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CNS Drugs Flashcards

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0
Q

Name the Inhibitory neurotransmitters of CNS:

A

GABA

Glycine

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1
Q

Name the Excitatory Neurotransmitters of the CNS:

A 
Acetylcholine
Norepinephrine
Dopamine
Serotonin
Glutamate
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2
Q

What is etiology of Parkinson’s Disease?

A

In Parkinson’s disease there is a loss of dopamine-containing neurons that project from the substantia nigra to the striatum where they inhibit cholinergic (ACh) neurons. Normally the striatum is connected to the substantia nigra by neurons that secrete the inhibitory transmitter GABA at their termini in the substantia nigra. In turn, substantia nigra sends neurons back to the striatum, secreting the transmitter dopamine to the termini. This mutual inhibitory pathway normally maintains balance. Destruction of cells of substantia nigra results in overproduction of Acetylcholine which triggers a chain of abnormal signaling, resulting in loss of control of muscle movements.

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3
Q

What types of drug therapies are available for Parkinson’s?

A

Dopamine Replacement Therapy
Dopamine Receptor Agonist Therapy
Anticholinergic Therapy

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4
Q

Anti-Parkinson Drugs: Dopamine Replacement Therapy

A
  • **Levodopa (L-dopa)
  • **Carbidopa (Lodosyn)
  • **Selegiline
  • **Amantidine
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5
Q

Anti-Parkinson Drugs: Dopamine Replacement Therapy –> Levadopa

A

***Levadopa (L-dopa) - dopamine replacement therapy for Parkinson’s
Levadopa is a metabolic precursor of dopamine. Decarboxylated to dopamine in brain. DA does not cross brain barrier.

Carbidopa and Levodopa are used today in combination. This is a prime example of a beneficial drug interaction that is logical based on the mechanism of action. Sinemet is the combined drug

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6
Q

Anti-Parkinson Drugs: Dopamine Replacement Therapy –> Carbidopa

A

Carbidopa (Lodosyn): Diminishes decarboxylation of L-dopa in peripheral tissies thereby prevents its peripheral biotransformation. Decreased required dose of L-dopa by about 75%.

Carbidopa and Levodopa are used today in combination. This is a prime example of a beneficial drug interaction that is logical based on the mechanism of action. Sinemet is the combined drug.

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7
Q

Anti-Parkinson Drugs: Dopamine Replacement Therapy –> Selegiline

A

***Selegiline (Deprenyl), is an inhibitor of monoamine oxidase - B (MAO - B), the enzyme that metabolizes dopamine in the CNS

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8
Q

Anti-Parkinson Drugs: Dopamine Replacement Therapy –> Amantidine

A

***Amandtidine (Symadine): in an antiviral drug effective in the Tx of influenza. It also enhances the synthesis, release and reuptake of dopamine from the surviving neurons.

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9
Q

Anti-Parkinson Drugs: Dopamine Receptor Agonist Therapy MOA:

A

DA Agonists can be used in Parkinson’s disease because although the dopamine-releasing neurons have disappeared, the postsynaptic dopamine receptors are still present and functional. Adminstration of dopamine agonists to stimulate these receptors should therefore restore the balance of inhibition and excitation in the basal ganglia.

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10
Q

Anti-Parkinson Drugs: Dopamine Receptor Agonist Therapy –>

A
  • **Bromocriptine (Parlodel): Powerful dopamine receptor agonist
  • **Ropinirole (Requip)
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11
Q

Anti-Parkinson Drugs: Dopamine Receptor Agonist Therapy –> Bromocriptine

A

Bromocriptine (Parlodel): powerful dopamine-receptor agonist

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12
Q

Anti-Parkinson Drugs: Dopamine Receptor Agonist Therapy –> Ropinirole

A

Ropinirole (Requip)

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13
Q

Anti-Parkinson Drugs: Anticholinergic Therapy MOA

A

These are muscarinic antagonists used in Parkinson’s disease. They reduce ACh: dopamine imbalance in the striatum. Side effects of these drugs include dry mouth, constipation, urinary retention, and confusion.

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14
Q

Anti-Parkinson Drugs: Anticholinergic Therapy - side effects

A

Side effects of these drugs include dry mouth, constipation, urinary retention, and confusion

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15
Q

Which Anti-Parkinson drug is also an anti-viral?

A

Amantidine is an antiviral drug effective in treating of influenza.

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16
Q

What is MOA of Anti-Alzheimer Drugs?

A

Alzheimer’s disease (AD) has been found to involve a number of systems in the brain. There is evidence for a decrease in choline acetyltransferase (that catalyzes the transfer of the acetyl group of acetyl CoA to choline, forming acetylcholine) and other markers of cholinergic neuron activity. Eventually cholinergic nuerons die or destroyed. Treatment has focused on increasing the amount of acetylcholine in the synapse by inhibiting the breakdown of acetylcholine. The most recent drug is an antagonist of N-methyl-D-aspartane (NMDA) receptor (Glutamate receptor), Overstimulation of these receptors may be a mechanism for neurodegenerative process in AD.

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17
Q

Anti-Alzheimer Drugs:

A

Cholinesterase Inhibitors - Donezepil (Aricept)

NMDA antagonists - Memantine: Appears to slow the progression of AD (slows the rate of memory loss).

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18
Q

Anti-Alzheimer Drugs - Cholinesterase Inhibitors - Donezepil

A

Donezepil (Aricept)

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19
Q

Anti-Alzheimer Drugs - NMDA Antagonist - Memantine

A

Memantine - Appearst to slow the progression of AD (slows the rate of memory loss).

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20
Q

What are Anxiolytic and Hypnotic Drugs?

A

These drugs are used for a variety of purposes, including treatment of anxiety and epilepsy, sleep induction and anesthesia. They are often called sedative-hypnotics or just anxiolytics. Cross tolerance occurs between all the CNS sedatives including the barbituates, benzodiazepines (BZDs) and ethanol.

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21
Q

How to classify Anxiolytics and Hypnotic drugs?

A

Barbituates
Benzodiazepines
And Other

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22
Q

What is MOA of Barbiturates?

A

Barbiturates enhance the fx of y-aminobutyric acid (GABA) in the CNS by enhancing the duration of chloride channel openings. This action hyperpolarizes the cell, and causes an increase in inhibition of CNS.

  • -Barbiturates produce sedation at low doses. At high doses, it can cause hypnosis, coma, death…
  • -Suppress respiration by inhibiting hypoxic and CO2 responses to chemoreceptors.
  • -Induce the LV P-450 system; so the metabolism of other drugs will be altered in its presence.
  • -Physical dependence occurs after chronic use.
  • -Symptoms of withdrawal in a person dependent on barbiturates include anxiety, nausea & vomiting, hypotension, seizures and psychosis. CV collapse may develop leading to death.
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23
Q

What does the duration of action of barbiturates depend on?

A

lipid solubility

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24
Anxiolytic and Hypnotic Drugs: Barbiturates: Long acting (1-2 days) --> Phenobarbital
Phenobarbital (Luminal): used as an anticonvulsant in epilepsy
25
Anxiolytic and Hypnotic Drugs: Barbiturates: Short acting (3-8 hours) --> Amobarbital
Amobarbital (Tuinal): Used by psychiatrists during analysis or therapy
26
Anxiolytic and Hypnotic Drugs: Barbiturates: Ultra-short acting (20 minutes) --> Thiopental (highly lipid soluble)
Thiopental (Pentothal): used in anesthesia
27
Anxiolytic and Hypnotic Drugs: Barbiturates: Ultra-short acting (20 minutes) --> Methohexital (highly lipid soluble)
Methohexital: used in anesthesia
28
MOA of Benzodiazepines: most widely used anxiolytic drugs
Benzodiazepines bind to a specific site on Neuronal GABA receptors. This binding enhances the affinity of GABA receptors for GABA, resulting in more frequent openings of the chloride channels. The increased influx of chloride causes increased inhibition
29
What do benzodiazepines do?
All BZDs reduce anxiety and sedation. In contrast to barbiturates BZDs reduce anxiety at doses that do not produce sedation. Some agents are used as antiepileptic agents and some are used in the induction of anesthesia. Duration of action and pharmacokinetic properties are important considerations in selecting the drug to be used.
30
What does dependence to BZDs look like?
Both physical and psychological dependence to BZDs can occur. Withdrawal can appear as confusion, anxiety, agitation and restlessness. BZD with short half-life induce more abrupt and severe withdrawal reactions than do drugs with longer half-lives.
31
Anxiolytic and Hypnotic Drugs: Benzodiazepines: Long acting --> Diazepam
Diazepam (Valium): used for anxiety and nerve disorders, skeletal muscle spasm, and spasticity from degenerative disorders such as MS and cerebral palsy
32
Anxiolytic and Hypnotic Drugs: Benzodiazepines: Shorter acting --> Alprazolam
Alprazolam (Xanax): used as an antidepressant, anxiolytic, and to treat panic attacks.
33
Anxiolytic and Hypnotic Drugs: Benzodiazepines: Shorter acting --> Oxazepam
Oxazepam (Serax): useful for treating elderly patients and patients with liver dysfunction because it does not rely on the liver for metabolism
34
Anxiolytic and Hypnotic Drugs: Benzodiazepines: Special Uses --> Diazepam
Long-acting: Diazepam (Valium): used in tx of status epilepticus
35
Anxiolytic and Hypnotic Drugs: Benzodiazepines: Special Uses --> Lorazepam
Short-acting: Lorazepam (Ativan): used in tx of status epilepticus
36
What 2 BZDs have the special use to treat status epilepticus?
Diazepam and Lorazepam
37
Anxiolytic and Hypnotic Drugs: Benzodiazepines: Special Uses --> Chlordiazepoxide
Long-acting: Chlordiazepoxide (Librium): used in case of alcohol withdrawal
38
What BZD has the special use to treat alcohol withdrawal?
Chlordiazepoxide (Librium)
39
What drug is a competitive benzodiazepine receptor antagonist? And uses?
Flumazenil is a competitive benzodiazepine receptor antagonist. It can be used to reverse the sedative effects of BZDs after anesthesia or after overdose with BZD.
40
What can be used in cases of overdose of BZD?
Flumazenil is a competitive BZD receptor antagonist and can be used after overdose of BZD.
41
Anxiolytic and Hypnotic Drugs: Other Anxiolytic Drugs: Buspirone
Buspirone (BuSpar): used to treat generalized anxiety disorder
42
Anxiolytic and Hypnotic Drugs: Other Anxiolytic Drugs: Zolpidem
Zolpidem (Ambien): used for short-term tx of insomnia, shows no tolerance or withdrawal effects. (Recently, Zolpidem has been cited in various medical reports mainly in UK as waking persistent vegetative state w/brain injuries)
43
What drug has been found to wake patients in persistent vegetative state with brain injuries?
Zolpidem (Ambien)
44
Effects of CNS Stimulants?
1. wakefulness (useful for narcolepsy) 2. more energy (fatigue) 3. more alert (fatigue) 4. more attentive (ADHD) 5. increase HT rate 6. increase respiratory rate (useful for neonatal apnea)
45
Classify CNS Stimulants:
1. Psychomotor Stimulants (Amphetamine, Methylphennidate, Nicotine, Bupropion, Theophylline, Caffeine, Cocaine) 2. Hallucinogens (Lysergic Acid diethylamids - LSD, Phencyclidine - PCP, Tetrahydrocannabinol - THC)
46
Uses of Psychomotor stimulants?
psychomotor stimulants have few clinical uses, but important as drugs of abuse
47
What is the main drug for ADHD?
Methylphennidate (Ritalin) used for ADHD and narcolepsy
48
CNS Stimulants: Psychomotor Stuimulants --> Bupropion
Bupropion is an antidepressant; can reduce craving for cigarettes
49
What is MOA of Cocaine?
Classified as a schedule II drug by DEA. It blocks the reuptake of norepinephrine, serotonin and dopamine into the presynaptic terminals thus potentiating and prolonging their actions. The prolongation of dopaminergic effects in the brain's pleasure system (limbic system) produces intense euphoria.
50
What are the uses of caffeine?
Used for prolonged apnea in pre-term infants. Included in some over the counter analgesic preparations, particularly headache remedies.
51
Classify Anesthetics:
1. General Anesthetics | 2. Local Anesthetics
52
What is general anesthetic?
The state of general anesthesia is a drug-induced absence of perception of all sensations. Depths of anesthesia appropriate for surgical procedures can be achieved with a wide variety of drugs.
53
What is MOA of general anesthetics?
Increase the sensitivity of GABA receptors to GABA
54
There are two categories of general anesthetics:
1. Inhaled Drugs | 2. IV Drugs
55
Anesthetics: General Anesthetics: Inhaled Drugs --> Halothane
Halothane (Fluothane)
56
Anesthetics: General Anesthetics: Inhaled Drugs --> Nitrous Oxide
Nitrous Oxide (Laughing Gas): Frequently employed at concentrations of 30% in combination with oxygen for analgesia, particularly in dental surgery
57
Anesthetics: General Anesthetics: IV Drugs --> Propofol
Propofol (Diprivan) - killed MJ
58
What are the 3 stages of General Anesthesia?
1. Induction 2. Maintenance of anesthesia 3. Recovery
59
What are the depths of General Anesthesia?
Stage I: Analgesia Stage II: Excitement Stage III: Surgical Anesthesia Stage IV: Medullary Paralysis
60
What is MOA of Local Anesthetics?
Local anesthetics block the sodium channels in the nerve membrane. This results in elevation of threshold for electrical excitation, reduction in the rate of rise of the action potential, and slowing of propagation of the impulse.
61
What can be mixed with certain local anesthetics in order to retard their systemic absorption?
Epinephrine
62
What is the order of effect with local anesthetics with increasing concentrations?
Pain Fibers -> Sensory Fibers -> Motor Fibers
63
What are the 2 categories of local anesthetics?
1. Esters | 2. Amides
64
Anesthetics: Local Anesthetics: Esters --> Cocaine
Cocaine is better known as a drug of abuse, but also an effect local anesthetic.
65
Anesthetics: Local Anesthetics: Amides --> Lidocaine
Lidocaine both local anesthetic and used via IV for the tx of cardiac arrhythmia
66
What is MOA of AntiDepressant Drugs?
All of the drugs in this group increase the concentrations of norepinephrine or serotonin in the synaptic cleft. In most cases they do by inhibiting the reuptake of the neurotransmitters. Remember that reuptake is a major route for termination of action of these neurotransmitters. Other drugs block their metabolic degradation or increase their release.
67
Classify Antidepressants:
1. Selective Serotonin re-uptake inhibitors (SSRIs) 2. Tricyclic Antidepressants (TCAs) 3. Monoamine Oxidase (MOA) Inhibitors 4. Serotonin/Norepinephrine Reuptake Inhibitors 5. Atypical 6. Drugs Used to treat Bipolar Disorder
68
Which group of AntiDepressants are most commonly prescribed?
Selective Serotonin Re-Uptake Inhibitors (SSRIs) SSRIs selectively inhibit reuptake of serotonin. It takes several weeks of tx with SSRIs to achieve a full therapeutic effect. In addition to depression, these drugs have efficacy in eating disorders, panic disorders. obsessive compulsive disorder, and borderline personality disorder.
69
Antidepressant Drugs: SSRIs --> Fluoxetine
Fluoxetine (Prozac): Increased suicide rate reported in patients taking Fluoxetine.
70
What are common SSRIs?
``` Fluoxetine (Prozac) Sartraline (Zoloft) Fluvoxamine (Luvox) Paroxitine (Paxil) Citalopram (Celexa) Escitalopram (Lexapro) ```
71
What is MOA of Tricyclic Antidepressants (TCAs)?
These drugs block the reuptake of biogenic amines, including norepinephrine and serotonin. They have a chemical structure of three-ring core. As with most antidepressants 2-3 weeks of dosing with the tricyclics are required before an effect on depression is detectable. In addition to depression, these drugs are used in enuresis, chronic pain, neuralgia, migraine, agoraphobia with panic attacks, obsessive compulsive neurosis,etc.
72
What are side effects of TCAs?
a. Anticholinergic effects: dry mouth, constipation, urinary retention, blurred vision, etc. This is most common side effect of TCAs. b. weak Alpha1 antagonists: causing orthostatic hypotension c. Weak H1 antagonists: causing sedation
73
MOA of Monoamine oxidase (MAO) inhibitors:
These drugs increase levels of norepinephrine, serotonin, and dopamine by inhibiting their degradation. The potential toxicities of MAO inhibitors restrict their use. MAO inhibitors can cause a fatal hypertension crisis. Patients who take MAO inhibitors should not eat foods rich in Tyramine. These foods include cheese, beer, and red wine. Normally tyramine is rapidly inactivated by MAO in the gut. Individuals who are taking MAO inhibitors are unable to inactivate the tyramine. The tyramine causes release of norepinephrine, which can lead to an increase in BP and cardiac arrhythmias.
74
What happens if a patient taking MAO drugs eats a lot of tyramine - containing food?
MAO inhibitors can cause a fatal hypertensive crisis. Patients who take MAO inhibitors should not eat foods rich in tyramine. These foods include cheese, beer, and red wine. Normally, tyramine is rapidly inactivated by MAO in gut. Individuals who are taking MAO inhibitors are unable to inactivate the tyramine. The tyramine causes release of norepinephrine, which can lead to an increase in BP and cardiac arrhythmias.
75
Anti-Depressants: MAO Inhibitors --> Phenelzine
Phenelzine (Nardil)
76
What are the uses for Venlafaxine?
Velafaxine (Effexor): Used to treat major depression, anxiety, panic attacks and nerve pain.
77
What are the uses of Bupropion?
Bupropion (Wellbutrin): Used as anti-depressant, but also for cessation of smoking.
78
What is the adverse effect of Trazodone?
priapism
79
What are the use, caution during use and adverse effects of Lithium?
Anti-depressants: Drugs used to treat Bipolar Disorder -- > Lithium (Eskalith) - is considered the standard tx for bipolar disorder. As a low therapeutic index. Frequent measurements of serum levels are routinely carried out during chronic Tx. - Its use is occasionally associated with hypothyroidism and nephrogenic diabetes insipidus. Both conditions are reversible on stopping lithium.
80
Overview of psychotic disorders:
Psychotic disorders are clinical syndroms characterized by impaired sense of reality, disturbance of thought and emotion, hallucinations (often auditory - the voice tells me), delusions and confusion. Schizophrenia is a psychotic disorder. Widely accepted theories suggest that psychoses are due, at least in part, to excessive dopamine neurotransmission.
81
MOA of neuroleptics:
These drugs block dopamine, muscarinic cholinergic, alpha-adrenergic, and H1-histaminergic receptors. Dopamine antagonism produces antipsychotic effect. Dopamine inhibits prolactin release. Thus an antagonism to dopamine results in an increase in prolactin release leading to lactation. All of these drugs produce extrapyramidal effects caused by blocking of dopamine receptors in striatum of basal ganglia.
82
What are extrapyramidal effects caused by blocking of dopamine receptors?
Dystonia - spasm of muscle of face, tongue, neck and back akathisia - motor restlessness tardive dyskinasia - stereotyped voluntary movements such as lip smacking, jaw movements, and darting tongue parkinsonism - tremor, rigidity and shuffling gate neuroleptic malignant syndrome - rare and potentially fatal - marked by catatonia, rigidity, stupor, fluctuating BP, fever and dysarthria
83
Classify Neuroleptics:
1. Typical Neuroleptics - these drugs block dopamine, muscarinic cholinergic, alpha-adrenergic, and H1- histaminergic receptors. Chlorpromazine (Thorazine) Haloperidol (Haldol) et. al 2. Atypical Antipsychotics - these drugs reduce both the negative and positive signs of schizophrenia, while causing minimal extrapyramidal side effects. Clozapine (Clozaril) Risperidone (Risperidal)
84
Drugs affecting CNS: Neuroleptics --> Chlorpromazine
Chlorpromazine (Thorazine): antipsychotic affect and also used for nausea, vomiting and hiccoughs
85
Drugs affecting CNS: Neuroleptics --> Haloperidol
Haloperidol (Haldol): antipsychotics and also used for Tourette's and Huntington's disease
86
What are the actions and advantages of using atypical antipsychotics?
They reduce both negative and positive symptoms of schizophrenia while causing a minimum of extrapyramidal side effects (dystonia, akathisia, tardive dyskinasia, parkinsonism, and neuroleptic malignant syndrome).
87
What are the side effects and precautions while using Clozapine?
Clozapine (Clozaril): can cause severe agranulocytosis. Should have your WBC count on a regular basis (weekly).
88
What are the positive symptoms of schizophrenia?
hallucination, delusion, disordered thought, agitation
89
What are the negative symptoms of schizophrenia?
withdrawal, flat affect, anhedonia (inability to experience pleasure while participating in normally pleasurable activities)
90
What is neuroleptic malignant syndrome? Cause, symptoms and treatment.
This is a rare, potentially fattal neurologic side effect of antipsychotic medication. It is marked by catatonia, rigidity, stupor, fluctuating BP, fever and dysarthria. Because mortality is high (10-20%) immediate medical attention is required. This syndrome has occurred with all neuroleptics. Antipsychotic drug must be discontinued immediately. Malignant syndrome is treated with bromocryptine (dopamine agonist) or dantrolene (mechanism of action associated with reversing malignant syndrome is unknown).
91
How to treat neuroleptic malignant syndrome?
Discontinue use of antipsychotics immediately. Treat with bromocryptine (dopamine agonist) or dantrolene.
92
Definition of narcotics?
Narcotics aka opiates refers to drugs that act on specific receptors in the central nervous system (CNS) to reduce perception of pain. In general they do not eliminate the pain, but the patient is not bothered by the pain. They act on 3 major classes of receptors in CNS called opioid receptors and designated mu, kappa and delta. Most of the actions of the narcotic analgesics are mediated by the mu receptor. Some actions are mediated through the kappa and delta receptors.
93
Classify Narcotics:
1. Strong (full) agonists (Morphine & Meperidine/Demerol) 2. Weak agonists (Codeine & Oxicodone) 3. Mixed agonists & antagonists (Pentazocine/Talwin) 4. Antagonists (Naloxone/Narcan) 5. Other central analgesic (Tramadol)
94
Narcotics: Strong (full) agonists --> Morphine
Morphine: highly effective opioid analgesic Actions on CNS: in most people produces drowsiness and sedation in addition to reduction in awareness of pain. Effective cough suppressant - codeine Actions on Eye: pupillary constriction by a direct action i the brain nucleus of oculomotor nerve - pinpoint pupil Respiratory depression by direct action on CNS; can cause death at high doses ***has no effect on cardiovascular Action on GI: increased resting tone of the smooth muscle resulting in decrease in the movement of ST and intestinal contents leading to spasm and constipation Action on genitourinary: increases the tone and produces spasm of the smooth muscle in the GU tract which can lead to urinary retention
95
What are symptoms of withdrawal from a narcotic?
autonomic hyperactivity, such as diarrhea, vomiting, chills, fever, tearing, and runny nose. Tremor, abdominal cramps and pain can be severe.
96
Narcotics: Strong (full) agonists --> Meperidine
Meperidine (Demerol): less potent than morphine and less spasmogenic. It has no cough suppressive ability.
97
Narcotics: Strong (full) agonists --> Fentanyl
Fentanyl (Sublimaze): is 80x more potent than morphine but has a short duration of action. It is used by anesthesiologists
98
Narcotics: Strong (full) agonists --> Heroin
Heroin: is more lipid soluble than morphine, and therefore, rapidly crosses the blood-brain barrier. It is hydrolyzed to morphine in the brain, thus it is a prodrug.
99
Narcotics: Strong (full) agonists --> Methadone
Methadone: a highly effective analgesic after oral administration and has a much longer duration of action than morphine.
100
Narcotics: weak agonists --> Codeine
Codeine: used for suppressing coughs and pain. It is much less potent than morphine
101
Narcotics: weak agonists --> Oxycodone
Oxycodone (Oxycontin)
102
What is the danger of using mixed group while withdrawn from a strong agonist? For example Pentazocine (Talwin)
Pentazocine (Talwin): produces effects that are qualitatively similar to Morphine... It can cause acute withdrawal symptoms in patients who have received regular doses of morphine or other agonists, eg Methadone
103
Narcotics: opioid antagonists --> Naloxone
Naloxone (Narcan): is the drug of choice for narcotic overdose
104
MOA and adverse effect of phenytoin (antiepileptic drug)?
Phenyltoin (Dilantin): blocks voltage gated sodium channels by selectively binding to the channel. Adverse effects are gingival hypertrophy and megaloblastic anemia.
105
Classification of drugs according to the type of Epilepsy:
Partial or Focal: Simple --> Phenytoin, carbamazepine Partial or Focal: Complex --> Phenytoin, carbamazepine Generalised: Tonic-clonic --> Phenytoin, carbamazepine Generalised: Absence --> Ethsuximide Generalised: Myoclonic --> Valproic Acid Generalised: Febrile Seizures --> Diazepam Generalised: Status Epilepticus --> Phenytoin, Diazepam

Pharmacology (7 decks)

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