epilepsy

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NUR-6011

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Medicine

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Apr 3, 2024

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docx

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Group C Grand mal seizures, also known as tonic-clonic seizures, are defined as a seizure that has a tonic phase followed by clonic muscle contractions (Kodankandath et al., 2023). First line medication therapy for this patient would be valproic acid. Valproic acid is a popular epilepsy treatment that helps prevent many different types of seizures (Rahman et al., (2023). Common side effects include gastrointestinal, neurological, and hematological symptoms such as nausea and vomiting, diarrhea, tremors, insomnia, depression, and weight changes (Rahman et al., 2023). Severe side effects include hepatotoxicity, hallucinations, and suicidal ideations (Rahman et al., 2023). It is important to monitor liver function tests and for signs and symptoms of pancreatitis. The efficacy of the drug will be seen by the decreased occurrence and intensity of seizures (Rahman, et al., 2023). If valproic acid alone was not working to reduce the number of seizures occurring, I would add levetiracetam, also known as Keppra, which is an anticonvulsant drug. The most common side effects include sedation, fatigue, mood swings, headache, irritability, aggression, and depression (Kumar et al., 2023). The effectiveness of Keppra manifests through reduced frequency of seizures. Status epilepticus is defined as a seizure that lasts more than five minutes involving continuous clinical and/or electrographic seizure activity or recurrent seizure activity without recovery in between seizures (Wylie et al., 2023). For a patient in the ED with status epilepticus, I would start with benzodiazepines such as lorazepam or diazepam (Heuser et al., 2022). These medications are commonly used as needed as a rescue medication and they are meant to rapidly stop seizures (Lorazepam, 2024). Respiratory and cardiovascular status should be monitored including blood pressure and heart rate (Ghiasi et al., 2023). Lorazepam takes longer to start working when compared to diazepam, however it is the preferred drug of choice due to its longer lasting effects (Ghiasi et al, 2023). Lorazepam can cause central nervous system and respiratory depression in the case of an overdose. Monitoring for hypotension, ataxia, confusion, coma, extreme drowsiness, and muscle weakness is crucial (Ghiasi et al., 2023). As an APN, it’s important to know the common causes of drug/chemical induced seizures which include the use of anti-depressants, stimulants and antihistamines (Chen et al., 2016). Seizures may be caused due to drug toxicity or an abrupt discontinuation of medications (Chen et al., 2016). References Chen, H. Y., Albertson, T. E., & Olson, K. R. (Mar 2016). Treatment of drug-induced seizures.   British journal of clinical pharmacology ,   81 (3), 412–419. https://doi.org/10.1111/bcp.12720
Ghiasi, N., Bhansali, R., Marwaha, R. (31 Jan 2023). Lorazepam. Stat Pearl Treasure Island (FL). https://www.ncbi.nlm.nih.gov/books/NBK532890/#:~:text=Monitor%20respiratory %20and%20cardiovascular%20status,liver%20function%20tests%2C%20and%20LDH . Heuser, K., Olsen, K., Ulvin, L., Gjerstad, L., Tauboll, E. (2 Apr 2022). Exon Publications. https://www.ncbi.nlm.nih.gov/books/NBK580620/#:~:text=The%20drug%20treatment %20algorithms%20for,anesthetics%20like%20propofol%20or%20midazolam . Kodankandath, T., Theodore, D., Samanta, D. (3 Jul 2023). Generalized tonic-clonic seizure. Stat Pearl Treasure Island (FL). https://www.ncbi.nlm.nih.gov/books/NBK554496/ Kumar, A., Maini, K., Kadian R. (3 Dec 2023). Levetiracetam. Stat Pearl Treasure Island (FL). https://www.ncbi.nlm.nih.gov/books/NBK499890/ Lorazepam. (2024). CURE Epilepsy Organization . https://www.cureepilepsy.org/for-patients/understanding/treatments/epilepsy-medications/ lorazepam/#:~:text=Lorazepam%20is%20a%20member%20of,the%20care%20of%20healthcare %20providers . Rahman, M., Awosika, A., Nguyen, H. (17 Aug 2023). Valproic acid. Stat Pearls Treasure Island (FL). https://www.ncbi.nlm.nih.gov/books/NBK559112/ Wylie, T., Sandhu, D., Murr, N. (8 May 2023). Status epilepticus. Stat Pearl Treasure Island (FL). https://www.ncbi.nlm.nih.gov/books/NBK430686/#:~:text=History%20and %20Physical,activity%20without%20recovery%20between%20seizures .
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