Bite size learning module for nurses. Anti-epileptic medicines. Anti-epileptic medicines

Transcription

1 Bite size learning module for nurses Anti-epileptic medicines Anti-epileptic medicines are the main treatment of epilepsy in both adults and children. Epilepsy is controlled in approximately 70% of people who take anti-epileptic medicines*. The aim of this learning is to support your understanding of anti-epileptic medicines, and to help you to care for people taking these medicines. By the end of this bite size learning you will be able to: Describe the range of medicines used to control epilepsy and the potential adverse reactions that can occur Describe the possible side effects of anti-epileptic medicines and how you can help to manage these This is the third in a series of bite size learning modules on epilepsy. This has been written specifically for nurses caring for individuals with epilepsy. Anti-epileptic medicines When people are first diagnosed with epilepsy they will often start their treatment by taking one medicine. Sometimes this is not successful and their doctor may need to slowly introduce a new medicine whilst gradually reducing (and finally stopping) the old one. Most people will be tried on a different anti-epileptic medicine rather than adding another medicine, although some people do need combinations of medicines to control their seizures. Some people with epilepsy are sensitive to changes if they receive a medicine made by a different manufacturer (a different brand) or if they are changed to a different formulation, potentially leading to a loss of seizure control. This is usually dependant on the medicine they take to control their epilepsy as some medicines have a greater risk than others. *NHS Choices

2 Action: After gaining the permission of the person who uses your services you may need to discuss with their GP and pharmacist if their medicine can be affected by changes in manufacturer or formulation and if necessary, how you can ensure that they receive the same brand and formulation with each prescription. Phenobarbital Phenobarbital was the first anti-epileptic medicine. It was first developed in 1912 and although it is still used licensed for epilepsy it less frequently prescribed today due to its side effects which include sedation, agitation, depression and behavioural changes. It is effective for tonic-clonic and focal seizures. Phenobarbital is a schedule 3 controlled drug and it is the only controlled drug for which emergency supplies may be made (for use in epilepsy only). For further information about emergency supplies see the Care of Medicines Foundation elearning module. Phenytoin Phenytoin was the second anti-epileptic medicine developed. It is licensed for tonicclonic and focal seizures. Phenytoin has a narrow therapeutic index therefore individuals may require blood monitoring to ensure their dose maintains within the therapeutic range (for Action while individual taking Phenytoin: Should any person using your service describe any fever, sore throat, rash, mouth ulcers, bruising or bleeding it is important that these are immediately reported to their GP (with their permission) as these may indicate adverse events associated with blood or skin disorders. more information about narrow therapeutic drugs see the Care of Medicines Advanced elearning module). Signs of phenytoin toxicity include: nystagmus (involuntary eye movements, otherwise known as dancing eyes ), double vision, slurred speech, ataxia (lack of voluntary muscle co-ordination), confusion, and hyperglycaemia.

3 Carbamazepine Carbamazepine is another older anti-epileptic medicine. It is used to treat focal seizures and tonicclonic seizures. When carbamazepine is started baseline liver function tests (LFTs), full blood Action while individual taking Carbamazepine: counts (FBC) and urea and electrolytes (U&Es) Like Phenytoin, Carbamazepine has been are obtained. These should be repeated six associated with blood and skin disorders so monthly thereafter. LFTs are particularly any fever, sore throat, rash, mouth ulcers, important for those individuals who have a bruising or bleeding should be reported to the history of liver disease and for the elderly. individual s GP (with their permission) immediately. Sodium Valproate Sodium valproate is another older anti-epileptic medicine. Sodium valproate is used for many different types of epilepsy; it is effective in tonic-clonic seizures, focal seizures, absence seizures and Action while individual taking Sodium myoclonic seizures. It can also be used in Valproate: Any signs of jaundice, malaise, atypical absence seizures and atonic and tonic anorexia, lethargy, drowsiness, vomiting or seizures. Liver dysfunction has been associated abdominal pain should be reported with sodium valproate so liver function should be immediately to the individual s GP (with their tested before starting treatment and periodically consent). during the first six months of treatment. Pancreatic damage and blood disorders have also been associated with sodium valproate. Sodium Valproate is also used in acute mania associated with bipolar disorder.

4 Sodium valproate is available in modified release preparations that allow once or twice daily administration. These are available as: Modified release tablets (Epival CR or Epilim Chrono ) which must not be crushed or chewed Capsules (containing modified release granules, Episenta capsules) - The capsules can be opened and mixed with soft cold food or drink if necessary. They must be swallowed immediately without chewing Granules (Epilim Chronosphere or Episenta granules) - The granules can be mixed with soft cold or room temperature food or drink if necessary. They must be swallowed immediately without chewing Gabapentin Gabapentin is one of the newer anti-epileptic medicines, launched in It is used either as monotherapy or as an adjunct to other antiepileptic medicines in focal seizures in adults. It is used as an adjunct only in children. It is also licenced for use in peripheral neuropathic pain. Pregabalin Pregabalin was launched in 2004 as an adjunct to other anti-epileptic medicines in focal seizures in adults. It is also licenced to treat neuropathic pain and generalised anxiety disorder (GAD).

5 Lamotrigine Lamotrigine was launched in the UK in It is licensed for use in focal seizures and tonic-clonic seizures. It can also be used to control absence seizures in children. Lamotrigine is used as both monotherapy and as adjunct. Blood and skin disorders have been associated with Lamotrigine. Action while individual taking Lamotrigine: Any rashes or signs of anaemia, bruising, or infection should be reported to the individual s GP (with their consent) immediately. Oxcarbazepine Oxcarbazepine is similar in structure to Carbamazepine so it can also cause blood, liver or skin disorders. Oxcarbazepine is used as both monotherapy or as an adjunct to control focal seizures with or without secondary generalised tonic-clonic seizures. Action while individual taking Oxcarbazepine: Any signs of lethargy, confusion, muscular twitching, fever, rash, blistering, mouth ulcers, bruising, or bleeding should be reported to an individual s GP (with their consent) immediately. Zonisamide Zonisamide is licensed for control of focal seizures. It has been associated with fatal cases of heat stroke, particularly in children. Action while individual taking Zonisamide: Maintain a fluid diary to ensure adequate hydration and prevent dehydration. Ensure that the individual, all staff and family know the signs and symptoms of and take steps to prevent heat exhaustion which can lead to heat stroke.

6 Topiramate Topiramate was licenced for use in epilepsy in It is used as monotherapy or adjunctive therapy to control tonic clonic seizures and focal seizures. It is also licensed for migraine prophylaxis Tiagabine Tiagabine is used in conjunction with other anti-epileptic medicines to control focal seizures that have not been controlled by other anti-epileptics. It is not used in absence, myoclonic, tonic and atonic seizures due to risk of seizure exacerbation. Levetiracetam Levetiracetam is used to treat focal seizures both as monotherapy and as an adjunct to other antiepileptic medicines. It is also used as with other anti-epileptic medicines to treat myoclonic and tonicclonic seizures. Vigabatrin Vigabatrin was the first of the new generation anti-epileptic medicines; launched in It is used as monotherapy in West s syndrome (infantile spasms) and an adjunct to other anti-epileptic medicines (for other seizure types) when other medicine combinations have not been tolerated or have been ineffective.

7 Side effects with anti-epileptic medicines Like all medicines, anti-epileptic medicines may have side effects. It is important to be able to recognise these so you can inform the individual s GP if they appear, with the individual s consent. The patient information leaflet provided with the medicine and the BNF will list reported side effects for your information. Action while individual taking anti-epileptic medicines: It is important to seek medical advice immediately (with the individual s consent) if the person who uses your services experiences any of these (or any other) symptoms after taking an anti-epileptic medicine. The side effects of anti-epileptic medicines include: Nausea and vomiting Stomach pain Sleepiness Dizziness Irritability Mood Changes Unsteadiness Poor concentration Interactions with anti-epileptic medicines Anti-epileptic medicines can interact with over-the -counter and herbal remedies. It is important that individuals do not take these without the advice of their GP or pharmacist first. People who use your services have the same rights as someone living in their own home including access to over the counter and herbal medicines. Action: Encourage people who use your services (and their parents, other relatives and friends) to let you know what over the counter and herbal remedies are brought into the care setting so you will be able to check with the pharmacist or GP, with their permission, if they are appropriate to take with their anti-epileptic medicines. For further information, refer to your local medicines policy or homely remedies policy.

8 Refusing medicines To reduce the chances of an individual experiencing a seizure it is very important that individuals with epilepsy keep taking their medicines and should never suddenly stop taking their medicines. You may need to discuss with the prescriber with their consent if an individual continually refuses medicines. Action: Refer to your local medicines policy for guidance if an individual refuses to take their medicines. Further information If you would like to know more about epilepsy: