药理学-抗癫痫药

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 Classification
Patient Teaching for Patients Taking Antiepileptic Agents
• Drug name and prescribed dosage • Measures for avoidance of adverse effects • Warning signs that may indicate possible problems • Need for monitoring and evaluation
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
– Treats tonic–clonic seizures and status epilepticus; prevents and treats seizures after neurosurgery
• Ethotoin (Peganone)
– Controls tonic–clonic and myoclonic seizures
Focus on the Prototype Drug Treating Partial Seizures: Carbamazepine
• Indications: Treatment of refractory seizure disorders, including partial seizures with complex patterns; tonic–clonic seizures; mixed seizures; trigeminal neuralgia. • Actions: Inhibits polysynaptic responses and blocks posttetanic 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.
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 epilepticus
药理学
抗癫痫药
Antiepileptic Agents
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 impulses
• Primidone (Mysoline)
– Treatment of tonic–clonic or partial seizures
• Mephobarbital (Mebaral)
– Treatment of tonic–clonic and absence seizures; anxiolytic/hypnotic agent
• Complex partial seizures
– Involve complex sensory changes – Motor changes may include involuntary urination, chewing motions, diarrhea, etc.
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Drugs for Treating Tonic–Clonic Seizures
– 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 seizures
– 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 • Ethosuximide (Zarontin)
• Valproic acid (Depakene)
– Reduces abnormal electrical activity in the brain; may increase GABA activity at inhibitory receptors
• Acetazolamide (Diamox)
Types of Benzodiazepines 苯二氮卓类药物
• Diazepam (Valium)
– Prototype benzodiazepine – Useful in relieving tension, anxiety, and muscle spasm.
• Clonazepam (Klonopin)
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
– 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 Seizures
• Fosphenytoin (Cerebyx)
– Controls short-term status epilepticus; prevents seizures after neurosurgery
Hydantoins (cont.)
• Mephenytoin (Mesantoin)
– Treats tonic–clonic, myoclonic, and partial (focal) seizures in patients who do not respond to less toxic antiepileptic agents.
治疗强直-阵挛发作的药物
• Hydantoins • Barbiturates • Barbiturate-like drugs
Sites of Action of Drugs Used to Treat Various Forms of Epilepsy
Hydantoins
乙酰脲类药物
• Phenytoin (Dilantin)