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INTRODUCTION

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oxcarbazepine (ox-kar-baz-e-peen)

Trileptal

Classification

Therapeutic: anticonvulsants

Pharmacologic: carbamazepine analogues

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Indications
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Monotherapy or adjunctive therapy of partial seizures in adults and children 4 yr and older with epilepsy. Adjunctive therapy in patients 2–16 yr with epilepsy. Unlabeled Use: Management of trigeminal neuralgia.

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Action
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Blocks sodium channels in neural membranes, stabilizing hyperexcitable states, inhibiting repetitive neuronal firing, and decreasing propagation of synaptic impulses. Therapeutic Effects: Decreased incidence of seizures.

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Adverse Reactions/Side Effects
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CNS: dizziness/vertigo, drowsiness/fatigue, headache, cognitive symptoms. EENT: abnormal vision, diplopia, nystagmus. GI: abdominal pain, dyspepsia, nausea, vomiting, thirst. Derm: acne, rash, urticaria. F and E: hyponatremia. Neuro: ataxia, gait disturbances, tremor. Misc: allergic reactions, hypersensitivity reactions, including Stevens-Johnson syndrome and multiorgan reactions, lymphadenopathy.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of allergic and hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Be especially alert for severe skin reactions (exfoliation, dermatitis) that might indicate Stevens-Johnson syndrome. Notify physician immediately if these reactions occur.

  • Document the number, duration, and severity of seizures to help determine if this drug is effective in reducing seizure activity.

  • Assess vertigo or dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Assess any gait disturbances, tremor, or ataxia. Attempt to determine if these problems are drug induced rather than caused by neuromuscular pathology.

  • Monitor daytime drowsiness, agitation, confusion, or other cognitive impairments. Repeated or excessive symptoms may require change in dose or medication.

  • Monitor signs of low sodium levels (hyponatremia), including headache, confusion, lethargy, irritability, decreased consciousness, and neuromuscular abnormalities (muscle weakness and cramps). Report severe or prolonged signs to the physician.

  • If used to treat trigeminal neuralgia or other types of neurogenic pain, assess pain using visual analogue scales or other appropriate pain scales to document whether this drug is successful in helping manage the patient's pain.

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Interventions
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  • Guard against falls and trauma (hip fractures, head injury, and so forth), especially if dizziness, vertigo, or ataxia affect gait and balance. Implement fall-prevention strategies, especially if balance is impaired (See Appendix E).

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Patient/Client-Related Instruction
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  • Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

  • Advise patients on prolonged antiseizure therapy not to discontinue medication without consulting their physician. Abrupt withdrawal may cause increased seizures.

  • Advise patient about the risk of daytime drowsiness and decreased attention and mental focus. Use care if driving or in other activities that require strong ...

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