Seizures (starting Page 18)

Question 0

Dose of lorazepam and max rate

Answer 0

.1 mg per kg repeat 5-10 minutes
May initiate with 2-4ivp (lower amount which is okay but if it doesn’t work jump to .1mg per kg

Max rate is 2mg/min other wise can get propylene induced hypotension

Question 1

Approximate half life of Ativan

Answer 1

About a day 24 hours (10-30 hours)

Question 2

Storage for ativan

Answer 2

Must be in refridgerator prior to use

Question 3

Diazepam kinetics

Answer 3

More lipid solubility, so long half life…
But bad because the levels needed to treat seizures drop a lot but still high enough that the patient gets Cns depression

Question 4

Diazepam dosing

Answer 4

.15-.25 mg per kg
May initiate at 5mg but only for non status
Max dose is 30

Question 5

Diazepam rate

Answer 5

5mg per minute

Question 6

Midazolam indication

Answer 6

REFRACTORY STATUS, if Ativan fails then jump to this

Question 7

Cons of midazolam

Answer 7

Very Cns depressant more than Valium and Ativan,

Question 8

Dosage and administration of midazolam

Answer 8

Most rapid acting IM. Agent
.1-.3 mg/kg over 1-2 min or IM
Repeat up to 2mg/kg
Followed by .05-2mg/kg

Question 9

What inactive does midazolam doesn’t. Have

Answer 9

Propylene glycol

Question 10

Propafols use and downside

Answer 10

Induction and maintenance of general anesthesia

Big risk of hypotension and respiratory depression

Question 11

Phenytoins place in status and also used for?

Answer 11

Used in addition to iv benzo because it’s too slow

Also used for digoxin induced arrythmias

Question 12

Phenytoins solvent it’s dissolved in

Answer 12

40% propylene glycol and ethanol 10%
Cardiotoxic can cause hypotension, bradycardia, qrs prolongation, ventricular fib (note that phenytoin is actually used as anti arrhythmic)

Question 13

Dose of Dilantin

Answer 13

Dilantin dose 18-20mg/kg actual body weight

Question 14

Phenytoin iv notes

Answer 14

Not comparable in d5w
Max rate is 50mg/min
Must use 0.22 micron in line filter to remove crystals

Question 15

How to minimize cardiac events for iv phenytoin

Answer 15

Do not exceed 10-20 mg/ minute

Question 16

Phenytoin extended release formulation how much phenytoin

Answer 16

92% phenytoin 8%sodium

Question 17

Advantage of fosphenytoin over Dilantin

Answer 17

Can infuse much faster than Dilantin (150mg/min)(max)

And less precipitating than Dilantin so no need to filter

Question 18

Disadvantage of fosphenytoin as injection adverse effects

Answer 18

Pruritis and paresthesia-perineal and perioral area

May administer IM though so that’s good

Question 19

If having to pick between fosphenytoin vs Dilantin for status and why

Answer 19

Pick fosphenytoin over Dilantin because no need to filter and no peripheral accumulation so little to no risk of purple glove syndrome and can infuse at faster rate

Question 20

How is phenytoin metabolized

Answer 20

Through cyp 2c9

Question 21

Target serum level of ohenytoin is ?

Answer 21

10-20 mcg/ml

Question 22

How to monitor for Hepatotoxicity for patient on Dilantin

Answer 22

If patient is just on ohenytoin get baseline and monitor every 3-6 months…if patient is taking more than one hepatotoxic drug then will need to check monthly but really clinicians discretion

Question 23

A patient who recently relieves ohenytoin can expect what on their lab test

Answer 23

40-50% of people get a spike in ast and alt and will end up going. Back to normal

Question 24

Adverse effects of dilantin

Answer 24

Hepatotoxic, osteoporosis, megaloblastic anemia, lymphadenopathy, hirtuisum, gingival hyperplasia

Question 25

Mechanism of oflic acid deficiency for those taking Dilantin

Answer 25

Conjugases in stomach convert dietary folic acid into absorbable(monoglutamates, and Dilantin inhibits the Conjugases (

Question 26

How to dose folic acid for those with folic acid deficiency

Answer 26

Give 1-1.5 mg no more than that because high levels of folic acid deceases concentration of Dilantin in body

Question 27

Things that aggrevate gingivitis or may also cause it

Answer 27

CCB, barbiturates,cyclosporine,

Question 28

Phenobarbital target level

Answer 28

15-30 mg ml

Over 50 can have coma and over 100

Question 29

Phenobarbital indication and a/e

Answer 29

Refractory seizures
Respiratory depression
Hypotension
Look out for bullae which means toxicity

Question 30

Valproate sodium IV indications

Answer 30

Broad spectrum so complex partial, absence, mixed seizures,

Really third line are Ativan midazolam then this for status epileptics

Question 31

Valproate sodium iv dosage and infusion rate

Answer 31

Loading dose is 15-20 mg/kg
Maintanence dose is 3-5 mg/kg max dose is 60mg/kg
Rate of less than 20mg/min but up to 1g over 5-10 min are safe

Question 32

Valproate sodium iv advantages

Answer 32

No respiratory p depression, no injection site injury, devoid of cardio toxicity, easy transition to oral 1:1 but IM leads to muscle injury