在重症患者中进行发作预防的乐维他的最佳剂量:一项前性观察性研究
Eduard Valdes1, Taolin Fang2, Michael Boffa2
1Department of Neurology, Columbia University Irving Medical Center, New York, NY.
Critical care medicine
|September 21, 2023
概括
较高剂量的 levetiracetam (LEV) 显著增加在危急病患者达到治疗血清水平的可能性. 这种优化剂量策略还可以降低新发作的发作风险,改善患者的治疗结果.
科学领域:
- 药理学 药理学是指药理学的学科.
- 关键护理医学 关键护理医学
- 神经学 神经学
背景情况:
- 危急病患者表现出迅速的 levetiracetam (LEV) 消除.
- 低剂量LEV经常用于ICU的发作预防,可能导致剂量不足.
- 需要在这个人群中比较不同LEV剂量方案的疗效.
研究的目的:
- 为了比较达到目标血清中 levetiracetam 度的水平.
- 评估新发作发作的发生率 (临床和/或电图).
- 评估低剂量与高剂量LEV对重症患者这些结果的影响.
主要方法:
- 一项前性观察性研究在第三级护理学术中心进行.
- 包括接受预防性LEV后神经损伤的患者,但不包括先前有发作或功能衰竭的患者.
- 用多变量逻辑回归分析了血清LEV水平和发作发生率,并对共变量进行调整.
主要成果:
- 在205名患者中,54%的人达到目标LEV水平;低剂量组 (500毫克两次) 的45%,高剂量组 (750-1000毫克两次) 的64%.
- 高剂量LEV与达到目标水平的可能性增加了2.23倍 (aOR2.23;P=0.016).
- 在调整后,高剂量LEV与发作几率降低68% (aOR 0.32;P=0.018) 相关.
结论:
- levetiracetam 的低剂量在重症患者中很常见.
- 较高的LEV剂量 (750-1000毫克两次) 在达到治疗度方面更有效.
- 增加LEV剂量显著降低了这种患者队列中的发作风险.
相关概念视频
Antiepileptic Drugs: Modulators of Neurotransmitter Release Mediated by SV2A Protein
332
Antiepileptic drugs, such as levetiracetam (Keppra) and brivaracetam (Briviact), have emerged as crucial tools in managing epilepsy. These medications exert their therapeutic effects by targeting the synaptic vesicle protein SV2A, a transmembrane glycoprotein primarily found in the brain.
SV2A is a transmembrane glycoprotein located predominantly in the brain, modulating the release of neurotransmitters for neuronal communication. Both levetiracetam and brivaracetam exhibit a high affinity for...
SV2A is a transmembrane glycoprotein located predominantly in the brain, modulating the release of neurotransmitters for neuronal communication. Both levetiracetam and brivaracetam exhibit a high affinity for...
332
Antiepileptic Drugs: Potassium Channel Activators
203
Ezocgabine or retigabine, an antiepileptic drug of remarkable efficacy, has revolutionized the management of seizures. It is a potassium channel activator, explicitly targeting the family of Q subtype potassium channels. It enhances the transmembrane potassium currents, regulating neuronal excitability. This action stabilizes the resting membrane potential, a pivotal factor in mitigating the hyperexcitability that characterizes epilepsy.
Ezogabine has gained approval as an adjunctive treatment...
Ezogabine has gained approval as an adjunctive treatment...
203
Drug Dosage Regimen: Overview
3.6K
A drug dosage regimen describes the specific instructions and schedule for administering a drug to a patient. It considers factors such as drug dosage, frequency, route of administration, and duration of treatment. Designing an appropriate dosage regimen for a patient aims to achieve a target drug concentration at the site of action.
Typically, the starting dose and dosing interval are guided by the manufacturer's recommendations based on clinical trials conducted during and after drug...
Typically, the starting dose and dosing interval are guided by the manufacturer's recommendations based on clinical trials conducted during and after drug...
3.6K
Acute Kidney Injury IV: Diagnostic Studies and Prevention
21
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
21
Renal Failure: Dose Adjustments
109
In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
109
Rational Dosage Regimen: Maintenance Dose and Loading Dose
4.1K
A rational dosage regimen considers a drug's pharmacokinetics, including its absorption, distribution, metabolism, and elimination from the body. By understanding these factors, the appropriate dosage can be determined, and the dosing schedule can be designed to achieve and maintain the desired therapeutic effect while minimizing adverse effects.
In most cases, drugs are administered repetitively or infused continuously to maintain a steady-state concentration in the body. At a steady...
In most cases, drugs are administered repetitively or infused continuously to maintain a steady-state concentration in the body. At a steady...
4.1K


