第十六章 抗癫痫药.ppt
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第十六章 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
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
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
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
? 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)
- 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 neurosurgery
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
? 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 agent
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
? 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 Seizures
? Valproic 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 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 post-tetanic potentiation.
? Oral route: Onset slow; peak 4-5 hours.
? ER oral route: Onset slow; peak 3-12 hours.
? T1/2: 25-65 hours, then 12-17 hours; metabolized in the liver, excreted in the urine and feces.
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
第十六章 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
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
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
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
? 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)
- 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 neurosurgery
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
? 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 agent
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
? 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 Seizures
? Valproic 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 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 post-tetanic potentiation.
? Oral route: Onset slow; peak 4-5 hours.
? ER oral route: Onset slow; peak 3-12 hours.
? T1/2: 25-65 hours, then 12-17 hours; metabolized in the liver, excreted in the urine and feces.
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
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