DefinisiEpilepsi (seizure)Partial seizureSimpleComplexGeneralized seizureTonic-clonic Absence Myoclonic seizureStatus epilepticus

epilepsi

sindroma kronis kejang rekurenk/ discharge abnormal pd neuron serebral

farmakokinetikPenggunaan : jangka panjangMonitor kadar plasma (phenytoin) Abs & bioav baikMetab o/ enzim hepatik Primadone & trimethadione metabolit aktifResistensi : k/ pe ekspresi transporter obat pd BBB

farmakokinetikinteraksi sering

kadar plasma anti-epilepsi :obat yg hambat metab menggeser dr ikatan protein plasma toksik

kadar plasma anti-epilepsi : obat yg induksi enzim hepatic (rifampin)

Mekanisme kerjamenekan potensial aksi repetitif pd fokus epileptik di otak .Blokade kanal sodium .GABA-related target .Blokade kanal kalsium .Mekanisme lain

Penggunaan KlinisPemilihan obat berdasarkan :efikasi suatu obat pd kejang spesifikrespons pasienantisipasi toksisitas obat

toksisitasTeratogenik Toksisitas overdosisToksisitas life-threateningWithdrawal

phenytoinbioav oral bervariasi terikat protein plasma (97-98%) kadar phenytoin bebas k/ obat yg berkompetisiSulfonamideValproic acid

phenytoinMetab : . k/ induser metabolisme liver phenobarbital, rifampin . k/ cimetidine, isoniazid Fosphenytoin : prodrug phenytoin larut airparenteral

phenytoin

Mek kerja : blokade kanal sodiumPenggunaan klinis :Generalized tonic-clonic & partial seizureStatus epilepticusGangguan afektif bipolarMigrainToksisitasSindroma hydantoin fetal

Phenytoin untuk status epilepticusu/ tx jangka panjangivefek sedasi < benzodiazepin a/ barbituratkardiotoksikfosphenytoin lebih aman

Thank you

A 26-year-old woman develops a seizure disorder characterized by recurrent contractions of the muscles in the right hand, which then spread to the right arm and to the right side of the face ("jacksonian march"). Consciousness is not impaired, and the attacks usually last for only 1 or 2 min. Which of the following drugs is LEAST likely to be useful in the treatment of this patient?

CarbamazepineEthosuximideLamotriginePhenytoinPrimidone

Which of the following statements concerning proposed mechanisms of action of anticonvulsant drugs is false?

Diazepam facilitates GABA-mediated inhibitory actionsEthosuximide selectively blocks K+ ion channels in thalamic neuronsPhenobarbital has multiple actions, including enhancement of the effects of GABA, antagonism of glutamate receptors, and blockade of Na+ ion channelsPhenytoin prolongs the inactivated state of the Na+ ion channelVigabatrin elevates brain GABA levels