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Chapter 23:
Antiseizure Agents
Chapter 23:
Antiseizure Agents
Copyright © 2017 Wolters Kluwer • All Rights Reserved
Epilepsy
Epilepsy
•
Most prevalent of the neurological disorders
•
Collection of different syndromes
•
Seizures
•
A loss of control
•
Frightening to patients
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Classification of Seizures
Classification of Seizures
•
Seizure type is very important
•
Formerly categorized as:
–
Grand mal (tonic-clonic seizures)
–
Petit mal (absence seizures)
•
Current classifications different
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International Classification of Seizures
International Classification of Seizures
Copyright © 2017 Wolters Kluwer • All Rights Reserved
Drugs for Treating Generalized Seizures
Drugs for Treating Generalized Seizures
•
Drugs typically used to treat generalized seizures
stabilize the nerve membranes by blocking channels in
the cell membrane or altering receptor sites. Because
they work generally on the central nervous system (CNS),
sedation and other CNS effects often result
–
Absence seizures may require drugs that are different
–
Used in both children and adults
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Hydantoins
Hydantoins
•
Ethotoin
(Peganone)
•
Fosphenytoin
(Cerebyx)
•
Phenytoin
(Dilantin)
–
Generally less sedating
–
May be the drugs of choice for patients unable to
tolerate sedation and drowsiness
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Hydantoins (cont.)
Hydantoins (cont.)
•
Therapeutic Actions and Indications –
–
Stabilize nerve membranes throughout the CNS
directly by influencing ionic channels in the cell
membrane, thereby decreasing excitability and
hyperexcitability to stimulation
•
Pharmacokinetics-
–
Well absorbed from the gastrointestinal (GI) tract,
metabolized in the liver, and excreted in the urine
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Hydantoins cont.
Hydantoins cont.
•
Therapeutic serum phenytoin levels range from 10 to 20
mcg/mL.
•
The therapeutic serum levels of ethotoin are from 15 to
50 mcg/mL. Fosphenytoin is given intramuscularly or
intravenously.
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Hydantoins cont.
Hydantoins cont.
•
Contraindications and Cautions-
–
Known allergies
–
Pregnancy and lactation
–
Caution should be used with elderly or debilitated
patients
–
Impaired renal or liver function
–
Depression, or psychoses
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Hydantoins cont.
Hydantoins cont.
•
Adverse Effects-
–
Relate mostly to CNS depression- Depression,
confusion, drowsiness, lethargy, fatigue, constipation,
dry mouth, anorexia, cardiac arrhythmias and
changes in blood pressure, urinary retention, and loss
of libido.
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- Spring '18
- Stephen Marrone
