第 16 章 抗癫痫药 和抗惊厥药 antiepileptics & anticonvulsive drugs
TRANSCRIPT
![Page 1: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/1.jpg)
第第 1616 章 抗癫痫章 抗癫痫药药
和抗惊厥药和抗惊厥药Antiepileptics &
anticonvulsive drugs
![Page 2: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/2.jpg)
§1 antiepileptic drugs
㈠ Epilepsy 癫痫 1 、 chronic CNS disorders ;
1 ) cerebral focus nerve cell 2 ) sudden 、 abnormity 、 rapid high frequency local discharge 3 ) around diffuse 4 ) cerebral function disorders 。
introduction
![Page 3: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/3.jpg)
Causes of epilepsy
Damage to the brain : 1 ) tumours 、 2 ) head injury 、 3 ) infection 、 4 ) cerebrovascular accident ;
![Page 4: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/4.jpg)
2 、 Character of paroxysm
1) abrupt onset ① staring (目瞪) ② cessation of ongoing activities ③ lasting less than 30 sec
2 ) transient 、 3 ) repeat ;
![Page 5: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/5.jpg)
Classification of epileptic1 、 Partial seizures : 1 )、 simple partial— key feature : preservation of consciousness ; 2 )、 complex partial— impaired consciousness lasting 30sc—2min 。
![Page 6: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/6.jpg)
2 、 generalized seizures : 1 ) absence seizures (peptit-mal ): 2 )myoclonic seizures : a brief shock like contraction of muscle ;3 ) tonic –clonic seizures : ( grand-mal epilepsy )
![Page 7: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/7.jpg)
§1 antiepileptic drugs 一、 manner of action : 1 、 ㈠ local discharge 2 、 around diffuse.
二、 mechanism of action 1 、 function of GABA 2 、 interfere Na+ 、 K+ 、 Ca2+
channel
![Page 8: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/8.jpg)
usual drugsphenytoin sodium (苯妥英钠、大仑丁, dilantin )
[ pharmacokinetics ] 1 、 PO.—absorption somewhat slow , F—difference obvious ; 2 、 stimulation , not suitable IM 3 、 extensively bound to serum protein ;
![Page 9: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/9.jpg)
3 、 elimination velocity with blood concentration correlation
10g/ml: first-order elimination
kinetics , t½ 6-24 h
10g/ml: zero-order elimination
kinetics , t½ 20-60 h
![Page 10: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/10.jpg)
[actions and uses]
1. epilepsy 1) Generalized tonic –clonic; partial seizure (first choice ) 2) absence seizures inefficacy ; 2.trigeminal and related neuralgias
3. arrhythmia (related to digitalis intoxication)
![Page 11: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/11.jpg)
[ adverse reactions ]
1.local stimulation (PH 2.chronic toxico ⑴ overgrown of gum collagen (in children and young) ⑵ CNS depression ; ⑶ a variety of endocrine ;
![Page 12: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/12.jpg)
3. other 1) hypersensitivity reaction ;
2) cardiac toxicity: iv-excessive rate;
3) fatal hepatic necrosis;
4) blood system :
reduce immunoglobulin
neutropenial folacin
![Page 13: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/13.jpg)
carbamazepine
卡马西平 ( 酰胺咪嗪 )[characteristics ]1 、㈠ Na+channel ,㈠ focus discharge ;2 、 generalized tonic clonic and
simple ---
first choice
neuralgia > phenytoin sodium ;
![Page 14: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/14.jpg)
3 、 po-- absorb slowly , induce hepatic enzyme ,4 、 adverse reaction
1 ) acute intoxication : stupor 、 coma
hyperirritability 、 convulsion respiratory depression 2 ) serious intoxication : ㈠ marrow , hepatic damage 。
![Page 15: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/15.jpg)
other usual drugs
药 名 character
苯巴比妥 ㈠ discharge and diffuses ,
Phenobarbital use : epilepsy
absence seizures efficacy乙琥胺
Ethosuximide
丙戊酸钠 widely anti epilepsy
Sodium valproate ㈠ Na+channel , GABA of CNS
![Page 16: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/16.jpg)
Clinic choice drugs principles
1 、 types of epilepsy ;2 、 long term
administration ;3 、 individual of dose ;4 、 not sudden stop ;3 、 note : adverse reaction and drug interration
![Page 17: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/17.jpg)
§2 anticonvulsantsmagnesium sulfate (硫酸镁) 1 、 Mg2+-Ca2+ competitive , 2 、 use : PO-catharsis im-anticonvulsion ; iv--BP 3 、 adverse reaction : ㈠ CNS、 ㈠ respiratory 、
administration slowly overdose : iv.Ca2+。
![Page 18: 第 16 章 抗癫痫药 和抗惊厥药 Antiepileptics & anticonvulsive drugs](https://reader036.vdocuments.pub/reader036/viewer/2022082204/5697bf8a1a28abf838c8a5c8/html5/thumbnails/18.jpg)
question
1 、 describe the choice agents of epilepsy ?
2、 which drugs prossess action anticonvulsion ?