第十六章抗癫痫药

第十六章抗癫痫药AntiepilepticAgentsFactorsAffectingtheFormofaSeizure影响癫痫发作形式的因素•Locationofthecellsthatinitiatetheelectricaldischarge•NeuralpathwaysthatarestimulatedbytheinitialvolleyofelectricalimpulsesClassificationofSeizures癫痫发作的类型•Generalizedseizures–Begininoneareaofthebrainandrapidlyspreadthroughoutbothhemispheresofthebrain•Partialseizuresorfocalseizures–InvolveoneareaofthebrainanddonotspreadthroughouttheentireorganClassificationClassificationClassificationofGeneralizedSeizures全身发作的类型•Tonic–clonicseizures(grandmalseizures)•Absenceseizures(petitmalseizures)•Myoclonicseizures•Febrileseizures•StatusepilepticusClassificationofPartialSeizures局部发作的类型•Simplepartialseizures–Occurinasingleareaofthebrainandmayinvolveasinglemusclemovementorsensoryalteration•Complexpartialseizures–Involvecomplexsensorychanges–Motorchangesmayincludeinvoluntaryurination,chewingmotions,diarrhea,etc.DrugsforTreatingTonic–ClonicSeizures治疗强直-阵挛发作的药物•Hydantoins•Barbiturates•Barbiturate-likedrugsSitesofActionofDrugsUsedtoTreatVariousFormsofEpilepsyHydantoins乙酰脲类药物•Phenytoin(Dilantin)–Treatstonic–clonicseizuresandstatusepilepticus;preventsandtreatsseizuresafterneurosurgery•Ethotoin(Peganone)–Controlstonic–clonicandmyoclonicseizures•Fosphenytoin(Cerebyx)–Controlsshort-termstatusepilepticus;preventsseizuresafterneurosurgeryHydantoins(cont.)•Mephenytoin(Mesantoin)–Treatstonic–clonic,myoclonic,andpartial(focal)seizuresinpatientswhodonotrespondtolesstoxicantiepilepticagents.BarbituratesandBarbiturate-LikeDrugs巴比妥和巴比妥类药物•Phenobarbital(Solfoton,Luminal)–Emergencycontrolofstatusepilepticusandacuteseizures;managementoftonic–clonicandcorticalfocalseizures;treatmentofsimplepartialseizures•Primidone(Mysoline)–Treatmentoftonic–clonicorpartialseizures•Mephobarbital(Mebaral)–Treatmentoftonic–clonicandabsenceseizures;anxiolytic/hypnoticagentTypesofBenzodiazepines苯二氮卓类药物•Diazepam(Valium)–Prototypebenzodiazepine–Usefulinrelievingtension,anxiety,andmusclespasm.•Clonazepam(Klonopin)–Usedforthetreatmentofabsence(petitmal)seizuresandmyoclonicseizuresAbsence.DrugsforTreatingAbsenceSeizures治疗失神性发作的药物•Ethosuximide(Zarontin)–Drugofchoicefortreatingabsenceseizures–Hasrelativelyfewadverseeffectscomparedwithmanyotherantiepilepticdrugs•Methsuximide(Celontin)–Usedtotreatabsenceseizuresthatareresistanttootherdrugs–HasbeenassociatedwithbonemarrowsuppressionOtherDrugsforTreatingAbsenceSeizures•Valproicacid(Depakene)–Reducesabnormalelectricalactivityinthebrain;mayincreaseGABAactivityatinhibitoryreceptors•Acetazolamide(Diamox)–Asulfonamidedrugespeciallyeffectivefortreatmentofabsenceseizuresinchildren•Zonisamide(Zonegran)–UsedasanadjuncttootherdrugsforthetreatmentofabsenceseizuresFocusonthePrototypeDrugTreatingPartialSeizures:Carbamazepine•Indications:Treatmentofrefractoryseizuredisorders,includingpartialseizureswithcomplexpatterns;tonic–clonicseizures;mixedseizures;trigeminalneuralgia.•Actions:Inhibitspolysynapticresponsesandblockspost-tetanicpotentiation.•Oralroute:Onsetslow;peak4–5hours.•ERoralroute:Onsetslow;peak3–12hours.•T½:25–65hours,then12–17hours;metabolizedintheliver,excretedintheurineandfeces.PatientTeachingforPatientsTakingAntiepilepticAgents•Drugnameandprescribeddosage•Measuresforavoidanceofadverseeffects•Warningsignsthatmayindicatepossibleproblems•Needformonitoringandevaluation