course material

1. NURS 2040 Pharmacology In Nursing
Answers:
What factors are known to be related to causing secondary epilepsy? Which factors relate to
John’s case?
Epilepsy or Seizures occurs in one out of ten individuals who had TBI (Traumatic Brain
Injury), based on where the injury took place in the brain cell. The secondary epilepsy starts
from one part of the human brain and then spreads to both the sides (Fordington &
Manford, 2020). Brain develops scars because of those injuries. Fall, stress, missed
medication, heavy alcohol consumptions, shortage of sleep are the factors that are known to
be related to causing secondary epilepsy. In John’s case, it is a conclusion which he incurred
five years ago, when he fell from a ladder.
Discuss the mechanism of action of phenytoin and phenobarbitone (discuss what happens
at the molecular target level and how this reduces the incidence/frequency of seizures).
In the case of phenytoin, it is to mention that it is a non-specific sodium-channel blocker,
which impacts all the subtypes of voltage gated sodium channel. It helps in the prevention
of epilepsy by intruding the present positive feedback loop, which lead to high frequency
action potential propagation in the neurons (Karlander, Ljungqvist & Zelano, 2021). The
GABAA receptor complex, NA-K-ATPase, the calcium channels and the ionotropic glutamate
receptors are the parts of it. It has antiarrhythmic effects in the heart and could impede Na+
influx within the cardiac cells.
In the case of phenobarbitone, it belongs to the class of medications called barbiturate
anticonvulsants/hypnotics (Yamada, 2021). It works by the regulation of the aberrant brain
electrical activities which takes place at the time of an epilepsy. It lengthens the time the
chloride channel remains open while lowering down the central nervous system. In this
activity the sub-units of GABA-A receptor are involved. It gets metabolised by the liver and
is excreted by the kidneys as per its clearance and metabolism.
Which medication could be responsible for John’s gums increasing in size? Discuss the
common adverse reactions of John’s medications.

2. The increase of gum size (Phenytoin-Induced Gingival Overgrowth or PGO) is linked with
the gingival hyperplasia. It is basically a side effect of phenytoin. However, John should not
stop taking his medication but could minimise the side effect by ensuring that he is
maintaining a good mouth hygiene all the time (Farook, M Nizam & Alshammari, 2019). PGO
could take place as early as three months all after the medication intake and could often
reach to a condition of balance weather end of the first year.
The other adverse effects of Jones medication of Phenytoin could be constipation, dizziness,
nausea, headache, drowsiness and trouble in sleeping.
The other adverse effects of Jones medication of Phenobarbitone could be depression, lack
of energy, hangover, feeling of restlessness or excitement, a spinning sensation and drunk
feeling (Patra et al., 2019).
Why should John be advised to avoid alcohol when taking his medications? Discuss the
mechanism of action of alcohol and how these mechanisms interfere with the actions of
Anti-epileptic drugs.
John should be advised for avoiding alcohol while taking his medications because intake of
alcohol could deplete the supply of several epilepsy medications in John’s body. This might
further increase his likelihoods of having seizure (D’Alessandro et al., 2022). There are
certain medications of epilepsy that have side effects, which could be exacerbated by
alcohol consumption. There are many anticonvulsants (these are the medications that are
used for treating seizures) that could interact with the alcohol. Mood swings, drowsiness,
feeling difficulty in concentrating and business are the most common adverse impacts.
References:
D’Alessandro, C., Benedetti, A., Di Paolo, A., Giannese, D., & Cupisti, A. (2022). Interactions
between Food and Drugs, and Nutritional Status in Renal Patients: A Narrative
Review. Nutrients, 14(1), 212.
Farook, F. F., M Nizam, M. N., & Alshammari, A. (2019). An update on the mechanisms of
phenytoin induced gingival overgrowth. The Open Dentistry Journal, 13(1).
Fordington, S., & Manford, M. (2020). A review of seizures and epilepsy following traumatic
brain injury. Journal of neurology, 267(10), 3105-3111.
Karlander, M., Ljungqvist, J., & Zelano, J. (2021). Post-traumatic epilepsy in adults: a
nationwide register-based study. Journal of Neurology, Neurosurgery & Psychiatry, 92(6),
617-621.
Patra, P. H., Barker?Haliski, M., White, H. S., Whalley, B. J., Glyn, S., Sandhu, H., ... & McNeish,

3. A. J. (2019). Cannabidiol reduces seizures and associated behavioral comorbidities in a
range of animal seizure and epilepsy models. Epilepsia, 60(2), 303-314.
Yamada, T. (2021). Application of humanized mice to toxicology studies: Evaluation of the
human relevance of the mode of action for rodent liver tumor formation by activators of the
constitutive androstane receptor (CAR). Journal of toxicologic pathology, 34(4), 283-297.