第十六章 抗癫痫药

null第十六章 抗癫痫药 Antiepileptic Agents第十六章 抗癫痫药 Antiepileptic AgentsFactors Affecting the Form of a Seizure 影响癫痫发作形式的因素Factors Affecting the Form of a Seizure 影响癫痫发作形式的因素Location of the cells that initiate the electrical discharge Neural pathways that are stimulated by the initial volley of electrical impulsesClassification of Seizures 癫痫发作的类型 Classification of Seizures 癫痫发作的类型 Generalized seizures Begin in one area of the brain and rapidly spread throughout both hemispheres of the brain Partial seizures or focal seizures Involve one area of the brain and do not spread throughout the entire organ Classification ClassificationClassification of Generalized Seizures 全身发作的类型 Classification of Generalized Seizures 全身发作的类型 Tonic–clonic seizures (grand mal seizures) Absence seizures (petit mal seizures) Myoclonic seizures Febrile seizures Status epilepticusClassification of Partial Seizures 局部发作的类型 Classification of Partial Seizures 局部发作的类型 Simple partial seizures Occur in a single area of the brain and may involve a single muscle movement or sensory alteration Complex partial seizures Involve complex sensory changes Motor changes may include involuntary urination, chewing motions, diarrhea, etc.Drugs for Treating Tonic–Clonic Seizures 治疗强直-阵挛发作的药物 Drugs for Treating Tonic–Clonic Seizures 治疗强直-阵挛发作的药物 Hydantoins Barbiturates Barbiturate-like drugsSites of Action of Drugs Used to Treat Various Forms of Epilepsy Sites of Action of Drugs Used to Treat Various Forms of Epilepsy Hydantoins 乙酰脲类药物 Hydantoins 乙酰脲类药物 Phenytoin (Dilantin) Treats tonic–clonic seizures and status epilepticus; prevents and treats seizures after neurosurgery Ethotoin (Peganone) Controls tonic–clonic and myoclonic seizures Fosphenytoin (Cerebyx) Controls short-term status epilepticus; prevents seizures after neurosurgeryHydantoins (cont.) Hydantoins (cont.) Mephenytoin (Mesantoin) Treats tonic–clonic, myoclonic, and partial (focal) seizures in patients who do not respond to less toxic antiepileptic agents.Barbiturates and Barbiturate-Like Drugs 巴比妥和巴比妥类药物Barbiturates and Barbiturate-Like Drugs 巴比妥和巴比妥类药物Phenobarbital (Solfoton, Luminal) Emergency control of status epilepticus and acute seizures; management of tonic–clonic and cortical focal seizures; treatment of simple partial seizures Primidone (Mysoline) Treatment of tonic–clonic or partial seizures Mephobarbital (Mebaral) Treatment of tonic–clonic and absence seizures; anxiolytic/hypnotic agentTypes of Benzodiazepines 苯二氮卓类药物Types of Benzodiazepines 苯二氮卓类药物Diazepam (Valium) Prototype benzodiazepine Useful in relieving tension, anxiety, and muscle spasm. Clonazepam (Klonopin) Used for the treatment of absence (petit mal) seizures and myoclonic seizures Absence. Drugs for Treating Absence Seizures 治疗失神性发作的药物Drugs for Treating Absence Seizures 治疗失神性发作的药物Ethosuximide (Zarontin) Drug of choice for treating absence seizures Has relatively few adverse effects compared with many other antiepileptic drugs Methsuximide (Celontin) Used to treat absence seizures that are resistant to other drugs Has been associated with bone marrow suppression Other Drugs for Treating Absence SeizuresOther Drugs for Treating Absence SeizuresValproic acid (Depakene) Reduces abnormal electrical activity in the brain; may increase GABA activity at inhibitory receptors Acetazolamide (Diamox) A sulfonamide drug especially effective for treatment of absence seizures in children Zonisamide (Zonegran) Used as an adjunct to other drugs for the treatment of absence seizuresFocus on the Prototype Drug Treating Partial Seizures: CarbamazepineFocus on the Prototype Drug Treating Partial Seizures: CarbamazepineIndications: Treatment of refractory seizure disorders, including partial seizures with complex patterns; tonic–clonic seizures; mixed seizures; trigeminal neuralgia. Actions: Inhibits polysynaptic responses and blocks post-tetanic potentiation. Oral route: Onset slow; peak 4–5 hours. ER oral route: Onset slow; peak 3–12 hours. T½: 25–65 hours, then 12–17 hours; metabolized in the liver, excreted in the urine and feces.Patient Teaching for Patients Taking Antiepileptic AgentsPatient Teaching for Patients Taking Antiepileptic AgentsDrug name and prescribed dosage Measures for avoidance of adverse effects Warning signs that may indicate possible problems Need for monitoring and evaluation