CNS agents Flashcards
Enzyme inducers
Rifampin Phenytoin Phenobarbital Carbamazepine Nafcillin Alcohol St. John’s wort
Enzyme inhibitors
Erythromycin Cimetidine Ciprofloxacin Fluconazole Ketoconazole Itraconazole Clarithromycin Amiodarone Grapefruit juice
Antidepressants BB warning
Increased risk of suicidal thoughts and behavior
Desipramine Nortriptyline Amitriptyline Imipramine Doxepin Tri-cyclic Antidepressants
Medications take weeks to work!
Amitriptyline
Dosing:
Elderly patients: start at half the dose
Monoamine Oxidase Inhibitors Phenelzine Isocarboxazid Tranylcypromine Selegiline
Avoid OTC decongestants
Wash out period
Paroxetine
Pregnancy Category D
Venlafaxine
Monitor BP
Bupropion
Smoking cessation, Alternative if experiencing sexual side effects from other agents
Nefazodone
Priapism
Trazodone
Often used as a hypnotic
Take with food
Butalbital with Caffeine and Acetaminophen
Report HA that persists for more than 3-4 days
5-HT Receptor Agonists “Triptans”
“Standard of care” in the treatment of acute migraine
Sumatriptan
injection
GABA
inhibitory neuro excitory transmitter
phenytoin dosing considerations
Hypo-albuminemia
ALBUMIN- Low albumin will increase phenytoin (higher free levels= more adverse effects)
phenytoin reactions
nystagmus (involuntary eye movement)
Decreases efficacy of oral contraceptives
carbamazepine
diplopia
Auto-inducer (induces its own metabolism)
Stevens Johnson Syndrome (SJS)
Valproic acid
weight gain, alopecia, blurry vision
avoid in young women
oxcarbazepine
Consider alternative/additional BC
Is not an auto-inducer
lamotrigine
Black box warning – risk of life threatening rash
lithium
mood stabilizer
Caution use of diuretics, NSAIDs, ACE-I’s, ARBs
Atypical Anti-psychotic agents
Have become 1st line or standard of therapy
Atypical agents BBW
Tight glycemic control for all agents- hyperglycemia (diabetes)
Aripiprazole
Hyperglycemia, drug induced diabetes mellitus
olanzapine
weight gain
Weight gain can lead to diabetes mellitus
quetiapine- seroquel
Hyperglycemia, drug-induced diabetes mellitus, EPRs
risperidone
Hyperglycemia
May prolong QT interval- Associated with Arrhythmias
Benzodiazepines
CNS effects
Avoid alcohol consumption
Schedule IV medication
Buspirone
Non-benzodiazepine anti-anxiety agent
Eldery patience to use half the dose
Effects of drug may take time (> 1 week)
Do not abruptly stop the drug
Alzheimer’s Disease
Causes: Deficiency in acetylcholine (neurotransmitter Poor prognosis Degeneration of brain tissue Atrophy occurs Medications are not curative
Donepezil
Bedtime dosing
Memantine
hallucinations)
Parkinson’s Disease
A deficiency of dopamine in the basal ganglia
Carbidopa/Levodopa
Levodopa circulates in plasma to the blood brain barrier then converted to dopamine
Carbidopa inhibits breakdown of levodopa which increases the amount of levodopa at the BBB
Ropinirole
Monitor blood pressure (orthostatic)
Sleep Inducing Agents
Gradual taper upon discontinuation to prevent rebound, relapse or withdrawal symptoms
Temazepam
Elderly patients should be started on lower doses
Varenicline
Black box warning: depression, suicidal thoughts
Pharmacist counseling points:
Family members should be aware of mood/suicide thoughts
Amphetamine/Dextroamphetamine
Cardiac effects, drug abuse/dependency
Growth suppression, psychiatric imbalance
Aggression, seizures, visual disturbances
Avoid doses close to bedtime
Drug holidays – children
For catch up growth
Methylphenidate
Avoid doses close to bedtime Drug holiday (children)
