Nursing Teaching on Contraindications for Keppra Use

 Nurse  educated the patient and caregiver on contraindications for using Keppra as follows:
  1. Do not take Keppra, if you ever manifested any allergic response to intake of Keppra. Discuss your history of allergic response to this medication with your physician, without fail.
  2. Keppra carries the risk of causing mild increase in blood pressure. Individuals can present with symptoms of poorly controlled blood pressure, such as, episodes of headache, nose bleeds, blurred vision, complaint of chest pain, pounding sensation in the neck and ears, and confusion. Individuals with history of poorly controlled blood pressure can also be at risk for stroke, secondary to elevated blood pressure with keppra. Keppra also carries the risk of causing and/or aggravating some underlying cardiac arrhythmias leading to episodes of chest pain, rapid heart rate, palpitations, dizziness, and shortness of breath. Keppra should be used with extreme caution in individuals with history of hypertension and arrhythmias, especially with poor control, to prevent further worsening of the cardiac status.
  3. Keppra carries significant risk of suppressing production of white blood cells from the bone marrow and lead to agranulocytosis. Reduced white blood cell count can contribute to lowered immunity, thus resulting in frequent fever, chills, sore throat, and risk for frequent infections. Keppra should be used with extreme caution in individuals with history of immunodeficiency and opportunistic infections, as it can result in further deterioration of immune status and lead to exacerbation of frequency of infections.
  4. In the event of any current manifestations of any allergic response with this medication, report it to your physician or other health care personnel immediately, to check regarding your safety with continuing on intake of this medication.
  5. Individuals with history of mood and behavior disorders, secondary to keppra intake, can present with deterioration of memory and awareness, feeling low and depressed, anxiety, panic attacks, trouble sleeping, gross appetite changes, impulsiveness, agitation, aggression, and suicidal thoughts. Keppra should be used with extreme caution in such individuals with close watch for deterioration of mood and behavior.
  6. Keppra is minimally metabolized by various pathways to inactive metabolites. Significant portion of the administered drug is unmetabolized, which along with the inactive metabolites is mainly excreted in urine by the kidneys. Individuals with renal disease cannot excrete keppra and metabolites normally, which allows the medication to stay in blood circulation for longer time, resulting in toxicity and consequent side-effects. So, keppra must be used with caution and dose adjustments in individuals with compromised renal function, with periodical monitoring for renal functions and development of any toxic symptoms.