- Body system
- Neurology
- Drug cards
- 3 in this guide
Drugs in this class
- PhenytoinDilantin, Phenytek
- LevetiracetamKeppra, Spritam, Elepsia XR
- Valproic acid (divalproex)Depakote, Depakote ER, Depakene
Other examples: Carbamazepine, Lamotrigine, Lacosamide, Topiramate, Gabapentin, Oxcarbazepine, Fosphenytoin.
How anticonvulsants (antiepileptic drugs) work
Reduce abnormal neuron firing by blocking sodium or calcium channels, enhancing GABA or modulating synaptic release (levetiracetam).
Uses
- Epilepsy
- Status epilepticus (after a benzodiazepine)
- Bipolar disorder (valproate, lamotrigine, carbamazepine)
- Neuropathic pain (gabapentin, carbamazepine for trigeminal neuralgia)
- Migraine prevention (valproate, topiramate)
Adverse effects
- Drowsiness, dizziness and ataxia
- Serious rashes (phenytoin, carbamazepine, lamotrigine)
- Liver injury and pancreatitis (valproate)
- Gingival hyperplasia (phenytoin)
- Suicidal thoughts (class warning)
- Birth defects (especially valproate)
Nursing considerations
- Monitor drug levels where used: phenytoin commonly 10 to 20 mcg/mL, valproate 50 to 100 mcg/mL, carbamazepine 4 to 12 mcg/mL.
- Seizure precautions; document seizure activity.
- IV phenytoin: normal saline only, slow rate, ECG and blood pressure monitoring.
Patient teaching
- Never stop suddenly: status epilepticus can occur.
- Do not drive until your provider and local law allow it.
- Many of these drugs reduce the effect of hormonal contraceptives; discuss birth control.
Anticonvulsants (antiepileptic drugs) NCLEX practice questions
Answer each question to see the rationale.
3 questions. Choose an answer to see the rationale.
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Which IV solution is compatible with phenytoin?
Show answer
Answer B: 0.9% sodium chloride Phenytoin precipitates in dextrose solutions; it is mixed and flushed with normal saline only.
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A patient taking phenytoin has nystagmus, unsteady gait and slurred speech. What does the nurse suspect?
Show answer
Answer D: Phenytoin toxicity Nystagmus and ataxia are classic signs of high phenytoin levels. Check the level and notify the provider.
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What teaching point applies to every antiepileptic drug?
Show answer
Answer C: Do not stop it suddenly Abrupt withdrawal can trigger seizures, including status epilepticus.
Frequently asked questions
What are anticonvulsants (antiepileptic drugs)?
Anticonvulsants prevent and stop seizures. Several have narrow therapeutic ranges, many interact with other drugs, and none should be stopped suddenly.
How do anticonvulsants (antiepileptic drugs) work?
Reduce abnormal neuron firing by blocking sodium or calcium channels, enhancing GABA or modulating synaptic release (levetiracetam).
What are examples of anticonvulsants (antiepileptic drugs)?
Phenytoin, Levetiracetam, Valproic acid (divalproex), Carbamazepine, Lamotrigine, Lacosamide, Topiramate and Gabapentin.
What are the nursing considerations for anticonvulsants (antiepileptic drugs)?
Monitor drug levels where used: phenytoin commonly 10 to 20 mcg/mL, valproate 50 to 100 mcg/mL, carbamazepine 4 to 12 mcg/mL. Seizure precautions; document seizure activity.