If Seizures Persist Intubate the Patient and Consider

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- Midazolam (Versed) 0.2 mg/kg IV push, then 0.045 mg/kg/hr; titrate up to 0.6 mg/kg/hr OR

-Propofol (Diprivan) 2 mg/kg IV push, then 2 mg/kg/hr; titrate up to 10 mg/kg/hr OR

-Phenobarbital as above.

-Induction of coma with pentobarbital 10-15 mg/kg IV over 1-2h, then 1-1.5 mg/kg/h continuous infusion. Initiate continuous EEG monitoring. 8. Consider Intubation and General Anesthesia Maintenance Therapy for Epilepsy: Primary Generalized Seizures -- First-Line Therapy:

-Carbamazepine (Tegretol) 200-400 mg PO tid [100, 200 mg]. Monitor CBC.

-Phenytoin (Dilantin) loading dose of 400 mg PO followed by 300 mg PO q4h for 2 doses (total of 1 g), then 300 mg PO qd or 100 mg tid or 200 mg bid [30, 50, 100 mg].

-Divalproex (Depakote) 250-500 mg PO tid-qid with meals [125, 250, 500 mg].

-Valproic acid (Depakene) 250-500 mg PO tid-qid with meals [250 mg]. Primary Generalized Seizures -- Second Line Therapy:

-Phenobarbital 30-120 mg PO bid [8, 16, 32, 65, 100 mg].

-Primidone (Mysoline) 250-500 mg PO tid [50, 250 mg]; metabolized to phenobarbital.

-Felbamate (Felbatol) 1200-2400 mg PO qd in 3-4 divided doses, max 3600 mg/d [400, 600 mg; 600 mg/5 mL susp]; adjunct therapy; aplastic anemia, hepatotoxicity.

-Gabapentin (Neurontin), 300-400 mg PO bid-tid; max 1800 mg/day [100, 300, 400 mg]; adjunct therapy.

-Lamotrigine (Lamictal) 50 mg PO qd, then increase to 50-250 mg PO bid [25, 100, 150, 200 mg]; adjunct therapy . Partial Seizure:

-Carbamazepine (Tegretol) 200-400 mg PO tid [100, 200 mg].

-Divalproex (Depakote) 250-500 mg PO tid with meals [125, 250, 500 mg].

-Valproic acid (Depakene) 250-500 mg PO tid-qid with meals [250 mg].

-Phenytoin (Dilantin) 300 mg PO qd or 200 mg PO bid [30, 50, 100].

-Phenobarbital 30-120 mg PO tid or qd [8, 16, 32, 65, 100 mg].

-Primidone (Mysoline) 250-500 mg PO tid [50, 250 mg]; metabolized to phenobarbital.

-Felbamate (Felbatol) 1200-2400 mg PO qd in 3-4 divided doses, max 3600 mg/d [400,600 mg; 600 mg/5 mL susp]; adjunct therapy; aplastic anemia, hepatotoxicity.

-Gabapentin (Neurontin), 300-400 mg PO bid-tid; max 1800 mg/day [100, 300, 400 mg]; adjunct therapy.

-Lamotrigine (Lamictal) 50 mg PO qd, then increase to 50-250 mg PO bid [25, 100, 150, 200 mg]; adjunct therapy.

-Topiramate (Topamax) 25 mg PO bid; titrate to max 200 mg PO bid [tab 25, 100, 200 mg]; adjunctive therapy. Absence Seizure:

-Divalproex (Depakote) 250-500 mg PO tid-qid [125, 250, 500 mg].

-Clonazepam (Klonopin) 0.5-5 mg PO bid-qid [0.5, 1, 2 mg].

-Lamotrigine (Lamictal) 50 mg PO qd, then increase to 50-250 mg PO bid [25, 100, 150, 200 mg]; adjunct therapy. 10. Extras: MRI with and without gadolinium or CT with contrast; EEG (with photic stimulation, hyperventilation, sleep deprivation, awake and asleep tracings); portable CXR, ECG.

11. Labs: CBC, SMA 7, glucose, Mg, calcium, phosphate, liver panel, VDRL, anticonvulsant levels. UA, drug screen.

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Getting to Know Anxiety

Getting to Know Anxiety

Stop Letting Anxiety Rule Your Life And Take Back The Control You Desire Right Now! You don't have to keep letting your anxiety disorder run your life. You can take back your inner power and change your life for the better starting today! In order to have control of a thing, you first must understand it. And that is what this handy little guide will help you do. Understand this illness for what it is. And, what it isn't.

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