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Pediatric Pharmacology - Anticonvulsant Therapy PowerPoint Presentation

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Description : Check out this medical presentation on Pediatrics, which is titled "Pediatric Pharmacology - Anticonvulsant Therapy", to know about Pediatric Pharmacology and Anticonvulsant Therapy.

Tags : Pediatrics, Pediatric Pharmacology, Anticonvulsant Therapy

Published on : Aug 02, 2021 | Views : 1700 | Downloads : 4

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Slide 1-

Dr.Azad A Haleem AL.Brefkani University Of Duhok College of pharmacy Pediatrics Department azad82d@gmail.com 2016
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Definition Seizure (Convulsion): the clinical manifestation of an abnormal and excessive excitation of a population of cortical neurons. Epilepsy: a disease characterized by spontaneous, unprovoked recurrent seizures.
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Basic principles of AED therapy Initiation of therapy Adding a second drug Monotherapy vs. Polytherapy Drug-Drug interaction Anticonvulsant level monitoring
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To Treat or Not to Treat ; that is the Question ? • For patients who have had more than 1 unprovoked seizure, treatment with an anticonvulsant is recommended.
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The risk of recurrence in the 2 years after a first unprovoked seizure is 15-70%. Principal factors that increase the risk of recurrence are an abnormal (MRI) study, an abnormal electroencephalogram (EEG), and a partial-onset seizure.
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Targets for AEDs Increase inhibitory neurotransmitter system—GABA Decrease excitatory neurotransmitter system—glutamate Block voltage-gated inward positive currents—Na+ or Ca++ Many AEDs —act via multiple mechanisms
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Action on Ion Channels Na+: Phenytoin, Carbamazepine, Lamotrigine Topiramate Valproic acid Ca++: Ethosuximide Valproic acid Enhance GABA Transmission Benzodiazepines (diazepam, clonazepam) Barbiturates (phenobarbital) Valproic acid Gabapentin Vigabatrin Topiramate Felbamate Inhibit EAA Transmission Topiramate Na+: For general tonic-clonic and partial seizures Ca++: For Absence seizures Most effective in myoclonic but also in tonic-clonic and partial Clonazepam: for Absence Classification of Anticonvulsants
Slide 8-

Carbamazepine Indications: Used in Generalized tonic-clonic& partial seizures. Affective disorders : Bipolar disorder Chronic pain syndromes: trigeminal neuralgia.
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phenytoin Used: generalized tonic – clonic , partial seizures , in status epilepticus.
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Ethosuximide Drugs that Affect Calcium Currents: Absence. May increase tonic- clonic seizures
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Phenobarbital Uses : Generalized tonic – clonic Partial seizures Neonatal seizures Status epilepticus
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Drugs with multiple mechanisms of action Valproate : Mechanism of action: Blocks voltage – dependant Na channels. Enhances GABA synthesis Acts against Ca currents. Uses : Broad spectrum AED used alone & in combination for partial seizures & several types of generalized seizures.
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Stopping antiepileptic treatment • • After 2 years with no seizers. Likelihood of recurrence after 2 years of control 30- 40 %
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Life long treatment • Juvenile myoclonic epilepsy • Progressive myoclonic epilepsy • Atypical absence seizures • Lennox-Gastaut
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Higher rates of recurrence Older age at the outset Syndromes Symptomatic epilepsy Poor initial control of seizures Change in the type of seizures during treatment
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Intractable ?? • Consider the following : Wrong diagnosis. Inadequate drug level Inattention to life style factors ( sleep deprivation,alcohol,stress) Underlying progressive brain disease or metabolic disease. Intrinsic intractable syndrome. Wrong drug
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Side effect issues Sedation - especially with barbiturates Cosmetic - phenytoin Weight gain – valproic acid, gabapentin Weight loss - topiramate Reproductive function – valproic acid Cognitive - topiramate Behavioral – leviteracetam Allergic - many
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Thanks