CNS Drugs Flashcards
Zolpidem
Z-Drug. Commonly associated with sleep related behaviors. Short duration of action.
Atomoxetine Indications
ADHD. Especially in addicts (doesn’t cause euphoria).
Parkinson’s Pathophysiology
Caused by a loss of DA neurons in the nigrostriatal system. Treatment must balance Ach and DA.
Cholinesterase Inhibitors MOA
Increase Ach in the nerve terminals. May slow the progression of Alzheimer’s.
Mepivacaine
Amide LA. Intermediate duration of action.
Eszopiclone
Z-Drug. Long half life. Used for long-term treatment.
Secobarbital
Barbituate
Smoking Cessation
Bupropion will treat nicotine craving.
DOC for Bipolar Disorder
Lithium
TCA MOA
Inhibit re-uptake of NE and 5HT. Also blocks alpha, histamine and Ach receptors. Dirty drugs!
Galantamine
Cholinesterase Inhibitor used in Alzheimer’s
Tigabine Indications
Adjunct for partial seizures.
Metratazpine MOA
Blocks presynaptic alpha 2 receptors. Increases the release of NE and 5HT.
Citalopram.
SSRI. DOC for depression. Low incidence of drug interactions.
Z-Drugs MOA
Sedative-hypnotics. Bind the GABA receptor to increase GABA mediated inhibition.
Alcohol MOA
Binds to GABAa receptrs to increase Cl influx and enhance GABA (inhibitory) transmisison. Increases beta-endorphins in the mesolimbic pathway.
Cocaine effects
CNS stimulant. Increased SNS tone. Alertness, euphoria, hyperactivity, tachycardia, vasoconstriction, HTN, hyperprexia.
Midazolam
Very short-acting Benzodiazepine. Used for anxiety disorders and short surgical procedures as anesthesia.
DOC for Partial Seizures
Carbamazepine
Vigabatrin Indications
Refractory complex partial seizures. West’s syndrome.
Carbamazepine Indications
DOC for partial seizures. Also used for Trigeminal neuralgia, TC seizures and Refractory cases of Bipolar disorder.
Disulfuram (antabuse) MOA
Inhibits aldehyde dehydrogenase. Causes build up of acetyldehyde (flusing, nausea, HA).
Ropinirole
DA D2 agonist. Used as monotherapy in mild Parkinson’s. Can cause sudden sleep during the day.
Korsakoff’s psychosis
Chronic disabling memory loss
Memantine
NMDA receptor antagonist, reduces excitotoxic effects of glutamate and slows degerneration. Used in the late stages of Alzheimer’s in combination with a Cholinesterase Inhibitor.
Lamotrigine Indications
Partial seizures, Bipolar Disorder (prevents relapse). May be effective at treating myoclonic and absence seizures in children.
Carbamazepine SE
Diplopia, ataxia, high risk of SJS, Teratogenic.
Valproic Acid Indications
Second line treatment of absence seizures. Myoclonic seizures, bipolar disorder (rapid cycling), Migraine prophyaxis, mixed seizures.
Levodopa (L-dopa) Contraindications
Psychosis, Cardiac disease, malignant melanoma. Don’r use with MAOIs (HTN crisis).
Pramipexole
DA D2 agonist. Used as monotherapy in mild Parkinson’s. Can cause sudden sleep during the day.
Olanzapine (Zyprexa)
Atypical Antipsychotic. Can also be used in bipolar disorder. Similar to clozapine without the risk of agranulocytosis. EPS is very rare. Contraindicated in DM due to hyperglycemia.
PCP/Ketamine
NMDA receptor antagonists. Developed as general dissociative anesthetics. Cause analgesia accompanied by aggression. Often produces psychosis (treat with haloperidol).
Botulinum Toxin
Direct acting muscle relaxant. Inhibits Ach release from the nerve at the junction. Very toxic in large amounts.
Amitriptyline
TCA. Tertiary amine (primarily 5HT uptake).
Nigrostriatal DA Pathway
SN to the Striaturm. Motor. Parkinson’s (not enough DA) and the side effects of many antipsychotics.
Naltrexone Indications
Treatment of alcoholism and opiod addiction. Decreases craving.
Baclofen SE
Drowsiness, weakness. Respiratory depression with intrathecal administration (can reduce other SE and increase treatment).
Topiramate Indications
Partial and TC seizures. Migraine prevention.
Opiod MOA
Closes voltage gated Ca channels on presynaptic nerve terminals to decrease neurotransmitter release and neuronal activity. Decreases glutamate from the dorsal horn or the spinal cord to the brain. Mu receptors also open K channels to hyperpolarize the cell.
Alcohol Withdrawal Treatment
Hydration. Diazepam or chlordiazepoxide to prevent seizures/DTs. Lorazepam to treat seizures. Phenytoin is second line to treat seizures.
Pentazocine MOA
Mixed Opiod. Kappa agonist (dysphoria) and partial Mu agonist.
DOC for Depression
Citalopram
Topiramate MOA
Anti-convulsant. Blocks Na channels to potentiate GABA and block glutamate.
SNRI Indications
Depression, neuro pain, post menopausal hot flashes. Have more side effects than SSRIs.
Buproprion Contraindications
History of seizures.
Dantrolene
Direct acting Muscle Relaxant. Inhibits Ca release by blocking the RyR1 channel on the SR (interferes with excitation/contraction coupling). Used in neuroleptic malignant syndrome and malignant hyperthermia.
Vigabatrin SE
Visual field problems and retinal damage.
Gabapentin Indications
Adjunct use for partial and TC seizures. Neuropathic pain and Bipolar Disorder (rapid cycling).
Clonazepam MOA
Benzodiazapine. Stimulates GABA.
Ethosuximide Indications
DOC for absence seizures.
Buproprion Indications
Refractory depression (combined with SSRIs), ADHD, Alcoholism, smoking cessation (extended release). Causes less sexual dysfunction than the other antidepressants.
Trazodone Indications
Sleep aid and pain. Not useful in depression.
Amantadine
Antiviral that increases DA transmissioin and is used to treat early/mild cases of parkinson’s or as an adjunct to other treatment . Can cause livedo reticularis (red/blue spotting of skin).
Imipramine
TCA. Tertiary amine (primarily 5HT).
Oxymorphone
Moderate Opiod. Similar to oxycodone but doesn’t need to be activated by CYP2D6.
GHB
GABA receptor weak agonist. Developed as general dissociative anesthetics. Used as date rape drugs.
Carbamazepine MOA
Anticonvulsant. Blocks Na channels (decreases glutamate)
Amide Metabolism
Metabolized via CYP 450s. Can cause toxicity in patients with liver disease. Excreted by the kidneys.
PTSD Treatment
Anti-Depressants
Atomoxetine MOA
Selective NE reuptake inhibitor.
Gabapentin MOA
Anti-convulsant. GABA analogue.
Phenytoin/Fosphenytoin SE
Gingival hyperplasia. Risk of SJS. Teratogenicity.
Methanol Poisoning Treatment
Fomepizole (alcohol dehydrogenase inhibitor) can also use ethanol.
Meperidien (demerol) SE
Renal failure (don’t use longer than 48 hours), Seizures (due to metabolite normeperidine), Tachycardia. MAOI: serotonin syndrome. No antitussive effects.
Antipsychotic Drug Interactions
Sedative-Hypnotics: Increased Sedation Smoking: Induces CYP450s
Naltrexone MOA
Opiod receptor antagonist. Reduces craving. Long-acting.
SNRI MOA
Inhibits NE and 5HT reuptake
Fluphenazine
Classical Antipsychotic. Selective for DA D2 receptors. Less anticholinergic effects so higher risk of EPS.
Meperidien (demerol) MOA
Opiod. Mu agonist plus NE/5HT reuptake inhibitor. Also blocks muscarinic receptors.
Diazepam
Long- acting Benzodiazepine. Used in anxiety disorders, status epilepticus, alcohol/barbituate withdrawal (prevents seizures) and as a muscle relaxant
Ester Metabolism
Metabolized via butyrulcholinesterases in the plasma. Shorter duration of action and increased systemic toxicity. excreted by the kidneys. Has PABA as a metabolite which can cause allergic reactions.
Donepezil
Cholinesterase Inhibitor used in Alzheimer’s
Levetricetam SE
Dizziness, ataxia, asthenia (weakness), minimal drug interactions.
Hydromorphone
Strong opiod
Morphine
Strong Opiod. Severe pain. Injected. Associated with itching and vomiting.
Trazodone MOA
Anti-depressant. 5HT receptor antagonist.
Chlorpromazine MOA
Classical antipsychotic. Blocks DA D2 receptors but also alpha adrenergic and Ach receptors.
Rasagiline SE
Causes insomnia (take in the morning). Don’t use with Merperidine (stupor, rigidity, agitation) or TCA/SSRIs (serotonin syndrome).
Benzocaine
Ester LA. Topical use only. Pka=3.5 so always in nonionized form.
Acute Alcohol Toxicity Presentation
Emesis, stupor, coma, respiratory depression, electrolyte imbalances, hypothermia, decreased BP and CO.
Diazepam MOA
Centrally acting muslce relaxant (benzodiazepine). GABAa medicated presynaptic inhibition of the spinal cord. Also used in anxiety disorders, status epilepticus, alcohol/barbituate withdrawal (prevents seizures)
Tramadol Drug interactions
Serotonin syndrome if combined with MAOIs, TCAs, SSRIs/ Seizures: antidepressants.
Barbituates SE
Low margin of safety! Drowsiness, respiratory depression. Paradoxical excitement. Causes euphoria (drug of abuse) Supra-additive effect with alcohol.
Methamphetamines
Increases the release of DA and NE in the basal ganglia.. Rapid physical and psychological dependence. Cardiac toxicity, odor (hyperthermia), meth mouth, meth bugs.
Lithium MOA
Suppresses second messengers. Not metabolized. Excreted by the kidneys.
Fluoxetine
SSRI. Inhibits CYP450 (drug interactions). Inhibits conversion of codeine to morphine. Impairs BGL in DM.
D2 agonist Side effects
Anorexia, N/V, GI upset, Dyskinesias, mental disturbance, decreased prolactin.
Thopental
Barbituate. Used for induction of anesthesia.
SSRI Drug Interactions
MAOIs: Serotonin syndrome St. Johns Wort: Serotonin syndrome Opiods: Fluoxetine inhibits the conversion of codeine to morphine. Tramadol: inhibits 5HT reuptake and can lead to seizures and serotonin syndrome.
Nitrous Oxide
Used as an inhalant. Chronic use causes peripheral neuropathy. Frequently abused by dentists.
Classic Antipsychotics MOA
“neuroleptics.” Block DA D2 receptors. Target the mesolimbic system so only alleviates positive symptoms.
Mesolimbic DA Pathway
From the VTA to the Limbic system. Emotion. Too much DA causes the positive symptoms of schizophrenia.
Cocaine overdose
V-tach and V-fib. Strokes, bleed, seizures.
Pentazocine Indications
Moderate pain. Useful in addicts (low abuse potential).
Fetal Alcohol syndrome
microceophaly, mental retardation, poor coordination, flat face, joint abnormalities, heart defects, impaired immune system.
Apomorphone
DA D2 agonist. Used as “rescue” for the on/off phenomenon in successful L-dopa therapy. Caused N/V give antiemetic (trimethobrinzamide) beforehand.
Metratazpine Indications
None of the side effects associated with SSRIs (blocks 5HT in other places). Useful in depression mixed with insomnia or anxiety.
Methadone Indications
Treatment for addicts (prevent withdrawal) and long term pain control.
Phenelzine
MAOI. Inhibits MAO-A and MAO-B. Drug of last choice for depression. Don’t eat dietary tyramine (HTN crisis).
Lidocaine
Amide LA. Rapid onset. Used for infiltrative and epidural blocks. Not for spinal blocks (risk of TNS). Also used as an anti arrhythmic.
Venlaxfaxine
SNRI. May increase BP.
Development of Opiod Tolerance
Occurs rapidly. NMDA antagonists may decrease the development of tolerance. No tolerance develops to miosis, constipation or seizures.