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Published byMay Bond Modified over 9 years ago
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Main function ACTIONDRUGS ↓Na currentDPH, CBZ, LTG, TOP, PRI ↑ GABAergic inhibitionPB, VA, BZD, CNZ, VGB, GPT ↓ transient Ca currentESX, VA
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Vigabatrin: inhibition of GABA aminotransferase Gabapentin: facilitate glutamic acid decarboxylase (GAD)
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Treatment of epilepsy Partial and GTC AbsenceAbsenceMyoclonic DPH++00 CBZ++00 PRI++00 VA++ PB+0+ CNZ++++ ESX0++0
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Pharmacokinetics All bind to plasma protein Phenytoin: zero order kinetics
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CBZ Enzyme inducer
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Drug interactions serum level influence by combine therapy Antibiotics:↑DPH, CBZ, PB ↑ contraceptives metabolism DPH: ↓coumadin (anticoagulant) CBZ, DPH: ↓theophylline
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Side effects of DPH nausea, dizziness, visual disturbance Nystagmus, diplopia, ataxia Cognitive impairment, confusion Allergic reaction Hirsutism, coarsening of facial Gingival hyperplasia Drug-induce hepatitis
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Side effect of CBZ nausea, dizziness, diplopia, ataxia Allergic reaction Stevens-Johnson syndrome Aplastic anemia Granulocyte suppression Titration therapy
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Side effect of VA nausea, dizziness, diplopia, lethargy ↑NH 3, Fetal hepatitis (1/40,000) Age <2, multiple medication Tremor Wt gain aleopecia
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VA: Spina bifida,neural tube defect (20X)
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Pregnancy in epilepsy Risk for seizure (mother and baby) Risk for teratogenicity Single-drug therapy Lowest dose divide dose to minimize peak levels
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DPH, CBZ: Carniofacial defects, cleft palate, cleft lip, septum defect, fingernail hypoplasia, delay development
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Fetal hydantoin syndrome
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Status epilepticus Continuous seizure > 30 min Recurrent seizure without complete recovery of consciousness between attacks Mortality 8-35% Neurological emergency
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Management of status epilepticus 0-5 min assessment airway; blood draw: drug level, toxin, glucose 5-10 min start IV infusion administer: thiamine; glucose
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Management of SE 10-30 min lorazepam or diazepam and phenytoin monitor Bp, arrhythmia 30-60 min phenobarbital > 60 min pentobarbital coma
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結語 中古世紀 — 怪力亂神 二十一世紀 — 新的希望 癲癇不影響個人成就 — 人盡其才
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