welcome to pharmacology. chapter 18 antiepileptic & anticonvulsive drugs
TRANSCRIPT
![Page 1: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/1.jpg)
Welcome to Pharmacology
![Page 2: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/2.jpg)
Chapter 18
Antiepileptic & Anticonvulsive Drugs
![Page 3: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/3.jpg)
Section 1 Antiepileptic Drugs
![Page 4: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/4.jpg)
Epilepsy Epilepsy is a heterogeneous symptom
complex, a chronic disorder characterized by sudden, transit and recurrent seizures which are episodes of brain dysfunction resulting from abnormal discharge of focal cerebral neuron and diffusion to normal neuronal tissues.
Somatic, sensory, automatic and psychotic
![Page 5: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/5.jpg)
![Page 6: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/6.jpg)
EpilepsyEtiology incidence:0.5%~1%
Primary epilepsy Secondary epilepsy
![Page 7: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/7.jpg)
Classifications1. Partial seizures
(1)Simple partial seizures 单纯局限性发作 (2)Complex partial seizures 复合性局限性发作2. Generalized seizures
(1)Absence seizures(petit mal) 失神发作(小发作) (2)Myoclonic seizures 肌阵挛性发作 (3)Generalized tonic-clonic seizures (grad mal)
强直 - 阵挛性发作(大发作)
(4)Status epilepticus 癫痫持续状态
![Page 8: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/8.jpg)
(1) Grand mal epilepsy
Loss of consciousness and myotonia-
myoclonus for a few minutes.
Continuous episodes with sustained loss
of consciousness is called epilepticism.
![Page 9: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/9.jpg)
(2) Absence
Involve a brief, sudden and self-
limiting loss of consciousness.The
patient stare and exhibits rapid eye-
blinking, which lasts for 3 to 5
seconds without any motor disorder.
![Page 10: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/10.jpg)
(3) Myoclonic
Consist of short episode of local
muscle contractions that may reoccu
r for several minutes.
![Page 11: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/11.jpg)
Partial
Simple partial
Do not lose conciousness and often
exhibit abnomal activity of a single
limb or muscle group.
![Page 12: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/12.jpg)
Partial
Complex partial
Exhibit motor dysfuntion and loss
of conciousness.
![Page 13: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/13.jpg)
Experimental Models1. Electric stimulate(maximal electroshock seizu
re, MES): grad mal
2. Pentylenetetrazol(PTZ): absence seizure
3. Spontaneously epileptic rat(SER)
4. Kindling response: Complex partial seizures
5. Glutamate
![Page 14: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/14.jpg)
History of Antiepileptic Drugs
1857 potassium bromide( 溴化钾 )
1912 phenobarbital
1912~1937 35 analogs of phenobarbital
1938 phenytoin
1938~1960
valproate(64), Antiepilepsrin(75) Carba
mazepin(80), gabapentin(90)
![Page 15: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/15.jpg)
The Classifications
Hydantoins
Anticonvulsive barbiturates
Benzodiazepines
Succinimides
New drugs
![Page 16: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/16.jpg)
Electrophysiology of antiepilepsy drugs
a. inhibit discharge in focus b. inhibit diffusion in normal neuron
![Page 17: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/17.jpg)
Mechanisms of action of antiepilepsy drugs
1. To affect inhibitory system involving GABAergic function
a. Enhancement of GABAergic transmission: reuptake or metabolism b. Direct action on the GABA-R chloride channel complex
![Page 18: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/18.jpg)
Mechanisms2.Modification of ion channel conductance
Inhibitory of Na+ and/or Ca2+ channel
N-typeCa2+ channel L-type T-type absence seizures
![Page 19: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/19.jpg)
Mechanisms
c. Diminution of
glutaminergic function
AMPA-R blockade
NMDA-R blockade
![Page 20: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/20.jpg)
Phenytoin Sodium (苯妥英钠 , Dilantin, 大仑丁)
![Page 21: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/21.jpg)
Mechanisms
1.inhibit diffusion in normal neuron
by inhibiting post tetanic potentiation(PTP)
![Page 22: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/22.jpg)
Post tetanic potentiation (PTP) :Increase in amplitude of EPSP after neuron has received tetanic stimulus, in neurons refers to any high frequency burst of stimulation
![Page 23: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/23.jpg)
Mechanisms2.Promote the stablization of the membrane
a.block voltage-sensitive (use-dependent effect) Na+ channel
b.block voltage-sensitive Ca2+ channel
c. inhibit K+ out
![Page 24: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/24.jpg)
Mechanisms
3.inhibit the activity of camudulin kin
ase
4. Potentiate GABA inhibiting functio
n
![Page 25: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/25.jpg)
Clinical uses1.Epilepsy:
generalized tonic-clonic seizures
simple partial seizures
complex partial seizures
first choice
except absence seizure
Pay attention to children
![Page 26: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/26.jpg)
Clinical uses2. Central pain syndrome: neuralgias
trigeminal neuralgia et al
3. Arrhythmia (心律失常)
![Page 27: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/27.jpg)
Pharmacokinetics1. Absorption
pKa8.3, slow and unpredictable
after oral administration
Css 5-7d
stimulation by oral and im(pH=10.4)
2. Distribution
PPBR about 90%,Vd 0.6-0.7L/kg
![Page 28: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/28.jpg)
Pharmacokinetics3. Metabolism :
by hepatomicroenzymes about 60%-70%,
5% unchanged
相互作用4. Elimination : dose-dependent
plasma concentration
less than 10g/ml, FOK, t1/2 6-24hrs
more than 10 g/ml, OOK, t1/2 20-60hrs
![Page 29: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/29.jpg)
Adverse Reactions
Cmax(E) 10g/ml; CTox 20g/ml
1. Gastrointestinal reaction
2. Gingival hyperplasia by increasing the
the induction of collagenase
![Page 30: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/30.jpg)
Adverse Reactions3. CNS symptoms 20g/ml : drowsiness, dizziness, ataxia,
﹥40g/ml: psychotic, ﹥50g/ml: coma4. Blood system: folic acid dysefficacy
![Page 31: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/31.jpg)
Adverse Reactions4. Allergy
leukopenia (白细胞减少) ,
agranulocytosis (粒细胞缺乏) ,
thrombocytopenia (血小板减少) , aplastic anemia (再生障碍性贫血)5. Bone system
hypocalcemia,osteomalacia, rachitis
reason : vitamin D
![Page 32: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/32.jpg)
Adverse Reactions6. 心血管反应 arrhythmia
hypotension
![Page 33: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/33.jpg)
Adverse Reactions7.Others:
a.Teratogenesis
fetal hydantoin syndrome
( 胎儿妥因综合征)
b.peripheral neuritis
![Page 34: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/34.jpg)
芬兰 1980 ~ 1998 年,研究人员追踪了一家产科诊所中 970 位怀孕的癫痫妇女,其中有 740 位在怀孕初期(前 3个月)服用抗癫痫药物,另外 239 位则无。结果在这些服用抗癫痫药物的怀孕妇女中,共产下 28 个严重畸形儿( 3.8% ),未服用抗癫痫药物组仅产下 2个严重畸形儿( 0.8% ; P=0.02 )
![Page 35: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/35.jpg)
Drug Interactions1. Hepatomicrosomal enzyme inducer
2. Hepatomicrosomal enzyme inhibiter
3. PPBR
![Page 36: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/36.jpg)
Carbamazepine (卡马西平)
Broad–spectrum antiepileptic agent
Mechanisms• inhibit Na+ channel• potentiat GABA inhibitory function
![Page 37: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/37.jpg)
Carbamazepine Actions and Uses
1. Antiepileptic effects
grad mal, partial seizures with complex symptomatology first choice
2. Central algesia: trigeminal neuralgia
more effective than phenytoin
3. mania (躁狂症) and depression
4. 尿崩症
![Page 38: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/38.jpg)
Pharmacokinetics1. slow and unpredictable after
oral administration
2. PPBR 80%
3. Active metabolite : cyclooxide
4. t1/2 35 hrs at beginning, then may shorten
by 50% due to enzyme induction
![Page 39: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/39.jpg)
Adverse Reactions 1. Gastrointestinal reaction 2. CNS reactions: drowsness, vertigo, nausea, vomit, ataxia 3. Blood system: leukopenia (白细胞减少) ,
agranulocytosis (粒细胞缺乏) , thrombocytopenia (血小板减少) ,
aplastic anemia (再生障碍性贫血) 4. Hepatic intoxication
![Page 40: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/40.jpg)
Phenobarbital
Broad-spectrum and much effective
in grad mal and partial seizures, but
not drug choice for grad mal, alternative and iv in the treatment of status epilepticus
![Page 41: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/41.jpg)
Mechanisms
1. Potentiate the GABA inhibitory function: pre-synaptic GABA-R
2. Ca2+ Neurotransmitter
3. Inhibitory of Na+ and Ca2+ channel
![Page 42: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/42.jpg)
Primidone (扑米酮) Effective for all types of epilepsies
Except absence mal, more effective
than phenobarbital in complex partial
seizures
Mechanism similar to phenobarbital
and Na+in, K+
out
![Page 43: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/43.jpg)
Primidone (扑米酮)Primidone is metabolized to
phenobarbital and
phenylethylmalonamides(PEMA,
苯乙基丙二酰胺 ) as active metabolites
![Page 44: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/44.jpg)
Ethosuximide (乙琥胺)The only indication: absence epilepsy
Mechanisms:
1. reducing the T-type Ca2+ current
2. inhibiting GABA aminotransferase( 转氨酶 ), Na+-K+-ATP
![Page 45: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/45.jpg)
Adverse Reactions(safe)
1. Gastric distress
2. CNS distress
3. Blood system : agranulocytosis,
thrombocytopenia, aplastic anemia
4. SLE
![Page 46: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/46.jpg)
Sodium Valproate (丙戊酸钠) Broad–spectrum antiepileptic agentMechanisms:
1.potentiate GABA function
inhibit GABA-T
increase the activity of GAD
2.inhibit Na+ channel
3.inhibit L-Ca2+ channel
inhibit T-Ca2+ channel
![Page 47: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/47.jpg)
uses Effective for all types of epilepsy,
more effective than ethosuxide,
less effective for grad mal and partial mal
grad mal combine with absence seizures
first choice
![Page 48: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/48.jpg)
Adverse Reactions1. Hepatic intoxication
2. CNS and blood system thrombocytopenia
3. Teratogenesis
![Page 49: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/49.jpg)
Benzodiazepines 1. Diazepam :first choice for status
epilepticus by iv
2. Nitrazepam (硝西泮) : myoclonic seizure, atypical absence seizure and infantile spasm
3. Clonazepam: absence seizure, atonic
and akinetic seizures
![Page 50: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/50.jpg)
Other New DrugsFlunarizine( 氟桂利嗪 )
1. Nonselective calcium channel-blocking drugs
2. Effective for all types of epilepsy,
more effective for grad mal and partial mal
3. inhibit Na+ channel
inhibit L-Ca2+ channel
inhibit T-Ca2+ channel
![Page 51: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/51.jpg)
Antiepilepsirin (抗痫灵)1. Broad–spectrum antiepileptic agent
2. 5-HT
3. Safe
![Page 52: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/52.jpg)
Lamotrigine( 拉莫三嗪)1. Used as an add-on therapy or monother
apy in the treatment of
absence or myoclonic seizure
2. The mechanism may related to inhibit voltage-dependent Na+ channel
![Page 53: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/53.jpg)
Topiramate (托吡酯)Used in the treatment of partial seizure with or without generalized tonic-clonic seizures
• inhibit Na+ channel• potentiat GABA inhibitory function• Diminution of glutaminergic function
![Page 54: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/54.jpg)
Therapy for EpilepsyGeneral Principles and Drug Choice fo
r The Therapy of Epilepsy1. Accurate evaluation2. The drug choice for initial treatme
nt of seizures
![Page 55: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/55.jpg)
Therapy for Epilepsy
(1) grad mal and simple partial seizures:(1) grad mal and simple partial seizures:
Carbamazepine, phenytoinCarbamazepine, phenytoin
Phenobarbital, primidone and valproic Phenobarbital, primidone and valproic acid as alternativeacid as alternative
![Page 56: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/56.jpg)
Therapy for Epilepsy(2)Absence seizure:
ethosuxide
valproic acid, clonazepam
(3)Complex partial seizures:
Carbamazepine
Phenytoin , primidone, valproic acid
![Page 57: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/57.jpg)
Therapy for Epilepsy( 4 ) Status epilepticus
Diazepam iv, or clonazepam,
phenytoin and phenobarbital
(5)Tonic seizure: valproic acid
(6)Myoclonic seizure:
Glucocorticoids, clonazepam
![Page 58: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/58.jpg)
Therapy for Epilepsy3. Increase dose gradually
4. Withdrawn or discontinue ----gradually (half year)
5. Change drug or add a second drug
and/or combination
6. Monitoring the serum drug level
7. Adverse reactions teratogenesis
![Page 59: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/59.jpg)
Section 2 Anticonvulsants Convulsion
Barbiturates
Benzodiazepines
Chloral hydrate
Magnesium Sulfate
![Page 60: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/60.jpg)
Magnesium Sulfate1. 给药途径不同,药理作用不同2. Relaxant of skeletal muscle and CNS dep
ression by iv or im3. Mechanism : calcium antagonism4. Used in convulsion caused by eclampsia ,
高血压危象5. respiratory inhibition and hypotension w
hen overdose.
![Page 61: Welcome to Pharmacology. Chapter 18 Antiepileptic & Anticonvulsive Drugs](https://reader035.vdocuments.net/reader035/viewer/2022081420/56649ddc5503460f94ad306d/html5/thumbnails/61.jpg)
Thanks!