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PHM 703: Crit Care/Heme/Onc > Critical Care: Seizure > Flashcards

Critical Care: Seizure Flashcards

the thing you get when you read all the typos

1
Q

inhibitory neurotransmitte4r

A

gaba

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2
Q

exctatory neurotransmitters

A
  • glutamte
  • asparate
  • acetylcholine
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3
Q

how long must a seizure last to be considered status epilepticus

A

5 min

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4
Q

at what point does a pt warrantt an antiepileptic

A

after 2nd seizew

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5
Q

goals of treatment of seizure

A
  • rapid and safe termination
  • prevent recurrence
  • avoid CV and resp complicaations
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6
Q

initial treatment of seizure

A
  • benzosssss - the stop the seizure
    - first line: lorazepam and diazepam IV
    - second line: diazepam PR and midazolam IM
  • anti-epileptics - prevent recurrence
    - fos/phenytoi
    - keppra
    - VPA

lacosamide can be used as an add on anti-epileptic

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7
Q

fos/phenytoin MOA

A

affect movement of Na across cell membranes -> stabilize neuronal membranes and decrease seizure activity

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8
Q

fos/phenytoin dose in treatment of seizure

A
  • loading dose: 20mg/kg IV (max 50 mg/min)
  • maintenance: 4-6 mg/kg/day divded BID or TD
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9
Q

fos/phenytoin monitoring

A
  • goal total phenytoin 10-20 mcg/dL
  • if pt actively seizing, can increase goal to 15-25
  • levels above 30 can cause seizures
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10
Q

fos/phenytoin PK

A
  • highly protein bound - correct phenytoin level if albumin < 3.5
  • liver metabolis
  • Michaelis-Menten saturable kinetics: once saturated, a small change in dose can lead to a big change in steady state level
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11
Q

fos/phenytoin ADR

A
  • CV: hypotension, bradycardia, QT prlongation (reduce indicince rate with lower infusion rate)
  • extravasation
  • rash -> SJS
  • neutropenia/thrombocytopenia
  • ==========
  • P - cyp450
  • H - hirsutism/hypertrichosis
  • E - enlarged gums
  • N - nystagmus
  • Y - yellow (hepattis)
  • T - teratogenicity
  • O - osteomalcia (vit D deficiency)
  • I - interferene with folate metabolism (anemia)
  • N - neuropathies (vertigo, ataxia, HA)
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12
Q

keppra MOA in treatment of seizures

A

unclear, but it is involved in neurotransmitter release

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13
Q

keppra dose in treatment of seizure

A
  • loading: 60 mg/kg IV (max 4500 mg)
  • maintenacne: 1000 mg IV BID

do NOT need to djust for AKI in pts with status epilepticus

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14
Q

keppra adr

A
  • drowsiness
  • agitation (aggression, agitatio, emotional lability)
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15
Q

VPA MOA

A
  • increase GABA synthesis and release
  • decrease excitatory amino acids and attenuate neuronal excitation mediated by NMDA receptors
  • block voltage dependent Na channels -> inhibit excitable membranes
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16
Q

VPA dose in treatment of seizures

A
  • loading: 40 mg/kg (max 3000mg)
  • maintenance: 5mg/kg IV q8h
17
Q

VPA monitoring

A

goal 50-100 mcg/mL

18
Q

VPA ADR

A
  • drowsiness
  • HA
  • thrombocytopenia
  • pancreatisi in peds
  • hyperammonia
19
Q

important VPA/phenytoin DDI

A

both are strong protein binders but VPA displaces phenytoin -> icreased serum phenytoin -> higher potential ofr phenytoin tox

20
Q

lacosamide MOA

A

enhance slow inactivtion of Na cchannels -> stabolize hyperexcitable neuronal membranes and inhibit repititve neuronal firing

21
Q

lacosamide dose in treatment of seizure

A

100-200mg iV BID

22
Q

refractory status epilepticus

A
  • seizure > 2 hrs long
  • 2+ seizures/hr with no recovery to baseline despite treatment

these pts often need to be intubated

23
Q

intubating refractory status epilepticus pts

A
  • start a continuous anti-epileptic infusion: propofol or midazolam (or both if needed)
  • paralytic will be needed -> hard to tell if pt is actively seizing -> need an EEG or LTM to monitor seizure activity
24
Q

IV midazolam dose for treatment of refractory status epilepticus

A

2 mg bolus follwoed by 2mg/hr
- doubled prn if pt still seizign

25
Q

when to do a phenobarb or pentobarb induced coma in a status epilepticus pt?

A
  • when nothing else works lol
  • pt is s/p several doses of benzos and at least 2-3 anti-epileptics with one of them being continouous

phenobarb and pentobarb are sedative hypnotics that suppress sensory cortex

26
Q

phenobarb and pentobarb ADR

A
  • resp depresion - pt MUST be intubated
  • hypotension - may need vasopressors
  • decreased GI mobility
  • suppressed immune system - monitor for s/s of infection, pt likely won’t develop a fever even if infected
  • thromocytopenia
27
Q

when to treat a status epilepticus pt with ketamine

A

when the phenobarb/pentobarb coma didn’t help

28
Q

status epilepticus treatment goal

A

burst suppression on LTM

29
Q

what to do when a status epilepticus pt achieves burst suppression is achieved on LTM (long term monitoring)/EEG

A
  • maintain burst suppression for 24-48 hrs then slowly tirtrate off IV infusions
    - start with agents with bad ADR: phenobarb, pentobarb, midazolm, propfol
    - slap the agents back on if pts starts seizing again
30
Q

post-ictal recovery care

A

frequent neuro exams to try and figure out cause of seizure/SE

PHM 703: Crit Care/Heme/Onc (16 decks)

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