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Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.

Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Upper Saddle River, NewJ ersey07458
All rights reserved.
Chapter 15
Drugs for
Seizures
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Media Directory
Slide 43 Diazepam Animation
Slide 45 Valproic Acid Animation
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Seizures
Abnormal or uncontrolled neuronal
discharges in the brain
Affect
Consciousness
Motor activity
Sensation
Symptom of an underlying disorder
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Convulsion
Involuntary violent spasm of large muscles
of face, neck, arms, and legs
Not synonymous with seizure
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Epilepsy
Seizures occurring chronically
International Classification of Epileptic
Seizures
Partial (focal)
Generalized
Special epileptic syndromes
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Known Causes of Seizures
Infectious diseases
Trauma
Metabolic disorders
Vascular diseases
Pediatric disorders
Neoplastic disease
2
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Additional Known Causes
of Seizures
Medications
High doses of local anesthetics
Eclampsia
Drug abuse
Withdrawal syndromes from alcohol or
sedative-hypnotic drugs
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Seizures of Unknown Etiology
Lower tolerance to environmental triggers
Sleep deprivation
Flickering lights
Fluid and electrolyte imbalances
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Seizures in Neonates,
Infants, and Children
Congenital abnormalities of CNS
Perinatal brain injury
Metabolic imbalances
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Later-Childhood Etiology
CNS infections
Neurological degenerative disorders
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Adult Etiology
Cerebral trauma or neoplasm
Cerebrovascular disorders
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Signs and Symptoms
of Seizures
Related to area of brain with abnormal
activity
International Classification of Epileptic
Seizures: classifies seizures
3
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Simple Partial (Focal) Seizures
Occur in limited portion of brain
Point of origin: abnormal focus or foci
Clients experience
Feeling that location is vague
Hallucinations with all senses
Extreme emotions
Twitching of arms, legs, or face
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Complex Partial
(Focal) Seizures
Altered levels of consciousness
Involve sensory, motor, and autonomic
symptoms
Aura commonly precedes seizure
No memory of seizure
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Generalized Seizures
Travel throughout brain
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Absence Seizures
Common in children
Subtle symptoms
Staring
Transient loss of consciousness
Eyelid fluttering
Myoclonic jerks
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Atonic Seizures
Last a few seconds
Characterized by stumbling or falling
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Tonic-Clonic Seizures
Most Common
Usually preceded by aura
Tonic Phase
Intense muscle contractions
Hoarse cry at onset
Loss of bowel or bladder control
Shallow breathing
Clonic Phase
Alternating contraction and relaxation of muscles
Postictal state (postseizure state)
Drowsiness, disorientation, deep sleep
4
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Special Epileptic Syndromes
Febrile seizures
Myoclonic seizures
Status epilepticus
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Febrile Seizures
Last one to two minutes
Tonic-clonic motor activity
Common in 3- to 5-year-olds
Occur with rapid rise in body temperature
Affect 5% of all children
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Myoclonic Seizures
Large, jerking body movements
Quick contraction of major muscles
Stumbling and falling
Similar to normal infantile Moro reflex
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Status Epilepticus
Medical emergency
Continuously repeating seizure
Common with generalized tonic-clonic seizures
Continuous muscle contraction
May compromise airway
May cause hypoglycemia, hypothermia, acidosis
May produce lactic acid
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Choice of Drug Depends Upon
Type of seizure
Clients history and diagnostic studies
Pathologic process causing seizures
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Barbiturates and GABA Agents
Monitor clients condition
Liver and kidney function
Pregnancy Category D
Depletion of nutrients
Common side effects
Alcohol and gingko biloba interactions
5
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Client Teaching
Use reliable contraception
Immediately report pregnancy
Report excessive signs of bleeding
Report drowsiness and bone pain
Avoid alcohol and gingko biloba
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Benzodiazepines
Schedule IV Drug
Monitor for drug-abuse potential
Pregnancy riskPregnancy Category D
Contraindicated in narrow-angle glaucoma
Liver and kidney function should be
monitored
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Benzodiazepines
Schedule IV Drug
Respiratory depression may result with
other CNS depressants.
Common side effects include dizziness,
drowsiness
Overdosegive flumazenil (Romazicon)
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Status Epilepticus
Give IV Valium and Ativan
Do not mix with other drugs in IV line
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Client Teaching
Avoid alcohol, OTC drugs, and herbal
medications
Avoid nicotine
Avoid driving and hazardous activities
Rebound seizures if discontinued abruptly
Take with food
Drug often used illegally
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Hydantoin and Phenytoin-like
Drugs
Monitor serum-drug levels
Monitor for signs of toxicity
Monitor for blood dyscrasias and bleeding
disorders
Monitor liver and kidney function
Fatal hepatotoxicity can occur
6
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Contraindications
History of heart block
History of seizures due to hypoglycemia
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Client Teaching
Routine labs for serum level
Routine labs for liver and kidney function
Immediately report signs of toxicity
Immediately report unusual bleeding
Immediately report liver or brain disease
Immediately report heart block,
hypoglycemia, or pregnancy
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Succinimides
Monitor liver and kidney function
Use with caution with antiseizure
medications, phenothiazines, and
antidepressants
Pregnancy riskpregnancy Category C
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Common Adverse Reactions
Drowsiness, headache, fatigue, dizziness
Depression or euphoria
Nausea, vomiting, weight loss
Abdominal pain
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Life-Threatening Reactions
Severe mental depression with suicide
intent
Stevens-J ohnson syndrome
Blood dyscrasias
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Symptoms of Overdose
CNS depression
Stupor
Ataxia
Coma
7
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Client Teaching
Immediately report mood changes or
suicidal thoughts
Avoid driving and hazardous activities
Do not suddenly stop taking
Take with food
Report symptoms of fever or sore throat
Report weight loss and anorexia
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Dosage Procedure
Start with smallest initial dose
Add additional drugs, if necessary
Ensure compatibility with other
medications
Monitor serum-drug levels
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Withdrawal of
Antiseizure Medications
Should be seizure free at least three years
Withdraw gradually over several months
Resume medications if seizures return
Be aware of rebound seizures
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Drugs That Potentiate
GABA Action
Barbiturates
Benzodiazepines
Miscellaneous GABA agents
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Barbiturates
Prototype drug: phenobarbital (Luminal)
Mechanism of action: changing the action
of GABA
Primary use: controlling seizures
Adverse effects: dependence, drowsiness,
vitamin deficiencies, laryngospasm
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Benzodiazepines
Prototype drug: diazepam (Valium)
Mechanism of action: similar to that of
barbiturates but safer
Primary use: for short-term seizure
control
Adverse effects: drowsiness and
dizziness
8
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Diazepam Animation
Click here to viewan animation on the topic of diazapam.
Back to Directory
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Miscellaneous GABA Agents
Prototype drug: valproic acid (Depakene)
Mechanism of action: similar to that of
barbiturates and benzodiazepines on
GABA
Primary use: as adjunct therapy
Adverse effects: sedation, drowsiness,
GI upset, prolonged bleeding time
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Valproic Acid Animation
Click here to viewan animation on the topic of valproic acid.
Back to Directory
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Hydantoins
Prototype drug: phenytoin (Dilantin)
Mechanism of action: to densitize
sodium channels
Primary use: treating all types of epilepsy
except absence seizures
Adverse effects: CNS depression,
gingival hyperplasia, skin rash, cardiac
dysrhythmias, and hypotension
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Phenytoin-Like Drugs
Prototype drug: valproic acid (Depakene )
Mechanism of action: to desensitize sodium
channels
Primary use: for absence seizures
Adverse effects: limited CNS depression,
visual disturbances, ataxia, vertigo, headache
Additional adverse reactions:
gastrointestinal effects, hepatotoxicity,
pancreatitis
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Succinimides
Prototype drug: ethosuximide (Zarontin)
Mechanism of action: suppress calcium
influx
Primary use: for absence seizures
Adverse effects: rare but include
drowsiness, dizziness, lethargy
Very rare but serious side effects:
systemic lupus erythematosis, leukopenia,
aplastic anemia, Stevens-J ohnson syndrome
9
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Drugs That Potentiate
GABA Action
Include barbiturates, benzodiazepines,
and miscellaneous GABA agents
Suppress the firing ability of neurons
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Examples of Barbiturates
Phenobarbital (Luminal)
Amobarbital (Amytal)
Secobarbital (Seconal)
Pentobarbital (Nembutal)
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Examples of Benzodiazepines
Clonazepam (Klonopin)
Clorazepate (Tranxene)
Lorazepam (Ativan)
Diazepam (Valium)
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Examples of Miscellaneous
GABA Agents
Gabapentin (Neurontin)
Primidone (Mysoline)
Tiagabine (Gabitril)
Topiramate (Topamax)
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Hydantoins and Phenytoin-like
Drugs
Desensitize sodium channels
Sodium movement is factor that
determines whether neuron will undergo
an action potential
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Examples of Hydantoins
Phenytoin (Dilantin)most common
Fosphenytoin (Cerebyx)
10
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Examples of Phenytoin-like
Drugs
Carbamazepine (Tegretol)tonic-clonic
and partial seizures
Felbamate (Felbatol)
Lamotrigine (Lamictal)
Valproic acid (Depakene, Depakote)
absence seizures
Zonisamide (Zonegran)
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Succinimides
Suppress seizures by delaying calcium
influx into neurons
Examples of succinimides
Ethosuximide (Zarontin)
Methsuximide (Celontin)
Phensuximide (Milontin)
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Drug Therapy for Epilepsy
Assessment
History of seizure activity
Allergies and drug history
Knowledge of disease process
Knowledge of drug therapy
Client lifestyle
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Drug Therapy for Epilepsy
(continued)
Nursing Diagnoses
Disturbed sensory perception related to
seizure activity
Risk for injury related to seizure activity
Deficient knowledge related to drug therapy
Deficient knowledge related to disease
process
Noncompliance related to drug regimen
Noncompliance related to serum lab testing
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Drug Therapy for Epilepsy
(continued)
Planning
Absence of or reduction in number of seizures
No injury during seizure activity
Understanding of disease
Understanding of drug regimen
Compliance with lab testing
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Drug Therapy for Epilepsy
(continued)
Implementation
Monitoring neurological status
Ensuring lab values in normal range
Client/family teaching about disease
Client/family teaching about drugs
Client/family teaching about care during
seizure activity
11
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Drug Therapy for Epilepsy
(continued)
Evaluation
Effectiveness of drug therapy
Client goals
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Drugs used in the management
of specific seizure types
Table 15.2 Management of Seizures
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Antiseizure drugs that
potentiate GABA action
Table 15.3 Antiseizure Drugs
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Antiseizure drugs that
potentiate GABA action
Table 15.3b Antiseizure Drugs
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Hydantoins and phenytoin-like
drugs
Table 15.4 Hydantoins and
phenytoin-like drugs
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Succinimides
Table 15.5 Succinimides