Pharmacology of Antiepileptic Drugs

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Pharmacokinetic Considerations • Most AEDs undergo complete or nearly complete absorption when given orally. • Fosphenytoin (prodrug) may be administered intramuscularly if intravenous access cannot be established in cases of frequent repetitive seizures • Diazepam (available as a rectal gel) has been shown to terminate repetitive seizures and can be administered by family members at home. • Phenytoin, fosphenytoin, phenobarbital, diazepam, lorazepam and valproate are available as IV preparations for emergency use. • Most AEDs are metabolized in the liver (P450) by hydroxylation or conjugation. These metabolites are then excreted by the kidney. Gabapentin undergoes no metabolism and is excreted unchanged by the kidney.
Treatment of Epilepsy • First consideration is efficacy in stopping seizures • Because many AEDs have overlapping, pleiotropic actions, the most appropriate drug can often be chosen to reduce side effects. Newer drugs tend to have less CNS depressant effects. • Potential of long-term side effects, pharmokinetics, and cost are other considerations
Page 1 and 2: Pharmacology of Antiepileptic Drugs
Page 3 and 4: Simple Complex Partial Seizures lo
Page 5 and 6: Complex Partial Seizures Local ons
Page 7 and 8: In generalized seizures, both hemis
Page 9 and 10: Generalized Seizures (cont) • Ato
Page 11 and 12: Video http://www.youtube.com/watch?
Page 13 and 14: Antiepileptic Drug A drug which de
Page 15 and 16: Current Pharmacotherapy • Just un
Page 17 and 18: General Facts About AEDs • Good o
Page 19 and 20: Side effect issues • Sedation - e
Page 21 and 22: Targets for AEDs • Increase inhib
Page 23 and 24: Epilepsy—Glutamate Epilepsy Gluta
Page 25 and 26: Felbamate • Antagonizes the glyci
Page 27 and 28: Epilepsy—GABA Epilepsy GABA Majo
Page 29 and 30: Clonazapam • -Benzodiazepine used
Page 31 and 32: Phenobarbital - Barbiturate used fo
Page 33 and 34: Na+ Channels as AED Targets • Neu
Page 35 and 36: AEDs That Act Primarily on Na+ Phen
Page 37 and 38: Carbamazapine • A tricyclic antid
Page 39 and 40: Zonisamide • Used as add-on thera
Page 41 and 42: Ca 2+ Channels as Targets • Gener
Page 43 and 44: Gabapentin and its second generatio
Page 45 and 46: Valproate (Valproic Acid) • First
Page 47 and 48: Levetiracetam • -Add-on therapy f
Page 49: Drug Interactions • Many AEDs are
Page 53 and 54: Partial seizures Simple Complex Sec
Page 55 and 56: • Treatment Status Epilepticus -
Page 57: Questions?

Pharmacology of Antiepileptic Drugs

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