Case prompt: LV is a 19 yo male recently diagnosed with grand-mal seizures. If you were prescribing the patient’s medication, what would you try first and 2nd if the first line was not adequately preventing recurrent seizures? What would you monitor for efficacy and side effects for the medication you started him on?
He was diagnosed with grand-mal seizures after being brought into an ED in status epilepticus. What mediation would you try first to stop the acute seizure? What are the monitoring parameters of efficacy and side effects of it?
What are some causes of drug induced/chemical induced seizures that as the APN you need to rule out?
SOLUTION TO CASE STUDY
- If You Were Prescribing the Patient’s Medication, What Would You Try First and 2nd If the First Line Was Not Adequately Preventing Recurrent Seizures? What Would You Monitor For Efficacy And Side Effects For The Medication You Started Him On?
I would prescribe valproic acid as the first-line treatment for grand mal seizures. It is classified as an anticonvulsant that works by blocking sustained high-frequency repetitive firing of neurons at therapeutic concentrations hence reducing seizures (Rosenthal & Burchum, 2020). Second-line medications include carbamazepine and phenytoin. Phenobarbital is used as an alternative agent in adults but is considered the first line in pediatric patients (Rosenthal & Burchum, 2020). Phenytoin Blocks sodium channels and inhibits the generation of rapidly repetitive action potentials.
When administering anticonvulsants like valproic acid, it is essential to carefully monitor liver function tests due to the increased risk of hepatotoxicity, especially in patients under 2years of age (Rahman & Nguyen, 2020). Also, CBC to ensure the drug levels are within the therapeutic ranges and dosage adjustments. The drug should be started gradually to avoid dose-related toxicities, including nausea, vomiting, heartburn, and abdominal pains.
- He Was Diagnosed With Grand-Mal Seizures After Being Brought Into An ED In Status Epilepticus. What Mediation Would You Try First To Stop The Acute Seizure? What Are The Monitoring Parameters Of Efficacy And Side Effects Of It?
Intravenous sodium valproate infusion 10-15mg/kg/day divided q12hr over 1 hour. The maximum dose is 60ml/kg/day, and the IV medications are to be switched to oral once the patient is stable (Rosenthal & Burchum, 2020). Patients taking valproic acid can develop adverse reactions such as anaphylaxis, hallucinations, psychosis, hyponatremia, hepatotoxicity, hypothermia, and thrombocytopenia; healthcare providers should closely monitor the patients. ALT and AST should be performed to ensure they are within the normal ranges (Rahman & Nguyen, 2020). In addition, mental health examinations should be done to screen for depression or other psychiatric disorders associated with the drug.
- What Are Some Causes Of Drug-Induced/Chemical-Induced Seizures That As The APN You Need To Rule Out?
Common causes of drug-induced seizures are dug intoxication caused by an overdose of medications such as antidepressants, stimulants, and antihistamines (Löscher et al., 2020) s. Some poisonous agents, such as parathion pesticides, can cause seizures. Administering benzodiazepines is the first line for drug-induced seizures.
Löscher, W., Potschka, H., Sisodiya, S. M., & Vezzani, A. (2020). Drug Resistance in Epilepsy: Clinical Impact, Potential Mechanisms, and New Innovative Treatment Options. Pharmacological Reviews, 72(3), 606–638. https://pharmrev.aspetjournals.org/content/72/3/606.abstract
Rahman, M., & Nguyen, H. (2020). Valproic Acid (Divalproex Sodium). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559112/
Rosenthal, L., & Burchum, J. (2020). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants – E-Book. In Google Books. Elsevier Health Sciences. https://books.google.co.ke/books?hl=en&lr=&id=IPm9DwAAQBAJ&oi=fnd&pg=PP1&dq=LEHNE%27S+PHARMACOTHERAPEUTICS+FOR+ADVANCED+PRACTICE+NURSES+AND+PHYSICIAN+ASSISTANTS
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