Podcast 576: Status Epilepticus Drugs

<p><strong>Author: Charlene Gnisci Melton, PharmD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Status Epilepticus is defined as continuous seizure activity for >5 minutes, or 2 or more seizures without full return to consciousness between events</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Status epilepticus is a true neurologic emergency with significant morbidity and mortality</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Aggressive, early treatment of status epilepticus is essential as GABA receptors will regress over time and make benzodiazepines less effective as time elapses</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Go large with doses of benzodiazepines and repeat doses if necessary: In adults this means lorazepam 4 mg IV push or Midazolam 10 mg intramuscular if no IV access</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Second line agents include:</span></li> <li style="list-style: none; display: inline;"> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Levetiracetam (Keppra) 60 mg/kg up to 4500mg</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Valproic Acid (40 mg/kg up to 3000 mg)</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Keppra has an arguably better side effect profile and compatibility compared to other second-line agents</span></li> </ul> </li> <li style="font-weight: 400;"><span style="font-weight: 400;">Third line agents include intubation and sedation with propofol, benzodiazepines, or even ketamine</span></li> </ul> <p><em><span style="font-weight: 400;">Editor’s note: from a time management perspective, call for your second-line treatment early to get it from pharmacy while you slam the benzodiazepines, then it will be arriving hopefully when you need it, and no harm if you don’t. Oh, and don’t forget a fingerstick gluco