Antiepileptics: Nursing pharmacology

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.

Now, let’s focus on sodium channel blockers first. These medications work by blocking voltage-gated sodium channels, eventually inhibiting excitatory neurons from firing action potentials.

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.

Common side effects of these medications include headaches, dizziness, visual disturbances, such as blurred vision, nystagmus, and diplopia, as well as gingival hyperplasia.