神经系统药理—魏尔清抗癫痫药.pptxVIP

Part 9Antiepileptic and Anticonvulsant Drugs;Psychomotor seizures;Classification of epilepsy (older);Classification of epilepsy;Normal EEG;The pathways for seizure propagation in partial seizures and primary generalized seizures;Stereotypical complex partial seizures;Mechanisms of antiepileptic drugs;A. Antiepileptic drugs;1. Pharmacological effects and the mechanism Inhibiting influx of Na+ and Ca2+ Inhibiting spread of abnormal discharges;;2. Clinical uses (1) Antiepilepsy Grand mal, status epilepticus; Partial seizures (simple and complex); Ineffective for petit mal (absence seizures) (2) Trigeminal and related neuralgia (3) Antiarrhythmia; 3. ADME Larger doses: non-linear kinetics（plasma concentration 10 ?g/ml） Necessary to monitor plasma concentrations Induction of hepatic drug-metabolizing enzymes;;;3. Adverse effects (1) Local reactions GI reactions; gingival hyperplasia (2) CNS reactions Particularly in the cerebellum and vestibular systems: nystagmus (眼球震颤), ataxia (共济失调), etc. Behavioral changes: confusion, hallucination ;(3) Hemological reactions Megaloblastic anemia (4) Allergic reactions Skin reactions; blood cell abnormality (including thrombocytopenia, agranulocytosis); hepatic toxicity; ect. (5) Skeletal reactions Osteomalacia by abnormal vitamin D metabolism and calcium absorption;4. Drug interactions (1) Increases plasma concentrations of drugs by displacement of plasma protein binding (salicylates) and inhibition of inactivation (isoniazid, chloramphenicol) (2) Decreases plasma concentrations of drugs (phenobarbital, carbamazepine) by enhancing metabolism (3) Phenytoin enhances the metabolism of corticosteroids and vitamin D;Inhibiting both formation and spread of discharges Effective for grand mal, partial simple seizures, status epilepticus;Effective for psychomotor seizures, and grand mal Effective for mania, depression, and neuralgia;; Broad spectrum of antiepilepsy Hepatic toxicity ;Other antiepileptic drugs Primidone 扑米酮：a