16 Anti-convulsant Drugs

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Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 16Chapter 16

nticonv!lsants nticonv!lsants


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EpilepsyEpilepsy

"ro!p of f!nctional disorders of the brain "ro!p of f!nctional disorders of the brain

characteri#ed by rec!rrent sin"le orcharacteri#ed by rec!rrent sin"le or

m!ltiple sei#!res accompanied by motorm!ltiple sei#!res accompanied by motor

activity or chan"es in sensory or emotionalactivity or chan"es in sensory or emotionalbehavior behavior

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$ei#!re %isorders$ei#!re %isorders

bo!t 10& of the pop!lation 'ill have one or bo!t 10& of the pop!lation 'ill have one ormore sei#!res at some point in life.more sei#!res at some point in life. 1& to (& of the pop!lation has a chronic sei#!re1& to (& of the pop!lation has a chronic sei#!re

disorder called epilepsy.disorder called epilepsy.

Most ca!ses of epilepsy are idiopathic b!t other ca!sesMost ca!ses of epilepsy are idiopathic b!t other ca!sesincl!de tra!ma to the head, neoplasm, dr!"s, andincl!de tra!ma to the head, neoplasm, dr!"s, andcon"enital malformations.con"enital malformations.

$ei#!re disorders are classified as either "eneral or$ei#!re disorders are classified as either "eneral orpartial.partial.

)eneral sei#!res incl!de "enerali#ed tonic*clonic)eneral sei#!res incl!de "enerali#ed tonic*clonicsei#!res and absence sei#!res.sei#!res and absence sei#!res.

(


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%r!" +herapy of%r!" +herapy of

$ei#!re %isorders$ei#!re %isorders +he intent of dr!" therapy is to red!ce the+he intent of dr!" therapy is to red!ce the

fre!ency of sei#!res and red!ce potentialfre!ency of sei#!res and red!ce potentialadverse reactions.adverse reactions.

Ideally, the intent is to completely control allIdeally, the intent is to completely control allsei#!res.sei#!res.

sin"le dr!" at the lo'est dose possible is sin"le dr!" at the lo'est dose possible is!sed first.!sed first.

If sin"le dr!" therapy fails, then m!ltiple dr!"If sin"le dr!" therapy fails, then m!ltiple dr!"therapy attherapy at lowlow doses is !sed.doses is !sed.

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)eneral dverse eactions to)eneral dverse eactions to

nticonv!lsant "ents nticonv!lsant "ents

C/$ depression is probably the mostC/$ depression is probably the mostcommon side effect of anticonv!lsants.common side effect of anticonv!lsants.

C/$ depressant effects incl!de di##iness,C/$ depressant effects incl!de di##iness,

sedation, impaired learnin" and co"nitivesedation, impaired learnin" and co"nitiveabilities, and ecitability.abilities, and ecitability.

)astrointestinal adverse effects incl!de)astrointestinal adverse effects incl!deanoreia, na!sea, vomitin", and )I !pset.anoreia, na!sea, vomitin", and )I !pset.

%ermatolo"ic adverse effects ran"e from a%ermatolo"ic adverse effects ran"e from amild rash to $tevens*ohnson syndrome,mild rash to $tevens*ohnson syndrome,'hich is rare.'hich is rare.


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%r!" Interactions%r!" Interactions

Many dr!" interactions can occ!r 'ithMany dr!" interactions can occ!r 'ithanticonv!lsant dr!"s.anticonv!lsant dr!"s. +hese dr!"s increase or decrease the+hese dr!"s increase or decrease the

metabolism of each other in the liver.metabolism of each other in the liver. +he dr!" interactions that occ!r 'ith each+he dr!" interactions that occ!r 'ith each

other are more si"nificant than other dr!"sother are more si"nificant than other dr!"sbeca!se of their narro' therape!tic indees.beca!se of their narro' therape!tic indees.

3lasma monitorin" of anticonv!lsant dr!"s is3lasma monitorin" of anticonv!lsant dr!"s isnecessary.necessary.

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7/19Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

%ental Mana"ement of 3atient%ental Mana"ement of 3atient

+a4in" nticonv!lsant "ents+a4in" nticonv!lsant "ents

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Carbama#epineCarbama#epine

Carbama#epine bloc4s sodi!m channelsCarbama#epine bloc4s sodi!m channels

'hich bloc4s the propa"ation of nerve'hich bloc4s the propa"ation of nerve

imp!lses.imp!lses.

dverse reactions !ni!e to carbama#epine dverse reactions !ni!e to carbama#epine

5 ematolo"icematolo"ic "ran!locytosis has been reported 'ith carbama#epine "ran!locytosis has been reported 'ith carbama#epine

therapy.therapy.

It !s!ally occ!rs 'ithin - months of startin" therapy or afterIt !s!ally occ!rs 'ithin - months of startin" therapy or after

an increase in dose.an increase in dose.



Carbama#epineCarbama#epine

dverse eactions 8ni!e to Carbama#epine dverse eactions 8ni!e to Carbama#epine %ry mo!th, "lossitis, and stomatitis can%ry mo!th, "lossitis, and stomatitis can

sometimes occ!r.sometimes occ!r.

+he pediatric che'able dose form contains 6(&+he pediatric che'able dose form contains 6(&s!"ar.s!"ar.

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%ental Mana"ement of 3atient%ental Mana"ement of 3atient

+a4in" Carbama#epine+a4in" Carbama#epine

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:alproate:alproate

+his dr!" may eert its anticonv!lsant+his dr!" may eert its anticonv!lsant

effects by increasin" the levels of );.effects by increasin" the levels of );. +his dr!" has been reported to ca!se+his dr!" has been reported to ca!se

hypersalivation.hypersalivation. epatotoicity has also been reported.epatotoicity has also been reported.

:alproate inhibits the second phase of platelet:alproate inhibits the second phase of platelet

a""re"ation. s a res!lt, bleedin" time may bea""re"ation. s a res!lt, bleedin" time may be

prolon"ed.prolon"ed.

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:alproate:alproate

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3henytoin3henytoin

3henytoin is the most commonly !sed3henytoin is the most commonly !sed

anticonv!lsant dr!".anticonv!lsant dr!". 3henytoin has a very narro' therape!tic inde.3henytoin has a very narro' therape!tic inde.

3henytoin demonstrates #ero*order 4inetics.3henytoin demonstrates #ero*order 4inetics.

1(


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3henytoin3henytoin

dverse Effects dverse Effects 3henytoin can ca!se hirs!tism 'hich can lead3henytoin can ca!se hirs!tism 'hich can lead

to noncompliance in yo!n" 'omen.to noncompliance in yo!n" 'omen.

$ome patients may eperience vitamin % or$ome patients may eperience vitamin % orfolate deficiency.


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3henytoin3henytoin

dverse Effects dverse Effects

)in"ival Enlar"ement)in"ival Enlar"ement

5 +his occ!rs in 0& of all chronic !sers.+his occ!rs in 0& of all chronic !sers.

5 It can appear in as little as a fe' 'ee4s afterIt can appear in as little as a fe' 'ee4s afterbe"innin" therapy or after several years ofbe"innin" therapy or after several years of

therapy.therapy.

5 Its ca!se is !n4no'n.Its ca!se is !n4no'n.

5 +he better the oral hy"iene, the less li4ely it 'ill+he better the oral hy"iene, the less li4ely it 'illocc!r or the less severe the lesions 'ill be.occ!r or the less severe the lesions 'ill be.

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3henytoin3henytoin

dverse Effects dverse Effects Mana"in" )in"ival Enlar"ementMana"in" )in"ival Enlar"ement

5 $top phenytoin and chan"e to another dr!".$top phenytoin and chan"e to another dr!".

5 Improve and maintain metic!lo!s oral hy"iene.Improve and maintain metic!lo!s oral hy"iene.5 "in"ivectomy may be necessary. "in"ivectomy may be necessary.

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3henytoin3henytoin

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/e'er nticonv!lsants/e'er nticonv!lsants

)abapentin is !ni!e in that it does not)abapentin is !ni!e in that it does not

appear to have any dr!" interactions.appear to have any dr!" interactions.

>elbamate is limited to those that are>elbamate is limited to those that are

refractory to other anticonv!lsants.refractory to other anticonv!lsants.

>elbamate has been associated 'ith>elbamate has been associated 'ith

aplastic anemia and ac!te hepatic fail!re.aplastic anemia and ac!te hepatic fail!re.

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16 Anti-convulsant Drugs