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17 Cards in this Set
- Front
- Back
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What is the first cause that should be excluded as a cause of a seizure? |
Hypoglycaemia with a BM |
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What can patient experience with delirium tremens? |
Generalised tonic-clinic seizures Hallucinations Confusion Delusions Severe agitation |
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When do symptoms of delirium tremens occur? |
After 8 hours, peaking on day 2 and recovering by day 5 In hospital look out for people 2 days post op who suddenly become confused/seizures |
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What is the most apportiate treatment for delirium tremens? |
50 mg Chlordiazepoxide orally as needed based on symptom score |
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What kind of medication is chlordiazepoxide? |
Benzodiazepine |
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What are the dangers of benzodiazepines? |
Risk of respiratory depression and can precipitate hepatic encephalopathy in patients with alcoholic liver disease (give lower dose) |
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What is the therapeutic range of phenytoin? |
10-20mg |
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When interpreting concentrations of phenytoin what is it important to consider in patients with liver disease? |
If the level of phenytoin is low in someone with liver disease it may be due to a reduced albumin level, therefore lowering the bound albumin. The free phenytoin may still be in the normal range |
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What is the most common cause of failure of antiepileptic drugs? |
Poor compliance |
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If someone starts seizing how long after will they require treatment what would be used? |
5 minutes IV lorazepam/PR diazepam/buccal midazolam (children) |
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After how long of seizing would you consider emergency investigation and what would you do? |
30 minutes ABG, glucose, U+E, LFTs, Ca, Mg, FBC, clotting screen, anticonvulsant blood level Blood + urine sample Glucose +/- IV thiamine |
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If someone is still seizing after 60 minutes what would you do? |
Admit to ICU, intubate, continuous EEG monitoring +/- intracranial pressure |
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What drugs are used in managing status epilepticus? |
Benzodiazepines: Lorazepam Diazepam (irritant to veins so emulsion used) Midazolam (if facilities for resuscitation available as very fast acting) IV Phenytoin as a bolus and then slow IV injection |
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What is the first line drug for focal seizures? |
Carbamazepine |
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What are common side effects of carbazmaepine? |
Drowsiness: Common in the beginning and usually wears off Rash (Han Chinese/Thai origin risk of Stevens Johnson syndrome) Hyponatraemia Neutropenia (bone marrow suppression) |
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In a patient taking carbamazepine why does the GGT go up? |
Because it is an P450 enzyme inducer and a raised GGT is a result- not harmful |
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What are some symptoms of carbamazepine toxicity? |
Nystagmus Ataxia Increased seizure frequency |
