Antiseizure Agents Across the Lifespan
不同生命阶段的抗癫痫制剂使用
Children 儿童
Antiepileptic drugs can have an impact on a child’s learning and social development. Children may also be more sensitive to the sedating effects of some of these drugs. Children should be monitored very closely and often require a switch to a different agent or dosage adjustments based on their response. Newborns (1–10 days of age) respond best to intramuscular phenobarbital if an antiepileptic is needed.
Older children (2 months–6 years of age) absorb and metabolize many of these drugs more quickly than adults do and require a larger dosage per kilogram to maintain therapeutic levels. Careful calculation of drug dosage using both weight and age are important in helping the child to receive the best therapeutic effect with the least toxicity. After the age of 10–14 years, many of these drugs can be given in the standard adult dose.
Parents of children receiving these drugs should receive consistent support and education about the seizure disorder and the medications being used to treat it. Many communities have local support groups that can offer lots of educational materials and support programs. It is a very frightening experience to watch your child have a tonic–clonic seizure, and parents should be supported with this in mind.
Adults using these drugs should be under regular care and should be monitored regularly for adverse effects. They should be encouraged to carry or wear a MedicAlert identification to alert emergency personnel that antiepileptic drugs are being taken. Adults also need education and support to deal with the old stigma of seizures as well as the lifestyle changes and drug effects that they may need to cope with.
Most of these drugs have been associated with fetal abnormalities in animal studies. Some of them are clearly associated with predictable congenital effects in humans. Women of childbearing age should be encouraged to use contraceptives while taking these drugs. If a pregnancy does occur, or if a woman taking one of these drugs desires to become pregnant, the importance of the drug to the mother should be weighed against the potential risk to the fetus. Stopping an antiepileptic can precipitate seizures that could cause anoxia and its related problems for the mother and the baby. Women who are nursing should be encouraged to find another way of feeding the baby to avoid the sedating and CNS effects that the drugs can have on the infant.
Older patients may be more susceptible to the adverse effects of these drugs. Dosages of all of these drugs may need to be reduced, and the patient should be monitored very closely for toxic effects and to provide safety measures if CNS effects do occur.
Patients with renal or hepatic impairment should be monitored very closely. Baseline renal and liver function tests should be done and dosages adjusted as appropriate. Serum levels of the drug should be monitored closely in such cases to prevent serious adverse effects.
The older patient should also be encouraged to wear or carry a MedicAlert identification in case there is an emergency and the patient is not able to communicate information about the drug or disorder.
应鼓励老年人携带或佩带医疗警示标识，以防出现意外，患者无法沟通药物或疾病相关信息。
★Vocabulary for Today ★
lifespan – n. 平均生命期，寿命
social development – 社交发展
sedate – a. v. 镇静的，使镇静
sedating effects – 镇静效应
switch – n. 转换，切换
phenobarbital – n. 苯巴比妥
therapeutic level – 治疗浓度
therapeutic effect – （治）疗效（果）
toxicity – n. 毒性作用，中毒
standard adult dose – 标准成人剂量
with sth in mind 记着某事
MedicAlert identification – 医疗警示标识
weigh (against) – v. 权衡，考虑
precipitate – v. 加速，使突然发生
anoxia – n. 缺氧症
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