Chapter 52 Drug Therapy for Seizure Disorders and Spasticity

1. A patient has a left temporal brain tumor. He smells an odor of ammonia prior to experiencing rapid rhythmic jerking movements. What is the odor of ammonia classified as?

1. A)  Chemical agent evoked by the tumor
2. B)  An aura prior to the seizure activity
3. C)  The metastatic process of tumor growth
4. D)  The inhibition of serotonin and acetylcholine

Ans: B
Feedback:
The smell of ammonia is an aura, which is a warning prior to seizure activity. The tumor will not evoke a chemical agent prior to the seizure. The metastatic process will not evoke a chemical smell. The chemical smell is not related to the inhibition of serotonin and acetylcholine.

2. A patient has been taking phenytoin (Dilantin) for a seizure disorder. He has recently run out of his medication and has not obtained a refill. What is the patient at risk for developing?

1. A)  Hypotension
2. B)  Migraine headaches
3. C)  Status epilepticus
4. D)  Depression

Ans: C

Feedback:

In a person taking medications for a diagnosed seizure disorder, the most common cause of status epilepticus is abruptly stopping AEDs. Abruptly stopping phenytoin will not cause hypotension. Abruptly stopping phenytoin will not cause migraine headaches. Abruptly stopping phenytoin will not cause depression.

3. A patient is admitted to the emergency room in status epilepticus. What medication may be administered intravenously to assist in reducing seizure activity?

A)
B)
C)
D)
Ans:
Feedback:
IV diazepam is an adjunctive skeletal muscle relaxant administered for the treatment of severe recurrent convulsive seizures and status epilepticus. Ethosuximide (Zarontin) is not administered for status epilepticus. Meperidine (Demerol) and insulin are not administered for status epilepticus.

Diazepam (Valium) Hydromorphone (Dilaudid) Insulin
Meperidine (Demerol)
A

Page 1

4. An 80-year-old patient has severe pain after a case of shingles. The pain is noted along the shoulder and back. He states the pain is so severe he cannot sleep. What is the primary medication that will relieve this pain?

1. A)  Meperidine (Demerol)
2. B)  Morphine sulfate (MS Contin)
3. C)  Naproxen sodium (Naprosyn)
4. D)  Gabapentin (Neurontin)

Ans: D

Feedback:

Gabapentin is the first oral medication approved by the FDA for the management of postherpetic neuralgia. Meperidine will provide pain relief but is not effective in postherpetic neuralgia. Morphine sulfate will provide pain relief but is not effective in postherpetic neuralgia. Naproxen sodium will decrease inflammation but is not effective for postherpetic neuralgia.

5. A patient who has been taking valproic acid (sodium valproate) for a seizure disorder is asking the nurse about getting pregnant. Why is pregnancy discouraged in women who are being treated for seizure disorders?

1. A)  Seizure disorders are genetic.
2. B)  Seizure disorders are familial.
3. C)  Antiepilepsy drugs decrease fertility.
4. D)  Antiepilepsy drugs are teratogenic.

Ans: D
Feedback:
Antiepileptic drugs such as valproic acid must be used cautiously during pregnancy because they are teratogenic. Seizure disorders are not normally genetic or familial. Antiepilepsy medications do not decrease fertility.

6. A patient is being treated for a seizure disorder with phenytoin (Dilantin). He is admitted to the emergency room with sinus bradycardia. What action will occur regarding his antiepileptic agent?

1. A)  Phenytoin (Dilantin) dose will be reduced.
2. B)  Phenytoin (Dilantin) will be discontinued.
3. C)  Phenytoin (Dilantin) will be given every other day.
4. D)  Phenytoin (Dilantin) dose will be increased.

Ans: B
Feedback:
Phenytoin should be discontinued immediately because it is contraindicated in patients with sinus bradycardia. Reducing the frequency of administration would likely be insufficient.