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CNS Flashcards

1
Q

Amphetamine based stimulants examples

A

Amphetamine (Adderal)
Methylphenidate (Ritalin)

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2
Q

What are the indications of amphetamines

A

ADHD
Narcolepsy

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3
Q

Mechanism of action of amphetamine

A

Stimulates CNS through a sympathomimetic mechanism involving the enhanced release and reduced reuptake of NE and Dopamine

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4
Q

Adverse effects of ampthetamines

A

Photosensitivity( due to mydriasis)
Visual disturbance (paralyze accommodation)
Elevated BP(release NE stimulate A1)
Infection (fight flight-increased steroid release)
Headache

Serious side effects=
Dependency and abuse
Psychosis
Growth suppression
Heart failure
Stevens-johnson syndrome

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5
Q

Drug interaction between amphetamines and CAI (carbonic anhydrase inhibitors) (Diamox)

A

Renal excretion of amphetamine is decreased in alkaline urine

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6
Q

Dug interaction between amphetamines and sympathomimetic drugs eg phenylephrine

A

Hypertensive crisis
Arrhythmia

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7
Q

Dug interaction between amphetamines and ophthalmic B-blockers

A

Hypertensive crisis

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8
Q

Contraindications of amphetamines

A

Glaucoma

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9
Q

ADHD results from low levels of

A

Dopamine

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10
Q

Depression results from low levels of

A

NE and serotonin

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11
Q

SSRI (selective serotonin reuptake inhibitors) examples

A

Escitalopram
Sertraline
Fluoxetine

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12
Q

Escitalopram (SSRI) indication

A

Major depression
Generalized anxiety disorder

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13
Q

Escitalopram (SSRI) adverse effects

A

Common:

  • Dizziness

Distinguishing:

  • suicidal risk
  • serotonin syndrome(serious)
  • Neuroleptic malignant syndrome
  • Seizures

Ocular:

  • dry eye
  • Blur
  • Diplopia
  • Conjunctivitis
  • Ptosis
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14
Q

Drug interactions with SSRI’s (Escitalopram)

A

NSAIDS & Omega 3- hemorrhage risk (diminishing platelet aggregation)
Ophthalmic B-Blockers- reduced B-blocker metabolism (CYP450)

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15
Q

SNRI (Serotonin norepinephrine reuptake inhibitors) examples

A

Duloxetine
Venlaflaxine

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16
Q

Indication of SNRI’s

A

Depression
Anxiety
Diabetic neuropathic pain
Fibromyalgia

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17
Q

Adverse effects of SNRI’s

A

Common:
Blurred vision
Headache
Dizziness
Sweating
Erectile dysfunction
Orthostatic hypotension
Hypertension
Syncope
Yawning
Constipation

Distinguishing:
Serotonin syndrome
Hypersensitivity: Angioedema, Stevens-Johnsons

Ocular:
Glaucoma

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18
Q

Drug interactions with SNRI’s

A

Opioids- additive effect- shut down digestion
NSAID & Omega 3 - hemorrhage
Beta-blocker- reduced B-Blocker metabolism

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19
Q

Cautions for use of SNRI’s

A

Risk of bleeding
Angle closure glaucoma

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20
Q

TCADs (tricyclic antidepressants) examples

A

Imipramine
Amitriptyline
Clomipramine

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21
Q

Indications of trazodone(atypical antidepressant)

A

Major Depressive disorder
Insomnia

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22
Q

Examples of atypical antidepressants

A 
Trazodone 
Bupropion (wellbutrin, Zyban) 
Nefazadone
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23
Q

Mechanism of action of Trazodone (atypical antidepressant)

A

SSRI
A1 blocker
Seratonin 2a/c blocker (5-HT a/c)

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24
Q

Adverse effects of Trazodone (atypical antidepressant)

A

Common:
Headache
Dizziness
Blurred vision
Ocular irritation

Distinguishing:
Suicidal ideation
5-HT syndrome (serotonin syndrome)

CVS: hemorrhage

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25
Drug interactions of Trazodone (Atypical antidepressant)
Cyclosporine, Macrolides(antibiotic),Azoles- QT prolongation & impaired hepatic metabolism NSAID-hemorrhage
26
Mania is due to an excess of which neurotransmitters
NE, 5-HT and DA
27
Difference between D1 and D2 receptors
D1- stimulatory D2- inhibitory
28
1st generation (typical) antipsychotics are antagonists of which receptor
Selective D2
29
2nd generation antipsychotics have selectivity for which receptors
Vary in selectivity for D2 and 5-HT2A- higher risk of metabolic side effects (hyperglycemia, dyslipidemia, weight gain)
30
3rd generation antipsychotic acts as functionally selective drugs. True or false
True
31
1st generation antipsychotic examples
Haloperidol Chlorpromazine Thiorodazine
32
2nd generation antipsychotic examples
Quetiapine Clozapine Olanzapine Risperidone Ziprasidone Iloperiodone
33
What was the first ever antipsychotic
Lithium
34
3rd generation antipsychotic examples
Aripiprazole (partial agonist of D2 and 5HT1A) Brexpiprazole (partial agonist of D2,D3 and near full agonist of 5HT1A)
35
Indications of Quetiapine( 2nd gen antipsychotics)
* Schizophrenia * Bipolar
36
Adverse effects of quetiapine
Common: * Headache * Anemia Hypersensitivity: * Stevens-Johnsons Muscular: * Extrapyramidal symptoms Ocular: * Cataracts
37
Quetiapine (2nd gen antipsychotic) mechanism of action
Antagonizes D2 and 5HT2 receptors
38
Name a CNS drug which is associated with cataract formation
2nd gen antipsychotics eg Quetiapine 1st gen antipsychotics eg Haloperidol
39
Interactions with quetiapine(2nd gen antipsychotic)
Macrolides, Azoles, cyclosporine - Prolonged QT segment Classic(sedating) antihistamines -additive CNS depression
40
1st gen antipsychotic side effects
Haloperidol: * Photosensitivity * Anticholinergic effects * Drowsiness * Anxiety * Cataracts * Retinopathy Chlorpromazine&Thioridazine: * Blur * Ocular pigmentation * Jaundice * Photosentitivity * Cataracts * Retinopathy * Night blindness * Salt & pepper fundus
41
What drug is associated with salt and pepper fundus
Chlorpromazine/ Thioridazine
42
Adverse effects of lithium
Blurred vision Seizures Bradycardia Idiopathic intracranial hypertension
43
Drug interactions with lithium
Caffeine and CAI - reduced lithium levels through diuresis NSAIDs , tetracycline- increased lithium levels
44
Alzheimers
Loss of cholinergic neurons
45
Donepezil (Alzheimer therapy) indication
Alzheimer's Dementia
46
Mechanism of action of Donepezil (Alzheimer's therapy)
Indirect acting, reversibly binds to and activates acetylcholinesterase (AChE) resulting in a sustained acetylcholine response
47
Adverse effects of Donepezil
* Headache * Dizziness * Arthritis * * Seizures * Dream disturbances * Hemolytic anemia * AV block (atrioventricular block) * Bradycardia * Syncope
48
Drug interactions with Donepezil
* Cholinergic agents(pilocarpine) - additive * NSAIDs- Hemorrhagic risk * Anticholinergics(atropine)- Antagonism * Macrolides& azoles- Reduced metabolism of donepezil * Dexamethasone- Enhanced metabolism of donepezil * Brimonidine & Timolol ophthalmic- Enhanced bradycardia and bronchospasm * Ester Anesthetics- Reduced metabolism of anesthetics
49
Sinemet (Levodopa &Carbidopa) combination is indicated for
Parkinson's
50
Mechanism of action of Sinemet(Levodopa and carbidopa)
Levodopa is a DA precursor that unlike DA crosses the BBB to enhance DA synthesis Carbidopa is an inhibitor of dopa decarboxylase (enzyme that degrades levodopa to dopamine), peripheral degradation prevents drug crossing BBB (makes sure the levodopa enters cns)
51
Adverse effects of sinemet(Levodopa&carbidopa)
Headache Confusion Psychosis(elevation of catecholamines) Suicidal ideation Hallucinations
52
Indications of Bromocriptine
Parkinson's Acromegaly (developemental condition) Hyperprolactinemia Neuroleptic malignant Syndromes(over activity in muscles)
53
Mechanism of action of Bromocriptine
Stimulates DA receptors Inhibits anterior pituitary prolactin secretion
54
Adverse effects of Bromicriptine
Headache Dizziness Nasal congestion(changes in vascular tone) Visual disturbance Seizures Neuroleptic malignant syndrome if abrupt discontinuing Hypertension Orthostatic hypotension
55
Drug interactions of Bromocriptine
Avoid: Pseudoephedrine, epinephrine- additive hypertension Monitor: Cyclosporine(more oral)- levels of both drugs may rise Caution: Cetirizine -additive CNS depression Macrolides, Azoles-elevated bromocriptine levels
56
Contraindications for bromocriptine
Uncontrolled hypertension (HTN)
57
Safinamide indications
Parkinson's Dystonia
58
Mechanism of action of Safinamide
Selectively inhibits MAOb Increasing extracellular DA in the striatum
59
Adverse effects of Safinamide
HTN (hypertension)(elevate sympathetic activity) Nausea cough Hallucinations NMS (Neuroleptic malignant Syndrome) if abrupt discontinuation Retinal degeneration(animal studies)
60
Contraindications of Safinamide
Tramadol(opioid) - additive 5HT-syndrome risk Monitor: (additive HTN) Caffeine, epinephrine, Naphazoline ophthalmic oxymetazoline opt phenylephrine oph pseudoephedrine
61
Anxiolytics
``` Majority of drugs in this class promote actions of GABA which is the CNS major inhibitory neurotransmitter ```
62
\_\_\_\_\_\_\_\_ is nr 1 stimulatory neurotransmitter \_\_\_\_\_\_ nr 1 inhibitory neurotransmitter in CNS
Glutamate is nr 1 stimulatory neurotransmitter in CNS GABA is the nr 1 inhibitory neurotransmitter in CNS
63
Anxiolytic/hypnotic drug classes
Benzodiazepines Non-benzodiazepines Barbiturates
64
Intermediate acting Benzo's
Alprazolam(low potency, high TI) Lorazepam Temazepam(low potency, igh TI) Clonazepam(high potency and lower TI)
65
Short acting Benzo's
Midazolam Triazolam
66
Long acting benzo's
Diazepam Chlordiazepoxide(low potency, high TI) Flurazepam
67
Indications of Alprazolam(Benzo)
Anxiety Panic disorder
68
Mechanism of action of Alprazolam(Benzo)
Selectively binds to BZD(benzodiazepine) site on GABAa receptors, allosterically enhancing GABA affinity Receptor activation opens ion channel leading to chloride influx or efflux and resultant hyperpolarization(inhibition)
69
Does cocaine, benzo's, amphetamines act directly or indirectly on receptors
Indirect
70
Side effects of alprazolam(Benzo)
* Diplopia * Drowsiness * Anterograde amnesia * Confusion * Dizziness * Hypotension * Steven's-Johnson * Angioedema
71
Drug interactions of Alprazolam(Benzo)
Cyclosporine, Azoles, Macrolides - reduced alprazolam metabolism Chlorpheniramine, diphenhydramine, opioids -additive effect
72
Contraindications of alprazolam(Benzo)
unstable Myasthenia gravis
73
Non-benzo example
Zolpidem
74
Indications of zolpidem
Insomnia
75
Mechanism of action of zolpidem(non-benzo)
Selective agonist of GABAa-BZD-1 receptor
76
Adverse effects of zolpidem
Headache Sinusitis Pharyngitis Amnesia Suicidal ideation Aggression Hallucinations (Flippen verslawend! veronderstel om nie te wees)
77
Drug interactions with zolpidem
Cyclosporine, Azoles - reduced metabolism of zolpidem Classic antihistamines, opioids- additive
78
Indications of phenobarbital(barbituate)
Seizure disorder Status epilepticus Sedation
79
Mechanism of action of phenobarbital(barbituate)
Convey synaptic inhibition to sensory cortex and to cerebellar and motor activities ,produces sedation, hypnosis and anesthesia Enhances GABA effects at GABAa receptor
80
Adverse effects of phenobarbital
Drowsiness Nausea and vomitting Respiratory depression Hypersensitivity: Steven's-Johnsons, angioedema, Blood dyscrasias Withdrawal symptoms if abrupt discontinuation
81
Drug interactions of phenobarbital
* Acetaminophen(paracetamol)-phenobarbital enhances acetaminophen metabolism leading to metabolic toxicity risk * Opioids-phenobarbital enhances acetaminophen metabolism leading to metabolic toxicity risk * Erythromycins(macrolides), tetracyclines, steroids- enhanced metabolism by phenobarbital * Azole antifungals- enhanced metabolism by phenobarbital * Classic antihistamines- additive cns depression * Lidocaine topical- increased methemoglobinemia risk
82
Contraindications of phenobarbital
Respiratory dysfunction
83
Indications of phenytoin
Seizure disorders Status epilepticus
84
Mechanism of action of phenytoin
Modulates neuronal voltage-dependant sodium and calcium chanels
85
Adverse effects of phenytoin
* Nystagmus * Blur * Headache * Pancytopenia (lower than normal red&white blood cells and platelets in blood) * Hypersensitivity- stevens johnsons, TEN (rare life threatening skin condition) * Lupus
86
Drug interactions with phenytoin
Acetaminophen- induced hepatic metabolism by phenytoin metabolite toxicity riak with repeated dosing Erythromycin,azoles,opiods,steroids- induced hepatic metabolism by phenytoin Antihistamines-additive cns depression Topical lidocaine- increased methemoglobinemia risk Acyclovir- reduced phenytoin levels
87
Contraindications of phenytoin
Caution in diabetes
88
Examples of muscle relaxants
Cyclobenzaprine Tizanidine
89
Indication of cyclobenzaprine and tizanidine
Muscle spasm Fibromyalgia
90
Mechanism of action of cyclobenzaprine
Central acting: potentiates NE and stimulates serotonin receptors
91
Mechanism of action of tizanidine
Central acting: binds to presynaptic alpha 2 adrenergic receptors, inhibits neurotransmitter release
92
Adverse effects of cyclobenzaprine symptoms
Blur Headache Hypersensitivity Myocardial infarction
93
Adverse effects of tizanidine
Hypotension Blur Syncope Bradycardia Hypersensitivity stevens johnsons
94
Drug interactions of cyclobenzaprine
Avoid anticholinergics- additive effects Avoid serotonergic agents - additive effects, risk of serotonin syndrome
95
Drug interactions of tizanidine
Ciprofloxacin- reduces tizanidine metabolism leading to a rise in levels with routine dosing
96
Adverse effects of cyclobenzaprine
Blur Headache Hypersensitivity Myocardial infarction
97
Adverse effects of tizanidine
Hypotension Blur Syncope Bradycardia Hypersensitivity stevens johnsons
98
Drug interactions with cyclobenzaprine
Avoid Anticholinergics- additive effects Avoid serotogenic agents- additive effects, riak of serotonin syndrome
99
Contraindications of cyclobenzaprine
CNS depressant use Narrow angles Elevated IOP
100
Contraindications of tizanidine
CNS depressant use
101
ADHD is characterized by low/high levels of which neurotransmitter
Low dopamine
102
Depression is characterized by low/high levels of which neurotransmitters
Low Norepinephrine and low serotonin
103
Mania/psychosis is characterized by low/high levels of which neurotransmitters
High Dopamine, high Norepinephrine and high Serotonin
104
Alzheimers is characterized by low/high levels of which neurotransmitters
Low Acetylcholine and high Glutamine
105
Parkinsons is characterized by low/high levels of which neurotransmitters
Low Dopamine , high Acetylcholine
106
Anxiety is characterized by low/high levels of which neurotransmitter
Low GABA

Pharmacology (19 decks)

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