Anti Seizures

Question 1

FIRST LINE MANAGEMENT OF

STATUS EP

Answer 1

LORAZEPAM

MIDAZOLAM

Question 2

SECOND LINE MANAGEMENT

Answer 2

• Valproate
• (Fos) phenytoin
• Phenobarbital
• Levetiracetam

Question 3

Third Line

Intubated

Answer 3

• Midazolam infusion
• Pentobarbital Infusion
• Propofol Infusion
• Ketamine Infusion

Question 4

Third Line

NON- INTUBATED

Answer 4

Lacosamide

Topiramate

Valproate

Question 5

Propylene Glycol Toxicity

*Larazepam has IV propylene Glycol

Answer 5

• Severe Hyperosmolar gar
• Metabolic Acidosis
• Hypotension
• Multi-organ failure

Question 6

Which patient will have a higher risk of Propylene Glycol toxicity?

Pt. 1 : on Lorazepam IV

Pt. 2 Diazepam IV

Answer 6

Pt. 1

Lorazepam IV will have a higher risk of Propylene Glycol Toxicity

Question 8

a second-line agent that you can give in big doses

What happens if you give this quickly?

Answer 8

Fosphenytoin

–> will cause HYPOTENSION

–> this has many drug interactions

–> rate dependent [arrythmias]

–> about similar property as Phenytoin but can be given doses

–> can also get hypotensive if given quickly

Question 9

Common Adverse Effects of Phenytoin

Answer 9

Hypotension

Arrhythmia

HEPATOTOXICITY

–> NONLINEAR KINETICS

–> CYP 450 INDUCER

Question 10

SE:

VALPROIC ACID

Answer 10

HYPERAMMONEMIA

THROMBOCYTOPENIA

HEPATOTOXICITY

–> AVOID WITH TRAUMATIC BRAIN INJURY– DO NOT GIVE WITH CARBAPENEMS [reducing Valproic acid, levels will be really low]

also cabamazepeme also being harmed

Question 11

LEVETIRACETAM

SE

Answer 11

sedattion/paradoxical excitation,

irritability

–> RENALLY CLEARED

MINIMAL DRUG INTERACTIONS

Question 13

PHENOBARBITAL

Answer 13

MOST SEDATING DRUG

SEDATION, HYPOTENSION, RESPIRATORY DEPRESSION

–> HAS PROPYLENE GLYCOL

Question 14

SE

LACOSAMIDE

Answer 14

• DIZZINESS
• BRADYCARDIA

Question 15

SE

TOPIRAMATE

Answer 15

• METABOLIC ACIDOSIS

ONLY PO MED!!!

Question 16

PENTOBARBITAL

–> BASICALLY PUTTING THE PATIENT IN A COMA

Answer 16

ABSOLUTELY REQUIRES MECHANICAL VENTILATION

BURST SUPPRESSION

SEDATION

HYPOTENSION

RESPIRATORY DEPRESSION –> INTUBATE

CONSTIPATION/ ILEUS

MYOCARDIAL DEPRESSION –> MAY DEPRESS BLOOD PRESSURE

IMMUNOSUPPRESSION

*PROPYLENE GLYCOL

Question 17

PROPOFOL INFUSION SYNDROME

Answer 17

• Refractory bradycardia
• Cardiac failure
• Metabolic Acidosis
• Rhabdomyolysis
• Hyperlipidemia
• Enlarged Liver
• Renal Failure

Question 18

Pharmacologic Considerations

SLIDE: MONA WANTS US TO KNOW

Answer 18

Question 19

fair choice for a seizing patient with hepatic failure

Answer 19

LEVETIRACETAM

LACOSAMIDE

Question 20

What is the timeline goal to control seizures?

Answer 20

control seizure within 30 minutes

Question 21

enteral administration of AEDs

Answer 21

BEZOAR! CARBAMAZEPINE!!!

Question 22

Seizure medication that will constantly bind to albumin

Answer 22

PHENYTOIN

VALPROIC ACID

–> BA CAREFUL FOR MALNOURISHED

Question 23

DRUG INTERACTIONS!

Answer 23

Question 24

FLUCONAZOLE

INHIBITS

Answer 24

WILL INCREASE

MIDAZ

PHENOBARB – WILL REDUCE FLUCONAZOLE

PHENYTOIN -- WILL REDUCE FLUCONAZOLE

Question 25

Lacosamide prolongs the PR intervals of which drugs?

Answer 25

B Blockers

Calcium Channel Blockers

Fentanyl

Question 26

VALPROIC ACID AND TOPIRAMATE

ADVERSE SE

Answer 26

• POSSIBLE GREATER RISK FOR HYPERAMMONEMIA

Question 27

DECREASE RESPONSE TO A NMB MAY BE SEEN IN A COMBINATION OF

Answer 27

PHENYTOIN AND NON-DEPOLARIZING NEUROMUSCULAR BLOCKER

Question 28

TBI what does it do

Answer 28

Question 29

Antibiotics that will increase the risk of seizures

Answer 29

• Penicillins
• Cephalosporins
• Carbapenems
• Monobactam

Question 30

What are common drug-induced seizure inducers

Answer 30

Question 31

COMMON DRUG - INDUCED SEIZURE INDUCERS

Answer 31