Brain, Mind, and Behavior Flashcards
Chlorpromazine
Typical antipsychotic - D2 receptor antagonists
Adverse Effects:
- Nigrostriatal: Motor “EPS” (tardive dyskinesia)
- Hypothalamus: Endocrine (hyperprolactinemia and therefore diminished GnRH)
Rare: Neuroleptic Malignant Syndrome (NMS)
- Symptoms = hyperthermia and muscle rigidity
- Treatment = withdraw typical antipsychotic, cooling/hydration, DANTROLENE (muscle relaxant) and BROMOCRIPTINE (dopamine agonist)
Note: Can treat Huntington’s chorea and Tourette’s (hyperkinetic movement disorders)
Note: The -azines cause anticholinergic and alpha-receptor blockage –> Dry mouth, constipation, orthostatic hypotension
Fluphenazine
Typical antipsychotic
Adverse Effects:
- Nigrostriatal: Motor “EPS” (tardive dyskinesia)
- Hypothalamus: Endocrine (hyperprolactinemia and therefore diminished GnRH)
Rare: Neuroleptic Malignant Syndrome (NMS)
- Symptoms = hyperthermia and muscle rigidity
- Treatment = withdraw typical antipsychotic, cooling/hydration, DANTROLENE (muscle relaxant) and BROMOCRIPTINE (dopamine agonist)
Note: Can treat Huntington’s chorea and Tourette’s (hyperkinetic movement disorders)
Note: The -azines cause anticholinergic and alpha-receptor blockage –> Dry mouth, constipation, orthostatic hypotension
Haloperidol
Typical antipsychotic
Adverse Effects:
- Nigrostriatal: Motor “EPS” (tardive dyskinesia)
- Hypothalamus: Endocrine (hyperprolactinemia and therefore diminished GnRH)
Rare: Neuroleptic Malignant Syndrome (NMS)
- Symptoms = hyperthermia and muscle rigidity
- Treatment = withdraw typical antipsychotic, cooling/hydration, DANTROLENE (muscle relaxant) and BROMOCRIPTINE (dopamine agonist)
Note: Can treat Huntington’s chorea and Tourette’s (hyperkinetic movement disorders)
Aripiprazole
Atypical antipsychotic (can be used in bipolar disorder too)
- Fewer EPS and Endocrine side effects than typicals (not zero though)
- Wider therapeutic window than typicals
- Similar efficacy to typicals
Adverse effects:
- Metabolic: weight gain, diabetes mellitus 2, elevated LDL
- Especially bad in pediatric and geriatric patients
Clozapine
Atypical antipsychotic
- Fewer EPS and Endocrine side effects than typicals (not zero though)
- Wider therapeutic window than typicals
- Similar efficacy to typicals
Adverse effects:
- Metabolic: weight gain, diabetes mellitus 2, elevated LDL
- Especially bad in pediatric and geriatric patients
Olanzapine
Atypical antipsychotic
- Fewer EPS and Endocrine side effects than typicals (not zero though)
- Wider therapeutic window than typicals
- Similar efficacy to typicals
Adverse effects:
- Metabolic: weight gain, diabetes mellitus 2, elevated LDL
- Especially bad in pediatric and geriatric patients
Risperidone
Atypical antipsychotic
- Fewer EPS and Endocrine side effects than typicals (not zero though)
- Wider therapeutic window than typicals
- Similar efficacy to typicals
Adverse effects:
- Metabolic: weight gain, diabetes mellitus 2, elevated LDL
- Especially bad in pediatric and geriatric patients
Quetiapine
Atypical antipsychotic (treats bipolar disorder too)
Atypical antipsychotic
- Fewer EPS and Endocrine side effects than typicals (not zero though)
- Wider therapeutic window than typicals
- Similar efficacy to typicals
Adverse effects:
- Metabolic: weight gain, diabetes mellitus 2, elevated LDL
- Especially bad in pediatric and geriatric patients
Imipramine
Tricyclic Antidepressant (depression) - Inhibits reuptake of NE
Risk: Cardiac arrhythmia
Escitalopram
SSRI (depression)
Adverse event: GI and Sexual
Fluoxetine
SSRI (depression)
NOTE: Only FDA approved med for Bulimia Nervosa
Adverse event: GI and Sexual
Paroxetine
SSRI (depression)
Adverse event: GI and Sexual
Sertraline
SSRI (depression)
Adverse event: GI and Sexual
Paroxetine
SSRI (depression)
Adverse event: GI and Sexual
Sertraline
SSRI (depression)
Adverse event: GI and Sexual
Venlafaxine
SNRI (depression)
Adverse event: GI and Sexual
Duloxetine
SNRI (depression)
Adverse event: GI and Sexual
Phenelzine
MAOI (depression)
Risk: Hypertensive crisis from dietary amines (such as yeast extracts like Vegemite)
Bupropion
Atypical antidepressant (also used as nicotine pharmacotherapy)
- Inhibits reuptake of dopamine and NE
NOTE: Contraindicated in anorexia nervosa & bulimia nervosa patients and in patients with decreased seizure threshold.
Mirtazapine
Atypical antidepressant
Lithium
Treats bipolar disorder
- Low sodium makes lithium more toxic
- Teratogenic
- Drug-drug interactions (esp. renal drugs)
Carabamazepine
Anticonvulsant (treats bipolar disorder)
- Induces Cytochrome P450 to interact with many other drugs
- Teratogenic
Valproic acid
Anticonvulsant (treats bipolar disorder)
- Induces Cytochrome P450 to interact with many other drugs
- Teratogenic
Lamotrigine
Anticonvulsant (treats bipolar disorder)
Amitriptyline
Tricyclic Antidepressant (depression) - Inhibits reuptake of NE
Risk: Cardiac arrhythmia
Note: Can be used for headache analgesia
Amphetamines
Release dopamine and NE
Cocaine
Inhibits reuptake of dopamine and NE
Desipramine
TCA - inhibits NE reuptake
Alpha-methyltyrosine
Decreased dopamine and NE - inhibits tyrosine hydroxylase
Reserpine
Decreased dopamine, NE, and serotonin - inhibits vesicular uptake
Prednisone
Headache analgesia
Aminosalicylic acid (ASA)
NSAID (Aspirin)
Used in headache analgesia and as a blood thinner.
- Irreversibly acetylates COX - fries platelet for good.
- *Warning: Reye’s Syndrome = if you give aspirin to child after viral illness, you can cause hepatotoxicity and death!!
- Aspirin not for kids with viral illness (URI, chickenpox, etc.)
Note: Other NSAIDs reversibly inhibit COX and cannot prevent clotting. Ex: no amount of Ibuprofen can prevent clotting.
Acetaminophen
Headache analgesia (Tylenol)
- NOT an NSAID. We don’t know how it works (COX, 5-HT, … ?)
- Is an OK antipyretic and analgesic
- No effect on GI, Platelet, Renal, CV (like NSAIDs)
- Overdose can cause fatal hepatic necrosis (its metabolite covalently binds to liver cells)
Ibuprofen
NSAID
Headache analgesia (Advil)
Ergotamine
Headache analgesia
Sumatriptan
Headache analgesia
Prochlorperazine
Headache analgesia
AAC
Acetaminophen, aspirin, and caffeine: Headache analgesia
Verapamil
Headache analgesia
Perphenazine
Typical antipsychotic - D2 receptor antagonists
Adverse Effects:
- Nigrostriatal: Motor “EPS” (tardive dyskinesia)
- Hypothalamus: Endocrine (hyperprolactinemia and therefore diminished GnRH)
Rare: Neuroleptic Malignant Syndrome (NMS)
- Symptoms = hyperthermia and muscle rigidity
- Treatment = withdraw typical antipsychotic, cooling/hydration, DANTROLENE (muscle relaxant) and BROMOCRIPTINE (dopamine agonist)
Note: Can treat Huntington’s chorea and Tourette’s (hyperkinetic movement disorders)
Note: The -azines cause anticholinergic and alpha-receptor blockage –> Dry mouth, constipation, orthostatic hypotension
Thioridazine
Typical antipsychotic - D2 receptor antagonists
Adverse Effects:
- Nigrostriatal: Motor “EPS” (tardive dyskinesia)
- Hypothalamus: Endocrine (hyperprolactinemia and therefore diminished GnRH)
Rare: Neuroleptic Malignant Syndrome (NMS)
- Symptoms = hyperthermia and muscle rigidity
- Treatment = withdraw typical antipsychotic, cooling/hydration, DANTROLENE (muscle relaxant) and BROMOCRIPTINE (dopamine agonist)
Note: Can treat Huntington’s chorea and Tourette’s (hyperkinetic movement disorders)
Note: The -azines cause anticholinergic and alpha-receptor blockage –> Dry mouth, constipation, orthostatic hypotension
Thiothixene
Typical antipsychotic - D2 receptor antagonists
Adverse Effects:
- Nigrostriatal: Motor “EPS” (tardive dyskinesia)
- Hypothalamus: Endocrine (hyperprolactinemia and therefore diminished GnRH)
Rare: Neuroleptic Malignant Syndrome (NMS)
- Symptoms = hyperthermia and muscle rigidity
- Treatment = withdraw typical antipsychotic, cooling/hydration, DANTROLENE (muscle relaxant) and BROMOCRIPTINE (dopamine agonist)
Note: Can treat Huntington’s chorea and Tourette’s (hyperkinetic movement disorders)
Trifluoperazine
Typical antipsychotic - D2 receptor antagonists
Adverse Effects:
- Nigrostriatal: Motor “EPS” (tardive dyskinesia)
- Hypothalamus: Endocrine (hyperprolactinemia and therefore diminished GnRH)
Rare: Neuroleptic Malignant Syndrome (NMS)
- Symptoms = hyperthermia and muscle rigidity
- Treatment = withdraw typical antipsychotic, cooling/hydration, DANTROLENE (muscle relaxant) and BROMOCRIPTINE (dopamine agonist)
Note: Can treat Huntington’s chorea and Tourette’s (hyperkinetic movement disorders)
Asenapine
Atypical antipsychotic
- Fewer EPS and Endocrine side effects than typicals (not zero though)
- Wider therapeutic window than typicals
- Similar efficacy to typicals
Adverse effects:
- Metabolic: weight gain, diabetes mellitus 2, elevated LDL
- Especially bad in pediatric and geriatric patients
Paliperidone
Atypical antipsychotic
- Fewer EPS and Endocrine side effects than typicals (not zero though)
- Wider therapeutic window than typicals
- Similar efficacy to typicals
Adverse effects:
- Metabolic: weight gain, diabetes mellitus 2, elevated LDL
- Especially bad in pediatric and geriatric patients
Ziprasidone
Atypical antipsychotic
- Fewer EPS and Endocrine side effects than typicals (not zero though)
- Wider therapeutic window than typicals
- Similar efficacy to typicals
Adverse effects:
- Metabolic: weight gain, diabetes mellitus 2, elevated LDL
- Especially bad in pediatric and geriatric patients
Seligiline
MAOI (antidepressant)
AND
Parkinson’s drug
Tranylcypromine
MAOI (antidepressant)
Fluvoxamine
SSRI (antidepressant)
Citalopram
SSRI (antidepressant)
Trazodone
Atypical antidepressant
Lisdexamfetamine
Treats binge eating disorder and ADHD
Acamprosate
Alcohol withdrawal pharmacotherapy - dampens excitatory neurotransmission associated with alcohol withdrawal
- Second line to naltrexone
- AND what about the alcohol?
Disulfiram
Alcohol withdrawal pharmacotherapy - inhibits aldehyde DH
- If you take this with alcohol, acetaldehyde builds and you get sick.
- Not that great…
*AND what about the alcohol?
Naltrexone
Alcohol withdrawal pharmacotherapy - opiate antagonist
- Opiate receptors stimulate reward system so by blocking, you inhibit dependence on alcohol to stimulate reward
- New first line
*AND what about the alcohol?
Varenicline
Nicotine pharmacotherapy
- Partial agonist at nAChR (alpha-4/beta-2 subtype)
- Dual agonist and antagonist properties: physically prevents nicotine from binding and releases intrinsically less dopamine at the nAcc.
Nicotine replacement therapy
Nicotine pharmacotherapy
Contraindications:
- Cardiac arrhythmias, post-MI, angina
- Pregnant women
Adverse reactions (patch):
- Skin irritation
- Sleep disturbances (vivid dreaming)
Adverse reactions (gum and lozenge)
- Hiccups and nausea
- Jaw aches and mouth soreness
Morphine
Mu receptor agonist
- Metabolites: Liver turns Morphine –> Morphine 3-glucoronide and Morphine 6-glucoronide. They both go to kidneys and get peed out.
- If patient has renal insufficiency… You build up these water-soluble metabolites.
- If morphine 6 glucoronide crosses the BBB, it is 100x more potent than morphine!!!!
- So anyone with renal insufficiency (like OLD PEOPLE), stay the fuck away from morphine!
Meperidine
Mu receptor agonist
- Metabolites: Liver turns Meperidine –> Normeperidine which goes to kidneys to be peed out.
- Normeperidine can cause seizures if levels too high.
- Patients with renal insufficiency… Normeperidine builds up and causes SEIZURES.
Hydromorphone
Mu receptor agonist
- No significant active metabolites: In patients with renal failure, this replaces morphine as treatment.
Pentazocine
Kappa agonist/Mu antagonist
- Kappa = krappy at analgesia and makes you krazy
- Do NOT give in chronic opioid users –> triggers withdrawal
- Causes less respiratory depression & sedation & euphoria via kappa.
- Give to reverse opioid side effects while maintaining analgesia
Butorphanol
Kappa agonist/Mu antagonist
- Kappa = krappy
Nalbuphine
Kappa agonist/Mu antagonist
- Kappa = krappy
Buprenorphine
Partial mu agonist (binds mu receptor very tightly but only turns it on a little bit)
- Used for heroin addicts/opioid addicts.
- It blocks heroin/opioid from binding AND it is weak so it doesn’t create withdrawal.
- When you take them off the buprenorphine finally, their withdrawal is super mild!
Naloxone
Mu receptor antagonist
- Give in opioid overdose
Naltrexone
Mu receptor antagonist
- Give in opioid overdose
Methadone
Mu receptor agonist
- Uniquely has 24 hour half life (all other opioids have 2-3 hour)
Codeine
Mu receptor agonist
Oxycodone
Mu receptor agonist
Hydrocodone
Mu receptor agonist
- Fun fact = this is Vicodin
Heroin
Mu receptor agonist
Fentanyl
Mu receptor agonist
Methadone
Mu receptor agonist
Tramadol
Mu receptor agonist
- Does mild/moderate pain only
Dephenoxylate
Antidiarrheal - opioid
Loperamide
Antidiarrheal - opioid
Meloxicam
NSAID
Celecoxib
NSAID
Selective COX 2 inhibitor
- No platelet effect
- Only NSAID that doesn’t increase bleeding (can give before surgeries)
Naprosyn
NSAID
Indomethacin
NSAID
Diclofenac
NSAID
Nabumetone
NSAID
Ketorolac
NSAID
NSAIDs
General:
- Inhibits COX 1 and 2 (cyclooxygenase) enzymes which take… Arachidonic acid –> Prostaglandins
Pain:
- COX 2 works when injury occurs AND is always active in CNS (to potentiate pain pathway). Thus, NSAIDs work peripherally and centrally.
GI:
- COX 1 making PG’s that help keep stomach lining intact (help make bicarbonate, thicken stomach wall, increase blood flow to stomach for repair). Chronic NSAID use increase risk of upper GI bleed.
- Put chronic NSAID user on PPI.
Renal:
- Need prostaglandins to maintain blood flow in low blood flow states through your kidneys!
- Don’t give NSAIDS if you have a case of low blood flow through kidneys or your patient will get ischemic tubular necrosis.
- Low perfusion states = hypovolemia (hemorrhage) AND congestive heart failure
Hemostasis:
- Endothelial cells have COX 2, which makes Prostacyclin (PGI2). PGI2 is a platelet inhibitor and vasodilator (enable blood flow)
- Platelets have COX 1 and make Thromboxane A2, which is a platelet activator and vasoconstrictor (how they do their job).
- Platelets have no nuclei and cannot counteract NSAID activity like endothelial cells can so NSAIDs inhibit platelet activity.
- Aspirin is the only NSAID to irreversibly inhibit COX. Others reversibly inhibit.
Note: COX 1 is ‘housekeeping’ which is present in tissues all the time.
Note: COX 2 is ‘inflammatory’ one which is present during injury (makes PG’s that bind to nociceptor and induce pain). Note: COX 2 also makes PGI2 (platelets) [not COX 1]
Opioids
- Analgesia
- Sedation
- Respiratory depression
- Miosis
Euphoria
Dependence
Timolol
Glaucoma drug
- Beta adrenergic antagonist
- Reduce aqueous humor production
Levobunolol
Glaucoma drug
- Beta adrenergic antagonist
- Reduce aqueous humor production
Metipranolol
Glaucoma drug
- Beta adrenergic antagonist
- Reduce aqueous humor production
Carteolol
Glaucoma drug
- Beta adrenergic antagonist
- Reduce aqueous humor production
Brimonidine
Glaucoma drug
- Alpha 2 agonist
- Decrease aqueous production AND increase uveoscleral outflow
Apraclonidine
Glaucoma drug
- Alpha 2 agonist
- Decrease aqueous production AND increase uveoscleral outflow
Acetazolamide
Glaucoma drug
- Carbonic anhydrase inhibitor
- Decrease rate of HCO3- formation: Inhibit secretion of aqueous
Methazolamide
Glaucoma drug
- Carbonic anhydrase inhibitor
- Decrease rate of HCO3- formation: Inhibit secretion of aqueous
Dorzolamide
Glaucoma drug
- Carbonic anhydrase inhibitor
- Decrease rate of HCO3- formation: Inhibit secretion of aqueous
Brinzolamide
Glaucoma drug
- Carbonic anhydrase inhibitor
- Decrease rate of HCO3- formation: Inhibit secretion of aqueous
Latanaprost
Glaucoma drug
- Prostaglandin analogue
- Increase uveoscleral outflow
- First line treatment
Bimatoprost
Glaucoma drug
- Prostaglandin analogue
- Increase uveoscleral outflow
- First line treatment
Travoprost
Glaucoma drug
- Prostaglandin analogue
- Increase uveoscleral outflow
- First line treatment
Pilocarpine
Glaucoma drug
- Cholinergic agonist
- Increase aqueous outflow through trabecular meshwork
Echothiophate
Glaucoma drug
- Inhibits acetylcholinesterase
- Increase aqueous outflow through trabecular meshwork
Amantidine
Parkinson’s drug
- Induces DA release from nigrostriatal neuron
Benztropine
Parkinson’s drug
- AChR antagonist
Carbidopa
Parkinson’s drug
- Inhibits peripheral DDC (dopa decarboxylase) so more reaches CNS
- Used with L-Dopa (“Sinemet”)
Entacapone
Parkinson’s drug
- Inhibits COMT (catechol-O-methyl transferase), which converts Dopamine and L-Dopa from their path.
Levodopa
Parkinson’s drug
- Dopamine precursor
Pramipexole
Parkinson’s drug
- D2/D3 agonist
Ropinirole
Parkinson’s drug
- D2/D3 agonist
Tolcapone
Parkinson’s drug
- Inhibits COMT (catechol-O-methyl transferase), which converts Dopamine and L-Dopa from their path.
Pergolide
Parkinson’s drug
- Dopamine agonist
Procaine
Local anesthetic
- Ester
Chloroprocaine
Local anesthetic
- Ester
Tetracaine
Local anesthetic
- Ester
Lidocaine
Local anesthetic
- Amide
Mepivacaine
Local anesthetic
- Amide
Prilocaine
Local anesthetic
- Amide
Bupivacaine
Local anesthetic
- Amide
Ropivacaine
Local anesthetic
- Amide
Propofol
IV General Anesthetic
Ketamine
IV General Anesthetic
Etomidate
IV General Anesthetic
Dexmedetomidine
IV General Anesthetic
Nitrous oxide
Inhalational General Anesthetic
Isoflurane
Inhalational General Anesthetic
Desflurane
Inhalational General Anesthetic
Sevoflurane
Inhalational General Anesthetic
Carbamazepine
Antiepileptic
Levetiracetam
Antiepileptic
Lamotrigine
Antiepileptic
Phenytoin
Antiepileptic
Valproate
Antiepileptic
Aprazolam
Anxiolytic, Alcohol withdrawal, Muscle spasms
- Benzodiazepine
- Allosteric ligand at GABA-A receptor. Potentiate effects of GABA (indirect effect on chloride influx through channel)
Chlordiazepoxide
Anxiolytic, Alcohol withdrawal, Muscle spasms
- Benzodiazepine
- Allosteric ligand at GABA-A receptor. Potentiate effects of GABA (indirect effect on chloride influx through channel)
Clonazepam
Anxiolytic, Alcohol withdrawal, Muscle spasms
- Benzodiazepine
- Allosteric ligand at GABA-A receptor. Potentiate effects of GABA (indirect effect on chloride influx through channel)
Diazepam
Anxiolytic, Alcohol withdrawal, Muscle spasms
- Benzodiazepine
- Allosteric ligand at GABA-A receptor. Potentiate effects of GABA (indirect effect on chloride influx through channel)
Lorazepam
Anxiolytic, Alcohol withdrawal, Muscle spasms
- Benzodiazepine
- Allosteric ligand at GABA-A receptor. Potentiate effects of GABA (indirect effect on chloride influx through channel)
- All benzos metabolized hepatically (either by oxidation OR glucoronidation).
- LOT: LOT drugs do not undergo oxidation (better for liver). Use in patients with liver problems or old patients.
Less lipophilic = Slow acting but More sustained relief.
- Does not cross BBB as quickly but does not deposit into peripheral fat either.
Midazolam
Anxiolytic, Alcohol withdrawal, Muscle spasms
- Benzodiazepine
- Allosteric ligand at GABA-A receptor. Potentiate effects of GABA (indirect effect on chloride influx through channel)
Temazepam
Anxiolytic, Alcohol withdrawal, Muscle spasms
- Benzodiazepine
- Allosteric ligand at GABA-A receptor. Potentiate effects of GABA (indirect effect on chloride influx through channel)
- All benzos metabolized hepatically (either by oxidation OR glucoronidation).
- LOT: LOT drugs do not undergo oxidation (better for liver). Use in patients with liver problems or old patients.
Oxazepam
Anxiolytic, Alcohol withdrawal, Muscle spasms
- Benzodiazepine
- Allosteric ligand at GABA-A receptor. Potentiate effects of GABA (indirect effect on chloride influx through channel)
- All benzos metabolized hepatically (either by oxidation OR glucoronidation).
- LOT: LOT drugs do not undergo oxidation (better for liver). Use in patients with liver problems or old patients.
Flumazenil
Benzodiazepine receptor antagonist
- Used in BZD complications
Buspirone
Anxiolytic
- Serotonin agonist
Zolpidem
Insomnia medication
- Lasts 3 hours
- Use less in women
Zaleplon
Insomnia medication
- Lasts 2 hours
- Jet lag
Eszopiclone
Insomnia medication
- Lasts 6 hours