CNS Flashcards
What are the inhibitory neurotransmitter of the brain
- GABA (brain)
- Glycine (spinal cord)
What are the excitatory neurotransmitter of the brain
- Glutamate
- 5-HT (serotonin)
Primary neurotransmitter of the brain
GABA
Primary neurotransmitter of spinal cord
Glycine
What are the Target Actions of CNS Drugs
- PISO (cations)
- MICO (cations)
- PhIClo [anions]
- SuliBio [anions]
Depolarization
- stimulatory effects (+)
- (kapag positive sa loob)
DeCaNa
(Depolarization Calcium Sodium)
Hyperpolarization
- inhibitory effects (-)
- (kapag negative sa loob)
HyKCl
(Hyperpolarization Potassium Chloride)
What Disease is stated below:
▪️↑ Dopamine
▪️↑ 5-HT (Serotonin)
▪️↓ Glutamate
Schizophrenia
What is the goal for drugs of Antipsychotics/ Neuroleptics / Major Tranquilizers
Goal: ↓ DA, ↓ 5-HT
What drug is under of this:
▪️1st Gen/Classical/Traditional Antipsychotics
▪️MOA: Block D2 receptors
▪️Additional effects: Anti-HAM (Histamine (H1)- sedation, Alpha-1-vasodilation, ↓BP, Muscarinic 1&3- urinary retention
▪️Use: For Positive Symptoms
- Phenothiazine (-azine)
- Butyrophenones (-peridol)
- Thioxenthenes (-thix)
What drug is it:
▪️1st Gen/Classical/Traditional Antipsychotics
▪️For Manic Phase, Huntington Disease, Tourette Syndrome (TS)
Haloperidol and/or Droperidol
1st Gen/Classical/Traditional Antipsychotics
▪️↑ Potency = ↑ D2 affinity & ↓ HAM
▪️Mnemonics: BP PTA
Butyrophenones = Piperazines > Piperidines > Thioxanthines > Aliphatic
What drug is under of this:
▪️2nd Gen/Atypical Antipsychotics
▪️MOA: Block 5-HT > D4 receptors
▪️Use: For Negative Symptoms
▪️Advantage: NO EPS (extrapyramidal symptoms)
-zapine, -xapine, -peridone
- Clozapine
- Olanzapine
- Risperidone
- Loxapine
- Aripiprazole
What drug is it:
▪️2nd Gen/Atypical Antipsychotics
▪️Only antipsychotic that ↓ suicide risk
▪️Never given as 1st line bcoz. of SAM (seizures, agranulocytosis, myocarditis)
▪️No EPS
▪️↑ risk of seizure
Clozapine
What drug is it:
▪️2nd Gen/Atypical Antipsychotics
▪️Partial D2 Agonist
▪️Least Seadating
Aripiprazole
What drug is it:
▪️2nd Gen/Atypical Antipsychotics
▪️S/E: Weight gain
▪️ NOF: Overweight/Obesity, DM
Olanzapine
What drug is it:
▪️2nd Gen/Atypical Antipsychotics
▪️For intractable hiccups
Risperidone
What drug is it:
▪️2nd Gen/Atypical Antipsychotics
▪️ Used to induce sedation
Quetiapine
What is the Adverse Effects/SE for 1st & 2nd Gen Antipsychotics due to DA receptor blockade
- EPS (Extrapyramidal Syndrome)
- Hyperprolactinemia-↑ PRL
- Neuroleptic malignant syndrome
What is the 1st line tx for EPS
Goal: ↓Ach -> centrally acting anticholinergics (BBT)
- Biperiden
- Benztropine
- Trihexyphenidyl
What is the management for neuroleptic malignant syndrome
- Dantrolene (DOC)
- Bromocriptine (D2 Agonist)
What is common adverse effect/SE in 2nd Gen Antipsychotic
Weight gain
Drugs in 2nd Gen Antipsychotics that does not have a S/E of weight gain
Mnemonics: AMA
- Aripiprazole
- Molindone
- Amisulpride
Mood Regulation Neurotransmitters
- 5-HT
- NE
- DA
Biologic Theory for Mood Disorders
↓ Ne, 5-HT, DA
What is the Goal for Antidepressants
Goal: ↑ 5-HT, NE, DA
What drug is it:
▪️MOA: Block reuptake of NE > 5-HT
▪️Additional Effect: Anti-HAM
▪️Use: Mgt. of neuropathic pain, enuresis, anxiety attacks (panic attacks), OCD
-triptyline (Ami-, Nor-)
- pramine (Imi-, Desi-)
Doxepine
Antidepressant
Management of neuropathic pain
Amitriptyline
Antidepressant
Mgt. of enuresis
Imipramine (DOC)
Antidepressant
Mgt. of anxiety attacks (panic attacks)
Imipramine
Antidepressant
Mgt. of OCD
Clomipramine
Toxicities due to narrow TI in Antidepressant of Mood Disorder
Triads 3C’s
1. Cardiotoxicity
2. Convulsions
3. Coma
What are the Tetracyclic Antidepressants Drugs
Mnemonics: Ma Mia Amor
Maprotiline
Mianserin
Amoxapine
What are the Non-Selective MAOI that also use for Mood Disorder
Use: Mgt. of atypical depression (psychotic features, phobias)
Phenelzine
Isocarboxazid
Tranylcypromine (PT)
Drug-Food Interactions with MAOI
MAOI + Tyramine rich foods = HTNsive crisis
What drug is under of this:
▪️Selective 5-HT Reuptake Inh.
▪️MOA: Blocks 5-HT reuptake
▪️1st line w/ MDD
▪️ All are Category C except Paroxetine
Flu-Flu (Fluoxetine & Fluvoxamine)
Paro-Ser (Paroxetine & Sentraline)
Citalopram & Escitalopram
What is safer to use than TCAs & MAOIs
SSRI
SSRI
▪️Mgt. of OCD (Flu Flu)
Fluoxetine (laging piliin pag mang huhula)
Fluvoxamine
SSRI
▪️Mgt. of PDD (Premenstrual Dysphonic Disorder)
Fluoxetine
Fluvoxamine
SSRI
▪️Mgt. of bulimia nervosa
▪️Mgt. of OCD
▪️Mgt. of PDD
Fluoxetine
Black Box Warning: Fluoxetine (Prozac) - ↑ risk of (?)
↑ risk of suicidality
What is the Mgt. for Serotonin Syndrome
Cyproheptadine (5-HT Antagonist)
What is SNRI
Serotonin Norepinephrine Reuptake Inhibitor
What drug is it:
▪️SNRI
▪️Use: Mgt. of depression in px. w/ back pain or muscle pain, chronic muscle pain
Duloxetine
Venlafaxine
What drug is it:
▪️SNRI
▪️Hepatotoxic
Duloxetine
What drug is it:
▪️SNRI
▪️Cardiotoxic
Venlafaxine
▪️Drugs for Mood Disorder
▪️MOA: (-) presynaptic alpha-2 receptor
▪️Adv: Does not cause sexual dysfunction
▪️Ex. Mirtazapine (Remeron)
NASSA (Noradrenergic & Selective 5-HT Antagonist)
What drug is it:
▪️Drug for Mood Disorder
▪️under Norepinephrine Dopamine Reuptake Inh.
▪️Use: for smoking cessation
▪️Does not cause sexual dysfunction
Bupropion
What drug is it:
Reversible Inh. of MAO-A
Moclobemide
Drugs for Bipolar Disorder (4)
- Lithium Carbonate (Eskalith)
- Valproic Acid
- Carbamazepine
- 2nd Gen Antipsychotics
What drug is it:
▪️MOA: (-) phosphoinositides recycling
▪️Use: 1 mgt of Mania & Hypomania
Lithium Carbonate (Eskalith)
What drug is it
▪️Drugs for Bipolar Disorder
▪️Better than Li for rapid recycles
Valproic Acid
What drug is it
▪️Drugs for Bipolar Disorder
▪️Prophylaxis or tx. of mania
Carbamazepine
Biological Theory for Anxiety
Biological Theory:
- ↓GABA, ↑ EPI, ↑ Cortisol
Drugs for Anxiety/ Anxiolytics/ Minor Tranquilizer
- Benzodiazepines (-zepam, -zolam)
- Barbiturates (-barbital, -bital)
Short-Acting BZDS [MT-zolam]
- use for initiation & maintenance of sleep
Midazolam
Triazolam
Intermediate-Acting BZDS [LTO-zepam, A-zolam]
- use for seizures and insomnia
Lorazepam
Temazepam
Oxazepam
Alprazolam
Long-Acting BZDS
Diazepam -> N-desmethyldiazepam
What are the Ultra Short Acting Barbiturates (sulfur containing)
“TTM”
- Thiopental
- Thiamylal
- Methohexital
What class of Barbiturates is stated below:
▪️Very lipophilic
▪️Rapid onset of action, short duration
▪️USE: For induction of anesthesia
Ultra short acting
What are the Short Acting Barbiturates
“5-6-7 barbital”
- Pentobarbital
- Hexobarbital
- Secobarbital
What class of Barbiturates is stated below:
▪️USE: Sedatives
Short Acting Barbiturates
What are the Intermediate Acting Barbiturates
” AmoButa”
- Amobarbital
- Butabarbital
What class of Barbiturates is stated below:
▪️USE: Hypnotic
Intermediate Acting Barbiturates
What are the Long Acting Barbiturates
- Phentobarbital
What class of Barbiturates is stated below:
▪️USE: Anticonvulsant, insomnia, migraine relief
Long Acting Barbiturates
What do we called to- transient loss of memory after administration of high doses of BZDs
Anterograde amnesia
What drug is it:
▪️Basis for date-rape drug
▪️Acceptable use: During surgery/procedure
Flunitrazepam (Rohypnol) “roofies”
What drug is it:
Management of spasticity states (Cerebral Palsy)
Diazepam
What drug is it:
Mgt. of seizures
CD-zepam & P-bital
- Clonazepam
- Diazepam
- Pino-barbital
What drug is it:
Mgt. of Neonatal Hyperbilirubinemia
Phenobarbital
What type of seizure is stated below:
▪️Involves 1 hemisphere
▪️Aka: Jacksonian Seizure
▪️Remains conscious/ No loss of consciousness
Simple Focal Seizure (Partial)
What type of seizure is stated below:
▪️Involves 1 hemisphere
▪️Aka: Psychomotor Seizure
▪️Loss consciousness
▪️(+) altered sensorium
Complex Focal Seizure (Partial)
DOC/ 1st line: Focal Partial Seizure
Phenytoin
Carbamazepine
What type of seizure is stated below:
▪️Both hemisphere
▪️Impaired consciousness
▪️Tonic-Clonic Seizure (Grand Mal)
Grand Mal Seizure
What type of seizure is stated below:
▪️Both hemisphere
▪️Blank stares, lip smacking
▪️Common in children
Absent Seizure (Petit Mal)
DOC/ 1st Line: Generalized Seizure/Grand-Mal
Valproic Acid
DOC/ 1st Line: Absence Seizure (Petit Mal)
Ethosuximide
DOC/ 1st line: Atonic Seizure [loss of muscle tone]
Clonazepam
DOC/ 1st Line: Acute Seizure
Diazepam
What type of seizure is stated below:
▪️medical emergency
▪️ 5 minutes or more of continuous seizure
▪️ recurrent seizures without recovery
Status Epilepticus
New DOC for Status Epilepticus
Lorazepam
Old DOC for Status Epilepticus
Diazepam
Drugs: Anticonvulsants
What drug is it:
▪️Na channel blocker (2)
- Carbamazepine
- Phenytoin
Drugs: Anticonvulsants
What drug is it:
▪️Na, Ca channel blockade
▪️↑ GABA
▪️Broadest spectrum
Valproic Acid
Drugs: Anticonvulsants
What drug is it:
▪️T-type
▪️Ca channel blockade
Ethosuximide
Drugs: Anticonvulsants
What drug is it:
▪️GABA-mimetics
Phenobarbital
Diazepam
Neurodegenerative Disorder
Parkinson’s Disease
Manifestation of Parkinson’s Disease
“TRAPS”
Tremors
Rigidity
Akinesia/ Bradykinesia
Postural instability
Shuffling gait
Drugs for Anti-Parkinsonism
What drug is it
▪️MOA: Precursor of DA
▪️It can pass through BBB
Levodopa
Drugs for Anti-Parkinsonism
What drug is it:
▪️Antiviral
▪️Used primarily in the mgt. of Influenza A
Amantadine
DOC for Parkinson’s Disease
Levodopa
What type of Anesthesia is stated below:
A state characterized by unconsciousness and loss of reflexes-through IV or inhalational
General Anesthesia
What type of Anesthesia is stated below:
Loss of sensation in a limited region of the body
Local Anesthesia
What Inhaled Anesthetics is stated below:
▪️aka: laughing gas
▪️non-volatile gas
▪️weakest anesthetic; potent analgesic
Nitrous oxide (N2O)
What Inhaled Anesthetics is stated below:
▪️ popular anesthetic for outpatient procedure
Desflurane
What Inhaled Anesthetics is stated below:
▪️For children-sweet & less pungent
Sevoflurane
What Inhaled Anesthetics is stated below:
▪️For asthmatic px.
Enflurane
What Inhaled Anesthetics is stated below:
▪️For children also but most hepatotoxic
Halothane
What Inhaled Anesthetics is stated below:
▪️Used: During labor
▪️Potent anesthetic; weak analgesic
Methoxyflurane
Intravenous Anesthetic
What drug is it:
▪️milk emulsion (milk of anesthesia)
▪️ most commonly used for induction
Propofol
Intravenous Anesthetic
What drug is it:
▪️MOA: (-) NMDA receptors
▪️Similar to Phencyclidine aka: Angel Dust
▪️Use: For dissociative anesthesia
Ketamine
Intravenous Anesthetic
What opioid analgesics is for General Anesthesia
Morphine
Fentanyl
Sulfentanyl
What Local Anesthetics is stated below: -MOA: Na channel blocker
- Ester Type: 1i
- Amide Type: 2ii
- Procaine, Cocaine
- Lidocaine, Bupivacaine (most cardiotoxic), Prilocaine
BN of Lidocaine + Prilocaine
EMLA