Antiepileptic and antiparkinson drug classes with their toxicity signs and key nursing monitoring points.
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- What is the therapeutic serum range for phenytoin (Dilantin)?
- 10 to 20 mcg/mL
- What are three classic signs of phenytoin toxicity?
- Nystagmus, ataxia, and slurred speech
- What long-term oral side effect is associated with phenytoin therapy?
- Gingival hyperplasia (overgrowth of the gums)
- What nursing instruction helps limit phenytoin-related gum overgrowth?
- Encourage frequent brushing, flossing, and regular dental checkups
- Why should IV phenytoin never be mixed with or infused through a dextrose (D5W) line?
- It precipitates (forms crystals) in dextrose solutions; it must be given with normal saline
- What is the maximum recommended IV push rate for phenytoin in adults?
- No faster than 50 mg per minute
- What lab values should be monitored regularly in a patient taking valproic acid?
- Liver function tests (AST/ALT) and ammonia level
- Why is valproic acid considered high risk during pregnancy?
- It is linked to neural tube defects in the fetus
- What lab test should be monitored regularly in a patient taking carbamazepine?
- Complete blood count (CBC), due to the risk of bone marrow suppression
- What two serious blood disorders can result from carbamazepine therapy?
- Aplastic anemia and agranulocytosis
- What serious skin reaction carries a black box warning for lamotrigine?
- Stevens-Johnson syndrome
- What should a patient starting lamotrigine be told to report immediately?
- Any new skin rash
- Which anticonvulsant is a first-line treatment specifically for absence seizures?
- Ethosuximide
- What behavioral side effects should be monitored in a patient taking levetiracetam?
- Mood changes, irritability, and depression
- What two adverse effects are commonly associated with topiramate?
- Cognitive slowing (word-finding difficulty) and kidney stones