Description of Anti-epileptics and Anticonvulsant Drugs

Session 38: Description of Anti-epileptics and

Anticonvulsant Drugs

Total Session Time: 120 minutes

Prerequisites

Learning Tasks

By the end of this session students are expected to be able to:

Resources Needed:

SESSION OVERVIEW

Activity/

Step Time Content

Method

1 05 minutes Presentation Introduction, Learning Tasks

Presentation Indications of Anti-Epileptics and

2 10 minutes

Brainstorming Anticonvulsant Drugs

Presentation Contraindications of Anti-epileptics and

3 20 minutes

Buzzing Anticonvulsant Drugs

Dose, Dosage and Course of Anti-epileptics

4 30 minutes Presentation

and Anticonvulsant Drugs

Presentation Side effects and Adverse Effects of Anti-

5 25 minutes

Brainstorming epileptics and Anticonvulsant Drugs

Interactions and Precautions of Anti-epileptics

6 20 minutes Presentation

and Anticonvulsant Drugs

7 05 minutes Presentation Key Points

8 05 minutes Presentation Evaluation

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SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Indications of Anti-epileptics and Anticonvulsant Drugs

(10 minutes)

Activity: Brainstorming (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Valproate

STEP 3: Contraindications of Anti-epileptics and Anticonvulsant Drugs (20

minutes)

Activity: Buzzing (5 minutes)

Ask students to brainstorm on the following question:

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

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Following are contraindications of phenobarbitone

o Acute intermittent porphyria

o Pulmonary diseases with decreased respiratory reserve (due to respiratory depressant

effect)

o Pregnant and nursing mothers

o Hypersensitivity

Following are contraindications of carbamazepine

o Previous bone marrow depression

o Atrioventricular conduction abnormalities

o Should not be given to patients taking MAO inhibitors or within 14 days of stopping

such treatment

o Pregnant and nursing mothers

Following are contraindications of phenytoin

o Pregnancy- it is teratogenic drug causing ―foetal hydantoin syndrome‖ craniofacial

anomalies, mental retardation and limb defect

o Hypersensitivity to the drug

o Heart blocks, sinus bradycardia

In treatment of status epilepticus, drug of 1st choice is Diazepam or Clonazepam; 2nd

choice treatment is Phenobarbitone; 3rd choice is Phenytoin.

o It is contraindicated to people with allergy to benzodiazepines

o Contraindicated to people with the following conditions:

 Alcohol Intoxication, Depression, Myasthenia Gravis, Wide-Angle Glaucoma,

Closed Angle Glaucoma, CYP2C19 Poor Metabolizer, Severe Chronic Obstructed

Lung Disease, Significant Decrease in Lung Function, Lung Disease, Liver

Problems, Severe Liver Disease, Serious Kidney Problems, Temporarily Stops

Breathing While Sleeping, Pregnancy, A Mother who is Producing Milk and

Breastfeeding, Low Amount of Albumin Proteins in the Blood

STEP 4: Dose, dosage and course of Anti-epileptics and Anticonvulsant

Drugs (30minutes)

o Phenobarbitone (O) once daily at night

o Phenytoin (O) once daily at night or twice daily when required

o Carbamazepine (O) as two divided doses

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o Sodium valproate (O)

First choice:

OR

o Clonazepam (O) 0.5mg to 2mg. Once the status epilepticus has been controlled the

patient should be maintained on other anti-epileptics

Second choice:

o Phenobarbitone 200mg (IV) slowly. Repeat after 10 minutes, thereafter it may be

Third choice:

STEP 5: Side Effects and Adverse Effects of Anti-Epileptics and

Anticonvulsant Drugs (25 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

o Phenobarbitone: Hepatitis, hypotension, respiratory depression, behavioural

disturbances, irritability, drowsiness, depression, hallucinations, impaired memory

and cognition, hyperactivity particularly in the elderly and in children, megaloblastic

anaemia (may be treated with folic acid), suicidal ideation

o Phenytoin: Nausea, vomiting, constipation, drowsiness, insomnia, transient

nervousness, tremor, dizziness, headache, anorexia, rash, acne, blood disorders

(including megaloblastic anaemia, leucopenia, thrombocytopenia, and aplastic

anaemia)

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o Carbamazepine: Dry mouth, nausea, vomiting, oedema, ataxia, dizziness, drowsiness,

fatigue, headache, blood disorders, dermatitis, constipation, involuntary movements,

visual disturbances, hypertension, hypotension, aggression, confusion, depression,

hallucinations

o Sodium Valproate: Nausea, gastric irritation, diarrhoea; weight gain, transient hair

loss (regrowth may be curly); less frequently increased alertness, aggression,

hyperactivity, behavioural disturbances, tremor, drowsiness, confusion,

hallucinations, blood disorders, hearing loss and rash, also reported menstrual

disturbances and male infertility

o Diazepam: Drowsiness and light headedness the next day; confusion, amnesia;

dependence; muscle weakness; occasionally: headache, vertigo, dizziness, slurred

speech, hypotension, salivation changes, gastrointestinal disturbances, visual

disturbances, changes in libido, incontinence, urinary retention, respiratory

depression, blood disorders, jaundice, skin reactions

o Clonazepam: Drowsiness, fatigue, dizziness, co-ordination disturbances; also poor

concentration, restlessness, confusion, amnesia, dependence, and withdrawal; salivary

or bronchial hypersecretion in infants and small children; rarely gastro-intestinal

symptoms, respiratory depression, headache, aggression and anxiety, sexual

dysfunction, urinary incontinence, pruritus, reversible hair loss, skin pigmentation

changes and visual disturbances on long-term treatment; blood disorders reported;

suicidal ideation

STEP 6: Interaction and precaution of Anti-epileptics and Anticonvulsant

Drugs (20 minutes)

epileptics are complex and may increase toxicity without a corresponding increase in

antiepileptic effect

supervision

can precipitate severe rebound seizures

drug may take months. In patients receiving several antiepileptic drugs, only one drug

should be withdrawn at a time

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contraceptive advice

efficacy of some anti-epileptics may be affected by hormonal contraceptives

(especially if used during the first trimester and particularly if the patient takes two or

more antiepileptic drugs)

malformations, and with developmental delay

STEP 7: Key Points (5 minutes)

characterized by chronic spontaneous recurring seizures whereas anticonvulsants are

indicated for status epilepticus

the liver, especially Warfarin, ARVs and Oral contraceptives

used by women of child-bearing age, when used in combinations and in case of

drowsiness

STEP 7: Evaluation (5 minutes)

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References

Ministry Of Health and Social Welfare. (2013). Standard Treatment Guidelines &

National Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam,

Tanzania government printers.

Pharmacotherapy: A Pathophysiologic Approach (9th ed.). New York,

McGraw-Hill Education.

Sally S.R, & Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed)

New York, Lippincott Williams and Wilkins.

School of Pharmaceutical sciences. (2011). Tanzania Pharmaceutical Handbook

(2nd ed.). Dar es Salaam, ARDHI University press.

The Royal Pharmaceutical Society of Great Britain. (2007). Martindale: The

Extra Pharmacopoeia (5TH ed). London, pharmaceutical press.

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

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