Medication

Dosage

Action

Special
Considerat

Anticonvulsants
Phenytoin (Dilantin)

Loading Dose: 10-20

mg/kg IV
Maint. Dose: 100 mg
q6-8h IV

Prevents the influx of

sodium at the cell
membrane

Fosphenytoin
(Cerebyx)

Loading Dose: 15-20

mg/kg IV
Maint. Dose: 4-6
mg/kg/24 hr IV

Prevents the influx of

sodium at the cell
membrane

Barbiturates
Phenobarbital

Loading Dose: 6-8

mg/kg/IV
Maint. Dose: 1-3
mg/kg/24hr IV

Produces CNS
depression and
reduces the spread of
an epileptic focus

Pentobarbital

Loading Dose: 3-10

mg/kg over 30 min
Maint. Dose: 0.5-3
mg/kg/hr IV

Induces barbiturate
coma

--Monitor seru
levels closely
--Therapeutic l
10-20 mg/L (if
hypoalbuminu
monitor free
phenytoin seru
levels: therape
level of 0.1-0.2
--Infuse no fas
than 50 mg/m
administer wit
normal saline
because it
precipitates w
other solutions
--Monitor seru
levels closely;
therapeutic lev
10-20 mg/L.
--Dosage,
concentration
infusion rate is
expressed as
phenytoin sod
equivalents (F
--May depress
and respirator
function
--Administer a
of 60 mg/min
--Monitor seru
closely; --Ther
level is 15-40
--Monitor seru
closely
--Therapeutic l
coma is 15-40

Osmotic Diuretics
Mannitol

1-2 g/kg IV

Treats cerebral
edema by pulling
fluid from the
extravascular space
into the intravascular
space; requires intact
blood-brain barrier

--Side effects:
hypovolemia a
increased seru
osmolality.
--Monitor seru
osmolality and
MD if >310 mO
--Warm and sh
before adminis
to ensure the
dissolve

CCBs
60 mg q 4h NG or PO
Nimodipine (Nimotop) for 21 days

Decreases cerebral
vasospasm

Thrombolytics
Tissue-Type
Plasminogen
Activator (tPA)

Converts
plasminogen to
plasmin to dissolve
clot

--Side effects:
hypotension,
palpitations,
headache, dizz
--Monitor blood
pressure frequ
when impleme
therapy
--Treatment m
start within 4.5
the onset of
symptoms
--Do not excee
mg
--Do not use
anticoagulants
the first 24 hr.
--Monitor patie
bleeding.

0.9 mg/kg total, with

10% of the dose
administered as IV
bolus over 1 minute
and 90% of the dose
administered as
continuous IV infusion
over 1 hour