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Winter Therapeutics Exam #2 - Epilepsy
n/a
82
Health Care
Graduate
01/16/2010

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Term
Epidemiology & Social Impact of Epilepsy
Definition
chronic medical condition marked by recurrent seizures; one of most common neurological disorders (1-2% of US pop); Incidence is 35-75 cases per 100,000 persons per yr; approx. 8% of US pop. will experience seizure during lifetime; Huge impact on quality of life & lifestyle --> limits driving, significantly affects education & employability
Term
Seizures
Definition
discrete, time-limited alterations in brain function including changes to motor activity, autonomic fcn, consciousness, or sensation that results from abnormal & excessive electrical discharge of a group of neurons within cerebral cortex; reflects area where seizure begins (seizure focus) accompanied by indescribable body sensations, "Pins & needles" sensations, smells or sounds, depression, hallucinations, momentary jerks or head nods; involuntary muscular contractions (Convulsions)
Term
Medications that can cause Seizures/Epilepsy
Definition
tramadol, bupropion, theophylline, antidepressants/antipsychotics, lithium, alcohol/drug withdrawal
Term
Epilepsy
Definition
condition characterized bgy recurrent (2 or more) seizures unprovoked by any immediately identifiable cause
Term
Aura
Definition
subjective disturbance of perception that represents start of certain seizures
Term
Ictus or ictal phase
Definition
the actual seizure itself
Term
postictal phase
Definition
period after seizure where individual may be sleepy, confused, disoriented, or experiences temporary neurological dysfunction
Term
Pathophysiology of Epilepsy/Seizures
Definition
onset occurs when small group of abnormal neurons undergo prolonged depolarization associated w/ rapid firing of repeated APs; these then recruit adjacent neurons --> electrical discharges of large # of cells that becomes abnormally linked together --> storm of electrical activity --> clinical seizure; occurs due to imbalancec between excitatory & inhibitory processes in brain: decreased inhibitory neurotransmission by GABA & enhanced excitatory neurotransmission mediated by glutamate
Term
Etiology of Epilepsy
Definition
80% is idiopathic (no specific cause); for infants/children: congenital malformations, perinatal injuries, hypoxia, neurological disorders, metabolic defects, injury, infection; Young adults: head trauma, brain tumors, infection, AVMs; Elderly: cerebrovascular dx, CNS degenerative dx, brain tumors; Genetic:
Term
partial seizures
Definition
seizures in which initial onset starts from a localized area in brain, then subdivided depending on maintenance of consciousness; most common type experienced by adults
Term
Simple Partial Seizures (SPS)
Definition
NO LOSS OF CONSCIOUSNESS; Clinical manifestations relate to particular area of brain involved (motor, sensory, autonomic, or psychic manifestations); Duration: 30 sec or less; Prognosis: good control in 30-50% of pts
Term
Complex Partial Seizure (CPS)
Definition
IMPAIRMENT or LOSS OF CONSCIOUSNESS; usually occurs with aura (SPS, fear, rising epigastric sensation, picking at clothes, mumbling, etc.); Duration: 1-3 min; Postictal phase: confusion, lethargy, altered behavior, amnesia; EEG: unilateral or bilateral discharge in temporal or frontotemporal region; Prognosis: controlled in 40-60% of pts; Most common type seen in adults
Term
Partial Seizures Secondarily Generalized
Definition
localized seizure that may progress thru several stages reflecting the spread of discharge to different brain areas
Term
Generalized Tonic-Clonic Seizures (GTC)
Definition
LOSS OF CONSCIOUSNESS --> sudden fall to ground; next phase --> muscles become rigid, simultaneous contractions of diaphragm & chest muscles ("epileptic cry") --> series of synchronous clonic movements of head, face, legs, & arms; Occurs most comonly during 2nd decade of life; Duration: 2-5 min; Postictal: lethargic/sleepy lasting several min to hours; Incontinence seen in early postictal stage; Occurs most commonly on awakening & to a lesser extent in evening; Prognosis: good control in 70-85% of pts
Term
Absence Seizures
Definition
Onset: 4-14 yrs old, resolved by age 18; brief episodes of staring w/ impairment of awareness & responsiveness, begins without warning & ends suddenly, leaving pt alert & attentitive; Simple = only staring; Complex = staring with automatic movements (blinking of eyes, drooping of head, chewing); Duration: 10-45 sec, pt unaware of occurrence; Abrupt recovery w/ no residual effects; 25-50% of pts develop generalized tonic-clonic seizures; Long-term prognosis is good; Important in children to differentiate from complex partial seizures since tx & prognosis vary
Term
Atonic Seizures
Definition
occurs between 2-5 yrs old; Sudden & total loss of muscle tone & postural control --> eyelids drop, head nods, pt falls to ground ("Drop Attack") - must wear a helmet for protection; Duration: 10-60 sec; Prognosis: dependent on presence of underlying neurological deficit and/or mental retardation
Term
Myoclonic Seizures
Definition
sudden, brief, shock-like jerk of a muscle or group of muscles that often occurs in healthy pts as they fall asleep; causes synchronous & bilateral jerks of neck, shoulders, upper arms, body, & upper legs
Term
Tonic Seizures
Definition
sudden bilateral stiffening of body, arms, or legs; Duration: less than 20 sec; more common during sleep; Seen in younger children, associated w/ metabolic disorder or underlying neurological deficit; Duration: 10-60 sec
Term
Infantile Spasms - aka West's Syndrome
Definition
occurs in infants less than 1 yr of age; specific EEG pattern & spasms or jitters; babies often develop other seizure types & epilepsies later in life; Tx: ACTH, prednisone, vigabatrin
Term
Febrile Seizures
Definition
convulsions brought on by a fever (rectal temp. >102 degress F) in infants or small children; generalized tonic-clonic seizures usually occur; children prone to this syndrome are not considered to have epilepsy; DO NOT tx with oral anticonvulsants (phenobarb, valproate); TREAT with diazepam (Oral or rectal) when infant has fever
Term
Lennox-Gastaut Syndrome
Definition
triad of intractable seizures, mental & developmental retardation, & slow spike & wave pattern on EEG; seizures begin between 1-6 yrs of age & respond poorly to antiepiletpic drugs; common behavioral problems
Term
Juvenile Myoclonic Epilepsy
Definition
myoclonic seizures that begin shortly before or after puberty; myoclonic & tonic-clonic seizures most often occur in early AM, shortly after pt awakes; mental development is normal; Usually well-controlled by valproic acid alone, but requires life-long therapy
Term
Diagnosing Epilepsy
Definition
1) confirm pt has epilepsy; 2) Correct classification of seizure type &/or epileptic syndrome; 3) Identify any underlying causes of seizures; 4) Treat w/ appropriate drug therapy if indicated
Term
Underlying Factors that Cause Seizures
Definition
metabolic and/or electrolyte imbalance; sedative or EtOH withdrawal; sleep deprivation; AED withdrawal or inadequate AED tx; fever or systemic infection; stimulants (IV drug use, cocaine, ephedrine)
Term
Diagnostic Evaluation of Epilepsy
Definition
History: medical hx, description of seizures (events preceding, during, & after, identify precipitating factors); Physical & Neurological Exam; Clinical Lab Data (CBC, LFTs, Serum chemistry); EEG (electroencephalogram); Neuroimaging studies (MRI, CT)
Term
Precipitating Factors of Epilepsy in Susceptible PTs
Definition
sleep deprivation; fever; emotional stress; lack of food; alcohol/drug withdrawal; pregnancy; menses; various sensory stimuli (photosensitivity, TV, reading, eating, music)
Term
First Aid for Generalized Tonic-Clonic Seizures
Definition
1) prevent pt from hurting themself; 2) do not force anything into pts mouth; 3) do not restrain pts movements; 4) Turn pt on side; 5) stay w/ pt until seizure ends naturally; 6) Give artificial respiration if pt does not resume breathing after seizure; 7) Provide area for pt to rest until fully awakened; 8) Be reassuring & supportive; 9) Immediate medical attention required if: seizure lasts >10 min, difficulty in rousing at 20 min intervals, complains of difficulty with vision, vomiting, persistent HA, unconsciousness w/ failure to respond, excessively dilated pupils
Term
First Aid for Nonconvulsive (Absence & Complex Partial) Seizures
Definition
1) do not restrain pt; 2) remove harmful objects from pt's path; 3) calmly try to encourage pt to sit down; 4) Observe but DO NOT approach pt who appears angry or combative; 5) Remain w/ pt until fully alert
Term
Nonpharmacological Treatment of Epilepsy
Definition
1) surgery (temporal lobectomy); 2) Vagal nerve stimulation ; 3) ketogenic diet; 4) Lifestyle modifications: adequate sleep, avoid EtOH, stimulants, avoid known precipitants, reduce stress
Term
Primary Goal of Drug Therapy
Definition
1) complete suppression of seizures & absence of disabling side effects; 2) when epilepsy can't be controlled, attain best compromise b/w maximizing seizure control & minimizing side effects; 3) It should maintain or restore pt's lifestyle & ability to lead active life
Term
Management of Epilepsy
Definition
1) appropriate diagnostic evaluation; 2) identify and correct any underlying causes; 3) treat seizures (assess necessity of drug therapy, begin appropriate AED therapy, identify & avoid any precipitating factors, evaluate for surgery or other options if refractory to AED therapy); 4) Prevent complications due to seizures
Term
Principles of AED Therapy
Definition
1) select most appropriate drug based on: seizure type (primary criteria), individualized selection based on lifestyle, ADRs, administration convenience); 2) MONOTHERAPY is preferred; 3) Individualization of Dosage - start at low end of recommended dosage range & slowly increasing until seizures are controlled or intolerable adverse effects develop; 4) Monitor Therapy - seizure diary, ADRs, Lab Tests, AED plasma concentrations; 5) Appropriate use of AED plasma concentrations; 6) Evaluate Pt with Chronic Active Epilepsy; 7) Termination of Antiepileptic Drug Therapy; 8) Patient Education
Term
Switching AEDs for Monotherapy
Definition
Titrate 2nd drug to recommended dose range, then start gradually withdrawing initial drug over 1-3 wks; After initial drug has been withdrawn, dose of 2nd drug should be increased until seizures are controlled or intolerable side effects develop
Term
Evaluation of Pt w/ Chronic Active Epilepsy
Definition
1) review diagnosis/etiology; 2) review adherence; 3) Try to improve adherence; 4) Review drug history; 5) Develop tx plan; 6) Reduce polytherapy if applicable
Term
Tapering Schedule for Withdrawing AED Therapy
Definition
1) ensure drug plasma conc. of DESIRED drug(s) are in usual therapeutic range, then slowly withdraw UNWANTED drug over several days to wks; 2) Decrease dose of UNWANTED drug by 25% every 1 to 2 wks; 3) If exacerbation of seizures occurs during drug withdrawal, dose should be increased to previous level, then retry withdrawing UNWANTED drug using a more gradual schedule
Term
Adverse Effects of AEDs
Definition
toxic CNS effects: somnolence, fatigue, dizziness, vision changes, nystagmus, ataxia, tremor, GI disturbances, difficulty thinking, & behavioral disorders; Increased suicide risk; Idiosyncratic effects: aplasatic anemia, skin rash, hepatotoxicity, pancreatitis, lupus-like rxn, SJS; SKIN RASH, HEPATOTOXICITy; APLASTIC ANEMIA/AGRANULOCTYOSIS; Chronic: connective tissue, endocrine, GI, hematologic, & neurologic disorders; TERATOGENICITY
Term
Guidelines for Management of AEDs during Pregnancy
Definition
1) take 1-4 mg folic acid daily; 2) use monotherapy when possible; 3) Use lowest doses that control seizures; 4) Monitor AED serum conc. at start of pregnancy & monthly thereafter; 5) Adjust AED doses to maintain baseline serum conc.; 6) Add supplemental Vitamin K to women receiving enzyme-inducing AEDs; Avoid valproic acid; Counsel pt on risk of potential complications & congenital malformations;
Term
phenytoin (Dilantin)
Definition
Indications: 1st line for PRIMARY GENERALIZED & PARTIAL SEIZURES except absence seizures - NOT EFFECTIVE for absence seizures; Pks: NON-LINEAR, zero-order; prolonged but completely absorbed orally; highly protein bound, enzyme INDUCER, non-linear elimination; Forms: acid - 100% bioavailable, sodium - 92% bioavailable; Chronic ADRs: gingival hyperplasia, hirsutism; Idiosyncratic ADRs: Fetal Hydantoin Syndrome (FHS)
Term
Acute Phenytoin Toxicity
Definition
>20 mcg/mL - nystagmus, ataxia, altered mental status; >30 mcg/mL - ataxia, seizures reported; >40 mcg/mL - lethargy, seizures, coma
Term
phenobarbital (Luminal)
Definition
Indications: PARTIAL & GENERALIZED seizures, NOT absence, 2nd line agent due to SEs; PKs: long half-life, dosed once daily, linear elmination; Dosing: start with low doses & titrate up; ENZYME INDUCER; Acute ADRs: dose-related CNS depression, sedation, nystagmus, dizziness, ataxia, PARADOXICAL EFFECT IN CHILDREN (hyperactivity);
Term
primidone (Mysoline)
Definition
Indication: PARTIAL & GENERALIZED, NOT absence seizures; ADRs: dose-related depression, sedation, nystagmus, dizziness, ataxia
Term
carbamazepine (Tegretol)
Definition
Indications: trigeminal neuralgia, PARTIAL & GENERALIZED seizures, NOT ABSENCE; DRUG OF CHOICE for complex partial seizures; PKS: enzyme INDUCER, induces its own metabolism (AUTOINDUCTION) -> levels drop after a month; Acute ADRs: dose-dependent CNS depression but MUCH LESS than phenytoin or phenobarb; Chronic ADRs: SIADH - monitor Na levels & signs & symptoms
Term
valproic acid (Depakene), divalproex sodium (Depakote)
Definition
Indications: broad sprectrum - effective for ALL seizure types; 1st line for GENERALIZED seizures (MYOCLONIC, ATONIC, & ABSENCE), monotherapy & adjunctive for PARTIAL, effective for mixed seizure types; PKs: bioavailability of ER product 15% less than EC formulation; metabolized in liver, enzyme INHIBITOR, causes hepatic toxicity; Acute ADRs: fine motor tremor, alopecia; Idiosyncratic ADRs: hepatotoxicity, monitor N/V, lethargy, anorexia, edema, LFTs for first 6-12 months; Chronic ADRs: hyperammonemia, weight GAIN, polycystic ovary-like syndrome, adverse endocrine effects
Term
ethosuximide
Definition
Indications: NARROW spectrum - effective ONLY for ABSENCE seizures; Chronic ADRs: HA, behavioral changes; IS NOT an enzyme inducer or inhibitor; drug levels reduced by carbamazepine & increased by valproic acid
Term
felbamate (Felbatol)
Definition
Indications: monotherapy or adjunctive therapy of PARTIAL or PARTIAL SECONDARILY GENERALIZED seizures, ATONIC seizures in Lennox-Gastaut syndrome, LAST LINE AGENT (aplastic anemia, hepatotoxicity)
Term
fosphenytoin (Cerebryx)
Definition
water-soluble PRODRUG; parenteral administration; safer & better tolerated than IV parent drug; Dose in terms of phenytoin equivalents (PE), 1 mg PE = 1 mg phenytoin;
Term
gabapentin (Neurontin)
Definition
Indications: adjunctive for PARTIAL & PARTIAL SECONDARILY GENERALIZED seizures, also used for chronic pain, peripheral neuropathy, & other nonepilepsy conditions; PKs: NOT protein bound, NO drug interactions; Acute ADRs: LESS CNS effects than traditional AEDs; Chronic ADRs: weight gain
Term
lamotrigine (Lamictal)
Definition
Indications: monotherapy & adjunctive for PARTIAL seizures, effective for GENERALIZED seizures in Lennox-Gastaut syndrome, also used for GENERALIZED TONIC-CLONIC seizures & nonepilepsy disorders like bipolar disorder; PKs: autoinduction occurs & increases CL by 25%; NO enzyme inhibition or induction; Acute ADRs: dizziness, diplopia, ataxia, folic acid deficiency; Idiosyncratic ADRs: RASH - occurs within 3-4 wks, SJS HAS OCCURRED
Term
oxcarbazepine (Trileptal)
Definition
Indication: monotherapy & adjunctive therapy in PARTIAL seizures, potential 1st line for PRIMARY GENERALIZED CONVULSIVE seizures; ENZYME INDUCER tho less than carbamazepine; Idiosyncratic ADRs: rash, 25-30% of pts that develop rash w/ carbazepine will develop rash w/ this drug; Chronic ADRs: SIADH
Term
topiramate (Topamax)
Definition
Indications: monotherapy of PARTIAL & GENERALIZED seizures, for children w/ Lennox-Gastaut syndrome, used for migraines, bipolar disorder, & PTSD; Acute ADRs: psychomotor slowing, difficulty with concentration & memory, parasthesias; Idiosyncratic ADRs: metabolic acidosis 2ndary to carboncic anhydrous inhibition; Chronic ADRs: kidney stones, weight LOSS
Term
tiagabine (Gabitril)
Definition
Indicaitons: 2nd line for PARTIAL seizures who have failed initial therapy, DOES NOT have role in primary generalized seizures
Term
levetiracetam (Keppra)
Definition
Indications: adjunctive therapy for PARTIAL ONSET seizures, MYOCLONIC seizures, PRIMARY GENERALIZED TONIC-CLONIC seizures; PKs: cleared renally, prolonged T1/2 in pts w/ renal insufficiency. DECREASED dosing in renal infsufficiency; DOES NOT induce or inhibit enzymes; Monitor: decreases in RBC count, Hgb/Hct, WBCs, & neutrophils, monitor CBCs routinely while on therapy
Term
zonisamide (Zonegram)
Definition
Indications: adjunctive for PARTIAL seizures; Idiosyncratic ADRs: rash, oligohydrosis (decreased ability to sweat); Chronic ADRs: kidney stones, weight LOSS; Monitor: BUN/CR, renal fcn, for skin rash, CBC & LFTs
Term
pregabalin (Lyrica)
Definition
Indications: adjunctive for PARTIAL ONSET seizures, also used for neuropathic pain (diabetic neuropathy), post-herpetic neuralgia (PHN), fibromyalgia; NO drug interactions
Term
lacosamide (Vinpat)
Definition
Indications: adjunctive for PARTIAL ONSET seizures, NOT indicated for neuropathic pain yet; ADRs: elevated liver enzymes, ECG changes; Dosing: use w/ caution in hepatic impairment & severe cardiac dx
Term
rufinamide (Banzel)
Definition
Indications: adjunctive for LENNOX-Gastaut SYNDROME; use with valproic acid increases blood levels of drug
Term
Recommended AEDs for Partial ONSET seizures with or without secondary generalization
Definition
carbamazepine, lamotrigine, oxcarbazepine, phenytoin, topiramate, valproate
Term
Recommended AEDs for PRIMARY GENERALIZED TONIC-CLONIC Seizures
Definition
carbamazepine, lamotrigine, topiramte, valproate, oxcarbazepine, phenytoin
Term
Recommended AEDs for Generalized ABSENCE Seizures
Definition
ethosuximide, lamotrigine, valproate
Term
Recommended AEDs for Generalized MYOCLONIC Seizures
Definition
lamotrigine, valproate, topiramate (for children)
Term
Recommended AEDs for Generalized TONIC Seizures
Definition
lamotrigine, valproate
Term
Recommended AEDs for Generalized ATONIC Seizures
Definition
lamotrigine, valproate
Term
Status epilepticus
Definition
neurologic emergency that can lead to permanent brain damage or death; recurrent epileptic seizures without full recovery of consciousness before next full seizure begins OR continuous electrical seizure activity lasting >30 min; present as Non-convulsive or Generalized convulsive
Term
Non-convulsive Status Epilepticus (NCSE)
Definition
persistent state of impaired consciousness and/or motor or sensory seizures without impaired consciousness; EEG is key to diagnosis
Term
Generalized Convulsive Status Epilepticus (GCSE)
Definition
involves entire brain; characterized by full body tonico-clonic motor seizures; consciousness is impaired
Term
Factors Affecting Outcome of SE
Definition
Age - incidence pks between 60-79 yrs old & children; Duration - responsiveness to 1st line therapy decreases w/ increasing duration of SE;, survival decreases with increasing duration
Term
Etiology of SE
Definition
CNS infection or tumor; trauma, hypoxia, stroke, metabolic disorders (hypoglycemia), chronic alcohol abuse, preexisting epilepsy, drug toxicity or withdrawal, AED change or subtherapeutic AED levels
Term
Principles for Management of SE
Definition
Goal: rapid termination of clinical & electrical seizure activity; Medical emergency; Predetermined Rx protocol more effective then letting pt "ride it out"
Term
Time 0 for Treating SE
Definition
Assess/Monitor: vitals, airway, cardiac function (EKG), pulse ox, check blood glucose, check lab tests; Tx: stabilize airway, administer O2, secure IV access & start fluids, give THIAMINE 100 mg + glucose if hypoglycemic
Term
Time 0-10 min during Tx of SE
Definition
Assess/monitor: vitals, PhEx, Pt hx (Rx, OTCs, herbals); Tx: give lorazepam 0.1 mg/kg IVP (MAX = 4 mg) at 2 mg/min - may repeat in 10-15 min to MAX = 8 mg if no response, IF NO IV ACCESS --> give diazepam 10 mg PR OR midazolam 0.2 mg/kg IM
Term
Time 10-30 min for Tx of SE
Definition
Assess/monitor: vitals, review lab results & correct any underlying abnormalities, CT scan (if controlled); Tx: phenytoin 15-20 mg/kg IV at MAX rate of 50 mg/min (or fosphenytoin 15-20 mg PE/kg IV at max rate of 150 mg/min), IF NO IV ACCESS --> give fosphenytoin IM, tx for possible infection
Term
Time 30-60 min for Tx of SE
Definition
Assess/monitor: vitals, consult neurologist/epileptologist, consider amdit to ICU, consider EEG; Tx: IF SEIZURES continue --> additional phenytoin bolus 5-10 mg/kg (or fosphenytoin 5-10 mg PE/kg) OR start phenobarbital at 20 mg/kg IV at MAX rate of 100 mg/min
Term
Time >60 min for Tx of SE
Definition
Assess/Monitor: vitals, transfer to ICU, obtain EEG, consider MRI when controlled; Tx: IF SEIZURES CONTINUE: repeat boluses of phenobarbital 10 mg/kg until seizures stop
OR valproate sodium 20 mg/kg at 6 mg/kg/min MAX followed by 1-4 mg/kg/hr continuous infusion
OR midazolam 2 mg/kg bolus followed by 0.05-2 mg/kg/hr CI
OR propofol 1 mg/kg bolus followed by 2-15 mg/kg/hr CI
OR pentobarbital 10-15 mg/kg bolus over 1-2 hrs followed by 0.5-4 mg/kg/hr;
Consider intubation;
Consider pressor support if needed
Term
diazepam (Valium)
Definition
Adv: rapid onset of action (1-3 min), can give rectally;
Disadv: short duration of action (15-30 min), depresses consciousness (10-30 min), respiratory depression/hypotension, accumulation of parent/active metabolies w/ repeated administration
Term
lorazepam (Ativan)
Definition
Preferred agent when treating SE;
ADV: rapid onset of action (5-10 min), long duration (12-24 hrs)
DISADV: depresses consciousness, respiratory depression/hypotension, tolerance may develop w/ long-term use
Term
midazolam (Versed)
Definition
ADV: can give IM, buccally, or intranasally, fewer repiratory & cardiovascular effects
DISADV: expensive, short half-life
Term
phenytoin (Dilantin)
Definition
ADV: long duration of action (24 hr), low risk of respiratory depression, little effect on consciousness, continued as chronic therapy
DISADV: IV administration only, hypotension & arrhythmias, infusion rate no > than 50 mg/min, extravasation can cause local color change edema, pain, & necrosis, can only give with D5W
Term
Problems with Parenteral Phenytoin Administration
Definition
contains 40% propylene glycot at pH 12; incompatibility problems with common IV fluids; venous irritation, pain, phlebitis at IV site; soft tissue damage, necrosis with extravasation; Slow, erratic IM absorption, tissue necrosis at IM injection site; DO NOT GIVE IM!!!
Term
fosphenytoin (Cerebryx)
Definition
ADV: greater water solubility, pH 8.5 --> compatible w/ most IV fluids including dextrose, reduction in infusion-related AEs, can administer at higher IV rates, Feasible IM administration (large injection volumes)
DISADV: paresthesias around lips & groin, very expensive

Prodrug of phenytoin, converted to phenytoin (delayed onset of action), administration at rates up to 3x max for phenytoin, use a dedicated line for IV administration, monitor ECG, BP
Term
phenobarbital (Luminol)
Definition
ADV: long duration of action (>48 hrs), no tolerance, continued as chronic therapy, IM/rectal administration possible
DISADV: depresses consciousness, respiratory depression/hypotension
Term
valproate sodium injection (Depacon)
Definition
substitute when oral therapy is not feasible; 1:1 conversion from oral to IV dose; administer as 60 min infusion no faster than 20 mg/min; infusion rates of 1.5-3 mg/kg/min well tolerated;
Term
rectal diazepam (Diastat)
Definition
drug has comparable efficacy to IV form
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