Seizure Disorder Management case study

Seizure Disorder Management Submitted by Shannon Delite Leake The University of Texas at Arlington College of Nursing In partial fulfillment of the requirements of Advanced Pharmacology N5334 Mary Davis, DNP, MSN, RN, APN-BC, CRNP, ADM-BC October 10, 2017 1 Seizure Disorder Management Seizure Disorder Management CASE SUMMARY: Mr. John Case Study is a 68-year-old male. He is currently receiving Carbamazepine for seizure control. Today labs will be obtained, and Mr. Study will be placed on a new antiepileptic medication with plans to begin titrating him off of current antiepileptic medication, he will also be placed on a supplement of calcium and vitamin D to support bone health. 5334 CASE SUMMARY TABLE 1. Symptoms: List two pertinent signs and symptoms Possible decreased serum blood levels of vitamin D related to long term use of antiepileptic. Possible decreased serum blood levels of calcium related to long term use of antiepileptic. 2. Recommended Drugs: **Drug of choice – list at least 3 recommended drugs List recommended drugs as indicated for this diagnosis  Gabapentin (Neurotin, Gralise, Horizant) 300mg orally 3 times a day and titrate up to therapeutic level which are usually 900mg – 1200mg/day in three divided doses no more than twelve hours apart, however 2400mg – 3500mg/day have been well tolerated in some individuals short term (Vallerand, Deglin, & Sanoski 2017).  Levetiracetam (Keppra) in adults and children greater than, or equal to 16-years-old start with 500mg two times a day for two weeks then increase by 1000mg/day every 2 Seizure Disorder Management two weeks until maintenance dose of 3000mg/day (1500mg two times a day) is reached (Vallrerand, Deglin, & Sanoski, 2017).  Phenytoin (Dilantin) loading dose of 15 to 20mg/kg/day in extended release capsules in three divided doses to be taken every two to four hours then move to maintenance dose of 5 to 6mg/kg/day in one to up to three divided doses. Dosing range is 200mg up to 1200mg (Vallerand, Deglin, & Sanoski).  Over-the-counter Vitamin D 1000 Independent Units – three soft gel capsules by mouth two times daily (Teagarden, Meador, & Loring, 2014).  Over-the-counter Calcium 600mg by mouth two times a day (Teagarden, Meador, & Loring, 2014). 3. Drug Categories and Subcategories: Identify the category of each recommended drug.  Gabapentin (Neurotin, Gralise, Horizant) is classified therapeutically as an antiepileptic, analgesic adjunct, and a mood stabilizer. It is categorized as a pregnancy c category medication (Vallerand, Deglin, & Sanoski, 2017).  Levetiracetam (Keppra) is therapeutically an anticonvulsant. Pharmacologically is a pyrrolidine, and is categorized as a pregnancy C category medication (Vallerand, Deglin, & Sanoski, 2017).  Phenytoin (Dilantin) is therapeutically classified as an anticonvulsant and an antiarrthymic and pharmacologically as a hyndantoin. It is categorized as a pregnancy D category medication (group IB) (Vallerand, Deglin, & Sanoski, 2017).  Vitamin D3 is classified as a vitamin (Vitamin, n.d.).  Calcium is classified as a mineral (Calcium, n.d.). 4. Drug(s) of Choice: FOR THE MAIN DIAGNOSIS ONLY, provide the chosen drug(s) of choice for treatment. 5. Rationale: Provide rationale, clinical guidelines, or evidence for the selected 3 Seizure Disorder Management drug of choice  Levetiracetam (Keppra) will be added to current medications due to no noted drug/drug interactions have been noted (Vallerand, Deglin, & Sanoski). 6. Contraindications and or Risks, as appropriate: Identify contraindications and risks as appropriate  Those patients with a hypersensitivity to Keppra and in lactation (Vallerand, Deglin, & Sanoski, 2017). 7. What Patients Must Understand: Identify at least 3 appropriate teaching points for the patient and/or family (HINT: 3 teaching points is rarely adequate for good patient care)  Suicidal thoughts, aggression, coordination difficulty, anxiety, apathy, dizziness, drowsiness, apathy, depression, hyperkinesia, depersonalization, Steven-Johnson Syndrome, irritability, hostility, fatigue, Toxic Epidermal Necrolysis, personality disorder, psychosis, hypertension, anemia, neutropenia, weakness, agranulocytosis, anemia, and Drug reaction with eosinophilia and symptomatic symptoms (DRESS) (Vallerand, Deglin, & Sanoski, 2017).  Take exactly as directed. Take missed doses as soon as you notice the missed dose, unless almost time for next dose. Do not double up on doses. Do not stop taking abruptly, always read the medication insert before starting this medication and with each refill (Vallerand, Deglin, & Sanoski, 2017).  Notify offce immediately if skin rash, fever, or swollen lymph glands occur, or if frequency of seizures increases (Vallerand, Deglin, & Sanoski, 2017).  Do not drive until you have been released to drive (Vallerand, Deglin, & Sanoski, 2017).  Report any suicidal thoughts, or behaviors immediately (Vallerand, Deglin, & 4 Seizure Disorder Management Sanoski, 2017).  Do not do any task that requires alertness until response to medication has been established (Vallerand, Deglin, & Sanoski, 2017).  Signs and symptoms of DRESS: fever, rash, swollen or enlarged lymph glands, (Choudhary, et al, 2013).  Physical activity helps strengthen bones (Shore, Stoelting-Gettelfinger, & Paddock, 2015).  Side effects of vitamin d (Vitamin, n.d.) and calcium (Calcium, n.d.) to report to office. 8. The Prescription(s