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Drugs Acting on CNS
Dr. Amged SirElkhatim 1
Depressant Drugs
Dr. Amged SirElkhatim 2
Antiepleptic Drugs
(AEDs)
Dr. Amged SirElkhatim 3
• An epileptic seizure is a transient symptom of
excessive or synchronous neuronal activity in
the brain.
• Brought about by a disturbance of
physicochemical function and electrical
activity of the brain.
• Manifested as an alteration in mental state,
tonic or clonic movements, convulsions, and
various other psychic symptoms.
• The outward effect can be as dramatic as a
wild thrashing movement or as mild as a brief
loss of awareness.Dr. Amged SirElkhatim 4
• Two possible mechanisms for convulsive
disorders have been suggested:
- A loss of the normal inhibitory control
mechanism.
- A chemical supersensitivity that increases
excitability of neuronal elements.
Dr. Amged SirElkhatim 5
Seizure Classification:
Dr. Amged SirElkhatim 6
Dr. Amged SirElkhatim 7
General Mechanism of Action of Antiseizure Drugs
• Enhancement of GABA-mediated inhibition.
• Suppression of rapid repetitive firing through
inactivation of Na+ channels.
• Reduction of current through T-type Ca++
channels.
• Reduction of excitatory glutaminergic
neurotransmission.
Dr. Amged SirElkhatim 8
Dr. Amged SirElkhatim 9
Antiseizure Drugs
• The primary use of antiseizure drugs is in the
prevention and control of epileptic seizures.
• Theoretically, the ideal antiseizure drug
should:
- Completely suppress seizures in doses that do
not cause sedation or other undesired CNS
toxicity.
Dr. Amged SirElkhatim 10
- It should be well tolerated and highly
effective against various types of seizures.
- Be devoid of undesirable side effects on vital
organs and functions.
- Its onset of action should be rapid after
parenteral injection for control of status
epilepticus.
- Have a long duration of effect after oral
administration for prevention of recurrent
seizures.
Dr. Amged SirElkhatim 11
Antiseizure Drugs Having Ureide Structure
Dr. Amged SirElkhatim 12
Non-Ureide Antiseizure Drugs
Dr. Amged SirElkhatim 13
Hydantoins
• Imidazo-2,4-dione structure.
Dr. Amged SirElkhatim 14
Dr. Amged SirElkhatim 15
• Prototype.
• pKa is in the range of 8.06 to 8.33.
• Water soluble sodium salt (pH > 11).
• CO2.
• Erratic absorption (IM, pH< 11).Dr. Amged SirElkhatim 16
• Prototype.
• pKa is in the range of 8.06 to 8.33.
• Water soluble sodium salt (pH > 11).
• CO2.
• Erratic absorption (Intramuscular route).Dr. Amged SirElkhatim 17
• Pro-drug (t1/2 = 8–15 minutes).
• Freely soluble in aqueous solutions.
• IV.
• IM (rapidly absorbed).
Dr. Amged SirElkhatim 18
Bio-activation of Fosphenytoin
Dr. Amged SirElkhatim 19
Barbiturates
Dr. Amged SirElkhatim 21
Benzodiazepines
Dr. Amged SirElkhatim 22
Oxazolidinediones
• Potential side effects!
Dr. Amged SirElkhatim 25
Succinimides
• Less toxic than oxazolidinediones!
Dr. Amged SirElkhatim 26
Iminostilbenes
• Carbamazepine is highly effective and
relatively less toxic.
• Carbamazepine 10,11 epoxide is an active
metabolite (trans-dihydroxy metabolite).
• Oxacarbazepine is a prodrug!Dr. Amged SirElkhatim 27
Dr. Amged SirElkhatim 28
Eslicarbazepine Acetate
• Improved efficacy and safety.
• Prodrug for (S)-licarbazepine.
• For partial-onset seizures (FDA, 2009).Dr. Amged SirElkhatim 29
Bis-Carbamates: Felbamate
• Approved by the U.S. FDA in 1993.
• Aplastic anemia and severe hepatotoxicity.
Dr. Amged SirElkhatim 30
Dr. Amged SirElkhatim 31
Dr. Amged SirElkhatim 32
Gabapentin
• No direct GABA-mimetic activity.
• It raises brain GABA levels in patients with
epilepsy.Dr. Amged SirElkhatim 33
Valproic Acid
• pKa of valproic acid is 4.7, the drug is
completely ionized at physiologic pH.
• Discovered serendipitously.
Dr. Amged SirElkhatim 34