Original ArticlesContinuous Infusion Antiepileptic Medications for Refractory Status Epilepticus A Review for NursesWiss, Adam L. BS; Samarin, Michael PharmD, BCPS, BCCCP; Marler, Jacob PharmD, BCCCP; Jones, G. Morgan PharmD, BCPS, BCCCPAuthor Information Department of Clinical Pharmacy (Mr Wiss and Drs Samarin, Marler, and Jones) and Department of Neurology and Department of Neurosurgery (Dr Jones), University of Tennessee Health Sciences Center, Memphis; and Department of Pharmacy, Methodist University Hospital, Memphis, Tennessee (Drs Samarin, Marler, and Jones). Correspondence and reprint: Michael Samarin, PharmD, BCPS, BCCCP, 1265 Union Ave, Memphis, TN 38104 ([email protected]). The authors have no financial interests to disclose. Critical Care Nursing Quarterly: January/March 2017 - Volume 40 - Issue 1 - p 67-85 doi: 10.1097/CNQ.0000000000000143 Buy Metrics Abstract Status epilepticus requires treatment with emergent initial therapy with a benzodiazepine and urgent control therapy with an additional antiepileptic drug (AED) to terminate clinical and/or electrographic seizure activity. However, nearly one-third of patients will prove refractory to the aforementioned therapies and are prone to a higher degree of neuronal injury, resistance to pharmacotherapy, and death. Current guidelines for refractory status epilepticus (RSE) recommend initiating a continuous intravenous (CIV) anesthetic over bolus dosing with a different AED. Continuous intravenous agents most commonly used for this indication include midazolam, propofol, and pentobarbital, but ketamine is an alternative option. Comparative studies illustrating the optimal agent are lacking, and selection is often based on adverse effect profiles and patient-specific factors. In addition, dosing and titration are largely based on small studies and expert opinion with continuous electroencephalogram monitoring used to guide intensity and duration of treatment. Nonetheless, the doses required to halt seizure activity are likely to produce profound adverse effects that clinicians should anticipate and combat. The purpose of this review was to summarize the available RSE literature focusing on CIV midazolam, pentobarbital, propofol, and ketamine, and to serve as a primer for nurses providing care to these patients. © 2017 Wolters Kluwer Health, Inc. All rights reserved.