CNS Drugs Flashcards
Anxiety?
DDx
How?
-just gimme suffix
Stress,
CVS stuff, arrhythmia need exclude
Give antianxiety aka hypnotic aka SLEEPING PILLs
- Benzodiazepine
- zepams and zolams
Benzodiazepines
- Names
- MOA
- Route
Midazolam - Short Lorazepam, Alprazolam -- note lorazepam no active intermediates; Diazepam - Long -- long can give for chronic anxiety
MOA
- binds to BZD sites at GABA channels, receptors
- increases CL channel opening
- more CL, more hyperpolarized
- POTENTIATES GABA, hence overdose ok;
- GABA is an inhibitory nT
IV
Oral (pills) onset 30 mins - 1hr
BZD AE
- think in systems
Contra I?
Gimme Macrolide A&E [4]
Gimme Penicillin A&E [1]
Gimme Opioid A&E [3]
CNS
- DROWSINESS, increase reaction time, depress motor skills
- ANTEROGRADE AMNESIA - roofies
CVS: decrease BP; RS: decrease respiration
Rare: Paradoxical; excitement, rage, violence
Neonatal toxicity: floppy child syndrome
Tolerance, Dependence, Withdrawal (lead to insomnia lol)
- ABUSE potential
Contra-I:
- causes FALLS in elderly
- roofies for anteriograde amnesia
- GOP: GI, Ototoxicity, Prolong QTC; N&V
- Allergy
- Constipation, N&V, Drowsiness
Insomnia give what? [2]
think sleep ZZ
Sleeping pills - BZD
- or non BZD hypnoptics eg Zolpidem, Zopiclone
- Zolpidem is Ambien
- Similar MOA to BZD and AE
Depression
- Pathophysiology
MED classes?
Monoamine Deficiency
- serotonin, NE
SSRI - selective serotonin reuptake inhibitor
SNRI - Serotonin-Norepinephrine RI
TCA - tricyclic antidepressants - prevent uptake of both S and NE by blocking transporters
SSRI
AE [4]
DDI
- anxiety
- weight gain, loss
- Headache, N
- Sexual Dysfunction
- DDI, bleeding
- possible serotonin syndrome
- drowsiness, insomnia; digestion problems
DDI: P450 inhibitor like Macrolide, FQ, Azole
Gimme 4 SSRI names
Flu-oxetine, Sertraline FS E Pram - Par-oxetine Escitalopram, Paroxetine
TCA
AE [4] 2 + 2
Names
- mi minnes :)
CNS: sedation, fatigue
CVS: TC, arrhythmia
Alpha block: postural hypotension (blocks vasoconstriction of periphery, skin) Muscarinic Block (glaucoma, blurred vision, urinary retention, constipation)
Names:
- Amitriptyline
- Imipramine
Effects of long term AD
Increase in BDNF in hippocampus;
increase growth of Serotonin, NE neurons
What is gold standard for AD, compare and contrast between TCA and SSRI
TCA is gold standard
- imipramine
SSRI preferred even tho more expensive but TCA can be fatal overdose; SSRI no severe CVS stuff like TCA
SSRI FAT also
Antipsychotic
- pathophysiology and name 1 psychotic dysorder
Excessive Dopamine transmission in mesocortico limbic system;
Schizophrenia
- delusions,
- poor concentration, disorganized thoughts, speech behavior
Name the antipsychotics and MOA
Gen 1 aka Typical - less Sedation than Gen 2
- Chlorpromazine
- Haloperidol (higher potency than chlorpromazine)
Blocks D1, D2, 5HT2, H2
- also blocks cholinergic; alpha adrenergic
Gen 2 Atypical - less EPSP than Gen 1
- OLANZAPINE
- Clozapine
- Blocks serotonin more than D2
- also others
MOA:
block Dopamine Receptors at limbic system helps psychosis
but blocking DoR at Basal Ganglia leads to EPS
List antipsychotic AEs
[4]
1st gen vs 2nd gen
EPS - bradykinesia, hypERtonia, lead pipe rigidity
Dystonia - repetitive twisting movement
(Dyskinesia is writhing)
Akathisia - restlessness
Tardy Dyskinesia - uncontrolled facial spasms
LESS SEDATION than Gen 2
but MORE EPSE than Gen 2
2nd gen
- weight GAIN for ALL, Sedation for ALL
- clozapine - need weekly blood test cos agranulocytosis
- olanzapine - weight gain, metabolic syndrome
Random afffffff DDIs
- Ginseng and TCM
- Codeine
- Sildenafil
TCM, Ginseng
- decreases BP
- careful when taking antihypertensives;
- (not CYP involved)
Codeine think Opioid
- Constipation, N&V
- Drowsiness, urinary retention
Sildenafil - Viagra lifestyle drug
- hypotension
Gimme the CNS targets and effects of
- HIV
- HSV
- Polio, EV
- Varicella
HIV: neuroglial - glial nodules
- also spinal cord vacuolation
- Posterior: DCML
- Anterior/Lateral: Corticospinal
HSV: temporal lobe - cowdry bodies
Polio, EV - motor neurons, flaccid paralysis
Varicella - Dorsal Root Ganglion
Fungal when?
Which for meningitis
Asper mould, Crypto for HIV, IC
capsulated yeast Cryptococcus Neoformans for meningitis
Whats imipramine
Gold standard AD
- TCA
Whats fluoxetine
- xexy X
Xetine think SSRI
SSRI lmao
Whats Escitalopram
novitalam
- SSRI
Whats paroxetine
- X
SSRI
Whats sertraline
SSRI
Whats amitriptyline
TCA
Name all SSRI and TCA and Sleeping pills and non sleeping pills
SSRI
- fluoxetine
- paroxetine
- escitalopram
- Sertraline SRI lmao
TCA
- imipramine
- Amitriptyline ATP
Sleeping pills
- Midazolam
- Lorazepam, Alprazolam
- Diazepam
Non-BZA - think zopis
- Zolpidem
- Zopiclone
Gimme the kopis
- ZZZs
Non-BZD sleeping pills
Zolpidem
Zopiclone
