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13408243
Antiseizure Pharmacotherapy
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User has deleted their subject information Mind Map on Antiseizure Pharmacotherapy, created by Deleted user on 23/04/2018.
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Mind Map by Deleted user, updated more than 1 year ago
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Olivia McRitchie
over 6 years ago
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Olivia McRitchie
over 6 years ago
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Resource summary
Antiseizure Pharmacotherapy
General concepts
Depends on signs presented by patient
Low initial dose that is gradually increased until control is achieved or side effects prevent further increase.
Serum drug levels may be obtained
If seizures continue, a different medication is added in small dose increments while the dose of the first drug is slowly reduced.
Meds are discontinued over 6-12 weeks
Newer antiseizure meds exhibit fewer troublesome side effects
Limited induction of drug-metabolizing enzymes
Pharmacokinetic profile less complicated
Generally well-tolerated
Less of a health risk in pregnancy
Many of the popular drugs have found to double the risk of suicidal ideation in mentally ill patients
Both newer and older drugs can cause this
Some antiseizure drug combos can increase incidence of seizures
Directed at controlling the movement of electrolytes across neuronal membranes or affecting neurotransmitter balance
Antagonism of the excitatory neurotransmitter glutamate.
Glutamate works w/ Na+-K+ ATPase pump
Blocking it indirectly prevents an influx of positive ions into cells
Taurine can antagonize glutamate
Stabilizes neuronal cell membranes by reducing glutamate-induce + ion influx
Drugs that potentiate GABA
Mimic effects of GABA by stimulating influx of chloride ions through GABA receptor channel
May enhance GABA release, block ruptake of GABA into nerve cells, or block GABA-degrading enzymes
These drugs are also used for depression, migraines, neuropathic pain, postherpetic neuralgia, dibromyalgia, spinal cord injury, anxiety and bipolar.
Barbiturates
Intensifies effects of GABA in brain
Works against all seizures except absence
Low margin of safety, high potential for dependence, profound CNS depression.
Phenobarbital:
Can suppress optimal neuronal discharges w/o causing sedation.
Inexpensive, long lasting, low incidence of adverse effects.
Several weeks may be needed for optimal effects.
Sometimes preferred for neonatal seizures
Primidone (Mysoline)
Potentiates GABA action
Similar pharmacolgic profile to phenobarbital
Although not frequent, it can terminate status epilepticus
Benzodiazepines
Bind directly to GABA receptor
Indicated for absence and myoclonic seizures
Diazepam (Valium) and lorazepam (Ativan) are used to terminal status epilepticus.
Tolerance may develop. so dose needs to be readjusted
Generally used in conjunction w/other antiseizure drugs
Drugs that suppress sodium influx
Sodium channels are desensitized because complete blocking will cause death
Other drugs will affect threshold of neuronal firing, or may interfere w/transduction of glutamate
Hydantons & Related Durgs
Phenytoin (Dilantin)
Treats all types except absence seizures
Seizure suppression w/o abuse potential or CNS depression
Dosages highly indiidualized
Narrow range between therapeutic and toxic
Valproic acid (Depakene)
Preferred ftor absence & myoclonic seizures.
Phenytoin-Like Drugs
Carbamazepine (Tegretol)
Fewer adverse effects than other phenytoin-related drugs
Perferred for tonic-clonic and partial seizures
Oxcarbazepine (Oxtellar XR/Trilepral)
Derivative of carbamazepine, so treatment profile is similar
Slightly better tolerated, though serious skin & organ hypersensitivity have been seen,
Lamotrigine (Lamictal
First-line drugs for partial, absence, and tonic-clonic seizures
Also approved for bipolar
Duration of action affected by other drugs that change hepatic metabolism.
Levetiracetam (Keppra) & zonisamide (Zonegran)
Adjunctive therapy of partial seizures in adults
Levetiracetam is generally less reactive and has less adverse effects than other antiseizure
Valproic acid derivatives, lamotrigine, felbamate, topiramate, and rufinamide are used for Lennox-Gastaut syndrome.
Drugs that suppress calcium influx
Succinimides
Raise seizure threshold by delaying entry of calcium into ions
Ethosuximide (Zarontin)
Preferred choice for absence seizures
Amino Acid compounds
Suppress positive ion influxes differently from other antiseizure meds
Effective for paroxysmal and the psychopatholigic component of epilepsy.
Acetazolamide (Diamox) & lacosamide (Vimpat)
Restore ionic, and thus neurologic, imbalances similar to natural amino acids
Acetazolmide can treat absence and myoclonic seizures
Also used for glaucoma, altitude sickness, nausea, dizziness, drowsiness, and fatigue
Carbonic anhydrase inhibitor
Lacosamide is chemically r/t serine
Does not produce effects through voltage-gated sodium channels, but other membrane protein channels are involved
Used in combo w/other drugs to treat adult patients w/partial onset seizurs
Drawbacks include allergies, drowsiness, dizziness, irregular heartbeat. and coordination problems
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