كتيب الجودة في الفحوصات المخبريه

Lab notes guide to lab and diagnostic tests

Antiepileptic agents

Drug name	MOA	Dose mg\day	Adm.	S\E	Notes
Phenytoin	1	150-600	Orally after meals, IV in severe attacks like st. epilepticus.	·         Gingival hyperplasia (interferes with collagen synthesis so can be used externally in treatment of burns, wound, diabetes ulcers) ·         Decrease vit.B12 absorption (pernicious anemia). ·         Increase folic acid metabolism (megaloblastic anemia). ·         Increase Ca++ metabolism (osteomalacia). ·         Decrease ADH and insulin (hyperglycemia and glucosuria). ·         Hirsutism. ·         Teratogenic. ·         Hepatotoxic.	·         Causes fetal hydantoin syndrome (cleft lip, cleft palate, congenital heart disease, mental deficiency). ·         It induces P-450 activity so increases metabolism of other drugs like antiepileptics, anticoagulants, oral contraceptives, antibiotics and other agents.
Carbamazepine	1	200-2000	Orally, high lipid soluble	·         Osteomalacia. ·         Anemia. ·         Coma, respiratory depression. ·         Vertigo, drowsiness, ataxia, diplopia, nausea, vomiting. ·         Hepatotoxic.	·         It induces liver enzymes. ·         May be used as analgesic in trigeminal neuroalagia and after tooth extraction.
Phnobarbitone	2	60-180	Oral	·         Sedation ·         Ataxia ·         Vertigo, hangover. ·         Behavior disturbances.	·         Sedative, anxiolytic ·         Enzyme inducers.
Primidone	2	250-1000	Oral	Metabolized into Phenobarbital, has the same actions as Phenobarbital.
Valproic acid	2	400-3000	Oral	·       N,V, sedation, ataxia, tremors. ·       Hepatotoxic. ·       Rash, alopecia. ·       Thrombocytopenia. ·       Weight gain.	·         Causes cleft lip.
Ethosuximide	1	500-1500	Orally	·         Dizziness, insomnia, agitation, anxiety, inability to concentrate. ·         Irritation to stomach, N,V. ·         Urticaria. ·         Leucopenia, aplastic anemia, thrombocytopenia.	---
Benzodiazepines			·         orally ·         IV in severe attacks. ·         Rectally in febrile seizure.	·             Tolerance. ·              Drowsiness, sedation, fatigue, behavior       disturbances. ·             Respiratory depression. ·             Cardiac depression with IV adm.	·         Clonazepam and Clorazepate are used for chronic treatment. ·         Diazepam for acute attacks, and rectally for febrile epilepsy.

** Phenytoin, Phenobarbitone, Primidone cause vit. K deficiency in new born leading to bleeding. (give vit. K injection)