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http://projects.csail.mit.edu/courseware/?term=school-essay-book school essay book What additional information is needed to make a decision about pharmacotherapy?. How should this information be used to make choices concerning aed therapy?. During the visit, he mentions several previous brief episodes of loss of consciousness, and friends tell him his left hand fumbles with his shirt. These started a couple of years ago and now occur 2 to 3 days each week. Is pharmacotherapy indicated?. If it is indicated, what drug should be used, and how should it be started?. What adverse effects are important to monitor?. Three months later he is doing well. He reports no generalized tonic-clonic seizures, and the brief spells are reduced to about 2 per month. What adjustments in pharmacotherapy should be made at this point?. Is it possible for him to discontinue aed therapy at some time in the future?. Pharmacotherapy (table 31–2). 28–30 while the guidelines make recommendations for specific drugs to be used in certain seizure types, the consensus recommendations use only high-quality data available from the medical literature. In many cases, a recommendation is not made due to lack of sufficient data for an evidence-based decision. Therefore, a drug may not appear in a guideline because insufficient data was available at the time the guideline was developed. Absence of a recommendation does not mean the drug is ineffective for a specific seizure type. For example, according to the aan practice parameter, topiramate is useful as monotherapy for primary generalized tonic-clonic seizures, but insufficient evidence was available at the time of guideline development to make any recommendation regarding gabapentin, lamotrigine, oxcarbazepine, tiagabine, levetiracetam, or zonisamide. 31 outside of the evidence-based guidelines, other pharmacologic treatments are commonly used or avoided. For initial treatment of absence seizures, ethosuximide and valproate are used. In absence and myoclonic seizures, carbamazepine, oxcarbazepine, gabapentin, tiagabine, and pregabalin should be avoided due to association with worsening of these seizure types. Antiepileptic drug therapy should usually be initiated carefully using a titration schedule to minimize adverse events. Moderate target doses are chosen until the patient’s response can be further evaluated in the clinic. If seizures continue, the dose is increased gradually until the patient becomes seizure free or chapter 31  |  epilepsy  483 adverse effects appear. For some drugs like lamotrigine, specific titration guidelines are established by the manufacturer. Treatment of refractory seizures (ie, unresponsive to at least two first-line aeds) is somewhat different. Combinations of drugs may be useful in patients with difficult to control seizures. All aeds, except ethosuximide, are effective in combination therapy for partial seizures. »» complications of pharmacotherapy adverse effects of aeds are frequently dose limiting or cause a drug to be discontinued. Two types of adverse effects occur with aeds. Serum concentration-related and idiosyncratic (table 31–3). Concentration-related adverse effects happen with increasing frequency and severity as the dose or serum concentration of a drug is increased.

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my worst holiday essay Common concentration-related adverse effects include sedation, ataxia, and diplopia. Adverse effects are considered one of the aed selection criteria. For example, if a patient has a job that requires mental alertness, it is best to choose an aed that is less likely to cause sedation (eg, lamotrigine).

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http://cs.gmu.edu/~xzhou10/semester/kit-thesis-template.html kit thesis template 2013;9. Cd004439. 19. Spellberg b, lipsky ba. Systemic antibiotic therapy for chronic osteomyelitis in adults. Clin infect dis. 2012:54:393–407. 20. Boucher h, miller lg, razonable rr. Serious infections caused by methicillin-resistant staphylococcus aureus. Clin infect dis. 2010;51(suppl 2):S183–s197. Chapter 81  |  osteomyelitis  1205 21. Bhavan kp, marschall j, olsen ma, et al. The epidemiology of hematogenous vertebral osteomyelitis. A cohort study in a tertiary care hospital. Bmc infect dis. 2010;10:158. 22. Liu c, bayer a, cosgrove se, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant staphylococcus aureus infections in adults and children. Clin infect dis.

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