Quiz 22: Pharmacotherapy of Seizures


Matt has been prescribed valproic acid (Depakene) to his medication regime. Valproic acid (Depakene) is given in oral route. Valproic acid - Mode of action: Valproic acid acts by increasing concentration of the inhibitory neurotransmitter GABA in the brain. Abnormal neuron discharges are inhibited, resulting in decrease seizure activity.

Lipid solubility of the drug: Medications that are more lipid-soluble will transfer more quickly, and in greater amounts, into breast milk in comparison to the less lipid-soluble medications. The antiepileptic drugs (AEDs) are allowed during the breast feeding time, since these drugs are low on the lipid solubility. The amount of AEDs transferred into the milk is of small amounts. Drug ionization: The antiepileptic drugs (AEDs) are not easily soluble in milk and are highly soluble in water. Majority of the AEDs are all moderately to highly protein-bound, and are not transferred in high concentrations in breast milk. Drug half-life: AEDs have a short-half life, in majority of cases the half-life is 3 hours. Since the half-life of the AEDs is short, the level of these drugs in the maternal plasma will be declining by the time the infant is ready to feed again. Therefore, AEDs are safe to be taken at the time of breastfeeding.

Below outlined is the list of home safety that J's mother could use to ensure proper care in case J experiences seizure: • Do not panic and stay calm: It is important for the parent to stay calm and reassure the child about his safety. • Prevent injury that might be caused due to the seizure: o Keep the child on soft surface, such as bed. o Keep the child away from sources of potential danger such as electric plug points, stove, stair case, or any other hazards. o The child should be laid his side or stomach in order to prevent choking. o Ensure that the child is breathing adequately. o Do not try to stop or restrict the movements. o Do not put any object or cloth in the mouth at the time of convulsions. o Clean the saliva coming out of the mouth with clean and soft cloth. • Keep a watch on the timing of the seizure and the also the duration. • Administer medication as prescribed to get the seizure under control. • In case the seizure does not stop within three to five minutes, call 911 immediately. • After regaining consciousness, administer medication for fever. In case the child has any other complaints, he should be taken to the doctor.

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