Medication

Dosage

Action

Special
Considerations

Anticonvulsants
Phenytoin (Dilantin)

Loading Dose: 10-20

mg/kg IV
Maint. Dose: 100 mg q68h 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
1-2 g/kg IV

Induces barbiturate coma

--Monitor serum levels

closely
--Therapeutic level is 1020 mg/L (if
hypoalbuminuria,
monitor free phenytoin
serum levels: therapeutic
level of 0.1-0.2 mg/L)
--Infuse no faster than 50
mg/min; administer with
normal saline only
because it precipitates
with other solutions.
--Monitor serum levels
closely; therapeutic level
is 10-20 mg/L.
--Dosage, concentration
and infusion rate is
expressed as phenytoin
sodium equivalents (FE)
--May depress cardiac
and respiratory function
--Administer at a rate of
60 mg/min
--Monitor serum level
closely; --Therapeutic
level is 15-40 mcg/mL
--Monitor serum level
closely
--Therapeutic level for
coma is 15-40 mg/L
--Side effects:
hypovolemia and
increased serum
osmolality.
--Monitor serum
osmolality and notify MD
if >310 mOsm/L
--Warm and shake before
administering to ensure
the crystals dissolve

Osmotic Diuretics
Mannitol

Treats cerebral edema by

pulling fluid from the
extravascular space into
the intravascular space;
requires intact bloodbrain barrier

CCBs
Nimodipine (Nimotop)

60 mg q 4h NG or PO for
21 days

Decreases cerebral
vasospasm

Thrombolytics
Tissue-Type Plasminogen
Activator (tPA)

0.9 mg/kg total, with

Converts plasminogen to
10% of the dose
plasmin to dissolve clot
administered as IV bolus
over 1 minute and 90% of
the dose administered as
continuous IV infusion
over 1 hour

--Side effects:
hypotension, palpitations,
headache, dizziness.
--Monitor blood pressure
frequenctly when
implementing therapy
--Treatment must start
within 4.5 hr of the onset
of symptoms
--Do not exceed 90 mg
--Do not use
anticoagulants during the
first 24 hr.
--Monitor patient for
bleeding.