Anticonvulsants Flashcards
What is the preparation steps for the team?
Self, team, environment, patient
What things should you do first when a fitting patient arrives?
ABCDE Secure airway High flow Glucose IV access
What drugs would you use to treat a fitting patient?
Buccal midazolam (up to 2 doses)
Rectal diazepam (esp infants)
Lorazepam
Phenytoin (need to know about allergy, pregnant) - if patient on phenytoin you can give phenobarbital or IV levetiracetam
What side effect are you most concerned about in anti-epileptic medication?
respiratory depression
What is better? Lorazepam or diazepam
Lorazepam - 1-3 min onset when IV, shorter acting effects, less resp depression
Diazepam - 1-5 action, variable response
What are some common anaesthetic drugs?
propofol, thiopentone, ketamine
What are some possible causes of status epilepticus?
febrile convulsions
epilepsy, haemorrhagic stroke, hypoglycaemia, hypoxia, alcohol intoxication
What are some medical complications of status epilepticus?
injury, hypoxia, hyperthermia, hypoglycaemia
long term - epilepsy, encephalopathy, focal neurological defects
What are some features of early alcohol withdrawal?
under 24 hours = autonomic hyperactivity
Shakes, insomnia, anxiety, hyperreflexia, sweating, tachycardia, tachypnoea, GI upset
How would you treat alcohol withdrawal?
Refer to alcohol liason service
Go home and drink if possible
Give 2-3 days chlordiazepoxide
consider social issues
What are the features of delirium tremens?
48-72h severe autonomic hyperactivity and altered sensorium
- above hyperthermia
- disorientation
- agitation
- hallucinations
- seizures
What is the mortality of delerium tremens if untreated?
30%
How do you manage delerium tremens?
fluid replacement
IV pabrinex
GABA replacement
How would you assess alcohol dependence when conscious?
CAGE, AUDIT, ADLs
