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7364 Critical Care Block 3 > Status Epilepticus > Flashcards

Status Epilepticus Flashcards

1
Q

Continuous seizure activity is seizure for ___ minutes

A

5

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2
Q

Risk of longterm consequences with seizure activity for > ___ minutes

A

30

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3
Q

__ is characterized by fluctuating state (epileptic twilight) that produces altered consciousness and/or behavior

A

non-convulsive status epilepticus (NCSE)

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4
Q

Continuous seizures for at least 5 mins or 2 seizures without return to consciousness in between

a. established GCSE
b. refractory GCSE
c. super-refractory GCSE
d. impending GCSE

A

d. impending GCSE

stage 1 (0-30mins)

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5
Q

Continuous seizures for at least 30 mins or 30 mins of intermittent seizures without return to consciousness in between

a. established GCSE
b. refractory GCSE
c. super-refractory GCSE
d. impending GCSE

A

a. established GCSE

stage 2 (30-60mins)

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6
Q

Continuous seizures despite initial treatment with 2-3 antiepileptic drugs

a. established GCSE
b. refractory GCSE
c. super-refractory GCSE
d. impending GCSE

A

b. refractory GCSE

stage 3 (> 120mins)

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7
Q

Seizures that continue 24hrs or longer after the administration of anesthesia, including cases in which SE recurs on reduction or withdrawal of anesthesia

a. established GCSE
b. refractory GCSE
c. super-refractory GCSE
d. impending GCSE

A

c. super-refractory GCSE

stage 4 (> 24hrs)

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8
Q

Which type of status epilepticus has no structural lesion?

a. type I
b. type II

A

a. type I

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9
Q

Which type of status epilepticus has structural lesion?

a. type I
b. type II

A

b. type II

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10
Q

What is the most common excitatory neurotransmitter?

A

glutamate

most common cause of seizures

Excitatory neurotransmitters:

  • glutamate
  • calcium
  • sodium
  • substance P
  • neurokinin B
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11
Q

What is the most important inhibitory neurotransmitter?

A

GABA

Inhibitory transmitters:

  • GABA
  • adenosine
  • potassium
  • neuropeptide Y
  • opioid peptides
  • galanin
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12
Q

What is first line for established GSCE?

A

phenytoin (IV) or fosphenytoin

Second line:
phenobarbital
valproate

Third line:
lacosamide
levetiracetam

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13
Q

What is first line for impending GSCE (0-30mins)?

A

IV lorazepam

may repeat in 5 mins if no response

consider IN or IM midazolam

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14
Q

what is first line for refractory GSCE (> 120mins)

A

midazolam, propofol, or pentobarbital infusions

if on propofol use continuous ECG monitoring

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15
Q

For refractory and super-refractory GSCE make sure cerebral perfusion pressure is > __mmHg and MAP is > 120mmHg

A

70, 120

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16
Q

For impending seizure prehospital care establishing IV/IO access is the first action to be taken

a. true
b. false

A

b. false

time should NOTS be wasted obtaining IV/IO access

first line in the hospital

17
Q

Established GSCE:

Phenytoin should be given __

a. IM
b. IV
c. both

A

b. IV

fosphenytoin may be given IV or IM

18
Q

Established GSCD:

Phenytoin dose/rate?

A

15-20mg/kg IVPB

rate < 50kg/min

mixed in propylene glycol diluent that can cause hypotension and cardiac arrhythmias

19
Q

Established GSCE:

fosphenytoin dose/rate?

A

15-20mg PE/kg IVPB

rate < 150mg PE/min

20
Q

Corrected phenytoin formula:

corrected phenytoin =

A

phenytoin level/adjustment x albumin + 0.1

21
Q

Established GSCE:

total phenytoin or corrected phenytoin goal levels?

A

10-20mcg/mL

1-2 mcg/mL

22
Q

Phenytoin is highly protein bound.

a. true
b. false

A

a. true

check free level if available

if not use total level and albumin and use corrected formula

23
Q

The phenytoin adjustment factor is ___ in most pts, but ___ in pts with renal failure (CrCl < 20)

A

0.2, 0.1

24
Q

Goal total phenytoin levels or corrected phenytoin levels for status epilepticus is __ to __ mcg/mL

A

10, 20

free phenytoin levels of 1-2mcg/mL

25
Q

Status epilepticus second line agents:

What is phenobarbital dose?

A

15-20mg/kg

< 100mg/min

contains propylene glycol

26
Q

Second line agents for status epilepticus:

Goal phenobarbital levels for infants and children?

A

15-30mcg/mL

27
Q

Goal phenobarbital levels for adults?

A

15-40mcg/mL

28
Q

Phenobarbital is an enzyme ___

a. inducer
b. inhibitor

A

a. inducer

3A4, 2C9

29
Q

Valproate dose?

A

25-30 mg/kg

up to 200mg/min

30
Q

Valproate goal levels?

A

50-100mcg/mL

31
Q

Third line agents:

Lacosamide dose?

A

50-400mg with 200 mg given over 15 mins

32
Q

Lacosamide MOA?

A

appears to block voltage gated sodium channels

33
Q

Lacosamide goal levels?

A

5-10mcg/mL

can monitor therapeutic levels although likely not clinically useful

not much evidence supporting the use of lacosamide currently

34
Q

third line agents:

levetiracetam inhibits __ channels

a. sodium
b. calcium

A

b. calcium

modulation of synaptic vesicle protein SV2A in the brain inhibits presynaptic calcium channels

35
Q

Levetiracetam dose?

A

40-60mg/kg

max dose 3000mg

usually dose between 1000 and 2000mg

American Epilepsy Society recommends 60mg/kg with max dose of 4500mg

36
Q

Two agents that are titrated to obtain burst suppression on EEG?

A

pentobarbital

propofol

37
Q

Ketamine maintains arterial blood pressure, pulse rate, and CO.

a. true
b. false

A

a. true

38
Q

Ketamine dose?

A

1-4mg/kg IVP followed by infusion of 1-5 mg/kg/hr

7364 Critical Care Block 3 (6 decks)

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