Pharmacological Management of Status Epilepticus Flashcards
What is status epilepeticus
Seizures that are non-stop for at least 5 minutes OR two or more episodes of seizures where a patient does not regain consciousness in between
T/F: Comatose patients do not have seizures
False: Comatose patients can have seizures that do not have convulsions but to have activity from an EEG
What are acute causes of SE
Traumatic brain injury, drugs or overdose, CNS infection, stroke, metabolic disturbances, hypoxia or hypoglycemia
What are chronic causes of SE
Epilepsy who have uncontrolled seizures, alcohol abuse, CNS tumors, stroke
What is the biggest cause of patients to have SE if they have no epilepsy, if they have epilepsy
Ischemic stroke/ epilepsy disease state and AED no compliance
What drugs could induce seizures
Antibiotics (beta-lactams, metronidazole, quinolones, carbamezapine), anti-dpressants, tramadol,meperidine, baclofen, methylphenidate, flumazenil
What AED and antibiotic class should be monitored for, why
Valporic acid and carbapenems, Valporic acid drop significantly within 24 hours causing no seizure control
What are the neurotransmitters that are associated with seizures
Glutamate (excitatory) and GABA (inhibition), imbalance in both
What systemic evidence of phase 1 SE
hypertension, tachycardia, hyperglycemia, hyperthermia, sweating, salivation
When does a patient progress to phase 2 of SE, what are systemic signs
after 30 mins/ hypotension, bradycardia, hypoglycemia, hyperthermia, hypoxia, elevated intracranial pressure
What is the timeline and options for treating Status Epilepticus
First 10 mins- IV benzodiazepine, 20 mins- Parenteral antiepileptic drug to prevent future seizure, 30 mins- Re-bolus AED if needed and find underlying resasion
What are the benzodiazepines given for emergent thereapy IV, IM
Lorazepam 0.1 mg/kg IVP @ 2 mg/min for a max of 4 mg, Diazepam 0.15 mg/kg IVP @ 5 mg/min for a max of 10 mg/ 5 mg of Midozolam if less than 40 kg or 10 mg if greater than 40 kg
What should be monitored while giving benzodiazepines
Respiratory rate, hypotension, seizure recurrence, IV site reactions
T/F: Diazepam is preferred as the go to Benzodiazepine for seizures over lorazepam because it is more lipophillic
False: Though diazepam is more lipophillic it goes into body fat quicker than desired even though it penetrates the BBB better than lorazepam
What is the antiepileptic drugs used for urgent therapy, what is the dosing
Phenytoin LD: 15-20 mg/kg IV (rate 50 mg/min) MD: 4-6 mg/kg/day after 12 hours post loading dose
Fosphenytoin Ld: 15-20 mg/kg IV (rate 150 mg/min) or IM MD: 4-6 mg IV or IM started 12 hours post load
What are other urgent therapy for SE
Phenobarbital valporate
What is a therapeutic range for phenytoin
10 to 20
What should be monitored if using AEDs to treat SE
Sedation, Respiratory rate, blood pressure, heart rate
T/F: Infusing phenytoin with in small viens can cause purple hand syndrome
True
What is another AED that is given instead of phenytoin due to no drug interactions and being less likekly to cause hypotension, what’s the dosing
Levitracetam LD: 2-5 mg/kg/min or a max of 4500 mg IV MD: 500-1500 IV or PO after 12 hours
What is refractory status epilepticus
seizure activity that does not respond to initial benzodiazepine and antiepileptic therapy over 30 mins
What are the treatment requirements for RSE
Continous IV therapy, mechanical ventilation and continous EEG monitoring
What are the three drugs indicated for RSE, which has the worst side effects
Propofol, Midazolam, and Pentobarbital/ Pentobarbital
What are problems with using propfol
significant hypotension, rhabdomylosis, cardiac failure, must use dedicated line
