ANTICONVULSANTS

Drugs used for epileptic seizures. They suppress the abnormal electric impulses from the seizure focus to other cortical areas, thus preventing seizure but not eliminating the cause of seizure. They are classified as CNS depressant.

Types of anticonvulsant
HYDANTOINS BARBITUATES SUCCINIMIDES OXAZOLIDONES/ OXAZOLIDINEDIONE BENZODIAPINES IMINOSTILBENES VALPORATE

PHARMAPHYSIOLOGY
1. By supressing sodium influx through the drug binding to the sodium channel when it is inactivated, prolonging the channel inactivation and thereby preventing neuron firing 2. By supressing the calcium influx , preventing the electric current generated by the calcium ions to the Ttype calcium channel 3. By increasing the action of the gammaaminobutyric acid (GABA), which inhibits neurotransmitter throughout the brain.

Drugs that suppress sodium influx: phenytoin fosphenytoin carbamazepine oxacarbazepine valporic acid topiramate zonisamide lamotrigine

Drugs that suppress calcium influx Valproic acid ethosuximide Drug groups that enhance the action of GABA: Barbituates Benzodiapines Tiagabine

HYDANTOINS
Inhibit sodium influx, stabilizing cell membrane, reducing repetitive neuronal firing, and limiting seizures Should not be used in pregnancy because it can have a teratogenic effect on fetus. SIDE EFFECTS: (SEVERE) gingival hyperplasia, or overgrowth of the gum tissues (reddened gums that bleed easily); neurologic and psychiatric effects ( slurred speech, confusion depression), thrombocytopenia and leukopenia. (LESS) nausea, vomiting, constipation, drowsiness, headache, alopecia, hirsutism, and nystagmus.

BARBITUATES
MEDS: Phenobarbital, mephobarbital (Mebaral), Primidone (Mysoline) ACTION: Reduce seizures by enhancing the activity of GABA, which is an inhibitory neurotransmitter. Problems associated includes sedation and client tolerance to the drug Discontinuance should be gradual to avoid recurrence of seizures.

SUCCINIMIDES
Used to treat absence or petit mal seizures May be used in combination with other anticonvulsant drugs. Adverse effects: blood dyscrasias, renal and liver impairment, systemic lupus erythematosus. Med: Ethosuximide (Zarontin)

Oxazolidones/ Oxazolidinedione
Prescribed to treat petit mal seizures. Meds: Paramethiadione (Paradione), Trimethadione (Tridione) Trimethadione may be used in combination with other drugs or singly to treat refractory petit mal seizures.

BENZODIAPINES
Three benzodiapines that have anticonvulsant effects are Clonazepam, Clorazepate dipotassium, Diazepam. Clorazepate is effective in controlling petit mal (absence) seizures. Clorazepate dipotassium is frequently admin in adjunctive theraphy for treating partial seizures. Diazepam is prescribed for treating acute status epilepticus and must be admin in IV.

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 be monitored carefully.

VALPROATE
Valproic acid is prescribed for petit mal, grand mal, and mixed types of seizures. Caution to very young children and clients with liver disorder, because of hepatotoxicity. Liver enzymes should be monitored. Serum anticonvulsant drug levels should also be closely monitor to prevent toxicity.

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