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Pharmacology Drug Chart > CNS Drugs - Tox > Flashcards

CNS Drugs - Tox Flashcards

1
Q

What are the Major and Secondary side effects of Levodopa (L-DOPA) (Dopar)

A

Major: Dyskinesias, on-off phenomenon (“off” = no symptoms relief, “on” = dyskinesia), NMS (muscle+autonomic+CNS probs) on withdrawal
Secondary: Peripheral DA-like side effects (anorexia, nausea, vomiting, fatigue, hypotension, dizziness, hallucinations, cardiac arrhythmias, pleural effusions, cough, SOB, pulmonary fibrosis, edema, psychosis with chronic use)

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2
Q

What are the Major and Secondary side effects of Carbidopa (Lodosyn)

A

Major: Dyskinesias, on-off phenomenon, NMS on withdrawal
Secondary: Peripheral DA-like side effects

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3
Q

What are the Major and Secondary side effects of Pergolide (Permax)

A

Major: Cardiac valve regurgitation
Secondary:

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4
Q

What are the Major and Secondary side effects of Bromocriptine (Parlodel)

A

Major:
Secondary: Peripheral DA-like side effects

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5
Q

What are the Major and Secondary side effects of Pramipexole (Mirapex)

A

Major: Somnolence/daytime sleep attacks, compulsive behavior (nucleus accumbens, D3)
Secondary: More acute side effects compared to bromocriptine (ex. nausea/GI distress, edema, psychosis)

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6
Q

What are the Major and Secondary side effects of Ropinorole (Requip)

A

Major: Somnolence/daytime sleep attacks
Secondary: More acute side effects compared to bromocriptine (ex. nausea/GI distress, edema, psychosis)

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7
Q

What are the Major and Secondary side effects of Rotigotine (Neupro)

A

Major: Somnolence/daytime sleep attacks
Secondary: More acute side effects compared to bromocriptine (ex. nausea/GI distress, edema, psychosis)

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8
Q

What are the Major and Secondary side effects of Apomorphine (Apokyn)

A

Major: Emesis (treat with trimethobenzamide or domiperidone), hypotension/LOC if given with 5HT antagonists
Secondary: Peripheral DA-like side effects

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9
Q

What are the Major and Secondary side effects of Entacapone (Comtan)

A

Major: Increase in dyskinesias, diarrhea (less than tolcapone), urine discoloration
Secondary: Peripheral DA-like side effects

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10
Q

What are the Major and Secondary side effects of Tolcapone (Tasmar)

A

Major: Fatal hepatotoxicity, increase in dyskinesias, diarrhea (worse than entacapone), urine discoloration
Secondary:

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11
Q

What are the Major and Secondary side effects of Benztropine (Cogentin)

A

Major: Confusion, impaired memory, hallucinations
Secondary: Typical anticholinergic (dry mouth, etc)

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12
Q

What are the Major and Secondary side effects of Biperiden (Akineton)

A

Major: Confusion, impaired memory, hallucinations
Secondary: Typical anticholinergic (dry mouth, etc)

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13
Q

What are the Major and Secondary side effects of Trihexyphenidyl (Artane)

A

Major: Confusion, impaired memory, hallucinations
Secondary: Typical anticholinergic (dry mouth, etc)

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14
Q

What are the Major and Secondary side effects of Procyclidine (Kemadrin)

A

Major: Confusion, impaired memory, hallucinations
Secondary: Typical anticholinergic (dry mouth, etc)

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15
Q

What are the Major and Secondary side effects of Ethopropazine (Parsidol)

A

Major: Confusion, impaired memory, hallucinations
Secondary: Typical anticholinergic (dry mouth, etc)

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16
Q

What are the Major and Secondary side effects of Amantadine (Symmetrel)

A

Major: NMS upon withdrawal
Secondary: Peripheral DA-like side effects

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17
Q

What are the Major and Secondary side effects of Deep brain stimulation

A

Major: Fatal intracerebral hemorrhage, cognitive impairment
Secondary: —

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18
Q

What are the Major and Secondary side effects of Tetrabenazine (Xenazine)

A

Major: NMS, depression, suicidality
Secondary: —

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19
Q

What are the Major and Secondary side effects of Riluzole (Rilutek)

A

Major: Rare hepatotoxicity (check serum transaminase levels)
Secondary: Nausea, diarrhea

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20
Q

What are the Major and Secondary side effects of Chlorpromazine (Thorazine)

A

Major: NMS, EPS (parkinsonism, akathisia/involuntary movements, dystonia/muscular spasms), tardive dyskinesias, hyperprolactinemia, sexual dysfunction, seizure risk
Secondary: Sedation, postural hypotension, weight gain, anticholinergic effects

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21
Q

What are the Major and Secondary side effects of Haloperidol (Haldol)

A

Major: NMS, EPS (more than chlorpromazine), tardive dyskinesias, hyperprolactinemia, sexual dysfunction
Secondary: Sedation, hypotension, anticholinergic effects (less than chlorpromazine)

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22
Q

What are the Major and Secondary side effects of Fluphenazine (Prolixin)

A

Major: NMS, EPS (more than chlorpromazine), tardive dyskinesias, hyperprolactinemia, sexual dysfunction
Secondary: Sedation, hypotension, anticholinergic effects (less than chlorpromazine)

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23
Q

What are the Major and Secondary side effects of Perphenazine (Trilafon)

A

Major: NMS, EPS (less than chlorpromazine), tardive dyskinesias, hyperprolactinemia, sexual dysfunction
Secondary: Sedation (less than chlorpromazine)

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24
Q

What are the Major and Secondary side effects of Loxapine (Loxitane)

A

Major: NMS, EPS (less than chlorpromazine), tardive dyskinesias, hyperprolactinemia, sexual dysfunction
Secondary: Sedation (less than chlorpromazine)

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25
Q

What are the Major and Secondary side effects of Trifluoperazine (Stelazine)

A

Major: NMS, EPS (less than chlorpromazine), tardive dyskinesias, hyperprolactinemia, sexual dysfunction
Secondary: Sedation (less than chlorpromazine)

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26
Q

What are the Major and Secondary side effects of Thioridazine (Mellaril)

A

Major: NMS, EPS (less than chlorpromazine), tardive dyskinesias, hyperprolactinemia, sexual dysfunction
Secondary: Sedation (less than chlorpromazine)

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27
Q

What are the Major and Secondary side effects of Thiothixene (Navane)

A

Major: NMS, EPS (less than chlorpromazine), tardive dyskinesias, hyperprolactinemia, sexual dysfunction
Secondary: Sedation (less than chlorpromazine)

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28
Q

What are the Major and Secondary side effects of Clozapine (Clozaril)

A

Major: Agranulocytosis, granulocytopenia, seizure risk, myocarditis
Secondary: Metabolic complications (weight gain, diabetes, hyperlipidemia), constipation, akathesia (rare, at high doses)

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29
Q

What are the Major and Secondary side effects of Olanzapine (Zyprexa)

A

Major: EPS, increased serum hepatic transaminases
Secondary: Metabolic complications, somnolence, dizziness, postural hypotension, constipation, hyperprolactinemia, akathesia

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30
Q

What are the Major and Secondary side effects of Quetiapine (Seroquel)

A

Major: —
Secondary: Metabolic complications, somnolence, dizziness, postural hypotension, constipation

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31
Q

What are the Major and Secondary side effects of Risperidone (Risperdal)

A

Major: EPS at greater doses (highest EPS risk of 2GAs)
Secondary: Fewer metabolic complications, insomnia, dizziness, postural hypotension, constipation, hyperprolactinemia

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32
Q

What are the Major and Secondary side effects of Paliperidone (Invega)

A

Major: EPS at greater doses, QT prolongation
Secondary: Fewer metabolic complications, insomnia, dizziness, postural hypotension, constipation, hyperprolactinemia

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33
Q

What are the Major and Secondary side effects of Ziprazidone (Geodon)

A

Major: EPS at greater doses, QT prolongation
Secondary: Fewer metabolic complications, somnolence, dizziness, postural hypotension, constipation, hyperprolactinemia

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34
Q

What are the Major and Secondary side effects of Asenapine

A

Major: Somnolence
Secondary: similar to other atypicals

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35
Q

What are the Major and Secondary side effects of Tranylcypromine (Parnate)

A

Major: Hypertensive crisis (with tyramine-rich foods); serotonin syndrome (MAOI + SSRI); agitation (rare), delerium –> seizures
Secondary: Anticholinergic, orthostatic hypotension, sexual dysfunction, weight gain, sedation

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36
Q

What are the Major and Secondary side effects of Phenelzine (Nardil)

A

Major: Hypertensive crisis (with tyramine-rich foods); serotonin syndrome (MAOI + SSRI); agitation (rare), delerium –> seizures
Secondary: Anticholinergic, orthostatic hypotension, sexual dysfunction, weight gain, sedation

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37
Q

What are the Major and Secondary side effects of Desipramine (Norpramin)

A

Major: Sympathomimetic (cardiac arrhythmias and conduction defects, especially at OD)
Secondary: Antimuscarinic, orthostatic hypotension, sedation (additive with alcohol), seizures

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38
Q

What are the Major and Secondary side effects of Imipramine (Tofranil)

A

Major: Sympathomimetic (cardiac arrhythmias and conduction defects, especially at OD)
Secondary: Antimuscarinic, orthostatic hypotension, sedation (additive with alcohol), seizures

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39
Q

What are the Major and Secondary side effects of Amitriptyline (Elavil)

A

Major: Sympathomimetic (cardiac arrhythmias and conduction defects, especially at OD)
Secondary: Antimuscarinic, orthostatic hypotension, sedation (additive with alcohol), seizures

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40
Q

What are the Major and Secondary side effects of Nortriptyline (Pamelor)

A

Major: Sympathomimetic (cardiac arrhythmias and conduction defects, especially at OD)
Secondary: Antimuscarinic, orthostatic hypotension, sedation (additive with alcohol), seizures

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41
Q

What are the Major and Secondary side effects of Fluoxetine (Prozac)

A

Major: Serotonin syndrome (with MAOIs)
Secondary: Fewer than tricyclics; mostly nausea, decreased sexual function

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42
Q

What are the Major and Secondary side effects of Paroxetine (Paxil)

A

Major: Serotonin syndrome (with MAOIs)
Secondary: Fewer than tricyclics; mostly nausea, decreased sexual function

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43
Q

What are the Major and Secondary side effects of Sertraline (Zoloft)

A

Major: Serotonin syndrome (with MAOIs)
Secondary: Fewer than tricyclics; mostly nausea, decreased sexual function

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44
Q

What are the Major and Secondary side effects of Escitalopram (Lexapro)

A

Major: Serotonin syndrome (with MAOIs)
Secondary: Fewer than tricyclics; mostly nausea, decreased sexual function

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45
Q

What are the Major and Secondary side effects of Citalopram (Celexa)

A

Major: Serotonin syndrome (with MAOIs)
Secondary: Fewer than tricyclics; mostly nausea, decreased sexual function

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46
Q

What are the Major and Secondary side effects of Bupropion (Wellbutrin)

A

Major: Lowers seizure threshold
Secondary: —

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47
Q

What are the Major and Secondary side effects of Lithium

A

Major: If elevated levels: neurotoxicity, cardiac toxicity, renal dysfunction
Secondary: Drowsiness, weight gain, tremor, polydipsia, polyuria

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48
Q

What are the Major and Secondary side effects of alcohol / ethanol

A

Major: Liver toxicity, chronic gastritis, diuresis, decreased testosterone synthesis, decreased uterine motility and milk ejection, teratogenicity
Secondary: Cardioprotection; acute drinking slows P450 metabolism of other drugs, chronic drinking induces P450 for faster metabolism

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49
Q

What are the Major and Secondary side effects of methyl alochol

A

Major: acidosis, blindness
Secondary:

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50
Q

What are the Major and Secondary side effects of ethylene glycol

A

Major: acidosis, kidney damage, CNS excitement then depression
Secondary:

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51
Q

What are the Major and Secondary side effects of isopropyl alcohol

A

Major: acidosis, gastritis, CNS symptoms
Secondary:

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52
Q

What are the Major and Secondary side effects of Disulfiram (Antabuse)

A

Major:
Secondary: Pulsating headache, nausea, vomiting, chest pain, hyperthermia, weakness, dizziness

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53
Q

What are the Major and Secondary side effects of Cocaine

A

Major: Sympathetic effects; paranoia, aggression
Secondary: —

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54
Q

What are the Major and Secondary side effects of Amphetamines (Benzadrine)

A

Major: Vasospasm leading to possible stroke or MI, arrhythmia, weight loss (anorexic effect)
Secondary: Tremor, anxiety, irritability, confusion, possibly paranoid state

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55
Q

What are the Major and Secondary side effects of Methyxanthines

A

Major:
Secondary: tremors, anxiety, irritability, restlessness, insomnia

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56
Q

What are the Major and Secondary side effects of LSD

A

Major: Bad trips (anxiety attack, panic attack), flashbacks, birth defects, chronic psychoses, chromosome damage, teratogenicity
Secondary: No recorded human overdose deaths

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57
Q

What are the Major and Secondary side effects of Marijuana (THC)

A

Major: Vasodilation –> tachycardia, dilation of conjunctival vessels, bronchodilation, decreased intraocular pressure, hunger
Secondary: May impair reproductive function in adolescents; heavy use may impair development of very young users; possible respiratory damage due to tar

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58
Q

What are the Major and Secondary side effects of Anandamide

A

Major: —
Secondary: CB1 receptor antagonists reduce food intake

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59
Q

What are the Major and Secondary side effects of Phencyclidine (PCP)

A

Major: Violent behavior, coma, seizures, arrest; inexplicable psychoses
Secondary: Dissociation, confusion, ataxia, marked nystagmus

60
Q

What are the Major and Secondary side effects of MDMA (Ecstasy)

A

Major: hyperthermia, dehydration, hallucinations, hypertensive crisis with intracerebral hemorrhage, paranoia, cardiac arrythmias, death
Secondary:

61
Q

What are the Major and Secondary side effects of Morphine

A

Major: Miosis, constipation, respiratory depression
Secondary: Dry mouth, nausea/vomiting, sedation, sweating; dreams, dysphoria, delerium, myoclonus, seizures, pruritis, urticaria, urinary incontinence

62
Q

What are the Major and Secondary side effects of Codeine

A

Major: Miosis, constipation, respiratory depression
Secondary: Dry mouth, nausea/vomiting, sedation, sweating; dreams, dysphoria, delerium, myoclonus, seizures, pruritis, urticaria, urinary incontinence

63
Q

What are the Major and Secondary side effects of Tramadol (Ultram)

A

Major: Miosis, constipation, respiratory depression
Secondary: Dry mouth, nausea/vomiting, sedation, sweating; dreams, dysphoria, delerium, myoclonus, seizures, pruritis, urticaria, urinary incontinence

64
Q

What are the Major and Secondary side effects of Fentanyl (Duragesic)

A

Major: Miosis, constipation, respiratory depression
Secondary: Dry mouth, nausea/vomiting, sedation, sweating; dreams, dysphoria, delerium, myoclonus, seizures, pruritis, urticaria, urinary incontinence

65
Q

What are the Major and Secondary side effects of Methadone (Methadose)

A

Major: Miosis, constipation, respiratory depression
Secondary: Dry mouth, nausea/vomiting, sedation, sweating; dreams, dysphoria, delerium, myoclonus, seizures, pruritis, urticaria, urinary incontinence

66
Q

What are the Major and Secondary side effects of Oxycodone

A

Major: Miosis, constipation, respiratory depression
Secondary: Dry mouth, nausea/vomiting, sedation, sweating; dreams, dysphoria, delerium, myoclonus, seizures, pruritis, urticaria, urinary incontinence

67
Q

What are the Major and Secondary side effects of Meperidine (Demerol)

A

Major: Miosis, constipation, respiratory depression; mental status changes and seizures (normeperidine)
Secondary: Dry mouth, nausea/vomiting, sedation, sweating; dreams, dysphoria, delerium, myoclonus, seizures, pruritis, urticaria, urinary incontinence

68
Q

What are the Major and Secondary side effects of Propoxyphene (Darvon)

A

Major: Miosis, constipation, respiratory depression; CNS toxicity (norpropoxyphene)
Secondary: Dry mouth, nausea/vomiting, sedation, sweating; dreams, dysphoria, delerium, myoclonus, seizures, pruritis, urticaria, urinary incontinence

69
Q

What are the Major and Secondary side effects of Loperamide (Imodium)

A

Major: Miosis, constipation, respiratory depression
Secondary: Dry mouth, nausea/vomiting, sedation, sweating; dreams, dysphoria, delerium, myoclonus, seizures, pruritis, urticaria, urinary incontinence

70
Q

What are the Major and Secondary side effects of Diphenoxylate (Lomotil)

A

Major: Miosis, constipation, respiratory depression
Secondary: Dry mouth, nausea/vomiting, sedation, sweating; dreams, dysphoria, delerium, myoclonus, seizures, pruritis, urticaria, urinary incontinence

71
Q

What are the Major and Secondary side effects of Naloxone (Narcan)

A

Major: Can precipitate withdrawal (flu-like symptoms of nausea, vomiting, diarrhea; piloerection, yawning, irritability)
Secondary: —

72
Q

What are the Major and Secondary side effects of Naltrexone (Revia)

A

Major: May produce a prolonged withdrawal state (nausea, vomiting, piloerection, yawning)
Secondary: —

73
Q

What are the Major and Secondary side effects of Diazepam (Valium)

A

Major: —
Secondary: Daytime sedation and drowsiness, anterograde amnesia, synergistic depression of CNS with other drugs, pyschologic and physiologic dependence (chronic use)

74
Q

What are the Major and Secondary side effects of Chlordiazepoxide (Librium)

A

Major: —
Secondary: Daytime sedation and drowsiness, anterograde amnesia, synergistic depression of CNS with other drugs, pyschologic and physiologic dependence (chronic use)

75
Q

What are the Major and Secondary side effects of Lorazepam (Ativan)

A

Major: —
Secondary: Daytime sedation and drowsiness, anterograde amnesia, synergistic depression of CNS with other drugs, pyschologic and physiologic dependence (chronic use)

76
Q

What are the Major and Secondary side effects of Flurazepam (Dalmane)

A

Major: —
Secondary: Daytime sedation and drowsiness, anterograde amnesia, synergistic depression of CNS with other drugs, pyschologic and physiologic dependence (chronic use)

77
Q

What are the Major and Secondary side effects of Alprazolam (Xanax)

A

Major: —
Secondary: Daytime sedation and drowsiness, anterograde amnesia, synergistic depression of CNS with other drugs, pyschologic and physiologic dependence (chronic use)

78
Q

What are the Major and Secondary side effects of Triazolam (Halcion)

A

Major: —
Secondary: Daytime sedation and drowsiness, anterograde amnesia, synergistic depression of CNS with other drugs, pyschologic and physiologic dependence (chronic use)

79
Q

What are the Major and Secondary side effects of Midazolam (Versed)

A

Major: —
Secondary: Daytime sedation and drowsiness, anterograde amnesia, synergistic depression of CNS with other drugs, pyschologic and physiologic dependence (chronic use)

80
Q

What are the Major and Secondary side effects of Zolpidem (Ambien)

A

Major: Sleep-walking; next morning impairment
Secondary: —

81
Q

What are the Major and Secondary side effects of Flumazenil (Romazicon)

A

Major: Withdrawal (may be life-threatening); seizures in mixed overdoses
Secondary: —

82
Q

What are the Major and Secondary side effects of Thiopental (Pentothal)

A

Major: P450 induction; overdose can cause respiratory depression, coma, and death
Secondary: Daytime sedation and drowsiness, dose-dependent depression of CNS, pyschologic and physiologic dependence (chronic use)

83
Q

What are the Major and Secondary side effects of Phenobarbitol

A

Major: P450 induction; overdose can cause respiratory depression, coma, and death
Secondary: Daytime sedation and drowsiness, dose-dependent depression of CNS, pyschologic and physiologic dependence (chronic use)

84
Q

What are the Major and Secondary side effects of Nitrous Oxide

A

Major: PONV, inactivates vitamin B (leading to abnormal embryonic development, abortion); accumulates in closed, air-containing spaces (bowel, middle ear, pneumothoraces, air emboli) because N2O insoluble in blood
Secondary: —

85
Q

What are the Major and Secondary side effects of Isoflurane (Forane)

A

Major: Pungent
Secondary: Dose dependent CNS depression; decrease in BP and respiratory function; increase in cerebral blood flow, ICP, and HR; skeletal muscle relaxation; malignant hyperthermia

86
Q

What are the Major and Secondary side effects of Desflurane (Suprane)

A

Major: Most pungent (airway irritation symptoms)
Secondary: Dose dependent CNS depression; decrease in BP and respiratory function; increase in cerebral blood flow, ICP, and HR; skeletal muscle relaxation; malignant hyperthermia

87
Q

What are the Major and Secondary side effects of Sevoflurane (Ultane)

A

Major: Can form CO if not combined with CO2 correctly
Secondary: Dose dependent CNS depression; decrease in BP and respiratory function; increase in cerebral blood flow, ICP, and HR; skeletal muscle relaxation; malignant hyperthermia

88
Q

What are the Major and Secondary side effects of Propofol (Diprivan)

A

Major: Propofol infusion syndrome: being given for several days leads to metabolic acidosis, rhabdomyolysis, renal failure, lowering of BP, bradycardia, and death (likely due to fatty acid oxidation)
Secondary: Painful injection site; supports bacterial growth

89
Q

What are the Major and Secondary side effects of Etomidate (Amidate)

A

Major: Pain on administration (due to solvent, propylene glycol); involuntary myoclonic movements due to subcortical disinhibition (not a seizure); PONV; single dose inhibits cortisol synthesis
Secondary: —

90
Q

What are the Major and Secondary side effects of Ketamine (Ketalar)

A

Major: Stimulates sympathetic nervous system outflow; increases cerebral blood flow, ICP; emergence delerium; nystagmus, lacrimation, salivation, and dissociative anesthesia
Secondary: —

91
Q

What are the Major and Secondary side effects of Dexmedetomidine (Precedex)

A

Major: Limited respiratory depression (wide safety margin)
Secondary: —

92
Q

What are the Major and Secondary side effects of Succinylcholine (Anectine)

A

Major: Malignant hyperthermia; cardiac dysrhythmias, hyperkalemia, increased intraocular pressure, increased intracranial pressure
Secondary: Increased intragastric pressure, myalgias, masseter spasm

93
Q

What are the Major and Secondary side effects of Pancuronium (Pavulon)

A

Major: Increase in HR
Secondary: —

94
Q

What are the Major and Secondary side effects of Vecuronium (Norcuron)

A

Major: No cardiovascular effects
Secondary: —

95
Q

What are the Major and Secondary side effects of Rocuronium (Zemuron)

A

Major: No cardiovascular effects
Secondary: —

96
Q

What are the Major and Secondary side effects of Atracurium (Tracrium)

A

Major: Histamine release (especially if given as rapid IV bolus), with resultant hypotension and tachycardia
Secondary: —

97
Q

What are the Major and Secondary side effects of Cis-atracurium (Nimbex)

A

Major: Unlike atracurium, no histamine release or downstream effects
Secondary: —

98
Q

What are the Major and Secondary side effects of Sugammadex (Bridion)

A

Major: Decrease in blood presure, nausea and vomiting, dry mouth
Secondary: —

99
Q

What are the Major and Secondary side effects of Glycopyrrolate (Robinul)

A

Major: DUMBELLS
Secondary: —

100
Q

What are the Major and Secondary side effects of Ester anesthetic

A

Major: Local: transient neurologic symptoms (basically, really bad pain), neuronal injury. Systemic (more common with long-acting local anesthetics): CNS (early excitation: decreased inhibition, sensory disturbances, restlessness, tremor, tinnitus; later depression: lethargy, hypotension, seizures), cardiovascular (reduced conductivity, excitability, and contractility; arrhythmias (QRS widening an early sign); indirect vasodilation and bradycardia.
Secondary: Methemoglobinemia (primarily with benzocaine and prilocaine)

101
Q

What are the Major and Secondary side effects of Amide anesthetic

A

Major: Local: transient neurologic symptoms (basically, really bad pain); neuronal injury Systemic (more common with long-acting local anesthetics): CNS (early excitation: decreased inhibition, sensory disturbances, restlessness, tremor, tinnitus; later depression: lethargy, hypotension, seizures); cardiovascular (reduced conductivity, excitability, and contractility; arrhythmias (QRS widening an early sign); indirect vasodilation and bradycardia
Secondary: Methemoglobinemia (primarily with benzocaine and prilocaine)

102
Q

What are the Major and Secondary side effects of Avonex

A

Major: Increased LFT (monitor every 6 mo.), hypothyroidism; least NAB formed
Secondary: Flu-like, injection site irritation, anemia (least side effects of the immunomodulants)

103
Q

What are the Major and Secondary side effects of Rebif

A

Major: Leukopenia, menstrual irregularities, depression, increase LFT and hypothyroidism (monitor every 3 mo.), more NAB formed than avonex
Secondary: Flu-like, injection site reaction, anemia; neutropenia; thrombocytopenia

104
Q

What are the Major and Secondary side effects of Betaseron / Betaferon

A

Major: Leukopenia, menstrual irregularities, depression, increase LFT and hypothyroidism (monitor every 3 mo.); more NAB formed than avonex and rebif
Secondary: Flu-like, inject site reaction, anemia

105
Q

What are the Major and Secondary side effects of Extavia

A

Major: Leukopenia, menstrual irregularities, depression, increase LFT and hypothyroidism (monitor every 3 mo.)
Secondary: Flu-like, inject site reaction, anemia

106
Q

What are the Major and Secondary side effects of Glatiramer acetate (Copaxone)

A

Major: Anxiety attack-like reaction
Secondary: injection site reaction

107
Q

What are the Major and Secondary side effects of Natalizumab (Tysabri)

A

Major: PML (JC virus); acute urticaria, systemic hypersensitivity infusion reaction
Secondary: Headache, dizziness, fatigue, arthralgia, rigors

108
Q

What are the Major and Secondary side effects of Fingolimod (Gilenya)

A

Major: Bradycardia and heartblock (EKG for first 6 hours); macular edema (need opthalmology exam before and after 3 months)
Secondary: Reduced FEV1, increased LFTs, lymphopenia, leukopenia, asthenia (weakness, lack of energy), back pain, blurred vision, headache, dizziness, infections

109
Q

What are the Major and Secondary side effects of Teriflunomide (Aubagio)

A

Major: Hepatotoxicity; teratogenicity
Secondary:

110
Q

What are the Major and Secondary side effects of Dimethyl fumarate / BG12 (Tecfidera)

A

Major: N & V; diarrhea; stomach pain; flushing
Secondary: Itching, redness, rash

111
Q

What are the Major and Secondary side effects of Mitoxantrone (Novantrone)

A

Major: Dose-dependent cardiac toxicity (decreased LVEF, irreversible CHF); induction of acute leukemia
Secondary: Nausea and vomiting, alopecia, menstrual irregularities, increased susceptibility to infection

112
Q

What are the Major and Secondary side effects of Azathioprine (Imuran)

A

Major: Systemic toxicity: monitor blood for changes
Secondary: —

113
Q

What are the Major and Secondary side effects of Methotrexate (Trexall)

A

Major: Systemic toxicity: monitor blood for changes
Secondary: —

114
Q

What are the Major and Secondary side effects of Cyclophosphamide (Cytoxan)

A

Major: Systemic toxicity: monitor blood for changes
Secondary: —

115
Q

What are the Major and Secondary side effects of Mycophenolate mofetil (CellCept)

A

Major: Systemic toxicity: monitor blood for changes
Secondary: —

116
Q

What are the Major and Secondary side effects of Methylprednisolone (MTP)

A

Major: —
Secondary: Short-term: insomnia, mood changes, fluid retention, epigastric pain, hypertension; long-term: osteoporosis, cushingoid, secondary malignancies

117
Q

What are the Major and Secondary side effects of Phenytoin (Dilantin)

A

Major: Rash, gingival hyperplasia, hirsutism, lupus-like reaction; can cause contraceptive failure
Secondary: Mild myelosuppression, increased LFT; long-term: cerebellar degeneration, peripheral neuropathy, osteoporosis

118
Q

What are the Major and Secondary side effects of Carbamazepine (Tegretol)

A

Major: Rash (rarely, Stevens-Johnson), mild myelosuppression, mild increase in LFTs; can cause contraceptive failure
Secondary: —

119
Q

What are the Major and Secondary side effects of Oxcarbazepine (Trileptal)

A

Major: Rash (rarely, Stevens-Johnson), mild myelosuppression, mild increase in LFTs; can cause contraceptive failure
Secondary: —

120
Q

What are the Major and Secondary side effects of Lamotrigine (Lamictal)

A

Major: Rash, (rarely, Stevens-Johnson): slow initial titration important; may lead to contraceptive failure
Secondary: —

121
Q

What are the Major and Secondary side effects of Valproate (Depakote)

A

Major: Weight gain, hair turnover, hyperammonemia (which can be mitigated with oral carnitine), teratogenicity, blood dyscrasias
Secondary: Pancreatitus

122
Q

What are the Major and Secondary side effects of Benzodiazapines

A

Major: Sedation
Secondary: —

123
Q

What are the Major and Secondary side effects of Gabapentin (Neurontin)

A

Major: Sedation only
Secondary: —

124
Q

What are the Major and Secondary side effects of Topiramate (Topamax)

A

Major: Mild metabolic acidosis, kidney stones (due to some carbonic anhydrase activity); modest weight loss; rare acute glaucoma; sedation
Secondary: Word-finding problems, cognitive problems

125
Q

What are the Major and Secondary side effects of Felbamate (Felbatol)

A

Major: Uncommon but potentially fatal. Aplastic anemia, acute hepatic failure. Requires monitoring.
Secondary: —

126
Q

What are the Major and Secondary side effects of Levetiracetam (Keppra)

A

Major: Well tolerated; sedation, mostly; rarely, irritability, aphasia, thrombocytopenia
Secondary: —

127
Q

What are the Major and Secondary side effects of Ethosuximide (Zarontin)

A

Major: Nausea (transient), sedation, irritability
Secondary: —

128
Q

What are the Major and Secondary side effects of Barbiturates

A

Major: Drowsiness, dizziness
Secondary: —

129
Q

What are the Major and Secondary side effects of Ergotamines

A

Major: Nausea, dizziness, paresthesia, chest pain, abdominal cramps
Secondary: Contraindicated in women planning pregnancy, uncontrolled HTN, sepsis, renal or hepatic failure, vascular disease

130
Q

What are the Major and Secondary side effects of DHE / dihydroergotamines (Migranal)

A

Major: Nausea (less than ergots); dizziness, paresthesia, chest pain, abdominal cramps
Secondary: Contraindicated in women planning pregnancy, uncontrolled HTN, sepsis, renal or hepatic failure, vascular disease; injectable

131
Q

What are the Major and Secondary side effects of Triptans, esp. Sumatriptan (Imitrex)

A

Major: Flushing, tingling, dizziness, chest discomfort (noncardiac)
Secondary: Contraindicated in vascular disease (including Prinzmetal), uncontrolled HTN, complicated migraine

132
Q

What are the Major and Secondary side effects of Onabotulinum toxin (Botox)

A

Major: —
Secondary: Injection site pain, headache, neck weakness, ptosis

133
Q

What are the Major and Secondary side effects of TCA

A

Major: Dry mouth, constipation, weight gain, cardiac toxicity, orthostatic hypotension
Secondary: —

134
Q

What are the Major and Secondary side effects of SSRIs

A

Major: Weight gain, sexual dysfunction, headache
Secondary: —

135
Q

What are the Major and Secondary side effects of Beta-blockers

A

Major: Drowsiness, depression, decreased libido, hypotension, memory disturbance
Secondary: —

136
Q

What are the Major and Secondary side effects of Calcium Channel Blockers

A

Major: Constipation, dizziness
Secondary: —

137
Q

What are the Major and Secondary side effects of Topiramate

A

Major: Mild metabolic acidosis, kidney stones (due to some carbonic anhydrase activity); modest weight loss; rare acute glaucoma; sedation
Secondary: Word-finding problems, cognitive problems, tingling (see above)

138
Q

What are the Major and Secondary side effects of Valproate

A

Major: Weight gain, hair turnover, hyperammonemia (which can be mitigated with oral carnitine), teratogenicity, blood dyscrasias
Secondary: Pancreatitus

139
Q

What are the Major and Secondary side effects of Gabapentin

A

Major: Sedation only
Secondary: —

140
Q

What are the Major and Secondary side effects of Lithium

A

Major: If elevated levels: neurotoxicity, cardiac toxicity, renal dysfunction
Secondary: Drowsiness, weight gain, tremor, polydipsia, polyuria

141
Q

What are the Major and Secondary side effects of Donepezil (Aricept)

A

Major: Bradycardia, urinary incontinence, vivid dreams, syncope, fatigue, muscle cramps
Secondary: Nausea, vomiting, diarrhea, sleep disturbance

142
Q

What are the Major and Secondary side effects of Galantamine (Razadyne)

A

Major: Bradycardia, depression, fatigue, somnolence
Secondary: Nausea, vomiting, diarrhea, dizziness, anorexia, weight loss, sleep disturbance

143
Q

What are the Major and Secondary side effects of Rivastigmine (Exelon)

A

Major: Bradycardia, syncope
Secondary: Nausea, vomiting, diarrhea, sleep disturbance (less GI effects with patch)

144
Q

What are the Major and Secondary side effects of Tacrine (Cognex)

A

Major: Hepatotoxicity
Secondary: Nausea, vomiting, diarrhea, abdominal cramping

145
Q

What are the Major and Secondary side effects of Memantine (Namenda)

A

Major: Less GI, nausea, and vomiting problems
Secondary: Dizziness, confusion, headache, constipation

Pharmacology Drug Chart (2 decks)

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