Digital PharmD

Informatics in Pharmacy

Seizures: Emergent and Codes

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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.