53例癫患者抗癫药物使用情况分析

目的了解癫患者抗癫药物使用情况,为合理使用抗癫药提供依据。方法采用回顾性调查方法,分析2002年9~12月住院的53例癫患者病历,对患者的一般情况、药物治疗情况和药物不良反应进行统计和分析。结果入选患者病情好转46例(86.79%),未愈7例(13.21%)。使用的抗癫药物主要有7种,分别是丙戊酸钠、卡马西平、苯巴比妥、苯妥英钠、氯硝西泮、托吡酯和拉莫三嗪。所有入选的患者均联合使用抗癫药,其中35例(66.04%)合并使用两种抗癫药,12例(22.64%)联合使用3种抗癫药,4例(9.43%)联合使用4种抗癫药,另有1例患者同时使用5种抗癫药。共监测到药物不良反应3例,其中卡马西平引起的药物不良反应2例,包括白细胞降低和转氨酶升高各1例;另外丙戊酸引起转氨酶升高1例。结论该院住院癫患者的用药基本合理。临床抗癫治疗时应加强对患者进行用药宣传,规范抗癫药使用,注意监测药物浓度和不良反应,合理联合用药,以保证癫患者的用药安全,提高疗效。     

与抗癫药相关的药物相互作用

目的 :探讨抗癫药物之间以及抗癫与其他药物之间的相互作用。方法 :检索国内外有关文献 ,归纳总结。结果 :抗癫药存在肝药酶诱导、肝药酶抑制以及蛋白置换作用 ,药物治疗的相互作用不仅表现在抗癫药物之间 ,也表现在抗癫药物与其他药物之间。结论 :掌握常见抗癫药物之间及与其他药物的相互作用 ,利于临床合理用药     

药师参与抗癫治疗药物监测的药学服务模式探讨

治疗药物监测(TDM)是癫患者医疗过程中的一个重要环节,本文通过简述药师在抗癫治疗药物监测工作内容中的作用,探讨药师参与抗癫治疗药物监测的药学服务模式。     

儿童难治性癫多药治疗及药物相互作用的研究进展

将相关文献进行归纳和整理,探讨新型抗癫药物拉莫三嗪、托吡酯、奥卡西平及左乙拉西坦在儿童难治性癫的多药治疗中药物间的相互作用、用法、用量和副作用。     

脑出血后继发性癫48例报告

目的 :探讨脑出血后继发性癫的临床特点及有效治疗手段。方法 :回顾分析经CT证实脑出血后继发性癫 48例临床资料。结果 :脑出血早期癫发作 2 0例 ,以强直 阵挛发作为主 ,发作次数少。迟发癫 2 8例 ,以局部发作多见 ,发作较频。按出血部位 :基底节区 14例 ,大脑脑叶 3 1例 ,小脑脑干 2例。需坚持服抗癫药 3 3例。结论 :大脑脑叶出血易继发癫 ,小脑脑干出血继发性癫少见。脑出血后早期发作癫常通过降低颅内压、注射地西泮可缓解 ,复发较少。迟发性癫易反复发作 ,需坚持服用抗癫药     

抗心律失常药物应用和安全性评价进展

抗心律失常药有治疗心律失常的作用,同时有致心律失常作用。临床上在应用各种抗心律失常药时,除了考虑充分利用其抗心律失常作用外,还应全面关注其安全性。本文通过对抗心律失常药物的作用机制以及对心律失常发生、维持机制的分析,对抗心律失常药物的应用和安全性评价进展作一综述。     

神经性疼痛和癫治疗新药普瑞巴林

美国FDA于2004年批准普瑞巴林作为治疗糖尿病性周围神经性疼痛和带状疱疹神经痛的药物。本文综述了近年来的相关临床研究情况,并总结了普瑞巴林的药理学、药动学、疗效及耐受性。     

抗癫癎药物与癫癎恶化

近20年来,许多资料显示抗癫癎药物(AEDs)会使癫癎恶化,即原有类型癫癎发作增多,或激发新的癫癎类型。临床上可见以下4种情况：①非特异性的药物中毒表现：即患儿仅出现癫癎发作加重,而无其他中毒表现,减少剂量或取消不必要的多药治疗后就可好转。②药物选择失误。③药物副作用。④抗癫癎药物引起的脑病和多种类型混合发作的儿童癫癎性脑病［1］。 1　药物过量 　　早已报道苯妥英钠(PHT)中毒量可致癫癎恶化。国内报道PHT致癫癎恶化发生率8.6%［2］。Dhana报道4例卡马西平(CBZ)中毒的患者中,有1例出现一系列全身性惊厥性癫癎发作［3］。尽管没有拉莫三嗪致癫癎恶化的报道,但当剂量增至20 mg*kg-1*d-1时出现新的肌阵挛性癫癎持续状态,撤除拉莫三嗪后临床症状很快好转。 2　药物选择不当 　　可引起癫癎发作、恶化和脑电图阵发性放电增加,如：CBZ可使失神发作、不典型失神发作和肌阵挛性及失张力性已发作癫癎恶化。PHT也可使失神发作和强直-阵挛性发作恶化。临床应用以来,不少作者报道乙琥胺可致全身惊厥性癫癎恶化。苯巴比妥可使失神发作恶化并可能导致失神持续状态,应慎用［4］。有报道严重肌阵挛性癫癎患者添加拉莫三嗪治疗,其中16例(80%)病情恶化,表明拉莫三嗪不适用于严重肌阵挛性患者［5］。隐原性或继发性部分性癫癎患儿加用氨己烯酸后出现新的肌阵挛性发作。     

托吡酯治疗小儿癫32例

目的 :评价托吡酯治疗小儿癫的疗效和安全性。方法 :3 2例癫患儿口服托吡酯 ,起始剂量为 0 .8～1.2mg·kg 1·d 1,qd或bid ,目标剂量为 4～ 9mg·kg 1·d 1,bid。随访时间为 3～ 9个月。结果 :托吡酯治疗小儿癫的总有效率 71.9% ,副作用较轻。结论 :托吡酯治疗小儿癫有较好的疗效 ,患儿对其有较好的耐受性     

癫合并烧伤患者的护理

癫是由于大脑功能紊乱而引起的一种综合病症,具有阵发性、突发性、刻板性,并常伴意识丧失[1]。癫患者发病时常伴有意外损伤,其中6%为烧伤、烫伤[2]。我院2003年10月~2004年10月共收治烧伤病人1 445例,其中癫合并烧伤18例,占1·25%,本组病人全部愈合。现将护理体会总结如下。1临床资料本组18例,男11例,女7例;年龄16~78岁,平均48岁;烧伤面积最小为2%,最大为47%;烧伤原因:热液烫伤8例,火焰烧伤10例,所有患者均在癫发作时接触热源,烧伤深度中Ⅰ~浅Ⅱ度创面占32%,深Ⅱ~Ⅲ度创面占68%。本组均经手术植皮后创面治愈,癫病情得以控制,平均住院38天。2…     

Rufinamide: a new anti-epileptic medication

Rufinamide (1-[2,6-difluorobenzyl]-1H-1,2,3-triazole-4-carboxamide) is a new anti-epileptic drug with a novel triazole derivative structure. The suspected mechanism of action is limitation of sodium-dependent action potentials, thought to result in a membrane stabilizing effect. Rufinamide is extensively metabolized in the liver by non-CYP450 enzymes with an elimination half-life of 8 – 12 h. Three randomized, placebo-controlled trials have shown that rufinamide is effective against partial seizures in adults. Efficacy in the Lennox-Gastaut syndrome, a severe, disabling childhood onset epilepsy syndrome, was shown in a single, randomized, placebo-controlled trial. It has recently been approved for treatment of Lennox-Gastaut syndrome in Europe. In the US it is under regulatory review. Most common adverse effects are somnolence, fatigue, dizziness, dipolopia, nausea and ataxia. Rufinamide has shown promise as adjunctive treatment for Lennox-Gastaut syndrome and may have some role in localization related epilepsies as well.     

非心血管药物所致尖端扭转型室性心动过速的分类与处理

目的：介绍引起QT间期延长及尖端扭转型室性心动过速（简称室速）的非心血管药物的种类和致病机制，以引起临床医生的重视。方法：对国内外相关文献进行综合、归纳。结果：许多非心血管药物可引起QT间期延长及尖端扭转型室速，包括抗微生物药、抗组胺药、三环类抗抑郁药、抗精神病药和胃肠动力药等。结论：了解导致这种较为罕见且严重的心带失常药物的种类及发病机制，对预防和正确治疗极为重要。     

中药药物不良反应评价与药物流行病学新方法

近年来,中药药物不良反应(ADR)报道不断增多,而中药的ADR评价有一定的难度。本文从讨论中药ADR的定义开始,讨论了药物流行病学的新方法,提出根据具体的情况选用合适的药物流行病学新方法来评价中药ADR。     

An assessment of zonisamide as an anti-epileptic drug

A brief review of epilepsy as a disease, anti-epileptic drugs and methods of evaluation of anti-epileptic drugs are presented as a background for assessment of zonisamide, which has been approved by the FDA as add-on therapy for the treatment of partial seizures with or without secondary generalisation in adults. Chemically, zonisamide is classified as a sulphonamide and is unrelated to other anti-epileptic drugs. The mode of action of zonisamide remains unclear, but likely mechanisms are blockade of sodium and T-type calcium channels. It is also shown to have some neuroprotective effect against hypoxia and ischaemia. It has a liner pharmacokinetics with excellent oral bioavailability. Zonisamide has been approved for use in Japan for ten years prior to approval in USA and Europe. Clinical experience with zonisamide in Japan has documented its efficacy in the treatment of partial seizures (partial-onset generalised tonic-clonic, simple partial and/or complex partial seizures) and to a more variable extent, generalised tonic-clonic, generalised tonic (mainly seen in symptomatic generalised epilepsies including Lennox-Gastaut Syndrome) and compound/combination seizures. The efficacy and safety was confirmed in trials conducted in USA and Europe in adults as well as children. Zonisamide compares favourably with other newly introduced drugs and has the potential for development as a monotherapy for epilepsy.     

New anti-epileptic drugs

Epilepsy represents the most common serious neurological disorder, with a prevalence of 0.4 - 1%. Approximately 30% of patients are resistant to currently available drugs. New anti-epileptic drugs are needed to treat refractory epilepsy, improve upon current therapies, improve the prognosis of epilepsy and to prevent the epileptogenic process. Designing compounds with specific physiological targets would seem the most rational method of anti-epileptic drug development, but results from this approach have been disappointing; the widespread screening of compounds in animal models has been much more fruitful. Older methods of animal screening have used acute seizure models, which bear scant relationship to the human condition. More modern methods have included the development of animal models of chronic epilepsy; although more expensive, it is likely that these models will be more sensitive and more specific in determining anti-epileptic efficacy. In this review, we consider the possible physiological targets for anti-epileptic drugs, the animal models of epilepsy, problems with clinical trials and ten promising anti-epileptic drugs in development (AWD 131-138, DP16 (DP-VPA), ganaxolone, levetiracetam, losigamone, pregabalin, remacemide, retigabine, rufinamide and soretolide). Perhaps the most important advances will come about from the realisation that epilepsy is a symptom, not a disease. Preclinical testing should be used to determine the spectrum of epilepsies that a drug can treat, and to direct later clinical trials, which need to select patients based on carefully defined epilepsy syndromes and aetiologies. Not only will such an approach improve the sensitivity of clinical trials, but also will lead to a more rational basis on which to treat.     

Anti-epileptic drugs in pregnancy: current safety and other issues

Women with epilepsy of child-bearing years have their own considerations, which must be taken into account if management of their epilepsy is to be optimised. The main issues to consider include the effects of: female hormones on seizure control, anti-epileptic drugs (AEDs) on hormonal methods of contraception, epilepsy and AEDs on fertility, epilepsy and AEDs on pregnancy itself, pregnancy on AEDs and seizure control and epilepsy, seizures and AEDs on the developing embryo/fetus. Whereas previous studies have concentrated on the increased risk of major congenital malformations from prenatal AED exposure, the effects on cognitive and behavioural development are increasingly being explored. This article looks at the evidence currently available for all of the above issues, taking into account the increased number of AEDs which are now available.     

New anti-epileptic drugs for the 21st century

Prior to 1993, there were only six major drugs available in the US for the treatment of patients with epilepsy. These included phenobarbital (PB), phenytoin (PHT), carbamazepine (CBZ), primidone (PRIM), valproic acid/sodium valproate (VPA) and ethosuximide (ESX). Of these drugs, VPA has the broadest spectrum of activity and ESX the most limited. Despite these six agents, as well as several secondary drugs, it is estimated that over 30% of patients have inadequate seizure control, while others, whose disease is adequately controlled, suffer from bothersome adverse events (AEs). Since 1993, ten new drugs have entered the worldwide market (not all in the US). Those released include felbamate (FBM), gabapentin (GBP), lamotrigine (LTG), topiramate (TPM), tiagabine (TGB), oxcarbazepine (OXC), levetiracetam (LVT), zonisamide (ZNS), clobazam (CLB) and vigabatrin (VGB). The purpose of this article is to review each of the above drugs, looking at efficacy, safety, tolerability and where they may play a role in the current treatment of epilepsy.     

Therapeutic drug monitoring—antiepileptic drugs

Aims To provide a brief critical review of the basis and contemporary practice of monitoring the concentrations of antiepileptic drugs in biological fluids.
Methods The review is based on literature data and observations from clinical practice.
Results As experience has accumulated, monitoring of antiepileptic drug concentrations has come to be applied mainly to certain of the drugs when present in whole plasma. For these drugs there is a reasonably established relationship between drug concentrations and biological effects, but attention still needs to be paid to issues such as the timing of the measurements in relation to drug intake, the presence or absence of steady-state conditions, the presence in plasma of active metabolites and possible nonlinear pharmacokinetics of particular agents e.g. phenytoin.
Conclusions Plasma antiepileptic drug concentration monitoring is coming to be used in a more thoughtful and critical manner. Lack of adequate knowledge of matters such as the relationship between the plasma concentrations and antiepileptic and toxic effects of the drugs, not only the newer, but also the longer established ones, in particular clinical situations, remains more important than deficiencies in analytical methodology in limiting the clinical usefulness of antiepileptic drug concentration monitoring.     

性传播疾病治疗药物的不良反应及其防治

参考美国2006年性传播疾病治疗指南,本文综述了性传播疾病治疗中常用的阿奇霉素、多西环素等10种药物的用法、不良反应及不良反应的防治。