.com/drugs/2/drug-8885/valproic-acid-oral/details
 Clayton BD, StockYN, Harroun RD. Basic pharmacology for nurses. (14th
ed.). Philadelphia: Mosby, 2007.
 Reiss, B. S., & Evans, M. E. (2002). Pharmacological aspects of nursing care
(6th ed.). NewYork: Delmar.
 Abrams, A.C.(2001). Clinical drug therapy: rationales for nursing practice.
(5th. Ed). Philadelphia: Lippincott.