Chapters15-17 (1)

Chapters15-17 (1) - Drugs Affecting the Central Nervous...

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Click to edit Master subtitle style 5/3/11 Chapters 15- 17 Drugs Affecting the Central Nervous System
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Click to edit Master subtitle style 5/3/11 CHAPTER 15 Antiepileptic Drugs
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5/3/11 Learning Objectives 1. Briefly describe the pathophysiology of epilepsy. 2. Discuss the rationale for the use of the various classes of antiepileptic drugs (AEDs) administered for management of the different forms of epilepsy. 3. Identify the various drugs in each of the following drug classes: iminostilbenes, benzodiazepines, barbiturates, hydantoins, and miscellaneous drugs. 4. Identify the mechanisms of action, indications, cautions, contraindications, dosages, routes of
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5/3/11 Epilepsy l Seizure l Brief episode of abnormal electrical activity in nerve cells of the brain l Convulsion l Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal and facial muscles l Epilepsy l Chronic, recurrent pattern of seizures
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5/3/11 Epilepsy (cont’d) Primary (idiopathic) Cause cannot be determined More than 50% of epilepsy cases Secondary (symptomatic) Distinct cause is identified Trauma, infection, cerebrovascular disorder
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5/3/11 Classification of Epilepsy Partial-onset seizures Simple (formerly known as petit mal seizures) Complex Secondary generalized tonic-clonic Generalized-onset seizures Formerly known as grand mal seizures Unclassified seizures Status epilepticus
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5/3/11 Antiepileptic Drugs (AEDs) Also known as anticonvulsants Goals of therapy To control or prevent seizures while maintaining a reasonable quality of life To minimize adverse effects and drug-induced toxicity AED therapy is usually lifelong Combination of drugs may be used
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5/3/11 Antiepileptic Drugs (cont’d) Single-drug therapy started before multiple-drug therapy is tried Serum drug concentrations must be measured Therapeutic drug monitoring Patients who are seizure free for 1 to 2 years may be able to discontinue antiepileptic therapy
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5/3/11 Mechanism of Action AED therapy must: Prevent generation and spread of excessive electrical discharge from abnormally functioning nerve cells Protect surrounding normal cells
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5/3/11 Mechanism of Action (cont’d) l Exact mechanism of action is not known l AEDs are thought to alter movement of sodium, potassium, and calcium ions across nerve cells in the brain l Reduce nerve’s ability to be stimulated l Suppress transmission of impulses from one nerve to the next l Decrease speed of nerve impulse conduction within a neuron
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5/3/11 Mechanism of Action (cont’d) Overall effect Neurons are stabilized Neuron hyperexcitability is decreased Spread of excessive nerve impulses is decreased
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5/3/11 Antiepileptic Drugs: Indications Prevention or control of seizure activity Long-term maintenance therapy for chronic, recurring seizures Acute treatment of convulsions and status epilepticus Other uses
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Chapters15-17 (1) - Drugs Affecting the Central Nervous...

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