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P A R T 4
Drugs acting on the central and peripheral nervous systems
CRITICAL THINKING
What teaching implications should be considered when
meeting with J.M.?
Consider his age and the setting of his
first seizure.
What problems might J.M. encounter in school and in
athletics related to the diagnosis and the prescribed
medication?
Consider measures that may help him avoid
some of the unpleasant side effects related to this particular
drug therapy. Driving a car may be a central social focus in
the life of an older high school student
.
What problems can be anticipated and confronted before
they occur concerning laws that forbid individuals with
newly diagnosed epilepsy from driving?
Develop a teaching protocol for J.M. How will you involve
the entire family in the teaching plan?
DISCUSSION
On their first meeting, it is important for the healthcare
professional to establish a trusting relationship with J.M. and
his family. J.M., who is at a sensitive stage of development,
requires a great deal of support and encouragement to
cope with the diagnosis of epilepsy as well as the need for
drug therapy. He may need to ventilate his feelings and
concerns and discuss how he can re-enter school without
worrying about having a seizure in class. The healthcare
professional should implement a thorough drug teaching
program, including a description of warning signs to watch
for that should be reported to a healthcare professional.
J.M. should be encouraged to take the following preventive
measures:
• Have frequent oral hygiene to protect the gums.
• Avoid operating dangerous machinery or performing
tasks that require alertness while drowsy and confused.
• Pace activities as much as possible to help deal with any
fatigue and malaise.
• Take the drugs with meals if gastrointestinal upset is a
problem.
This information should be given to both J.M. and his
family in written form for future reference, along with the
name of a healthcare professional and a telephone number
to call with questions or comments. The importance of
continuous medication to suppress the seizures should be
stressed. The adverse effects of many of these drugs make
it difficult for some people to remain compliant with their
drug regimen.
After the discussion with J.M., the healthcare
professional should meet with his family members, who
also need support and encouragement to deal with his
diagnosis and its implications. They need to know what
seizures are, how the prescribed antiepileptic drugs affect
the seizures, what they can do when seizures occur, and
complete information about the drugs he must take and
their anticipated effects. In addition, it is important to work
with family members to determine whether any particular
thing precipitated the seizures. In other words, was there
any warning or aura? This may help with adjustment of drug
dosages or avoidance of certain situations or stimuli that
precipitate seizures. Family members should be encouraged
to report and record any seizure activity that occurs.
Most states and territories do not permit individuals
with newly diagnosed epilepsy to drive, and states have
varying regulations about the return of the driver’s licence
after a seizure-free interval. In New Zealand drivers are
prohibited from driving for 12 months after a seizure. Driving
may then be allowed once the epilepsy is considered to be
under control. If driving makes up a major part of J.M.’s social
activities, this news may be even more unacceptable than
his diagnosis. J.M. and his family should be counselled and
helped to devise other ways of getting to places and coping
with this restriction. J.M. may be interested in referral to a
support group for teens with similar problems, where he can
share ideas, support and frustrations.
J.M.’s condition is a chronic one that will require
continual drug therapy and evaluation. He will need
periodic reteaching and should have the opportunity to
ask additional questions and to ventilate his feelings. J.M.
should be encouraged to wear or carry a MedicAlert tag
so that emergency medical personnel are aware of his
diagnosis and the medications he is taking.
CARE GUIDE FOR J.M.: ANTIEPILEPTIC AGENTS
Assessment: History and examination
Allergies to any of these drugs; hypotension; arrhythmias;
bone marrow suppression; coma; psychoses; pregnancy
or breastfeeding; hepatic or renal dysfunction
Concurrent use of sodium valproate, cimetidine, disulfiram,
isoniazid, sulfonamides, diazoxide, folic acid, rifampicin,
sucralfate, theophylline, primidone, paracetamol
CV: blood pressure, pulse, peripheral perfusion
CNS: orientation, reflexes, affect, strength, EEG
Skin: colour, lesions, texture, temperature
GI: abdominal evaluation, bowel sounds
Respiratory: respiration, adventitious sounds
Laboratory tests: FBC, liver and renal function tests
Implementation
Discontinue drug at first sign of liver dysfunction or skin
rash.
Provide comfort and safety measures: positioning; give with
meals; skin care.
Provide support and reassurance to cope with diagnosis,
restrictions and drug effects.
Provide teaching regarding drug name, dosage, side effects,
symptoms to report and the need to wear MedicAlert
information; other drugs to avoid.
Evaluation
Evaluate drug effects: decrease in incidence and frequency
of seizures; serum drug levels within therapeutic range.
