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anticonvulsants - Coggle Diagram
anticonvulsants
第二線用藥(Add-on AED)
sodium channel blocker
Topiramate (TOP)
Lamotrigine (LTG)
GABA increases
Vigabatrin(VGB)
inhibit GABA transaminase
Calcium channel blocker (CCB)
Gabapentin
Pregabalin
inhibit Ca2+ channel α2δ subunit
AMPA-R / ↓Glutamatergic channel
Perampanel
SV2A regulator
Levetiracetam
bind synaptic vesicle protein 2A(SV2A)
↓Vesicle release/reuptake
0.6 = 1 AED / 0.2 = 2-3 AED
Status epilepticus
Cri.
在癲癇完全恢復前再度發作
more than 30 / 5 mins
0-5
ABC + Blood draw
5-10
IV Glu + thiamine
10-30
(1) Lorazepam or Diazepam
(2) Phenytoin or Levetiracetam or Valproic acid
2 AED
30-60
Phenobarbital or Midazolam
Have all 3 functions
Valproic acid (valproate,VA)
inhibit GABA-T & (SSADH)
succinate-semialdehyde dehydrogenase
Block ca2+channel
AE
lethargy
sodium channel blocker
Carbamazepine(CBZ)
AE
Stevens-Johnson syndrome(SJS)
Toxic epidermal necrolysis (TEN)
可先做基因檢測
HLA-B*1502
aplastic anemia
Phenytoin(DPH)
AE
Nausea、dizziness、visual disturbance、ataxia
Gingival hyperplasia
Hirsutism / coarsening of facial
Prolonged inactivated state
GABA increases
Phenobarbital(PB)
Clonazepam(CNZ)
allosteric modulation
indication
Myoclonic
Valproate
CNZ(Clonazepam)
Weak
Phenobarbital (PB)
Absence
weak
CNZ
VA
ESX
Partial and GTC
Excecption
ESX
PK
Zero-order kinetics
Carbamazepine -> CYP inducer
Pregnancy
致畸胎性
CNZ
Phenytoin DPH
Principal
1 AED
Low dose
frequent but small
Calcium channel blocker (CCB)
Ethosuximide(ESX)
absence seizure
Block channel
emergency
Increase GABAergic inhibition
Lorazepam
Diazepam
IV
PD
TX
Levodopa + Carbidopa
Levodopa = Dopamine 前驅物
Carbidopa = DOPA decarboxylase inhibitor(DDC-inhibitor)
prevent Levodpa 過早代謝
Brand = Madopar + Sinemet
AE
Dyskinesia(異動症)
Fluctuation(藥效波動)
Psychosis
choose atypical antipsychotics
Drug holiday
Drug interaction
NO Vit. B6
Dopamine receptor agonist (D2 mainly)
Pergolide
Bromocriptine
Pramipexole
Increase dopamine release
Amantadine(PK-Merz)
AE
Edema
membrane fluidity
MAO-B inhibitor
Selegiline(Deprenyl)
early PD
COMT inhibitor
Tolcapone(Tasmar)
Entacapone(Comtan)
ACh blocking agents
Trihexyphenidyl(Artane)
Biperiden(Akineton)
SX
Thalamotomy
Pallidotomy
Subthalamotomy
deep brain stimulation
Subthalamus