Assessment for Patients Receiving Antiepileptics 抗癫痫药治疗患者的评估
The information that follows primarily relates to drug therapy with hydantoins and succinimides, acetazolamide, valproic acid, and zonisamide.
下列信息主要与乙内酰脲和琥珀酰亚胺类药、乙酰唑胺、丙戊酸和唑尼沙胺等的药物疗法相关。
1. Assess for contraindications or cautions to the use of hydantoins, including known history of allergy to hydantoins to avoid hypersensitivity reactions; cardiac arrhythmias, hypotension, diabetes, coma, or psychoses, which could be exacerbated by the use of the drug; history of renal or hepatic dysfunction that might interfere with drug metabolism or excretion; and current status related to pregnancy and lactation.
评估乙内酰脲类药使用的禁忌症或注意事项，包括乙内酰脲类药已知过敏史，以避免超超反应；心律异常、低血压、糖尿病、昏迷或重性精神病，药物使用可能加剧这些疾病；肾或肝功能障碍史，该病史可能影响药物代谢或排泄；以及当前与妊娠或哺乳相关的状况。
2. Assess for contraindications or cautions to the use of succinimides, including any known allergies to these drugs; history of intermittent porphyria, which could be exacerbated by these drugs; history of renal or hepatic dysfunction that might interfere with drug metabolism or excretion; and current status related to pregnancy or lactation because of the potential risks to the fetus or baby.
评估琥珀酰亚胺类药使用的禁忌症或注意事项，包括这些药物的任何已知过敏；间歇卟啉症，这些药物可能加重此病；肾或肝功能障碍史，病史可能影响药物代谢或排泄；以及当前与妊娠或哺乳相关的状况，因为有潜在的胎儿或婴儿危险。
3. Obtain a description of seizures, including onset, aura, duration, and recovery, to determine type of seizure and establish a baseline.
获取癫痫发作说明，包括发病、病兆、持续时间和恢复，以确定癫痫发作类型，建立基线数据。
4. Perform a physical assessment to establish baseline data for determining the effectiveness of therapy and the occurrence of any potential adverse effect.
进行身体评估，确立基线资料，以确定治疗效果及潜在不良效应的发生。
5. Inspect the skin for color and lesions to determine evidence of possible skin effects; assess pulse and blood pressure and auscultate heart to evaluate for possible cardiac effects; assess level of orientation, affect, reflexes, and bilateral grip strength to evaluate any CNS effects; monitor bowel sounds and urine output to determine possible GI or genitourinary (GU) effects; and evaluate gums and mucous membranes to establish baseline and monitor changes associated with adverse effects.
检查皮肤颜色和病损，明确可能的皮肤影响证据；评估脉搏和血压，听诊心脏，评价有无可能的以及效应；评估定向力、情感、反射及双手握力等程度，以评价其CNS效应；监测肠鸣音和尿排量，确定可能的GI或生殖泌尿（GU）效应；评价牙龈和粘膜，建立基线数据，监测与不良效应相关的变化。
6. Obtain a baseline electroencephalogram if appropriate to evaluate brain function.
适当获取基线心电图，评价脑功能。
7. Assess the patient’s renal and liver function, including renal and liver function tests, to determine appropriateness of therapy and determine the need for possible dose adjustment.
评价患者的肾、肝功能，包括进行肾、肝功能试验，以确定治疗的合适性，明确是否有必要进行剂量调整。
★Vocabulary for Today ★
hydantoin – n. 乙内酰脲
succinimide – n. 琥珀酰亚胺类药
acetazolamide – n. 乙酰唑胺
valproic acid – n. 丙戊酸
zonisamide – n. 唑尼沙胺
porphyria – n. 卟啉症
aura – n. 病兆，预兆
grip strength – 握力
GU -- genitourinary 生殖泌尿的
1. A 15-year-old boy presents to clinic for follow-up for his tonic-clonic seizures. He reports that he has not had a seizure in the past 6 months. However, he has been more tired recently and is unsure why. A complete blood count is performed and shows megaloblastic anemia. The physician told the patient that this was most likely a side effect of his antiseizure medication. What is the most likely medication he was taking?
A. Ethosuximide
B. Phenobarbital
C. Phenytoin
D. Valproic acid 2. A 25-year-old woman has been taking an antiepileptic drug for a seizure disorder for 1 year. She now complains of episodes of blurred vision and diplopia. Which of the following antiepileptic drugs has she most likely been taking?
A. Carbamazepine
B. Ethosuximide
C. Lorazepam
D. Phenobarbital
答案Answers 1. C. Phenytoin.
Phenytoin is used in the treatment of tonic-clonic seizures. Phenytoin has many side effects, like hirsutism, nystagmus, gingival hyperplasia, and megaloblastic anemia. 2. A. Carbamazepine.
There are many drugs used to control or limit seizure activity. Carbamazepine is a drug that may cause blurred vision and diplopia with use. Of the drugs listed, carbamazepine is the most likely culprit behind this patient’s symptoms. Carbamazepine induces its own metabolism, so dosage adjustments early in therapy may be necessary. It is also used to treat trigeminal neuralgia.
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