【文档说明】神经系统药理魏尔清抗癫痫药课件.pptx，共(32)页，2.198 MB，由小橙橙上传

转载请保留链接：https://www.ichengzhen.cn/view-236205.html

以下为本文档部分文字说明：

PsychomotorseizuresPetitmal(absence)Grandmal(tonic-clonic)Epilepsyisnotasingleentity;itisafamilyofdifferentrecurrentseizuredisord

ersthathaveincommonthesudden,excessiveanddisorderlydischargeofcentralneurons.Thisresultsinabnormalmovementorperceptionsthatareofshortdurationbut

thattendtorecur.Classificationofepilepsy(older)Generalizedseizures(全身发作）Grandmal（大发作）：tonic-clonicsei

zures（强直－阵挛）Petitmal（小发作）：absenceseizures（失神发作）Partialseizures(部分性发作)Pshychomotor（精神运动性）：temporallobeseizures（颞叶癫痫）Partial（部分发作）：motor,sensory,ANS

,etc.（局限性发作）ClassificationofepilepsyNormalEEGAbsenceEEGThepathwaysforseizurepropagationinpartialseizuresandprim

arygeneralizedseizuresStereotypicalcomplexpartialseizuresIneffectiveforpetitmal(absenceseizures)(3)AntiarrhythmiaNecessarytomonitorplasmaconce

ntrations(1)Grandmal/Partial：BroadspectrumofantiepilepsyIneffectiveforpetitmal(absenceseizures)Phenytoin,Car

bamazepine,PhenobarbitalAdverseeffects：AntiepilepticdrugsHepatictoxicityGrandmal,statusepilepticus;Mephenytoin美芬妥英,Ethotoin乙苯妥英：a

naloguesofphenytoinInductionofhepaticdrug-metabolizingenzymes(3)Antiarrhythmia(3)AntiarrhythmiaAntiepi

lepticdrugsPsychomotorseizuresLamotrigine拉莫三嗪Primidone,ValproatesodiumPrincipalsofantiepilepticdrugusesMe

chanismsofantiepilepticdrugsElectrophysiologicalInhibitingexcessivedischargesInhibitingspreadofdischargesMolecularPotentiatingGAB

AneuronalfunctionsModulatingNa+,Ca2+,K+channelfuctionsA.AntiepilepticdrugsSpecialdrugsPhenytoinSodium苯妥英钠CONNHC6H5C6H5NaO1.Phar

macologicaleffectsandthemechanismInhibitinginfluxofNa+andCa2+InhibitingspreadofabnormaldischargesA.Antiepilepticdrugs2.

Clinicaluses(1)AntiepilepsyGrandmal,statusepilepticus;Partialseizures(simpleandcomplex);Ineffectiveforpetitm

al(absenceseizures)(2)Trigeminalandrelatedneuralgia(3)AntiarrhythmiaA.Antiepilepticdrugs3.ADMELargerdoses:non-linearkinetics（plasmaconcentrati

on>10g/ml）NecessarytomonitorplasmaconcentrationsInductionofhepaticdrug-metabolizingenzymesA.Antiepilepticdrugs3.Adverse

effects(1)LocalreactionsGIreactions;gingivalhyperplasia(2)CNSreactionsParticularlyinthecerebellumandvestibularsystems:nyst

agmus(眼球震颤),ataxia(共济失调),etc.Behavioralchanges:confusion,hallucinationA.Antiepilepticdrugs(3)HemologicalreactionsMegaloblasticanemia(4)Allergicreac

tionsSkinreactions;bloodcellabnormality(includingthrombocytopenia,agranulocytosis);hepatictoxicity;ect.(5)SkeletalreactionsOsteomala

ciabyabnormalvitaminDmetabolismandcalciumabsorptionA.Antiepilepticdrugs4.Druginteractions(1)Increasesplasmaconcentrationsofdrugsbydisplacemento

fplasmaproteinbinding(salicylates)andinhibitionofinactivation(isoniazid,chloramphenicol)(2)Decreasesplasmaconcentrationsofdrugs(p

henobarbital,carbamazepine)byenhancingmetabolism(3)PhenytoinenhancesthemetabolismofcorticosteroidsandvitaminDA

.AntiepilepticdrugsEffectiveforpsychomotorseizures,andgrandmalEpilepsyisnotasingleentity;itisafamilyofdi

fferentrecurrentseizuredisordersthathaveincommonthesudden,excessiveanddisorderlydischargeofcentralneurons.(2)TrigeminalandrelatedneuralgiaPhe

nytoin,Carbamazepine,PhenobarbitalThisresultsinabnormalmovementorperceptionsthatareofshortdurationbutthattendtorecur.Otherant

icovulsantdrugsParticularlyinthecerebellumandvestibularsystems:nystagmus(眼球震颤),ataxia(共济失调),etc.AdverseeffectsPartial（部分发作）

：Primidone,ValproatesodiumDruginteractionsPartialseizures(simpleandcomplex);Phenytoin,Carbamazepine,PhenobarbitalInhibiting

spreadofdischargesCHCOOHPrincipalsofantiepilepticdrugusesPetitmal（小发作）：ClassificationofepilepsyPrincipalsofantiepi

lepticdrugusesvasodilatation,BP;(1)AntiepilepsyInhibitingbothformationandspreadofdischargesEffectiveforgrandmal,

partialsimpleseizures,statusepilepticusPhenobarbital苯巴比妥A.AntiepilepticdrugsC2H5CONHNHCOCOCC6H5Effectivefor

psychomotorseizures,andgrandmalEffectiveformania,depression,andneuralgiaCarbamazepine卡马西平NCONH2A.Antiepilept

icdrugsBroadspectrumofantiepilepsyHepatictoxicityValproatesodium丙戊酸钠A.AntiepilepticdrugsCH3CH2CH2CHCOOHCH3CH2CH2Otherantiepile

pticdrugsPrimidone扑米酮：analoguesofphenobarbital,usedforphenobarbital-andphenytoin-ineffectivepatientsMepheny

toin美芬妥英,Ethotoin乙苯妥英：analoguesofphenytoinEthosuximide乙琥胺：peptitmalDiazepam:statusepilepticus(i.v.)Nitrozepam硝西泮,Clonazepam氯硝西泮：peptitmalLamotri

gine拉莫三嗪A.AntiepilepticdrugsBoxCommontoxicityofantiepilepticdrugs:CNSreactionsHemologicalreactionsHepatictoxicityA.

Antiepilepticdrugs(1)AntiepilepsyPrimidone,ValproatesodiumplasmaconcentrationmonitoringifnecessaryClassificationofepilepsy(older)CHCOOHParticularlyi

nthecerebellumandvestibularsystems:nystagmus(眼球震颤),ataxia(共济失调),etc.AntiepilepticdrugsInductionofhepaticdrug-metabolizingen

zymes),Phenobrbital(i.Effectiveforpsychomotorseizures,andgrandmalClassificationofepilepsy(older)Partialseizures(simpl

eandcomplex);Otheranticovulsantdrugs(2)Peptitmal:Ethosuximide(2)CNSreactions(3)Phenytoinenhancesthemetabolismofc

orticosteroidsandvitaminDChoiceofdrugs(1)Increasesplasmaconcentrationsofdrugsbydisplacementofplasmaproteinbindin

g(salicylates)andinhibitionofinactivation(isoniazid,chloramphenicol)hypertensioncrisis),Phenobrbital(i.Mechanismsofa

ntiepilepticdrugsvasodilatation,BP;smalllargerdoses;hypertensioncrisistonic-clonicseizures（强直－阵挛）Primi

done,ValproatesodiumClinicaluses(2)Peptitmal:EthosuximiderelaxingskeletalmusclesCHCOOHInhibitingbothformationandspreadofdischargesCHC

OOHStereotypicalcomplexpartialseizures(2)CNSreactionsSpecialdrugsAntiepilepticdrugsNecessarytomonitorplasmaconcentrationsO

theranticovulsantdrugsMechanismsofantiepilepticdrugsIneffectiveforpetitmal(absenceseizures)temporallobeseizures（颞叶癫痫）dosei

ndividualization;Principalsofantiepilepticdruguses1.Choiceofdrugs(1)Grandmal/Partial：Phenytoin,Carbamazepine,P

henobarbitalPrimidone,Valproatesodium(2)Peptitmal:EthosuximideClonazepam,Valproatesodium(3)Psychomotor：Car

bamazepine,Phenytoin(4)Statusepilepticus：Diazepan(i.v.)Phenytoin(i.v.),Phenobrbital(i.m.)A.Antiepilepticdrugs2.Dosage：

small→largerdoses;doseindividualization;plasmaconcentrationmonitoringifnecessary3.Usage：drugcombination4.Withdrawal：graduallyandsl

owlyA.Antiepilepticdrugs1.Effects：centraldepression;vasodilatation,BP;relaxingskeletalmuscles2.Uses：convulsion；hypertensioncrisis3.A

dverseeffects：depressionofrespiratoryandvasomotorcenters,antagonizedbycalciumpreparations(i.v.)Magnesi

umSulfate硫酸镁A.AnticonvulsantdrugsOtheranticovulsantdrugsSedative-hypnoticdrugsA.Anticonvulsantdrugs