Seizure and Status Epi Flashcards
0-5 min seizure treatment
BZDs
IV lorazepam 0.1mg/kg (max 4mg) repeat q5min to 8mg
OR IM midazolam if no IV
BZD first line agents
-IV Lorazepam 0.1-0.2 mg/kg (max 4mg)
-IV diazepam 0.15 mg/kg
5-30 min treatment protocol
ASMs
-IV Keppra
-IV Phenytoin
-IV valproic acid
-IV lacosamide
-IV penobarb 20 mg/kg (max2.5g)
phenytoin dosing
LD: 20 mg/kg IV (max 2g)
MD: 4-6 mg/kg/day (bid-tid)
(fos)phenytoin ADRs
P: -450 interactions
H: hirsutism
E: enlarged gums
N: nystagmus
Y: yellow browning of skin
T: teratogenicity
O: osteomalacia (vit.d deficiency)
I: interference w folate (anemia)
N: neuropathies (vertigo, HA)
Phenytoin TDM
-goal level 10-20 mcg/dL
-must correct level: albumin <3.5 or CrCl <10 or dialysis
Phenytoin albumin <3.5 calculation
phenytoin level = measured level / ((0.275 x albumin) + 0.1)
renal failure (CrCl <10 or dialysis) phenytoin calculation
phenytoin level = measured level / ((0.1 x albumin) + 0.1)
levetiracetam dosing
LD: 60 mg/kg IV (max 4g)
MD: 1000mg bid
Valproic acid dosing
LD: 40 mg/kg IV (max 3g)
MD: 5mg/kg q8h
goal: 50-100 mcg/mL
Lacosamide dosing
LD: 200-400 mg IV x1
MD: 100-200 mg bid
phenobarbital dosing
LD: 20 mg/kg IV
MD: 2 mg/kg IV bid-tid
seizures and intubation
-meds that sedate and paralyze are given during intubation
-no more movements during paralysis
-continuous inf of ASM and long-term EEG
30-60 min treatment protocol for responsive w NCSE or focal
load 2nd ASM
30-60 min treatment protocol for unresponsive w convulsive or NCSE
propofol, midazolam, ketamine
still seizing?
-rebolus or additional ASM
-bolus and increase anesthetic
-add phenobarbital
super refractory status epilepticus possibility
ketogenic diet
