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Digital PharmD

Informatics in Pharmacy

Seizures: Emergent and Codes

August 13, 2018 By Dr. G, PharmD

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*See the seizure medication table for quick reference.

Seizure overview.

Head trauma:

  • Early seizure – within first 7 days, prevent with 5/mg/kg day phenytoin (valproate has higher mortality)
  • No prophylaxis for late seizures.

Emergent:

For emergent seizures, benzos are the drug of choice to stop seizing.

  • Lorazepam – onset 2-3 minutes, 0.1 mg/kg up to 4 mg every 5-10 minutes.
  • Diazepam – onset rapid, but duration is short.  0.15/mg/kg up to 10 mg every 5 minutes.
  • Midazolam – 0.2 mg/kg up to 10 mg/dose

After benzos, start control med:

  • Phenytoin 20 mg/kg
  • Fosphenytoin
  • Phenobarbital 20 mg/kg
  • Valproic Acid 20-40 mg/kg
  • Levetiracetam 20-30 mg/kg
  • Lacosamide 200-400 over 15 minutes

If refractory to above:

  1. Phenobarbital 5-15 mg/kg over 15 minutes then 0.5 mg/kg/hr
  2. Thiopental 2-7 mg/kg then 0.5 mg/kg/hr
  3. Midazolam 0.2 mg/kg then 0.5 mg/kg/hr
  4. Propofol 1-2 mg/kg then 20-200 mcg/kg/min

*******No Valproic Acid in potentially pregnant patients***********

Also avoid: phenytoin, carbamazepine, and phenobabital, but not as severely.  Try to use a single agent.

Filed Under: Neurology

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acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia bcps Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020