Pharmacological Effects of Anti-Epileptic Medications
Health practitioners prescribe anti-epileptic drugs (AEDs) to patients with epilepsy and epilepsy syndromes. These medications react differently to patients’ bodies. More importantly, the physiologic changes such as drug interactions, diseases, and aging affect the pharmacokinetics of the AEDs (Matvanova, 2016). For this reason, nurse practitioners have to be careful when administering AEDs to patients. The newer generations of AEDs—second and third—have proven to have fewer pharmacological effects compared to the older generations. Although the newer generations of AEDs have benefits such as improved cognitive functions, reduced drug-drug interactions, and less life-threatening adverse events, they still are unable to control seizures without affecting the quality of life of patients.
Some of the AEDs have adverse effects on the lives of patients. One of the predominant impacts of these drugs is anticonvulsant hypersensitivity syndrome (AHS) that manifests in the form of rash, fever, hepatitis, or eosinophilia (Brown, 2016). The upside is that this side effect, even though fatal, is rare. Children are more susceptible to this effect than adults. Some of the AEDs with this life-threatening condition include carbamazepine, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, and zonisamide (Brown, 2016). This effect mostly originates from taking a higher dose than recommended. The common pharmacodynamic effects of AEDs are dizziness and somnolence. In a recent study, researchers noted that patients who took pregabalin, topiramate, acetate, oxcarbazepine, and perampanel were likely to experience dizziness (Zhuo, Jiang, Li, Shao, Chen, et al., 2017). In case a patient notices this symptom, they need to seek medical advice since it is characterized as one of the adverse effects of AEDs. Meanwhile, patients who take perampanel, pregabalin, and topiramate are at higher risks of suffering from somnolence (Zhuo et al., 2017). These drugs make patients develop strong feelings of sleepiness for long periods.
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There are other life-threatening effects of AEDs that need to be investigated within the field of medicine. They include hepatic failure, hematological, acute pancreatitis, acute renal failure, Stevens-Johnson syndrome, congestive heart failure, and pancreatic failure (Brown, 2016). If not well managed, these symptoms can result in death in patients with epilepsy. Some of the drugs that exhibit these pharmacodynamic properties are carbamazepine, gabapentin, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, pregabalin, topiramate, and valproate (Brown, 2016). Despite the research that has been applied in the manufacture of the second and third generation of AEDs, there is no assurance of safety when taking these drugs.
Apart from life-threatening conditions, the AEDs also have adverse reactions. They include fatigue, severe sedation, headache, weight gain, tremor, hyponatremia, restlessness, dizziness, and irritability (Bown, 2016). Despite the effects, the FDA has been approving the new AEDs over the years. Currently, there is limited research about the resistance to AEDs since the development of new drugs is risky and costly. Take, for example, rufinamide, which the FDA has licensed for the treatment of epilepsy in patients above four years of age and weighing above 30 kg, has effects such as nausea, constipation, and weight loss (Brown, 2016). Nevertheless, the drug is still used in care settings. Topiramate is another drug that has predisposed patients to adverse reactions, including renal calculi, acute angle-closure glaucoma, memory impairment, and difficulty in concentration (Brown, 2016). Despite the above effects, these drugs have proven to be effective in the treatment of epilepsy.
Nursing Implications
Nonetheless, nurse practitioners need to understand the pharmacodynamic properties of these drugs so that they can enhance their care delivery. All AEDs caution patients about the possibility of a suicide attempt: knowing the pharmacology and adverse effects of AEDs is vital since it enables the nurse practitioners to check on the dosage that they administer to patients (LaPenna & Tormoechlen, 2017). Although the AEDs improve the health outcomes of patients, any mistake in the administration of the drugs can result in negative consequences. The understanding of the pharmacodynamic properties of AEDs enables nurse practitioners to prioritize the medicines that have minimal effects on the patients’ health. This knowledge enhances the clinical decision-making process as it considers aspects such as patients’ ability to endure the side effects, cost, the availability of the drugs, drug-drug interactions, and the usage of monotherapy or multitherapy (Zhuo et al., 2017). Once the caregivers have considered these factors, they will determine the most suitable approach to manage patients with epilepsy.
Besides, the knowledge of the pharmacological properties of AEDs enables nurse practitioners to measure the required dosage accurately. Take, for example, topiramate, which has been described as one of the most effective AEDs due to its ability to inhibit synaptic conductance and excitatory glutamatergic transmission, both factors for seizure discharges (Zhuo et al., 2017). Although it is vital in treating epilepsy, it has been associated with somnolence and dizziness. Nurse practitioners can prevent the occurrence of these adverse reactions by setting the low doses of the drugs using slow titration. Another factor is the unique population. By knowing the pharmacological properties of AEDs, nurse practitioners will understand that different populations require appropriate dosages. For instance, older adults need to be given AEDs that do not result in sedation, confusion, and drowsiness (Brown, 2016). Before administering medicine to this population, a nurse practitioner has to go through the list of the AEDs and take the one that has minimal adverse effects. Although death is rare when taking the AEDs, nurse practitioners have to evaluate the circumstances that require multitherapy to minimize the chance of such an outcome (Yasam, 2016). The understanding of the pharmacology properties of AEDs fosters the improvement of the quality of life in patients with epilepsy. It informs the nurse practitioners about the dosage of a given drug, the target population, and the associated risk. Thus, the caregivers can determine the optimum dosage and the right combination that will have little or no adverse health outcomes.
References
Brown, C. (2016). Pharmacological management of epilepsy. Progress in Neurology and Psychiatry , 20 (2), 27-347.doi:10.1002/pnp.422
LaPenna, P., & Tormoehlen, L. M. (2017). The pharmacology and toxicology of third-generation anticonvulsant drugs. Journal of Medical Toxicology , 13 (4), 329-342.doi:10.1007/s13181-017-0626-4
Marvanova, M. (2016). Pharmacokinetic characteristics of anti-epileptic drugs (AEDs). Mental Health Clinician , 6 (1), 8-20.doi:10.9740/mhc.2015.01.008
Yasam, V. R., Jakki, S. L., Senthil, V., Eswaramoorthy, M., Shanmuganathan, S., Arjunan, K., & Nanjan, M. J. (2016). A pharmacological overview of lamotrigine for the treatment of epilepsy. Expert Review of Clinical Pharmacology , 9 (12), 1533-1546.doi:10.1080/17512433.2016.1254041
Zhuo, C., Jiang, R., Li, G., Shao, M., Chen, C., Chen, G., Jiang, D., et al. (2017). Efficacy and tolerability of second and third generation anti-epileptic drugs in refractory epilepsy: A network meta-analysis. Scientific Reports , 7 (1), 1-12.doi:10.1038/s41598-017-02525-2
