Interventions for Patients Receiving Antiepileptics 抗癫痫药治疗患者的护理措施
1. Discontinue the drug at any sign of hypersensitivity reaction, liver dysfunction, or severe skin rash to limit reaction and prevent potentially serious reactions.
出现任何超敏反应、肝功能障碍或严重皮疹等体征时停药用，限制反应，防止严重的潜在反应发生。
2. Administer the drug with food to alleviate GI irritation if GI upset is a problem.
有GI不适问题时，药物可与食物同服，减轻GI刺激
3. Monitor for adverse effects and provide appropriate supportive care as needed to help the patient cope with these effects.
监测是否出现不良效应，必要时提供支持性医疗，帮助患者处理这些效应。
4. Monitor complete blood count (CBC) before and periodically during therapy to detect bone marrow suppression early and provide appropriate interventions.
治疗前及治疗期间应监测全血计数（CBC），尽早发现骨髓抑制，提供适当措施
5. Discontinue the drug if skin rash, bone marrow suppression, or unusual depression or personality changes occur to prevent the development of more serious adverse effects.
一旦出现皮疹、骨髓抑制或异常的抑郁或人格变化，停止使用药物，防止出现更为严重的不良效应。
6. Discontinue the drug slowly, and never withdraw the drug quickly, because rapid withdrawal may precipitate absence seizures.
慢慢停药，千万不要快速撤药，因为快速撤药可能触发失神性癫痫发作。
7. Monitor for drug–drug interactions to arrange to adjust doses appropriately if any drug is added to or withdrawn from the drug regimen.
监测有无药药相互作用，若在治疗方案中添加任何药物或撤药，应安排适当的剂量调整。
8. Arrange for counseling for women of childbearing age who are taking these drugs. Because these drugs have the potential to cause serious damage to the fetus, women should understand the risk of birth defects and use barrier contraceptives to avoid pregnancy.
安排服药的育龄期妇女的咨询。因为这些药物有可能引起严重的胎儿伤害，妇女应该了解出生缺陷危险，使用屏障避孕器，避免怀孕。
9. Offer support and encouragement to help the patient cope with the drug regimen and diagnosis.
提供支持和鼓励，帮助患者应对药物治疗和诊断
10. Provide thorough patient teaching, including drug name and prescribed dosage, as well as measures for avoidance of adverse effects and warning signs that may indicate possible problems to enhance patient knowledge about drug therapy and to promote compliance; and the need for periodic blood tests to evaluate blood counts to reduce the risk for infection and for drug levels to evaluate therapeutic effectiveness and minimize the risk for toxicity.
提供彻底的患者教育，包括药名、处方剂量及避免不良效应的措施和提示可能问题的警示信号，增加患者药物疗法知识，促进治疗依从性；定期验血必要性，评价血液计数，减少感染危险，评估药物浓度，评价治疗效果，最大限度减少毒性风险。
11. Suggest the wearing or carrying of a MedicAlert bracelet to alert emergency workers and health care providers about the use of an antiepileptic drug.
建议佩带或携带医疗警示手环，提醒应急工作者及健康医疗服务提供者患者使用抗癫痫药。
★Vocabulary for Today ★
discontinue – v. 停止，中断
hypersensitivity – n. 过敏症，超敏感性
skin rash – 皮疹
alleviate – v. 缓解，减轻
supportive care – 支持性医疗
detect – v. 发现，检测
withdrawal – n. 戒断，撤药，取消
precipitate – v. 使突然发生，加速
birth defects – 出生缺陷
1. A 23-year-old woman with a history of seizure disorder is planning to become pregnant. She realizes that being on this medication during pregnancy can have fetal effects of mental retardation. Which of the following agents would likely produce a newborn with the lowest intelligence quotient (IQ)?
A. Carbamezapine
B. Lamotrigine
C. Phenytoin
D. Valproic acid 2. A 22-year-old woman recently began medical treatment for a seizure disorder. She presents with dysuria; and a urine dipstick shows microhematuria but no leukocytes and no nitrites. A KUB X-ray shows calcifications in the renal pelvis, although she has neither personal nor family history of kidney stones. Which seizure medicine is she likely taking?
A. Ethosuximide
B. Phenobarbital
C. Phenytoin
D. Topiramate
答案Answers 1. D. Valproic acid.
In utero exposure to valproate, when compared with other commonly used antiepileptic drugs, is associated with an increased risk of impaired cognitive function at 3 years of age. Valproate should not be used in women of childbearing potential. 2. D. Topiramate.
This patient’s presentation is consistent with nephrolithiasis or kidney stones. This can be attributed to her seizure medication because she has no prior history of stones. Of the seizure medications listed, only topiramate is known to cause nephrolithiasis. Topiramate is used in the treatment of partial seizures and generalized tonic-clonic seizures as well as for migraine prophylaxis. Its exact mechanism is unknown but appears to block seizure spread rather than raise seizure threshold.
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