CNS Flashcards

Question

benztropine

Answer 1

Cogentin | muscarinic receptor antagonist, anticholinergic ## Footnote -make take with food to decrease GI symptoms -potential anticholinergic side-effects -used in treatment of Parkinson's disease (PD) and extrapyramidal symptoms except tardive dyskinesia

Answer 2

Sinemet | dopamine agonist (levodopa), decarboxylase inhibitor (carbidopa) ## Footnote -carbidopa prevents the metabolization of levodopa before it can reach the brain -levodopa is prodrug, derivative of dopamine -antiparkinson agent to treat muscle stiffness, tremors, poor muscle control -can also be used in treatment of carbon monoxide poisoning or manganese intoxication which causes PD-like symptoms

Answer 3

Mirapex | non-ergot dopamine agonist (antiparkinson agent) ## Footnote -hallucinations may occur, report any changes in vision to MD -may cause drowsiness and sleep attacks (falling asleep without warning) -treats signs and symptoms of idiopathic PD and restless legs syndrome (RLS)

Answer 4

Requip | non-ergot dopamine agonist (antiparkinsons agent) ## Footnote -may cause drowsiness/dizziness, orthostasis may occur -avoid alcohol use during therapy -may cause sleep attacks (falling asleep without warning) -first FDA approved drug for moderate-severe restless legs syndrome (RLS)

Answer 5

Zyprexa | thienobenzodiazepine, 2nd-gen atypical antipsychotic ## Footnote -initially may cause dizziness -use caution when operating heavy machinery due to drowsiness -may cause weight gain, dyslipidemia (high cholesterol), increase risk of diabetes

Answer 6

Seroquel | 2nd-gen atypical antipsychotic ## Footnote -typically well-tolerated and used in pts with high sensitivity to other drugs (e.g. olanzapine, clozapine) -may initially cause dizziness -use caution when operating heavy machinery due to drowsiness -used in treatment of schizophrenia, MDD, bipolar disorder -low adverse side effects during long-term treatment

Answer 7

Risperdal | 2nd-gen atypical antipsychotics ## Footnote -first dose may cause fainting -may impair judgement -avoid alcohol use -used in treatment of schizophrenia, bipolar mania, psychosis, and as adjunct for MDD

Answer 8

Geodon | 2nd-gen atypical antipsychotic ## Footnote -may cause arrhythmias -do not DC abruptly -take with food -used in treatment of schizophrenia -monotherapy for manic and mixed episodes of bipolar disorder, but also as adjunct with lithium

Answer 9

Abilify | 2nd-gen atypical antipsychotic ## Footnote -avoid alcohol -can cause QT prolongation -do not DC abruptly -used in treatment of wide variety of mood disorders (e.g. MDD, schizophrenia, bipolar I, irritability associated w/ autism or Tourette's)

Answer 10

Antivert | 1st-gen antihistamine, H1 antagonist (nonselective) ## Footnote -potential anticholinergic side effects -antivertigo agent -treats nausea, vomiting, dizzinesss associated with motion sickness

Answer 11

Xanax | benzodiazepine ## Footnote -antianxiety -do not exceed prescribed dose -do not take with alcohol -may cause drowsiness/dizziness -do not operate heavy machinery -do not DC abruptly

Answer 12

Klonopin | benzodiazepine ## Footnote -antianxiety -do not exceed prescribed dose -do not take with alcohol -may cause drowsiness/dizziness -do not operate heavy machinery -do not DC abruptly

Answer 13

Valium | benzodiazepine ## Footnote -antianxiety -do not exceed prescribed dose -do not take with alcohol -may cause drowsiness/dizziness -do not operate heavy machinery -do not DC abruptly

Answer 14

Ativan | benzodiazepine ## Footnote -antianxiety -do not exceed prescribed dose -do not take with alcohol -may cause drowsiness/dizziness -do not operate heavy machinery -do not DC abruptly

Answer 15

Restoril | benzodiazepine ## Footnote -antianxiety -do not exceed prescribed dose -do not take with alcohol -may cause drowsiness/dizziness -do not operate heavy machinery -do not DC abruptly

Answer 16

Adipex-P | anorectics (appetite suppressant), indirect sympathomimetic, CNS stim ## Footnote -decreases appetite, although actual MOA unknown -used for obesity management -cardiovascular risk caution -take in morning

Answer 17

Concerta, Ritalin | CNS stimulant ## Footnote -take as directed, don't share pills -can cause dependance quickly -used for ADHD treatment for pts 12 and older -also used as second-line treatment for narcolepsy in adults -used off-label for cancer-related fatigue, refractory depression in older adults, apathy in pts with Alzhiemer's, and cognitive enhancement

Answer 18

Strattera | selective norepinephrine reuptake inhibitors (SNRIs) ## Footnote -ADHD treatment used to improve attention and reduce hyperactivity and impulsiveness -non-stimulant treatment for ADHD -may impair cognitivee and motor function -use caution when operating machinery -not drug of abuse

Answer 19

Adderall | CNS stimulant ## Footnote -take as directed, do not share pills -high potential of abuse, dependence, habit-forming -notify MD if past history of alcohol/drug abuse -stimulants increase risk of stroke, heart attack, sudden death in those with HBP, heart disease, or heart defects -do not use within 14 days of use MAOi or methylene blue injection -may cause new or worsen psychosis -do not use if pt has glaucoma, overactive thyroid, severe agitation, heart disease, coronary artery disease, HBP, vascular disease -watch for symptoms of serotonin syndrome (e.g. agitation, hallucinations, coma, fast heart rate, dizziness, sweating, shakiness, nausea, vomiting, diarrhea)

Answer 20

Vyvanse | CNS stimulant ## Footnote -take as directed, do not share pills -also used to treat moderate-severe binge eating disorders -prodrug of dextroamphetamine -can be habit forming, do not suddenly DC

Answer 21

Provigil | CNS stimulant ## Footnote -used for narcolepsy by promoting wakefulness -take in morning or 1hr prior to work -avoid driving until deemed safe by MD -also used in treatment of obstructive sleep apnea -used off-label for ADHD treatment, unipolar or bipolar depressive episodes, cocaine dependence, chronic fatigue due to cancer or multiple sclerosis (with mixed efficacy)

Answer 22

Focalin | CNS stimulant ## Footnote -can be habit forming, do not use if history of alcohol/drug abuse -take as drected, do not share pills -watch for signs of serotonin syndrome (e.g. agitation, hallucinations, coma, fast heart rate, dizziness, sweating, shakiness, nausea, vomiting, diarrhea) -do not DC abruptly -do not take with lithium, within 14 days of an MAOi, other stimulants for weight loss or attention disorder or wakefulness disorders

Answer 23

Sonata | pyrazolopyrimidine (non-benzo) hypnotic, "Z-drug" ## Footnote -take 30mins to 1hr prior to sleep -allocate at least 5 hours after dose to sleep -slightly effective in treatment for insomnia, very short half-life -meant to faciliate sleep induction rather than maintainence, may not reduce premature awakening, but can help with middle-of-night awakening -watch out for sleep-walking -has not shown to increase sleep time -not recommended for chronic use in geriatric population

Answer 24

Flexeril | tricyclic antidepressant, muscle relaxant ## Footnote -may cause drowsiness/dizziness and other anticholinergic side effects -avoid alcohol use -reduces muscle hyperactivity, although true MOA undetermined -food increases duration of drug in body and rate of absorption

Answer 25

Skelaxin | oxazolidione, skeletal muscle relaxant ## Footnote -least drowsy muscle relaxant -requires frequent dosing -used to treat muscle pain or spasms

Answer 26

Soma | skeletal muscle relaxant ## Footnote -used to relieve pain of musculoskeletal disorders -high rates for abuse despite low risk of dependence and low potential for abuse -caution for drowsiness -should only be used short term for acute treatment

Answer 27

Duragesic | opioid analgesic ## Footnote -100 times more potent than morphine, take caution and monitor narcotic naive pts -caution for respiratory depression -do not exceed prescribed dose -avoid exposing patches to heat, as it increases delivery and thus the risk of toxicity -dispose by folding over and flushing it -patch usually used for several days (~72hrs), but may be changed every 48hrs in some pts -high potential of abuse and dependence

Answer 28

MS Contin | opioid analgesic ## Footnote -risk of CNS and respiratory depression -avoid alcohol -may cause drowsiness/dizziness -do not operate heavy machinery -may cause constipation

Answer 29

Oxycontin | opioid analgesic ## Footnote -may cause CNS depression -avoid alcohol -may cause drowsiness/dizziness -do not operate heavy machinery -may cause constipation

Answer 30

Percocet, Roxicet | opioid analgesic ## Footnote -may cause CNS depression -avoid alcohol use -may cause drowsiness/dizziness -do not operate heavy machinery -may cause constipation -be aware of daily dose of APAP from all sources (4000mg max for 150lbs adult)

Answer 31

Tylenol with Codeine | opioid analgesic ## Footnote -may cause CNS depression, drowsiness/dizziness, constipation -do not operate heavy machinery -avoid alcohol use -be aware of daily dose of APAP from all sources (max 4000mg)

Answer 32

Tussionex | opioid analgesic ## Footnote -may cause CNS depression, drowsiness/dizziness, constipation -do not operate heavy machinery -avoid alcohol -may cause GI upset, take with food -max dose of 5mL BID

Answer 33

Vicoprofen | opioid analgesic ## Footnote -may cause CNS depression, drowsiness/dizziness, constipation -do not operate heavy machinery -avoid alcohol use -may cause GI upset, take with food -monitor daily ibuprofen intake (1200mg OTC, 3200mg if prescribed)

Answer 34

Norco, Lortab, Vicodin | opioid analgesic ## Footnote -may cause CNS depression, drowsiness/dizziness, constipation -avoid alcohol -do not operate heavy machinery

Answer 35

Lyrica | gabapentinoid analgesics, anticonvulsant ## Footnote -may cause drowsiness -do not DC abruptly -side effects may include weight gain, edema, confusion -avoid alcohol use -take with or without food -for treatment of neuropathic pain, fibromyalgia -although structurally similar to GABA, doesn't bind to GABA receptors

Answer 36

Chantix | partial cholingeric nicotinic receptor agonist ## Footnote -used for smoking cessation -usually titrated upwards with most effectiveness at ~44% at 12 weeks -watch for nightmares or changes in affect/behavior -side effects vary with dose -black box warning for aggression, seizures, and blacking out when taken with alcohol as it may increase the effects of alcohol

Answer 37

Namenda | NMDA (N-methyl-D-aspartate) receptor antagonist ## Footnote -first-line treatment of dementia associated w/ Alzheimer's disease (AD) -different MOA than other AD treatments, as it blocks effects of glutamate instead of inhibiting cholinesterase enzyme (can be used in combo with cholinesterase inhibitors for additional benefit) -take in evening, with or without food but take with full glass of water -may cause nausea and diarrhea, dizziness, agitation -set realistic expectations

Answer 38

Voltaren | NSAID, COX-2 inhibitor ## Footnote -take with food -monitor for symptoms of GI bleeding or ulcers, has cardiovascular and renal risks -enteric coated has slow onset, not for PRN pain; use non-EC formulation for PRN pain -greater risk of hepatotoxicity than other NSAIDs -treatment of arthritis, reducing inflammation -avoid excessive/chronic alcohol consumption

Answer 39

Lodine | NSAID ## Footnote -take with food -monitor for symptoms of GI bleeding or ulcers, has cardiovascular and renal risks -used in treatment of arthritis and acute pain -avoid alcohol

Answer 40

Indocin | NSAID, nonspecific COX inhibitor ## Footnote -take with or without food, but food helps with GI symptoms -monitor for symptoms of GI bleeding or ulcers, has cardiovascular and renal risks -most likely to cause headache and CNS side effects of all NSAIDs -treatment for chronic musculoskeletal pain in adults -also used to induce closure of ductus arteriosus in premature infants -avoid alcohol

Answer 41

Toradol | NSAID, nonselective COX inhibitor ## Footnote -take with food -very high risk of GI bleeding, should limit drug therapy for 5 days max -monitor for cardiovascular and renal symptoms -used in treatment of moderate-severe pain, headaches, menstral pain, arthritis, ankylosing spondylitis, post-op pain -has similar efficacy to morphine, good opioid sparing agent -should not take if pregnant past 30 weeks, may impair fertility for those attempting to conceive, can be excreted in breast milk but monitor carefully if deemed that benefits outweigh costs

Answer 42

Mobic | NSAID, COX inhibitor (preferential to COX-2) ## Footnote -take with or without food, food helps reduce GI symptoms -monitor for symptoms of GI bleeding, has cardiovascular and renal risks -used in treatment of musculoskeletal pain and arthritis in both children and adults -longer half-life than most NSAIDs, good for once daily dosing -used in combo with bupivacaine for post-op pain; in combo with rizatriptan for migraines -avoid alcohol

Answer 43

Relafen | NSAID, COX inhibitor (slight preference for COX-2) ## Footnote -take with food, increases rate of absorption -monitor for symptoms of GI bleeding, has potential for cardiovascular and renal risks -used for symptomatic relief of arthritis

Answer 44

Naprosyn, Aleve | NSAID, COX inhibitor (nonselective) ## Footnote -take with food to reduce GI symptoms -monitor for symptoms of GI bleeding, potential cardiovascular and renal risks -naproxen sodium (Aleve) has fast onset, regular naproxen (Naprosyn) has slow onset -regular naproxen used for chronic relief of arthritis pain, not acute pain -can be used in combo with sumatriptan to reduce migraine pain -used in combo with esomeprazole to reduce GI side effects

Answer 45

Feldene | NSAID, COX inhibitor (nonselective) ## Footnote -take with food to reduce GI symptoms -monitor for symptoms of GI bleeding, potential cardiovascular and renal risks -used in treatment of arthritis, musculoskeletal disorders, post-op pain -avoid alcohol

Answer 46

Motrin, Advil | NSAID, COX inhibitor (nonselective) ## Footnote -take with food to avoid GI upset, monitor for signs of bleeding -potential cardiovascular and renal risks -at low doses (OTC), is an analgesic and antipyretic, but for true anti-inflammatory effects, need doses of 2400-3200 mg/day (max dose range for adults) -first available OTC NSAID, mostly commonly used and prescribed NSAID -good for menstral cramps, as it reduces in uterine hypercontractility -exact MOA unknown?! -avoid alcohol

Answer 47

Celebrex | NSAID, COX-2 inhibitor ## Footnote -report signs of GI bleeding, has potential cardiovascular risks -not safer for renal function, but may be safer for GI bleeding risks -used in treatment of arthritis symptoms, acute pain, menstral pain, reducing polyps in familial adenomatous polyposis -avoid alcohol -avoid multivalent ions, separate from aluminum/magnesium containing drugs by several hours -under 200mg can be taken with or without food, 400mg+ should be taken with

Answer 48

Arthrotec | NSAID, prostaglandin ## Footnote -take with food -misoprostol may decrease GI bleeding risks -has potential cardiovascular and renal risks -avoid in pregnancy -diarrhea common side effect of prostaglandin component

Answer 49

Ultram | opiod analgesic, SNRI ## Footnote -may cause drowsiness, has increased seizure risk -has some GI effects, but can be taken with or without food -avoid alcohol, which increases risk of CNS effects -some risk of dependence due to weak opioid receptor agonist activity -has some SSRI properties, may cause serotonin syndrome -although structurally similar to other opioids, has additional drug interactions with SSRIs, SNRIs, 5-HT1 agonists/triptans -about 1/10 potency of morphine, but still has risk of dependence, abuse, and overdose -used off-label for treatment of premature ejaculation -unlike morphine, doesn't cause histamine release; may cause respiratory depression -if APAP combo (Ultracet), monitor amount of APAP per day (max 4g)

Answer 50

Tylenol | antipyretic, analgesic ## Footnote -used alone or in combo with opioids for pain relief -limit daily dose to 4g, 3g for geriatric population or frequent drinker, 2g if taking warfarin -consider total daily dose from all sources -black box warning for hepatotoxicity and angioedema (swelling in deep layers of skin (e.g. face, lips, tongue)) -most commonly taken analgesic worldwide -MOA not fully established -avoid alcohol, increases risk of hepatotoxicity -can be taken with or without food

Answer 51

Lunesta | nonbenzodiazepine sedative-hypnotic (Z-drug), cyclopyrrolone ## Footnote -do not take with alcohol -take 30 mins prior to bed -long half life (~6hrs) which can cause morning residual sedation and motor coordination impairment -many complain of bitter taste in morning -need to have minimum 8hrs sleep after taking -can cause complex sleep behaviors (e.g. sleepwalking, eating, driving), increasing risk of accidents -approved for long-term treatment of insomnia, while other sedative-hypnotics are only approved for short-term relief (6-8 weeks) -rapidly induces sleep and decreases sleep latency, aiding in sleep maintenance and preventing awakenings -do not take with high-fat meal, as it decreases absorption of eszopiclone

Answer 52

Ambien | nonbenzodiazepine sedative-hypnotic (Z-drug) ## Footnote -do not take with alcohol -take 30 mins prior to bed -do not take with or immediately after meals -long half life (~6hrs) which can cause morning residual sedation and motor coordination impairment -many complain of bitter taste in morning -need to have minimum 8hrs sleep after taking -can cause complex sleep behaviors (e.g. sleepwalking, eating, driving), increasing risk of accidents -used for short-term treatment of insomnia to improve sleep latency, increase sleep duration, decrease number of awakenings -low risk of drug withdrawal, dependence, and tolerance -has mild muscle relaxant properties, has propensity to partially/completely reverse abnormal metabolism of damaged brain cells after injury -suggest lower dosages for women

Answer 53

Pristiq | SNRI antidepressant ## Footnote -avoid alcohol -avoid St. John's Wort -take with or without food -do not DC abruptly -active metabolite of venlafaxine, but no added benefit over it, recommend generic venlaxafine instead -indicated for treatment of MDD -also used off label to treat hot flashes in during menopause

Answer 54

Cymbalta | SNRI antidepressant ## Footnote -do not abruptly DC -avoid excessive/chronic alcohol consumption as it increases risk of hepatotoxicity -take with/without food, but do not open capsule to sprinkle onto food/liquids -report changes in affect/behavior, has psychiatric side effects such as suicidal ideation -indicated in treatment of MDD, GAD, diabetic neuropathic pain, osteoarthritis in knee, fibromyalgia, musculoskeletal pain, chronic lower back pain, stress incontinence in women -used off-label in chemo-induced peripheral neuropathy, stress urinary incontinence in men after prostatectomy

Answer 55

Effexor | SNRI antidepressant ## Footnote -avoid alcohol -avoid St. John's Wort, may lead to serotonin syndrome -take with food to reduce possible GI upset -do not DC abruptly -monitor blood pressure -indicated in treatment of MDD, GAD, social anxiety disorder, panic disorder -second-line treatment of OCD -off-label uses in prophylaxis of migraines, reduction of vasomotor symptoms due to menopause

Answer 56

Celexa | SSRI antidepressant ## Footnote -may cause drowsiness -do not DC abruptly -avoid alcohol, St. John's wort (risk of serotonin syndrome) -take with/without food -no more than 40mg/day -avoid in pts with CV disease as it can cause QT prolongation -indicated in treatment of MDD in adults -used off-label in treatment of sexual dysfunction, alcohol abuse, OCD, social anxiety disorder, panic disorder, diabetic neuropathy, eating disorders -only SSRI that has tertiary amine and 2 nitrogen-containing metabolites

Answer 57

Lexapro | SSRI antidepressant ## Footnote -may cause drowsiness -do not DC abruptly -indicated in treatment of MDD, GAD -used off-label for symptoms of OCD -S-enantiomer of racemic citalopram, 150 times more potent than R-enantiomer -has allosteric action on target, superior efficacy and faster onset compared to other SSRIs

Answer 58

Prozac, Sarafem | SSRI antidepressant ## Footnote -may cause drowsiness or dizziness -avoid alcohol use, can take with or without food -longest SSRI half-life (~9 days) and most activating, thus AM dosing only -major inhibitor of CYP 2D6 -indicated for treatment of MDD, OCD, acute panic disorder independent of agoraphobia, bulimia nervosa, premenstral dysphoric disorder (PMDD) in female pts -can be used in combo with olanzapine to treat depression in BP I or treatment resistant depression

Answer 59

Paxil | SSRI antidepressant ## Footnote -may cause drowsiness -avoid alcohol, take with/without food -do not DC abruptly, most likely SSRI to cause discontinuation syndrome -short half-life, most tricyclic-like of SSRIs (e.g. sedation, major inhibitor of CYP 2D6) since it is highly potent in inhibition of serotonin reuptake -well tolerated in pts with adverse effect profile to other SSRIs -indicated in treatment of MDD, panic disorder, OCD, social phobia, generalized anxiety disorder, vasomotor symptoms of menopause (brand Brisdelle in 7.5mg dose), premenstrual dysphoric disorder -used off-label for treatment of premature ejaculation or IBS -CR formulation designed to decrease likelihood of nausea associated with IR

Answer 60

Zoloft | SSRI antidepressant ## Footnote -may cause drowsiness or dizziness -avoid alcohol use, St. John's wort (serotonin syndrome) -take with/without food -only SSRI recommended for those with CV disease and MDD -indicated in treatment of MDD, PTSD, OCD, panic disorder, prementral dysphoric disorder, social anxiety disorder -off-label uses include prevention of post-stroke disorder, GAD, fibromyalgia, premature ejaculation, migraine prophylaxis, diabetic neuropathy, neurocardiogenic syncope -onset of beneficial effects takes 4-6 weeks

Answer 61

Lidoderm | group I antiarrhythmic, topical anesthetic ## Footnote -do not apply to broken skin -apply in cycles of 12 hours on, 12 hours off -numbing effect caused by blocking sodium channels so neurons of local tissue cannot send pain signals to CNS -also decreases muscle contractile resulting in vasodilation, hypotension, irregular heart rate (not so much in patch form)

Answer 62

Elavil | tricyclic antidepressant ## Footnote -may cause drowsiness or dizziness -avoid alcohol, St. John's wort, limit caffeine intake, take with food to reduce GI upset -indicated for but rarely used for MDD, not well-tolerated and has anticholinergic effects; prophylaxis for chronic tension headaches and migraines, nocturnal enuresis in children -in low doses, used off-label for diabetic neuropathy, IBS, sleep disorders, agitation, fibromyalgia -risk of overdosing and causing CV death, arrhythmias -caution for suicidal ideation -has analgesic and sedative effects

Answer 63

Tofranil | tricyclic antidepressant ## Footnote -may cause drowsiness or dizziness -avoid alcohol, St. John's wort, bran/high-fiber foods, limit caffeine intake, take with food -has significant anticholinergic effects and risk of overdose -indicated in treatment of MDD and reduce childhood enuresis -used off-label for chronic pain, diabetic neuropathy, panic disorder, ADHD, PTSD

Answer 64

Lithobid, Eskalith | antimanic mood stabilizer ## Footnote -avoid alcohol (increases peak serum concentrations), avoid iodine-containing foods and supplements (causes hypothyroidism), limit caffeine intake (decrease lithium concentrations) -take with food to reduce GI upset -do not exceed recommended doses -drink 2-3 quarts of water every day -monitor serum levels -major interations with thiazide diuretics, which may require dosage reduction of lithium -indicated for monotherapeutic treatment of manic episodes or maintainence for BP I