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You should be able to: Defined epilepsy, Different seizure type , List the major drugs used for generalized tonicclonic, partial seizure; absence seizure and status epilepticus, Recommended drugs of choice and alternative therapy Identify the mechanisms of antiseizure drug action Identify the main pharmacokinetics and the most common adverse effects , and monitoring parameters for anticonvulsants.
Level of Competency of Epilepsy and other seizures: ( attach KKI, appendix 1 and 2 ) Focal epilepsy 2 Generalized epilepsy 3A Absence seizure 3A Status epilepticus 3B Narcolepsy 2 Sleep apnea syndrome 1
Term Seizures
Defination
Finite episodes of brain dysfunction resulting from abnormal discharge of cerebral neuron
Conciousnes preserved, manifested variously as convulsive jerking, paresthesias, psychic symptom ( sensory perception, illusions, hallucinations, affect changes) and autonomic dysfunction Impaired conciousness that is preceded , accompanied, or followed by psychologic symptoms.
Term
Tonic-Clonic seizures, generalized / Grand mal epilepsy Absence seizure, generalized / Petitmal epilepsy Myoclonic seizures Status epiepticus
Defination
Loss of conciousness, tonic phase ( < 1 minute), clonic phase ( 2 3 minutes), , tounge bitting, fecal and urinary incontinence.
Impaired conciusness ( often abrupt onset and brief) . automatisms, loss of postural tone, enuresis, begin in childhood, usually cease by age 20 years. Single or multiple myoclonic muscle jerks A series of seizures ( usually tonic clonic) without recovery of conciousness between attacks; it is a life-threatening emergency.
Term
Partial seizures, simple
Drug of choice: Carboxylic acid ( valproic acid, sodium valproate) Tricyclics compounds (carbamazepine) Hydantoins ( phenytoin ) Alternative: Barbiturates (Phenobarbital , or pirimidone ) Partial Seizures, ----- idem ----Complex
Term Absence seizure, generalized / petitmal epilepsy Myoclonic seizures Status epiepticus
Subclass / prototype drug Drug of choice: Succinimides ( ethosuximide ) Valproic acid if concomitant with generalized tonic-clonic or myoclonic seizures Valproic acid Benzodiazpines ( clonazepam ) Diazepam or lorazepam i.v. General anesthesia may be employed in very severe case and does not response with conventional drugs
Pharmacokinetic principles Phenytoin : first pass effects / oral bioavailability is variable, inducers liver metabolisms Phenytoin metabolism is nonlinier, Plasma protein binding 97 98 %, Carbamazepine Inducer liver metabolisms Valproic acid Inhibits the metabolisms of phenytoin, phenobarbital, A toxic metabolite --- hepatotoxicity
Mechanisms of action
To suppress repetitive action potentials in epileptic focus
GABA Receptor:
Diazepam Phenobarbital
Phenyto Dilantin in
A : 300 mg / Therapeutic drug C : 5 mg/Kg/d monitoring Effective level 1020ug/ml Tpxic level > 20 ug/ml hyperplasia Ginggiva diplopia teratogenic with drawl
Antiparkinson
Level of Competency of Movement Disorders ( see, appendix 1 and 2 ) Parkinson's disease 3A Tremor 3A Secondary parkinsonism 3A
You should be able to : Describe the neurochemical imbalance underlying the symptoms of Parkinsons disease Identify the mechanisms of levodopa, dopamine receptor agonists and muscarinic blocking drugs alleviate parkinsonism Describe the adverse drug reaction of antiparkinsons drugs