抗癫痫药和抗惊厥药50433课件.ppt

1、文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Table 16-1(1)Table 16-1(1)Types of Epilepsy and Types of Epilepsy and Anti-epileptic DrugsAnti-epileptic Drugstypes of types of epilepsy epilepsy clinical features clinical features a

2、nti-epileptic drugs anti-epileptic drugs(*preferred)preferred)partial seizurespartial seizures 1.simple 1.simple partial partial seizures seizures involuntary muscle involuntary muscle contraction and contraction and abnormal sensory abnormal sensory experience without loss experience without loss o

3、f consciousnessof consciousness,seizures lasting for seizures lasting for 2060 sec;2060 sec;carbamazepinecarbamazepine*,valproate,clonazepam,valproate,clonazepam,phenytoin,phenytoin,phenobarbital,phenobarbital,primidoneprimidone,antiepilepsirine,antiepilepsirine,lamotrigine;lamotrigine;plex plex par

4、tial partial seizures seizures(psychomotor psychomotor epilepsy)epilepsy)conscious disturbance conscious disturbance and psychiatric symptom and psychiatric symptom with often involuntary with often involuntary movement,such as shake movement,such as shake head,lasting for head,lasting for 0.52min;0

5、.52min;t the same drugs mentioned he same drugs mentioned above;above;文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Table 16-1 (2)Table 16-1 (2)Types of Epilepsy and Types of Epilepsy and Anti-epileptic DrugsAnti-epileptic Drugstypes of types of epilepsy epilepsy clinical features clinical features anti-ep

6、ileptic drugs anti-epileptic drugs(*preferred)preferred)3.partial 3.partial seizures with seizures with following following tonic-clonic tonic-clonic seizures seizures partial seizures is partial seizures is followed by tonic-followed by tonic-clonic seizures without clonic seizures without loss of

7、consciousness,loss of consciousness,lasting for 12min;lasting for 12min;t the same drugs mentioned he same drugs mentioned above;above;generalized seizures generalized seizures 1.tonic-1.tonic-clonic clonic seizures seizures(grandmal)grandmal)and status and status epilepticus epilepticus immediate l

8、oss of immediate loss of consciousness with consciousness with generalized tonic-generalized tonic-clonic convulsion,clonic convulsion,lasting for a few lasting for a few minutes.Seizures minutes.Seizures lasting for longer time lasting for longer time is termed as status is termed as status epilept

9、icus;epilepticus;carbamazepinecarbamazepine*,phenytoin,valproate,phenytoin,valproate,phenobarbital,phenobarbital,primidoneprimidone,vigabatrin,vigabatrin,lamotrigine,lamotrigine,antiepilepsirine;antiepilepsirine;status epilepticus:status epilepticus:diazepamdiazepam*(i.v.);(i.v.);文档仅供参考，不能作为科学依据，请勿模

10、仿；如有不当之处，请联系网站或本人删除。Table 16-1 (3)Table 16-1 (3)Types of Epilepsy and Types of Epilepsy and Anti-epileptic Anti-epileptic DrugsDrugstypes of types of epilepsy epilepsy clinical features clinical features anti-epileptic drugs anti-epileptic drugs(*preferred)preferred)2.2.absence absence seizures seiz

11、ures(petit mal)(petit mal)patient abruptly patient abruptly ceases whatever he or ceases whatever he or she is doing,and she is doing,and stares vacantly for a stares vacantly for a few seconds,with few seconds,with unaware of unaware of surroundings;surroundings;ethosuximideethosuximide*,clonazepam

12、,valproateclonazepam,valproate,nitrazepam,clobazam;nitrazepam,clobazam;3.atypical3.atypical absence absence seizures seizures This seizures occurs This seizures occurs and recovers more and recovers more slowly than absence slowly than absence seizures;seizures;ethosuximideethosuximide*,clonazepam,v

13、alproate,clonazepam,valproate,nitrazepam,clobazam;nitrazepam,clobazam;文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Table 16-1 (4)Table 16-1 (4)Types of Epilepsy and Types of Epilepsy and Anti-epileptic DrugsAnti-epileptic Drugs types of types of epilepsy epilepsy clinical features clinical features anti-e

14、pileptic drugs anti-epileptic drugs(*preferred)preferred)4.myoclonic 4.myoclonic seizures seizures local myoclonia local myoclonia lasts for a few lasts for a few seconds;seconds;valproate,valproate,clonazepam,clobazam;clonazepam,clobazam;5.infant 5.infant myoclonic myoclonic seizures seizures gener

15、alized rhythmic generalized rhythmic myoclonia with myoclonia with unconsciousness in unconsciousness in infant.infant.clonazepam,clonazepam,valproate,clobazam,valproate,clobazam,glucocorticoid glucocorticoid 文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。CCONCOHHNNNOOOH5C2HH ethosuximide carbamazepine valp

16、roate sodium phenytoin phenobarbital primidone Fig.16-1 Molecular structures of antiepileptic drugsNNOOH5C2HHCNCCOOH5C2H3CCH2HNONH2CHCH2CH2COONaCH2CH2CH3CH3文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。【抗癫【抗癫药物的作用机制】药物的作用机制】文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。【抗癫【抗癫药物的作用机制】药物的作用机制】文档仅供参考，不能作为科学依据，请勿模仿；如

17、有不当之处，请联系网站或本人删除。苯妥英钠苯妥英钠(Phenytoin,大仑丁大仑丁dilantin)文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。【药理作用】【药理作用】文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。【临床应用】【临床应用】文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。【不良反应】【不良反应】文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。4血液系统反应血液系统反应 抑制folinic acid的吸收并加速其代谢，以及抑制二氢叶酸还原酶活性，长期用药可

18、致巨幼红细胞性贫血。5骨骼系统反应骨骼系统反应 诱导肝药酶而加速Vit.D代谢，可致低钙血症、佝偻病样改变和骨软化症。6过敏反应过敏反应 可发生皮疹、血小板减少、粒细胞缺乏、再生障碍性贫血。7其他反应其他反应 偶见男性乳房增大、女性多毛症等。偶致畸胎，故孕妇慎用。久服骤停可使癫发作加剧，甚至诱发癫持续状态。【不良反应】【不良反应】文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。【药物相互作用】【药物相互作用】文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。药物药物 应用应用 不良反应不良反应PhenobarbitPhenobarbit

19、al al 大发作、癫大发作、癫持续状态、持续状态、单纯部分性发作、精神运单纯部分性发作、精神运动性发作动性发作 见镇静催眠药见镇静催眠药Primidone Primidone 对大发作疗效优于对大发作疗效优于phenobarbitalphenobarbital，但对部，但对部分性发作疗效不及分性发作疗效不及phenytoinphenytoin和和carbamazepine carbamazepine 嗜睡、共济失调、巨嗜睡、共济失调、巨幼红细胞性贫血、白幼红细胞性贫血、白细胞和血小板减少细胞和血小板减少 Mephenytoin Mephenytoin 主要用于癫主要用于癫大发作，由大发作，由

20、于不良反应较重，仅用于于不良反应较重，仅用于其他药物不能控制的患者其他药物不能控制的患者 多形性红斑、高热、多形性红斑、高热、黄疸、中毒性肝炎、黄疸、中毒性肝炎、精神症状精神症状 Ethotoin Ethotoin 对大发作和复杂部分性发对大发作和复杂部分性发作有效。由于作用弱，只作有效。由于作用弱，只作辅助药物与其他药合用作辅助药物与其他药合用 不良反应少见不良反应少见 常用抗癫常用抗癫药的比较药的比较(1)(1)文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。药物 应用 不良反应Ethosuximide 对小发作不及氯硝西泮(clonazepam)，但副作用及

21、耐受性较少，故仍为防治小发作的首选药 常见为胃肠道反应，其次为中枢神经系统症状如头痛，偶见粒细胞缺乏症和再障Benzodiaze-pine diazepam是癫持续状态的首选药，nitrazepam主要用于小发作和非典型失神性发作，clonazepam和clobazam对各型癫有效 diazepam静过快可致呼吸抑制，故应缓慢静脉注射。其他见镇静催眠药Valproate 对各型癫均有效。对大发作不及phenytoin和phenobarbital；对小发作疗效优于ethosuximide常见有恶心、呕吐等，CNS反应少，约25%的患者有肝毒性Carbamaze-pine 对各类型癫有效，其中对精

22、神运动性发作和大发作疗效较好 眩晕、恶心、呕吐，少数可有粒细胞和血小板减少。文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。抗癫抗癫药的合理应用药的合理应用文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Table 16-2 (1)Table 16-2 (1)Summary of Charateristics of Some Newly Developed Summary of Charateristics of Some Newly Developed Anti-epileptic DrugsAnti-epileptic Drugs

23、drugs drugs cellular cellular mechanisms mechanisms main uses main uses mainly mainly unwanted unwanted effects effects antiepilepsantiepilepsirine irine i increase in ncrease in content of 5-content of 5-serotonin;serotonin;broad therapeutic broad therapeutic profile;profile;relatively free relativ

24、ely free of side-of side-effects,effects,drowsiness etc.drowsiness etc.vigabatrin vigabatrin inhibition of inhibition of GABA GABA transaminase;transaminase;effective in effective in patients patients unresponsive to unresponsive to conventional conventional drugs;drugs;drowsiness,drowsiness,behavio

25、ur and behaviour and mood changes mood changes lamotrigine lamotrigine inhibition of inhibition of NaNa+channels;channels;broad therapeutic broad therapeutic profile;profile;hypersensitivithypersensitivity reactions y reactions(especially(especially skin rashes)skin rashes)文档仅供参考，不能作为科学依据，请勿模仿；如有不当之

26、处，请联系网站或本人删除。Table 16-2 (2)Table 16-2 (2)Summary of Charateristics of Some Newly Developed Summary of Charateristics of Some Newly Developed Anti-epileptic DrugsAnti-epileptic Drugsdrugs drugs cellular cellular mechanisms mechanisms main uses main uses mainly unwanted mainly unwanted effects effects

27、 felbamate felbamate unknown;unknown;broad broad therapeutic therapeutic profile;profile;use limited to use limited to intractable disease,intractable disease,owing to risk of owing to risk of hypersensitivity hypersensitivity reactions resulting reactions resulting in aplastic anemia in aplastic an

28、emia gabapentigabapentin n unknown;unknown;partial partial seizures;seizures;safe in overdose.safe in overdose.relatively free of relatively free of side-effects side-effects 文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Table 16-2 (3)Table 16-2 (3)Summary of Charateristics of Some Newly Developed Summary

29、of Charateristics of Some Newly Developed Anti-epileptic DrugsAnti-epileptic Drugsdrugs drugs cellular cellular mechanisms mechanisms main uses main uses mainly unwanted mainly unwanted effects effects tiagabine tiagabine GABA uptake GABA uptake inhibitor;inhibitor;partial partial seizures in seizur

30、es in adults;adults;dizziness and dizziness and confusion confusion flunariziflunarizine ne block of block of CaCa2+2+and Na and Na+channels;channels;broad broad therapeutic therapeutic profile;profile;relatively free of relatively free of side-effects,side-effects,drowsiness,increase drowsiness,increase in body weight in body weight 文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。第二节第二节 抗惊厥药抗惊厥药文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。硫酸镁硫酸镁(Magnesium sulfate)文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。下一章下一章主菜单主菜单前一章前一章