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Drugs for Seizures

Drugs for Seizures. Epilepsy - Recurrence of Seizures. Symptoms depend on type of seizure Include blackout, fainting spells, sensory disturbances, jerking body movements, temporary loss of memory. Seizures - Disturbances of Electrical Activity in the Brain.

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Drugs for Seizures

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  1. Drugs for Seizures

  2. Epilepsy - Recurrence of Seizures • Symptoms depend on type of seizure • Include blackout, fainting spells, sensory disturbances, jerking body movements, temporary loss of memory

  3. Seizures - Disturbances of Electrical Activity in the Brain • May affect consciousness, motor activity, sensation • Caused by abnormal or uncontrollable neuronal discharges in the brain • Electroencephalogram (EEG) measures this activity • All seizures are not convulsions

  4. Convulsions - Involuntary, Violent Spasms of Large Skeletal Muscles • Face, neck, arms, and legs • All convulsions are seizures

  5. Causes of Seizure Activity • Acute Infectious Diseases • Trauma • Metabolic Disorders • Vascular Disorders • Respiratory hypoxia, in oxygenation • Hypotension • Pediatric Disorders - Rapid Increase in Body TemperatureNeoplastic Disease - Rapidly Growing Brain Tumors

  6. Continued • Medications • Eclampsia During Pregnancy • Low Tolerance to Environmental Triggers • Sleep deprivation • Exposure to strobe or flickering lights • Small fluid and electrolyte imbalances • Idiopathic - No Known Cause

  7. Atonic Seizures • Last for seconds • Patient stumbles or falls for no reason

  8. Tonic-Clonic Seizures - Most Common Type in All Age Groups • Last 1 to 2 minutes • Preceded by an aura - a warning • Described as a spiritual feeling • A flash of light • Special noise • Tonic phase - intense muscle contractions • Hoarse cry - air forced from lungs • Temporary loss of bladder and bowel control • Breathing shallow or stops momentarily

  9. Drugs that Reduce Seizure Activity by Intensifying GABA Action • Examples • Barbiturates - phenobarbital (Luminal), amobarbital (Amytal) • Benzodiazepines - clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium) • Miscellaneous drugs - gabapentin (Neurontin), tiagabine (Gabitril)

  10. Succinimides Delay the Influx of Calcium into the Neuron • Examples - ethosuximide (Zarontin) • Mechanism of action - block calcium channels in neuron membrane which increases the electrical threshold of neurons which decreases abnormal firing of neurons • Primary uses - absence seizures, myoclonic seizures, akinetic epilepsy • Adverse effects - hiccups, epigastric pain, drowsiness, increased bleeding time

  11. Drugs for Coagulation Disorders

  12. Coagulation-Modifier Drugs • Anticoagulants • Thrombolytics • Hemostatics

  13. Anticoagulants - Prevent the Formation of Clots • Inhibiting specific clotting factors in the coagulation cascade • Diminishing the clotting action of platelets • Both ways increase the time to form clots

  14. Thrombolytics • Dissolve life-threatening clots

  15. Hemostatics • Promote formation of clots • Inhibit removal of fibrin

  16. Anticoagulants Prevent the Formation and Enlargement of Clots • Examples - heparin (Heplock), warfarin (Coumadin) • Mechanism of action - inhibit specific clotting factors which interfere with coagulation cascade in order to prevent formation or enlargement of clot • Primary use - thromboembolic disease; prevent formation of clots in veins • Adverse effects - abnormal bleeding

  17. Antiplatelet Agents Prolong Bleeding Time by Interfering with Platelet Aggregation • Example - ticlopidine (Ticlid) • Mechanism of actions • Aspirin: inhibits thromboxane2, which prevents aggregation of platelets • ADP receptor blockers: interfere with platelet plasma membrane, which prevents platelet aggregation • Glycoprotein IIb/IIIa inhibitors: glycoprotein IIb/IIIa enzyme inhibited which prevents platelet aggregation

  18. Thrombolytics Are Used to Dissolve Existing Clots • Example - alteplase (Activase) • Mechanism of action - convert plasminogen to plasmin which causes fibrin to degrade, then preexisting clot dissolves • Primary uses - acute MI, pulmonary embolism, acute ischemic CVA, DVT, arterial thrombosis, coronary thrombosis, clear thrombi in arteriovenous cannulas and blocked IV catheters • Adverse effects - abnormal bleeding; contraindicated in patients with active bleeding or recent trauma

  19. Hemostatics Are Used to Promote the Formation of Clot • Example - aminocaproic (Amicar) • Mechanism of action - prevent fibrin from dissolving, which enhances stability of the clot • Primary use - prevent and treat excessive bleeding from surgical sites • Adverse effects - none listed

  20. Disorders Associated with Heart Failure • Mitral stenosis • Myocardial infarction • Chronic hypertension • Coronary artery disease • Diabetes

  21. First-Choice Drugs - ACE Inhibitors and Diuretics • Given first • Reduce most symptoms of mild to moderate heart failure • Fewer side effects

  22. Second-Choice Drugs - Phosphodiesterase inhibitors, vasodilators, and beta-adrenergic blockers • Used in severe heart failure • First-choice drugs not effective

  23. Nonpharmacological Methods for Controlling Heart Failure • Stop using tobacco • Limit salt (sodium) intake and eat foods rich in potassium and magnesium • Limit alcohol consumption • Implement a medically supervised exercise plan • Learn and use effective ways to deal with stress • Reduce weight to an optimum level • Limit caffeine consumption

  24. Cardiac Glycosides Increase the Force of Myocardial Contraction • Example - digoxin (Lanoxin) • Mechanism of action - 1) positive inotropic effect: more blood ejected per beat leads to increased cardiac output in order to meet, the metabolic demands of tissues; 2) slow electrical conduction through the heart, which creates fewer beats per minute and decreases heart rate

  25. ACE Inhibitors Have Become First-Line Drugs for Heart Failure • Example - lisinopril (Prinivil) • Mechanism of action - blocks ACE enzyme, which lowers blood pressure, increases cardiac output, decreases preload and reduces peripheral edema; increased excretion of sodium and water leads to decreased blood volume • primary use - heart failure and hypertension • Important adverse effects - elevated potassium levels, cough, taste disturbances, hypotension

  26. Diuretics Relieve Symptoms of Heart Failure by Reducing Blood Volume • Example - furosemide (Lasix) • Mechanism of action - prevents reabsorption of sodium by the nephron of the kidney, which increases excretion of sodium and water; decreases blood volume, edema, and congestion; lowers blood pressure, and reduces workload on heart. Cardiac output then increases • Primary use - acute heart failure • Important adverse effects - electrolyte imbalances

  27. Phosphodiesterase Inhibitors Are Used for Short-Term Therapy of Advanced Heart Failure • Example - milrinone (Primacor) • Mechanism of action - blocks phosphodiesterase enzyme, which increases the amount of calcium available for myocardial contraction, which then increases force of contraction and vasodilation • Primary use - short-term support of advanced heart failure • Important adverse effects - ventricular dysrhythmia

  28. Vasodilators Reduce Symptoms of Heart Failure by Decreasing Cardiac Oxygen Demands • Example - Isosorbide (Isordil) • Mechanism of action - relaxes vascular smooth muscle, which leads to vasodilation, which decreases cardiac workload and increases cardiac output • Primary use - cannot tolerate ACE inhibitors, angina pectoris, hypertension • Important adverse effects - headache, hypotension, reflex tachycardia

  29. Beta-Adrenergic Blockers Are Used in Combination with Other Drugs to Slow the Progression of Heart Failure and to Prolong Patient Survival • Example - carvedilol (Coreg) • Mechanism of action - blocks beta1, beta2, and alpha1 receptors, which decreases heart rate and blood pressure, decreases afterload, and reduces the workload on the heart

  30. Beta-Adrenergic Blockers Are Used in Combination with Other Drugs to Slow the Progression of Heart Failure and to Prolong Patient Survival (cont’d) • Primary use - slow progression of heart failure and increased exercise tolerance when combined with other heart failure drugs • Important adverse effects - worsen heart failure

  31. Hyperlipidemia - Excess Amounts of Lipids in the Blood • Major risk factor for cardiovascular disease • Hypercholesterolemia • Saturated fats

  32. Three Basic Classes of Lipids • Triglycerides • Steroids • Phospholipids

  33. Three Most Common Lipoproteins, Based on Weight or Density: • Low-density lipoproteins (LDL) • High-density lipoproteins (HDL) • Very low-density lipoproteins (VLDL)

  34. Low-density Lipoproteins (LDL) • Highest amount of cholesterol • Created in liver • Build plasma membranes and produce steroids • Stored in tissues • Contribute to plaque deposits and CHD • Aka bad cholesterol

  35. High-Density Lipoproteins (HDL) • Picks up cholesterol • Returns it to the liver • Becomes part of bile and excreted in feces • Aka good cholesterol

  36. Very Low-Density Lipoproteins (VLDL) • Triglyceride carrier • Converted to LDL in blood • High levels are associated with pancreatitis

  37. HMG CoA Reductase Inhibitors (Statins) • Drugs of first choice in reducing blood lipid levels • Reduce LDL, triglyceride, and VLDL levels • Raise HDL levels (good cholesterol)

  38. Drug Profile - HMG-CoA Reductase Inhibitor (Statin) • Atorvastatin (Lipitor) • Actions • Adverse effects and interactions

  39. Newer Approaches to Treating Hyperlipidemia • Ezetimibe (Zetia) • Fixed-dose combination therapy

  40. Ezetimibe • Blocks absorption of dietary cholesterol • LDL and triglycerides are reduced • Slight increase in HDL • Well tolerated by patients

  41. Two Categories of Drugs Used to Treat • Preventers - used prophylactically • Antihistamines • Glucocorticoids • Mast cell stabilizers • Relievers - used to provide immediate, temporary relief of symptoms • Nasal decongestants - oral and intranasal sympathomimetics

  42. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) • Primary treatment for mild to moderate inflammation • Includes aspirin, ibuprofen, and COX-2 inhibitors

  43. Aspirin Treats Inflammation by Inhibiting Cyclooxygenase • Aspirin • Ibuprofen is an Alternative to Aspirin • Additional Cyclooxygenase Inhibitors • Celecoxib, refecoxib, and valdecoxib • Newest and most controversial class of NSAID

  44. Drug Profile - Nonsteroidal Anti-Inflammatory Drug • Naproxen (Naprosyn) and naprox sodium (Aleve, Anaprox) • Actions and uses • Adverse effects and interactions • Mechanism in action

  45. Systemic Glucocorticoids • Effective in treating severe inflammation • Naturally released by adrenal cortex • Suppress histamine and prostaglandins • Can inhibit immune system to reduce inflammation

  46. Serious Adverse Effects • Can suppress adrenal gland function • Can mask infections • Creates potential for existing infections to grow rapidly and undetected • Contraindicated with active infections

  47. H1 Receptor Blockers (Antihistamines) • Block action of histamine at H1 receptor • Used in OTC preparations for relief of: • Allergy symptoms • Motion sickness • Insomnia • Can cause sedation

  48. Drug Profile - Nonsedating Antihistamine • Fexofenadine (Allegra) - 2nd generation H1 receptor antagonist; nonsedating • Actions and uses • Adverse effects and interactions

  49. Immunosuppressants • Used to inhibit immune response • Primarily used to avoid tissue rejection following organ transplant

  50. Transplanted Organs Have Antigens that Trigger the Immune Response • Transplant rejection • Humoral response - acute response • Antibodies destroy transplanted tissue • Acute response occurs in days • Cell-mediated response slower • Starts about 2 weeks following surgery • Chronic rejection can occur months or years after surgery

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