A 33-year-old patient with a history of seizures and medication compliance of phenytoin (Dilantin) and carbamazepine (Tegretol) is brought to the ED by the MS personnel for repetitive seizure activity that started 45 minutes prior to arrival. You anticipate that the physician will order which drug for status epilepticus?
A. Phenytoin and Carbamazepine PO
B. Carbamazepine (Tegretol) IV
C. Magnesium sulfate IV
D. Lorazepam (Ativan) IV
Correct Answer: D. Lorazepam (Ativan) IV.
IV Lorazepam (Ativan) is the drug of choice for status epilepticus. Benzodiazepines are the antiepileptic drug of choice for emergent control. Lorazepam is preferred because of its rapid onset of action and is dosed at 0.1 mg/kg IV. No more than 2 mg should be administered per minute.
Option A: PO (per os) medications are inappropriate for this emergency situation. Intravenous administration is preferred, but benzodiazepines can be administered via the intramuscular, rectal, nasal, or buccal route if vascular access is not available.
Option B: Tegretol is used in the management of generalized tonic-clonic, absence or mixed type seizures, but it does not come in an IV form. Carbamazepine is used to manage and treat epilepsy, trigeminal neuralgia, and acute manic and mixed episodes in bipolar I disorder. Indications for epilepsy are specifically for partial seizures with complex symptomatology (psychomotor, temporal lobe), generalized tonic seizures (grand mal), and mixed seizure patterns.
Option C: Magnesium sulfate is given to control seizures in toxemia of pregnancy. If eclampsia is suspected, intravenous magnesium sulfate is the antiepileptic drug of choice. Delivery of the fetus is the definitive treatment of eclampsia.
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