For seizures

Carbonic anhydrase inhibitors During treatment for glaucoma, contact the primary health care provider immediately if eye pain is not relieved or if it increases. When a patient with epilepsy is being treated for seizures, a family member of the patient should keep a record of all seizures witnessed and bring this to the primary health care provider at die time of the next visit. Contact the primary healdi care provider immediately if die seizures increase in number. 

Antipsychotics are not indicated for the treatment of withdrawal, except when hallucinations or severe agitation are present (Naranjo and Sellers 1986), in which case they should be added to a benzodiazepine. In addition to their potential to produce extrapyramidal side effects, antipsychotics lower the threshold for seizures, which is particularly problematic during alcohol withdrawal. 

Hypertonic sahne is actively excluded from an intact BBB and also acts to draw water into the intravascular space by the creation of a sodium gradient. Various concentrations have been evaluated, with continuous sodium chloride infusions ranging from 3% to 9%, and bolus infusions up to 23.4% administered over 20 minutes in a 30 mL solution. When a continuous infusion is used, the serum sodium is typically titrated to the 155-160 range. Sodium levels above this range raise the concern for seizures and other toxic side effects. Hypertonic saline may hold an advantage over mannitol, as it has been found in animal models to decrease edema in both... 

PCP raises the threshold and decreases the duration of the afterdischarge produced by electrical stimulation of the suprasylvian gyrus (Domino 1964). In rats, the latency for seizures produced by fluorothyl is prolonged by PCP (Geller et al. 1981). The doses... 

Patients receiving antiepileptic drugs for seizures should have regular monitoring for seizure frequency, seizure patterns,... 

Instruct patients, family members, and caregivers on first aid for seizures. First aid for seizures consists primarily of keeping the patients from hurting themselves. They should be placed on the floor, if possible, and their heads cushioned. First responders to a seizure should never attempt to restrain them or force an item into their mouth. If a seizure lasts longer than 5 to 10 minutes, emergency medical assistance should be called. 

Diazepam Being extremely lipophilic, diazepam penetrates quickly into the CNS, but can rapidly redistribute into body fat and muscle. This results in a faster decline in CNS levels and early recurrence of seizures. It is dosed at 5 to 10 mg (or 0.15 mg/kg) and infused no faster than 5 mg/minute. Repeated doses can be given every 5 minutes until seizure activity stops or toxicities are seen (e.g., respiratory depression). Diazepam can also be administered as a rectal suppository, making it possible for non-medical personnel to provide rapid therapy for seizures that develop at home or in public areas.11 The adult dose is 10 mg given rectally and this dose may be repeated once if necessary. Diazepam is erratically absorbed via the intramuscular route therefore, IM administration is not recommended. 

Continue to evaluate the patient for seizure activity and adjust therapy as needed to control seizures and optimize quality of life. 

Bupropion causes insomnia, nightmares, decreased appetite, anxiety, and tremors, but the most concerning adverse effect is seizures. Because of the risk for seizures, patients who should not receive the drug include those with a CNS lesion or those with a history of seizures, head trauma, or bulimia. The daily dose of bupropion should not exceed 450 mg/day, and any single dose of the immediate-release formulation should not exceed 150 mg/day Occurrences of insomnia and/or nightmares often respond to moving the last daily dose from bedtime to late afternoon.7,9,22,23... 

The following is a very simplistic example of what a time-to-event data set might look like when the event of interest is seizure. Here you assume that there is a seizure event form that collects whether a subject had a seizure and the date when the seizure occurred. You also assume that you do not need to search other ancillary data forms such as adverse events for seizure events. 

Program 4.15 Creating a Time-to-Event Data Set for Seizures... 

Patients should be chronically monitored for seizure control, side effects, social adjustment, drug interactions, compliance, quality of life, and toxicity. 

For seizures continuing after the initial loading dose, some practitioners have recommended an additional loading dose of 5 mg/kg (after waiting 60 minutes for response), but additional phenytoin may result in toxicity and exacerbation of seizures. There is no evidence that a total loading dose greater than 20 mg/kg will be of benefit in these patients. 

Recurrences of mood episodes causes behavioral sensitivity and electrophysiologic kindling (similar to the amygdala-kindling models for seizures in animals) and can result in rapid or continuous mood cycling. 

Clozapine Increased clozapine serum concentrations increased risk for seizures and orthostatic hypotension... 

Methamphetamine intoxication is an acute condition that may result in death pharmacotherapy may be indicated for seizures. 

Atypical Antidepressants. None of the so-called atypical antidepressants have been tested in the treatment of AN. However, mianserin, an antidepressant available in Europe, has been found to increase body weight in patients with various depressive disorders. Although bupropion (Wellbutrin, Zyban) has not been tested in the treatment of AN, it is effective in the treatment of BN. However, immediate-release bupropion is associated with an especially high risk for seizures in these patients and is therefore contraindicated in those with eating disorders. The seizure risk associated with sustained-release bupropion remains unclear at this time, as the doses studied have not been as high as those for immediate-release bupropion. 

Antidepressants. Depression after TBl is routinely treated with antidepressant medicines. Although all antidepressants are potentially helpful, antidepressants prone to burdensome side effects, particularly sedative and anticholinergic side effects, should generally be avoided, as they are likely to be tolerated poorly by these patients. In addition, antidepressants that may increase the risk for seizure, such as many of the older tricyclic antidepressants (TCAs) and bupropion (Well-butrin), should be avoided because post-TBl patients as a rule are already more vulnerable to seizures. 

For seizures of liquids, quantities reported in kilograms have been converted into litres using the following factors ... 

Neurologic sequelae with vinblastine are much less common than those seen with vincristine and vindesine. Nonetheless, a causal relationship has been established for seizures, psychotic episodes, and confusional episodes. As common with other vinca agents, absence of reflexes and peripheral neuropathy are well described 23,24). 

Seizures associated with eciampsia For seizure prevention and control in severe pre-eclampsia or eclampsia without producing deleterious CNS depression in the mother or infant. 

Conversely, certain drugs modify the effectiveness or side effects of aspirin. Phenobarbital, occasionally used for seizures, induces liver enzymes that increase the metabolism and excretion of aspirin, (3-adrenoceptorblocking drugs, such as propranolol, and decrease the antiinflammatory effects of aspirin, whereas reserpine decreases its analgesic effects. Antacids decrease the absorption of aspirin. Alcohol consumption in combination with aspirin increases the latter s ulcerogenic effects. 

Imipenem-cilastatin is one of the drugs of first choice for the empirical therapy of many polymicrobial pulmonary, intraabdominal, and soft tissue infections. The notable adverse effect of imipenem-cilastatin is seizures affecting 1% of patients. Risk factors for seizures are old age, head trauma, previous seizure disorder, cerebrovascular accident, and renal failure. Among patients with a history of penicillin allergy, 10% are cross-sensitive to imipenem-cilastatin. 

Monitor for seizures, sedation, respiratory depression, or other residual benzodiazepine effects for an appropriate period (up to 120 min) based on dose and duration of effect of the benzodiazepine employed pharmacokinetics of benzodiazepines are not altered in the presence of flumazenil... 

Adjunctive therapy for seizure control PO Initially, 300 mg 3 times a day. May titrate... 

Do not discontinue the drug abruptly after long-term therapy strict maintenance of drug f herapy is essential for seizure conf rol... 

Do not discontinue levetiracetam therapy abruptly because this may precipitate seizures strict maintenance of drug therapy is essential for seizure control... 

Observe the patient s mental status, and be alert for seizures or tremors... 

Serum phenobarbital concentration (therapeutic range for seizure disorders 20-40 mcg/ml)... 

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