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ANTICONVULSANTS

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Drugs used for epileptic seizures.They suppress the abnormal electric

impulses from the seizure focus to

other cortical areas, thus preventingseizure but not eliminating the cause

of seizure.

They are classified as

CNSdepressant.

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Types of anticonvulsant

HYDANTOINS

BARBITUATES

SUCCINIMIDESOXAZOLIDONES/

OXAZOLIDINEDIONE

BENZODIAPINES

IMINOSTILBENES

VALPORATE

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PHARMAPHYSIOLOGY

1. By supressing sodium influx throughthe drug binding to the sodium channelwhen it is inactivated, prolonging thechannel inactivation and thereby

preventing neuron firing2. By supressing the calcium influx ,

preventing the electric currentgenerated by the calcium ions to the T-

type calcium channel3. By increasing the action of the gamma-aminobutyric acid (GABA), whichinhibits neurotransmitter throughoutthe brain.

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Drugs that suppress sodiuminflux:

phenytoin

fosphenytoin

carbamazepine

oxacarbazepine

valporic acid

topiramate

zonisamide

lamotrigine

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Drugs that suppress calcium

influxValproic acid

ethosuximide

Drug groups that enhance theaction ofGABA:

Barbituates

BenzodiapinesTiagabine

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HYDANTOINS

Inhibit sodium influx, stabilizing cellmembrane, reducing repetitive neuronalfiring, and limiting seizures

Should not be used in pregnancy because itcan have a teratogenic effect on fetus.

SIDE EFFECTS: (SEVERE) gingival hyperplasia,or overgrowth of the gum tissues (reddenedgums that bleed easily); neurologic andpsychiatric effects ( slurred speech, confusiondepression), thrombocytopenia and

leukopenia.(LESS) nausea, vomiting, constipation,

drowsiness, headache, alopecia, hirsutism,and nystagmus.

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BARBITUATES

MEDS: Phenobarbital, mephobarbital(Mebaral), Primidone (Mysoline)

ACTION: Reduce seizures by enhancingthe activity ofGABA, which is aninhibitory neurotransmitter.

Problems associated includes sedation

and client tolerance to the drugDiscontinuance should be gradual to

avoid recurrence of seizures.

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SUCCINIMIDES

Used to treat absence or petit mal

seizures

May be used in combination withother anticonvulsant drugs.

Adverse effects: blood dyscrasias, renal

and liver impairment, systemic lupus

erythematosus.

Med: Ethosuximide (Zarontin)

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Oxazolidones/ Oxazolidinedione

Prescribed to treat petit malseizures.

Meds: Paramethiadione(Paradione), Trimethadione(Tridione)

Trimethadione may be used in

combination with other drugs orsingly to treat refractory petit malseizures.

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BENZODIAPINES

Three benzodiapines that have

anticonvulsant effects are Clonazepam,

Clorazepate dipotassium, Diazepam.

Clorazepate is effective in controlling petitmal (absence) seizures.

Clorazepate dipotassium is frequently

admin in adjunctive th

eraph

y for treatingpartial seizures.

Diazepam is prescribed for treating acute

status epilepticus and must be admin in IV.

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IMINOSTILBENES

Carbamazepine is effective in treating

refractory seizure disorders that have

not responded to other anticonvulsant

therapy. It is also use to control grand

mal and partial seizures and a

combination of these seizures.

Drug concentrations must bemonitored carefully.

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VALPROATE

Valproic acid is prescribed for petitmal, grand mal, and mixed types ofseizures.

Caution to very young children andclients with liver disorder, because ofhepatotoxicity.

Liver enzymes should be monitored. Serum anticonvulsant drug levels

should also be closely monitor toprevent toxicity.

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