DOTD (drug of the day) #dotd Keppra💉

Regram @rishimd

Levetiracetam (Keppra) is an oral and intravenous antiepileptic drug (AED) indicated as adjunctive therapy for partial onset seizures, myoclonic seizures, and generalized tonic-clonic (“grand mal”) seizures in adults. The medication is used in the pediatric population as well for various reasons beyond my scope of practice. Most AEDs either enhance the release or limit the uptake of GABA – the primary inhibitory neurotransmitter in the central nervous system. Levetiracetam’s activity is thought to center around SV2A, a ubiquitous synaptic vesicle protein involved in regulating the exocytosis of neurotransmitters from vesicles. 💉🤓
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Post-traumatic seizures (PTSs) are fairly common in patients who sustain traumatic brain injuries (TBIs), and the early initiation of AEDs like phenytoin help decrease early PTS in severe TBI; however NO AED prophylaxis I’m aware of helps prevent late TBIs. Lower levels of data suggest that newer AEDs like levetiracetam may be a safer alternative to phenytoin for early PTS prophylaxis. 👍🏥
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As an anesthesiologist, I can’t remember when I last administered levetiracetam intraoperatively (general anesthesia tends to be a pretty good antiepileptic itself), but as an intensivist, I’ve written for this many times at the recommendation of my colleagues in neurology. Interestingly, the oral formulation of levetiracetam is ~100% bioavailable, and its renally-excreted metabolites have no activity. 😷
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Regardless of why it’s given, levetiracetam can increase the risk of suicidal ideations (even within a week), so providers must remain vigilant about any unusual changes in mood or behavior in patients initiated on therapy. 👨🏽‍⚕️
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About the Author
I am an experienced trauma nurse who has seen a lot of super tragic and gnarly things. On the flip side, I’ve have seen and done a lot of amazing things in my 20 years of nursing as well. I’ve saved lives for a living and I have had the privilege and the honor of holding patients hands as they take their last breath. I have seen SO many patients and their loved ones in their most fragile moments. I am proud of my profession, and for the fact that I have fought so valiantly to be here. Sometimes nurses get burnt out, but I have been blessed to be at the bedside all of my career. I have earned multiple degrees and certifications in nursing. I am the nurse you want at your bedside when you’re critically injured and dying. I put my blood, sweat and tears into being clinically astute & relevant. This blog is to help new nurses, nursing students, paramedics, experienced nurses, or whomever comes across my blogs path and think it is intriguing, educational or inspiring to them. In this career, we are all here to share and help one another grow. I believe in building others up, so they can reach the next level, whatever their goal may be. Carpe Diem & ENJOY!

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