藥理學(xué)-抗癲癇藥

藥理學(xué)第十六章抗癲癇藥

AntiepilepticAgentsFactorsAffectingtheFormofaSeizure

影響癲癇發(fā)作形式的因素LocationofthecellsthatinitiatetheelectricaldischargeNeuralpathwaysthatarestimulatedbytheinitialvolleyofelectricalimpulsesClassificationofSeizures

癲癇發(fā)作的類型GeneralizedseizuresBegininoneareaofthebrainandrapidlyspreadthroughoutbothhemispheresofthebrainPartialseizuresorfocalseizuresInvolveoneareaofthebrainanddonotspreadthroughouttheentireorganClassificationClassificationClassificationofGeneralizedSeizures

全身發(fā)作的類型Tonic–clonicseizures(grandmalseizures)Absenceseizures(petitmalseizures)MyoclonicseizuresFebrileseizuresStatusepilepticusClassificationofPartialSeizures

局部發(fā)作的類型Simplepartialseizures

OccurinasingleareaofthebrainandmayinvolveasinglemusclemovementorsensoryalterationComplexpartialseizuresInvolvecomplexsensorychangesMotorchangesmayincludeinvoluntaryurination,chewingmotions,diarrhea,etc.DrugsforTreatingTonic–ClonicSeizures

治療強直-陣攣發(fā)作的藥物HydantoinsBarbituratesBarbiturate-likedrugsSitesofActionofDrugsUsedtoTreatVariousFormsofEpilepsyHydantoins

乙酰脲類藥物Phenytoin(Dilantin)Treatstonic–clonicseizuresandstatusepilepticus;preventsandtreatsseizuresafterneurosurgeryEthotoin(Peganone)Controlstonic–clonicandmyoclonicseizuresFosphenytoin(Cerebyx)Controlsshort-termstatusepilepticus;preventsseizuresafterneurosurgeryHydantoins(cont.)Mephenytoin(Mesantoin)Treatstonic–clonic,myoclonic,andpartial(focal)seizuresinpatientswhodonotrespondtolesstoxicantiepilepticagents.BarbituratesandBarbiturate-LikeDrugs

巴比妥和巴比妥類藥物Phenobarbital(Solfoton,Luminal)Emergencycontrolofstatusepilepticusandacuteseizures;managementoftonic–clonicandcorticalfocalseizures;treatmentofsimplepartialseizuresBarbituratesandBarbiturate-LikeDrugs

巴比妥和巴比妥類藥物Primidone(Mysoline)Treatmentoftonic–clonicorpartialseizuresMephobarbital(Mebaral)Treatmentoftonic–clonicandabsenceseizures;anxiolytic/hypnoticagentTypesofBenzodiazepines

苯二氮卓類藥物Diazepam(Valium)PrototypebenzodiazepineUsefulinrelievingtension,anxiety,andmusclespasm.Clonazepam(Klonopin)Usedforthetreatmentofabsence(petitmal)seizuresandmyoclonicseizuresAbsence.DrugsforTreatingAbsenceSeizures

治療失神性發(fā)作的藥物Ethosuximide(Zarontin)DrugofchoicefortreatingabsenceseizuresHasrelativelyfewadverseeffectscomparedwithmanyotherantiepilepticdrugsMethsuximide(Celontin)UsedtotreatabsenceseizuresthatareresistanttootherdrugsHasbeenassociatedwithbonemarrowsuppressionOtherDrugsforTreatingAbsenceSeizuresValproicacid(Depakene)Reducesabnormalelectricalactivityinthebrain;mayincreaseGABAactivityatinhibitoryreceptorsAcetazolamide(Diamox)

Asulfonamidedrugespeciallyeffectivefortreatmentofabsenceseizuresinchildren

Zonisamide(Zonegran)UsedasanadjuncttootherdrugsforthetreatmentofabsenceseizuresFocusonthePrototypeDrugTreatingPartialSeizures:CarbamazepineIndications:

Treatmentofrefractoryseizuredisorders,includingpartialseizureswithcomplexpatterns;tonic–clonicseizures;mixedseizures;trigeminalneuralgia.Actions:

Inhibitspolysynapticresponsesandblockspost-tetanicpotentiation.FocusonthePrototypeDrugTreatingPartialSeizures:CarbamazepineOralroute:Onsetslow;peak4~5hours.ERoralroute:Onsetslow;peak3~12hours.T?:

25~65hours,then12~17hours;metabolizedintheliver,excretedintheurineandfeces.PatientTeachingforP