2. Neuromodulators Flashcards
What is the most common drug we use to treat ADHD and Narcolepsy?
Amphetamine [Adderall]. 5-40mg/day
What is the mechanism of action of Amphetamine?
It stimulates CNS through a sympathomimetic mechanism involving the enhanced release and reduced reuptake of norepinephrine and dopamine.
What are the different neuromodulator drug classes?
Psychomotor Stimulants Antidepressants Antipsychotics/Neuroleptics Neurodegenerative Therapies Anxiolytics & Hypnotics
What are the different neuromodulator drug classes?
Psychomotor Stimulants Antidepressants Antipsychotics/Neuroleptics Neurodegenerative Therapies Anxiolytics & Hypnotics
What happens if you give a patient opthalmic beta blockers & alpha 2 agonists in the presence of Amphetamine?
Hypertensive crisis. DO NOT do this.
What happens if you give a patient carbonic anhydrase inhibitors in the presence of Amphetamine?
renal excretion decreased in alkaline urine
What happens if you give a patient NSAIDs or Decongestants in the presence of Amphetamine?
Additive effect. NSAIDs is a caffeine base drugs.
Why is Amphetamine contraindicated with glaucoma patients?
Normally glaucoma is treated with sympathetic activity drugs (beta blockers and alpha 2 agonists) but Amphetamine is the opposite.
Why is Amphetamine contraindicated with glaucoma patients?
Normally glaucoma is treated with a drug (beta blockers and alpha 2 agonists) but Amphetamine is the opposite.
The different classes of antidepressant drugs.
- Selective serotonin reuptake inhibitor (SSRIs),
- Selevtive serotonin/norepinephrine reuptake inhibitor (SNRIs)
- Tricyclic antidepressant (TCADs)
- Atypical
- MAOIs
The most common SSRI antidepressant is?
Escitalopram [Lexapro]
The most common SSRI antidepressant is?
Escitalopram [Lexapro]
What is the indicator for Escitalopram?
major depressive disorder and generalized anxiety disorder
10-20mg qd
Your patient comes in with a subconjunctival hemorrhage, which combination of drugs give you that?
Escitalopram with NSAIDs and Omega 3 FA Or Duloxetine with NSAIDs and Omega 3 FA.
What is the effect of Escitalopram (SSRI) or Duloxetine (SNRI) on Beta blockers metabolism?
it will reduce it, which increases beta blockers concentration in the blood. Beware of glaucoma patients who are taking this.
Which SNRI drug is the the most commonly prescribed?
Duloxetine [Cymbalta]
What is the indication for Duloxetine (SNRI)?
Depression, anxiety, neuropathic pain (DM), Fibromyalgia
Dosing: 60mg qd
What effect does Opiods give in the presence of Duloxetine?
it’s an additive
Which antidepressant drug can cause angle closure glaucoma and bleeding risk?
Duloxetine (SNRI) because this drug is an stimulant for catecholamines, which naturally will produce a dilation.
The different classes of antidepressant drugs.
- Selective serotonin reuptake inhibitor (SSRIs),
- Selevtive serotonin/norepinephrine reuptake inhibitor (SNRIs)
- Tricyclic antidepressant (TCADs)
- Atypical
- MAOIs
Which drug is the most commonly prescribed Tricyclic antidepressants?
Imipramine [Tofranil]
Which drug is the most commonly prescribed Atypical antidepressants?
Trazadone [Desyrel]
What is the indication for taking Trazodone (atypical antidepressant)
Major depressive disorder (50-100mg bid - tid)
Insomnia (25-50mg qhs)
The mechanism of action of Trazodone is to block _______ and serotonin subtypes ______ and ______.
adrenergic alpha 1, 2A, 2C
Which Antidepressant has ocular irritation adverse effect?
Trazodone
What is the drug interactions of cyclosporine, macrolides and azoles in the presence of Trazodone?
QT prolongation & impaired hepatic metabolism.
What is the drug interactions of NSAIDs in the presence of Trazodone?
Hemorrhage
The most common antipsychotics/neuroleptics is?
Quetiapin [Seroquel]
Which receptors do Quetiapine (antipsychotics) blocked?
Quetiapine is a 2nd generation antipsychotics. It blocks D2 and 5-HT2 receptors. It also has ancillary effects that come from blocking of H1 (histamine) and alpha 1 (vasoconstrictor) receptors.
What is the drug interactions of NSAIDs in the presence of Trazodone?
Hemorrhage
Which receptors do Quetiapine (antipsychotics) blocked?
Quetiapine is a 2nd generation antipsychotics. It blocks D2 and 5-HT2 receptors. It also has ancillary effects that come from blocking of H1 (histamine) and alpha 1 (vasoconstrictor) receptors.
Which anti-psychotic drugs can cause cataracts?
Quetiapine. BPH uses to treat hypertension also causes cataracts.
What is the drug interactions of Macrolides, Azoles, CsA in the presence of Quetiapine (anti-psychotic)?
Prolonged QT segment
What is the drug interactions of Classic Anti-histamine in the presence of Quetiapine (anti-psychotic)?
Additive CNS depression because Quetiapine has sedative effect and classic 1st generation anti-histamines have that as well.
What is the drug interactions of Classic Anti-histamine in the presence of Quetiapine (anti-psychotic)?
Additive CNS depression because Quetiapine has sedative effect and classic 1st generation anti-histamines have that as well.
Patients with Alzheimer disease have a significant loss of _______ in the temporal lobe and entorhinal cortex. Most of the drugs available to treat the disease are __________.
cholinergic neurons, acetylcholinesterase inhibitors
Which is the most commonly prescribed alzheimer therapy drug?
Donepezil [Aricept]
dosing: 1 tabs qhs (bed time) [5/10/23] mg
Is Donepezil a neural protected drug?
No. It has indirect acting; reversibly binds to and inactivates acetylcholinesterase.
Is Donepezil a neural protected drug?
No. It has indirect acting; reversibly binds to and inactivates acetylcholinesterase.
What is the most commonly prescribed Anti-parkinson therapies drug?
Carbidopa (10-25 mg) and Levodopa (100-250 mg)
[Sinemet]
Which Sinemet drug component (Carbidopa and Levodopa) crosses the blood brain barrier (BBB)?
Levodopa crosses the BBB to enhance dopamine synthesis in the substantia nigra.
What is the function of Carbidopa in Sinemet?
It inhibits dopa decarboxylase. It also degrades levodopa to dopamine, which it can’t enter the BBB.
What is the drug interactions of Sinemet?
NONE. It’s a safe drug to take with other drugs!!
Which receptor in the CNS does Anxiolytics & Hypnotics drugs act on?
GABAa
What are the Anxiolytic & hypnotic drug classes?
BENZODIAZEPINES (BZD)
NON-BENZODIAZEPINES
BARBITURATES
Which of the Anxiolytic & hypnotic drug class is the most toxic?
Barbiturates
Which is the first Benzodiazepine being produced?
Librium has a distinct generic name and is recognized as the first BZD, produced in 1955
Which is the most commonly abused Benzodiazepine?
Temazepam’s pharmacokinetic properties render it the most commonly abused BZD
Which is the most commonly prescribed Benzodiazepine?
Alprazolam [Xanax]
Dosing: [1/4, 1/2, 1, 2mg]_ 1 tab tid
Which Benzodiazepine drug can cause anterograde amnesia?
Alprazolam [Xanax]
What happens if you prescribe Cyclosporine, Azoles, and Erythromycins in the presence of Alprazolam [Xanax]?
Reduce Alprazolam metabolism
What happens if you prescribe Chlorpheniramine (anti-histamines) or Diphenhydramine (anti-histamines) or Opioids in the presence of Alprazolam (anxiolytic)?
Additive effect in sedation
T/F Alprazolam causes disregulated muscle tone.
True. Diplopia. Unstable Myasthenia Gravis
T/F Alprazolam causes disregulated muscle tone.
True. Diplopia. Unstable Myasthenia Gravis
What is the most common Non-Benzodiazepines?
Zolpidem [Ambien]
Dosing: [5/10mg] 1 tab ghs (bed time)
Zolpidem [ambien] treats _______.
Insomnia
T/F Zopidem is a long term therapy drug.
False. Only 7-10 days. Relatively safe to take because of that.
Mechanism of action of Zopidem.
Selective agonist of GABAa-BZD-1 receptor
