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|ANTIEPILEPTICS, PART 1|
|DRUG NAME||phenytoin (Dilantin), fosphenytoin (Cerebyx), carbamazepine (Tegretol), valproic acid (Depacon), sodium valproate (Depakote), lamotrigine (Lamictal)||ethosuximide (Zarontin), levetiracetam (Keppra)|
|CLASS||Sodium channel blockers||Calcium channel blockers|
|MECHANISM OF ACTION||Block voltage-gated Na+ channels; inhibition of action potentials in excitatory neurons; ↓ seizure activity||Block voltage-gated Ca2+ channels; inhibition of action potentials in excitatory neurons; ↓ seizure activity|
|ROUTE(S) OF ADMINISTRATION|
|SIDE EFFECTS||Phenytoin, fosphenytoin|
|CONTRAINDICATIONS AND CAUTIONS||Phenytoin|
|ANTIEPILEPTICS, PART 2|
|DRUG NAME||vigabatrin (Sabril)||gabapentin (Neurontin, Gralise)|
|CLASS||GABA inhibitors||GABA analogues|
|MECHANISM OF ACTION||Prevent GABA reuptake into presynaptic neurons; ↑ GABA concentration in synapse; ↓ seizure activity||Structurally similar to GABA|
|ROUTE(S) OF ADMINISTRATION||vigabatrin: PO||PO|
|CONTRAINDICATIONS AND CAUTIONS||Vigabatrin|
|NURSING CONSIDERATIONS: ANTIEPILEPTICS|
|ASSESSMENT AND MONITORING||All antiepileptics|
|CLIENT EDUCATION||All antiepileptics|
|Sodium channel blockers||GABA inhibitors|
Antiepileptics, also known as anticonvulsants, are medications primarily used to treat epilepsy, as well as generalized or partial seizures. On rare occasions, these medications can be used to treat mood disorders.
Now, the most commonly used antiepileptics can be subdivided, based on their mechanism of action, into four main groups: sodium channel blockers, calcium channel blockers, GABA inhibitors, and GABA analogues.
In addition, other medications can be used as antiepileptics, including barbiturates like phenobarbital and benzodiazepines like diazepam, which are primarily used as anxiolytics and sedative-hypnotics.
Decreased activity of excitatory neurons results in the reduction and alleviation of seizures. Sodium channel blockers include hydantoins, iminostilbene derivatives, valproate derivatives, and lamotrigine.
First, let’s focus on hydantoins. These medications include phenytoin, which can be administered orally or intravenously; and its prodrug, fosphenytoin, which can be administered intravenously or intramuscularly.
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