A seizure presents as uncontrolled, abnormal electrical activity of the brain that causes changes in level of consciousness, behavior, and even memory and feelings (Huff & Murr, 2022).  Luckily, anti-seizure drugs are numerous. There are different classes and many different medications that are prescribed to treat seizures. Adherence to these medications is the key to success.

Phenobarbital is in the class of Barbiturates. Phenobartbital can cause side effects such as drowsiness, vitamin B and D deficiency, laryngospams. Overdose on this medication can cause severe respiratory depression, CNS depression, coma, and death. It is important to teach the patient to not take this medication with alcohol or other CNS depressants. It could increase the possibility of respiratory depression or cardiac arrest.

Valproic acid causes side effects such as sedation, drowsiness, Gi upset, prolonged bleeding time, visual disturbances, weight gain, muscular weakness, abdominal cramps, and photosensitivity. Important patient teaching includes fatal hepatic failure can occur especially in children under 2. Patients on thsi medication must have liver function test at specific intervals within the first 6 months. Taking over the counter medications like aspirin can increase valproic acid toxicity.

Dilantin causes side effects such as somnolence, drowsiness, dizziness, nystagmus, gingival hyperplasia, aplastic anemia, Stevens–Johnson syndrome, toxic epidermal necrolysis, cardiovascular collapse, and cardiac arrest. Important teaching includes to not drink alcohol while on this medication, speak with your provider prior to taking any herbs/supplements, include good sources of Vitamin D, Vitamin K and folic acid in diet, and never double your doses if a dose is missed.

References

Adams, M., Holland, N., & Urban, C. (2017). Pharmacology for nurses: A Pathophysiological approach (5th ed.). Prentice Hall. 

Huff JS, Murr N. Seizure. [Updated 2022 Oct 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430765/

Seizures are a result of uncontrolled discharges of the neurons (Adams et al., 2017). Medications geared towards the treatment of seizures is aimed at controlling electrolytes as they move across neuronal membranes and affect the balance of neurotransmitters (Adams et al., 2017). This is achieved in multiple ways. Medications like benzodiazapines and barbiturates stimulate GABA pathways to move chloride into the cell and suppress neurons, hydantoins like phenytoin desensitize the reception of sodium channels while succinimides like ethosuximide work to increase the threshold sensitivity to calcium influx and thereby reduce the cells excitability (Adams et al., 2017).

Side effects generally include dizziness, fatigue, urinary retention, nausea and can decrease the effectiveness of contraceptives (Mutanana et al., 2020). Some medications like levitracitam can even increase lipid profiles causing hypercholesterolemia (Asranna & Thomas, 2021). To address these concerns, we should teach patients to get up slowly if they are dizzy. Promote good sleep with normal bed times and naps with proper diets if fatigued. Urinary retention can be helped with proper hydration and voiding techniques like listening to running water while voiding. Hypercholesterolemia may be addressed by promoting a healthy diet low in cholesterol and increasing physical activity. Alternative means of contraceptives should be taught to prevent pregnancy since it lowers the effectiveness of oral contraceptives. 

 

Adams, M. P., Holland, N., & Urban, C. Q. (2017). Pharmacology for nurses. A pathophysiologic approach.  (5th ed.). Pearson Education.
https://online.vitalsource.com/books/9780134255378

Links to an external site.

Asranna, A., & Thomas, S. V. (2021). Metabolic Effects of Anti-Seizure Medications: A Time to Reevaluate Risks? Neurology India, 69(4), 964–965. https://doi.org/10.4103/0028-3886.325336

Mutanana, N., Tsvere, M., & Chiweshe, M. K. (2020). General side effects and challenges associated with anti-epilepsy medication: A review of related literature. African journal of primary health care & family medicine, 12(1), e1–e5. https://doi.org/10.4102/phcfm.v12i1.2162

Parkinson’s disease affects one’s activities of daily living and quality of life. Some of these may be corrected with non-pharmaceutical interventions to target specific problems. Postural instability, changes in posture and impaired gait are some of the motor features that become increasingly problematic as the condition progresses. Physiotherapy can improve function and maintain a sense of independence. Occupation therapy can assist with maintaining one’s independence with ADLs. Speech and language therapy can address speech intelligibility as well as the person’s ability to swallow, which is crucial to decrease the risk of aspiration. It also addresses any changes to communication that stem from cognitive-linguistic factors. Mental health therapies can also help with addressing feelings of anxiety or apathy that can arise when dealing with a new diagnosis and its progression and management. Medications to treat Parkinson’s include Levadopa, Benztropine and Dopamine Agonists.

Levadopa works by entering the remaining nerve cells and converts into dopamine. This helps overcome the deficit associated with the nerve cell death related to Parkinson’s. Levadopa is typically given in combination with a dopa-decarboxylase (DDC) to aid in breaking it down. It is most often it’s given with Carbidopa or Benserazide. This medication is started at a low dose and gradually increased until symptoms are under control. Levadopa works to improve stiffness and slowness of movement. It also improves non-motor symptoms such as speech, swallowing, sleep and depression.

Benztropine inhibits the act of acetylcholine in the brain. It also inhibits the over-activity of this neurotransmitter in the corpus striatum, which allows dopamine to exert more influence. This medication can be used alone. Benztropine works by treating the tremors and uncontrolled muscle movements.

Dopamine Agonists mimic the action of dopamine in the brain and stimulate dopamine receptors. Typically this medication is taken alone, but can be used alongside Levadopa. This medications works to control symptoms during the day for longer periods of time. It is shown to have good effects on sleep disturbances, pain and mood as well.

References

Adams, M., Holland, N., & Urban, C. (2017). Pharmacology for nurses: A Pathophysiological approach (5th ed.). Prentice Hall.


Parkinson’s disease in adults: Diagnosis and management. (2017). National Institute for Health and Care Excellence (UK). 

The cell death of dopaminergic neurons characterizes Parkinson’s disease (Armstrong & Okun, 2020) and manifests in different ways. There are the classic motor movement symptoms as well as the nonmotor aspect to consider. The treatment of the motor symptoms includes dopamine related pharmacological means while nonmotor symptoms utilize nondopaminergic means (Armstrong & Okun, 2020). Levodopa, monoamine oxidase-B inhibitors as well as dopamine agonists is the standard treatment for motor symptoms while nonmotor symptoms are treated with appropriate pharmacological families for the symptoms (Armstrong & Okun, 2020). Depression is treated with SSRI’s, sleep disorder is treated with melatonin and fiber/stool softeners are used for constipation (Armstrong & Okun, 2020).

People generally live 6.9-14.4 years after diagnosis, most often succumbing to aspiration pneumonia (Armstrong & Okun, 2020). Regarding different populations, studies show that geographic location has more relevance to PD than ethnicity (Ben-Joseph et al., 2020). The same article states that black-Africans living in Africa have statistically lower PD occurrences than African origin blacks in the United States (Ben-Jjoseph et al., 2020). Blacks tend to also have poorer outcomes of motality with a HR of 1.12, followed by Hispanics with HR 0.87, Asians with HR 0.86 and Whites 0.72 (Ben-Joseph et al, 2020).

 

Armstrong, M., & Okun, M. (2020) Diagnosis and treatment of parkinson disease: a review. JAMA. 323(6)548–560. doi:10.1001/jama.2019.22360

Ben-Joseph, A., Marshall, C. R., Lees, A. J., & Noyce, A. J. (2020). Ethnic Variation in the Manifestation of Parkinson’s Disease: A Narrative Review. Journal of Parkinson’s disease, 10(1), 31–45. https://doi.org/10.3233/JPD-191763