Mgminute without risk of cardiovascular collapse it

mg/minute) without risk of cardiovascular
collapse
 It is also more
expensive
7. If the above measures to abort status
epilepticus are unsuccessful, intubate and
administer phenobarbital (Luminal), 100
mg/minute IV to a maximum of 20 mg/kg.
8. If still unsuccessful after 60 minutes, consider
general anesthesia with propofol (Diprivan),
loading dose of 3-5 mg/kg, followed by an
infusion of 30-100 mcg/kg/min.
D. Clinical pharmacology of the antiepileptic
drugs (AEDs) (Table 6.1)
E. Drugs for specific types of seizures (Table
6.2)

F. Titrate dosages to achieve adequate serum
levels. If a first drug partially controls seizures
at a maximal therapeutic level, add a second
drug to achieve therapeutic levels. Evaluation
of serum phenytoin may require additional
correction based on serum albumin level and/or
current renal function; consult pharmacist for
appropriate correction of phenytoin levels to
avoid unnecessary dosage adjustments.
G. If the patient is seizure-free, monitor the
patient, not the levels.
H. One should never abruptly withdraw an
anticonvulsant from a patient; these drugs
should be tapered.
I. Vagus nerve stimulation is used in conjunction
with medications by patients with severe,
uncontrolled seizures. Stimulation is typically
applied for 30 seconds every 5 minutes.
When the vagus is stimulated, resultant
impulses in some way interrupt or prevent
abnormal neuronal firing.
Pharmacologic Agents
Drug Dosing Dail
y
Dos
age
Targe
t
Seru
m
Level
Mcg/
ml
Induces
Hepatic
Drug
Metaboli
sm
Carbamaze
pine
Tegretol
Epitol
Tegretol XR
Carbatrol
Equetro
3xdail
y
3xdail
y
2xdail
y
2xdail
y
2xdail
y
600
-
180
0
4-12 Yes
Ethosuximi
de
Zarontin
1-2
xdaily
750 40-
100
No
Phenobarb
ital
1-
2xdail
y
60-
120
15-45 Yes
Phenytoin
Dilantin-125
Dilantin
Infatab
Phenytek
Dilantin ER
2-
3xdail
y
2-
3xdail
y
1xdail
y
1xdail
y
200
-
300
10-20 Yes
Primidone
Mysoline 3-
4xdail
y
500
-
750
5-15 Yes
Valproic
acid
Depakene
Depakote
Depakote
ER
Stavzor
3-
4xdail
y
3-
4xdail
y
2xdail
y
2-
3xdail
y
750
-
300
0
40-
100
Yes
Gabapenti
n
Neurontin
3xdail
y
120
0-
360
0
ND No
Lacosamid
e
Vimpat
2xdail
y
200
-
400
ND No
Lamotrigin
e
Lamictal
Lamictal
ODT
Lamictal XR
2xdail
y
2xdail
y
1xdail
y
400 ND No
Levetirace
tam
Keppra
2xdail
y
200
0-
300
0
ND
No
Oxcarbaze
pine
Trileptal
2xdail
y
900
-
240
0
3-40 No
Pregabalin
Lyrica 2-
3xdail
y
150
-
600
ND No
Rufinamid
e 2xdail 320 ND Yes

Banzel y 0
Tiagabine
Gabitril 2-
4xdail
y
16-
32
ND No

GUILLAIN-BARRE SYNDROME
I. Definition
A. Guillain-Barre syndrome (GBS) is an acute,
usually rapidly progressive, form of
inflammatory demyelinating
radiculoneuropathy; typically motor greater
than sensory.
B. Characterized by a monophasic course of
muscular weakness, mild distal sensory loss,
and autonomic dysfunction, with the majority of
patients reporting an antecedent infection
1. The maximum deficit is usually attained by
week 4.
C. Most frequently acquired demyelinating
neuropathy
II. Etiology
A. Unknown, although an autoimmune basis is
probable
B. Majority of cases are triggered by an
antecedent infection, suggesting a response
involving antibodies cross-reacting with both
humoral and cellular immunity with peripheral
nerve
Gangliosides
C. Frequent antecedent infections include the