Status Epilepticus
Assess the need for SEIZURE prophylaxis
As a critical care pharmacist, questions are still popping up about seizure prophylaxis after a neurological injury, trauma, intracranial hemorrhage, etc. Who should get it? Continue to use seizure prophylaxis after a SEVERE traumatic brain injury (TBI); Glasgow Coma Scale 3 to 8. About 1 in 10 TBI patients have seizures…
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Stroke
Update your INTRAcerebral Hemorrhage protocol
As a hospital pharmacist, you will be asked about spontaneous intracerebral hemorrhage (ICH) treatment , due to updated guidelines. Follow these points... Anticoagulant reversal. Use 4-factor prothrombin complex concentrate ( Kcentra ) for warfarin-related ICH when INR is 1.3 or higher, along with IV vitamin K to reduce risk of INR reb…
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Status Epilepticus
Phenytoin is difficult drug to dose
Phenytoin ( Epanutin, Epilog ) is one of the most difficult drugs to dose. This is because phenytoin metabolism depends on the dose. Higher doses take longer to metabolize, so doubling the dose can more than double the serum concentration. Follow these steps... Loading doses help get to therapeutic levels faster. Give 15 to 20 mg/kg PO or IV, about 1000 mg fo…
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Seizures
Weigh considerations for anticonvulsant in women of childbearing age
As a preofessional pharmacist, you will need to navigate risks when antiepileptics are started in women of childbearing age. Keep in mind, these medications are often used for migraine, mood disorders, fibromyalgia, etc, NOT only seizures. Weigh teratogenic risk . Generally, feel comfortable if lamotrigine ( Lamictal ) or levetira…
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Status Epilepticus
Use benzodiazepines first-line in status epilepticus
AS A HOSPITAL PHARMACIST, you will see more emphasis on the management of status epilepticus due to new guidelines from the American Epilepsy Society. We know seizures lasting more than five minutes are hard to stop. Create a stepwise protocol and order set to ensure fast and seamless treatment of your status epilepticus patients... …
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Status Epilepticus
Consider levetiracetam for benzo-resistant status epilepticus
New evidence will renew debate about which medication to use for status epilepticus patients who DON’T respond to a benzodiazepine. Continue to first optimize the benzodiazepine dose, such as giving up to 8 mg of lorazepam (drug of choice; duration of action 12–24 hours). There are several recommended options to try next, but many hospitals use IV fosphenytoin …
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