CNS Drugs: Uses, S/Es Flashcards
decreases EtOH craving and relapse rate…
acamprosate
This drug can be used for aversion therapy for EtOH addiction, but it is not recommended. Effects can be severe.
disulfiram
anticonvulsant used for:
EtOH abuse: decreases craving, increases abstinence.
topiramate
this is a short acting barbiturate for induction of anesthesia…
thiopental
this is a long acting barbiturate for anciconvulsant use
phenobarbital
The below are S/Es of what class?
CNS Depression (10-22 hours)
Paradoxical Excitement
Severe dependence: physio and psych
barbiturates
The below are C/Is to what drugs?
Porphyria: enhanced porphyrin synth
Pulmonary Insufficiency: respiratory depression
Combination w. CNS Depressants: supra-additive effects
barbiturates
Which anxiolytic class shouldn’t be used for the below conditions? What should be used instead?
OCD
Agoraphobia/Panic d/o
PTSD
Anxiety in children and adolescents
benzos, use SSRI
The below three BZs are useful to treat…
flurazepam
temazepam
triazolam
insomnia (can’t stay asleep)
What two BZs are DOC for status epilepticus?
diazepam, lorazepam
This BZ is useful for sedation/anesthsia induction and can cause anterograde amnesia…
midazolam
Which BZ can be useful for muscle relaxation
diazepam
chlordiazepoxide
diazepam
lorazepam
these can tx…
alcohol, barb withdrawal
Three C/Is for B Z use…
Pregnancy
Sleep Apnea
Elderly
this drug can cause withdrawal sxs or seizures for those with BZ dependence…
flumazenil
non-GABA anxiolytic used for:
GAD
Anxiety + Depression
PMS/PMDD
ADHD, Autism w. Anxiety
bupropion / wellbutrin
DA/NE reuptake inhibitor
Which anxiolytic can be used for those with hx of abuse, and has a low addiction potential?
buspirone
Which Z Drug can exhibit withdrawal sxs if abrupt cessation?
eszopiclone
The below are S/Es for which sedative hypnotic?
Sleep Paralysis
Hallucination
Muscle weakness
Depression exacerbation
suvorexant
The below are common S/Es of which drug class?
Decreased Seizure Threshold
Autonomic: anticholinergic sxs (dry mouth, tachy, etc), alpha adrenergic sxs (hypotension), antihistamine sxs (sedation)
Antipsychotics
Which classic antipsychotic is also an anti-emetic?
prochlorperazine
Which classic antipsychotic is used as an acute antipsychotic?
haloperidol
antipsychotic
used as pre-anesthetic or for drug psychosis
chlorpromazine
(classical antipsychotic, antimaniac)
(blocks mesolimbic DA receptors, alpha adrenergic receptors)
Which classic antipsychotic exhibits EPS with chronic use?
haloperidol
This classic antipsychotic has high anticholinergic activity, and therefore low EPS.
Also can cause retinal deposits
chlorpromazine
This drug is 1st line for psychosis. it treats positive and negative sxs
risperidone
antipsychotic, prolonged QT
risperidone, ziprazidone
antipsychotic
used for tourette’s and acute mania.
ziprasidone (atypical antipsychotic)
D2, 5HT2a antagonist, 5HT1a agonist
The below are side effects of which antipsychotic…
Prolonged QT
Decreased seizure threshold
increased mortality in elderly
Ziprasidone (atypical antipsychotic, inhibits 5HT, NE reuptake)
antipsychotic
drug of last resort
agranulocytosis risk
clozapine
This antipsychotic neither elevates prolactin nor causes agranulocytosis.
S/Es are
Few EPS sxs
Very Sedating
Constipation
dizziness
Quetiapine (atypical antipsychotic)
D2 and 5HT2 antagonsit
This antipsychotic has the below S/Es
No Agranulocytosis
EPS sxs rare
Hyperglycemia w. T2DM
olanzapine
this drug doesn’t increase prolactin, nor prolong QT. But it can cause decreased esophageal motility
aripiprazole/abilify
atypical antipsychotic: binds D2, D3, 5HT1a and 2a
antipsychotic
used for depression w. bipolar
Lurasidone
Agranulocytosis and neutropenia are S/Es for…
lurasidone
optimal conc. of lithium is between…
0.6-1.2 mEq/L
which mood stabilizer can cause diabetes insipidus
lithium
this drug is used to produce a calming effect in manic patients
lithium
lithium concentration has a(n)______ relationship with sodium because they ______for reabsorption in the proximal tubule
inverse, compete in PT
This drug can be used as a mood stabilizer if there is no lithium response. It is used for rapid cycling manic/depressive phases
valproic acid
increased GABA, sodium and calcium channels
this drug can be used in refractory bipolor d/o in combo with lithium
carbamazepine (anticonvulsant, sodium channel blocker)
which anticonvulsant has the following uses in mood d/o?
prevention of relapse, depression following mania, acute manic episodes
lamotrigine (sodium channel blocker, SJS risk)
Dibucaine is used topically in the US. A dibucaine number measures butyrylcholinesterase activity.
A number of ____ or below is considered deficient
80
which drug class provides relief for spastic muscle disorders like CP, MS, CVA
spasmolytics
Which spasmolytic has the below side effects?
Drowsiness, weakness
Increased seizure activity
Resp. depression if intrathecal
baclofen (muscle relaxant)
This spasmolytic has the below side effects and can be used for acute and chronic spasm…
Sedation, dry mouth, weakness, falls in elderly, hepatotoxic
tizanidine
Which spasmolytic is used for…
Neuroleptic Malignant Syndrome
Malignant Hyperthermia
dantrolene
prevents ca release from SR
which spasmolytic?
Local injection to control spasm after CVA or Neuro Injury
Effects last for weeks/months
botox
Which anticonvulsant?
Use: Partial Seizures, Generalized Tonic-Clonic
Not effective for Absence Seizure
S/Es: Gingival hyperplasia, SJS, Teratogenic
phenytoin
sodium channel blocker
This is DOC for partial seizures and trigeminal neuralgia
carbamazepine (sodium channel blocker)
Which anticonvulsant has the below side effects?
SJS (screen for HLA-B 1502), Teratogenic, aplastic anemia, agranulocytosis, GI sxs
carbamazepine
sodium channel blocker
lamotrigine is used for…
partial seizures
Which drug?
Uses: Partial and Generalized Tonic-Clonic Seizures
Migraine Prevention
topiramate
sodium channel blocker, increases GABA
Levetiracetam is mostly used for what seizure type?
partial seizures
which drug is used for…
GAD, neuropathic pain
pregabalin (GABA Analog, anticonvulsant)
which drug is an adjunct for partial seizures?
tiagabine (GABA enhancer)
Which anticonvulsant has the below side effects?
Rare rash, Teratogenic, CNS sxs
tiagabine
Which anticonvulsant?
Uses: Refractory Complex Partial Seizures┃Infantile Spasm (West’s Syndrome)
vigabatrin
DOC for absence seizures
ethosuximide
This drug is used for mixed seizures…
valproic acid
anticonvulsant
hepatotoxic
increased risk for spina bifida
valproic acid
MAOIs are used for what type of depression?
refractory depression
which antidepressant class is limited due to toxicity and overdose risk, but has the below side effects?
Analgesia SIADH + Hyponatremia Sexual Dysfunction Decreased seizure threshold Tolerance
TCAs
SNRI
hepatotoxic
causes acute angle closure glaucoma
duloxetine (cymbalta)
Which SNRI can cause severe HTN?
venlafaxine (effexor)
what is the current DOC for depression?
citalopram (celexa) or escitalopram (lexapro)
The below are contraindications to what class?
Use of Partial Agonist with a Full Agonist
Head Injury
Pregnancy
Pulm. Insufficiency
Hepatic/Renal Dysfunction
Endocrine d/o
opioids
The below are side effects of…
Derm: Itching Pulm: Resp. Depression Cardio: hypotension GI: N/V, Constipation GU: Urinary Retention MSK: Restlessness Psych: Dysphoria
opioids
whch parkinson’s drug?
Tx of parkinson’s sxs, bradykinesia
Doesn’t affect disease progression
Effectiveness decreases over time
Not effective in Parkinson-ism
l-dopa
What are the two major side effects of L-Dopa?
N/V, Arrhythmia
Which class of parkinson’s meds has the below side effects?
insomnia (catecholamines), HTN Increased L-Dopa S/Es No combination w. Meperidine Serotonin Syndrome w. TCAs or SSRIs
MAOIs
which parkinson’s drug has the below characteristics?
Uses: prolonged DA action, Increases L-Dopa pool
S/Es: hepatic failure
tolcapone (COMT inhibitor)
which parkinson’s drug has the below characteristics?
Uses: prolonged DA action, Increases L-Dopa pool
S/Es: orange urine
Entacapone/comtan
COMT-Inhibitor
Which parkinson’s drugs have the below SEs?
Class S/Es: GI: Anorexia, N/V CV: Postural hypotension, Arrhythmia Dyskinesia Psych Sxs Decreased Prolactin
DA receptor agonists
bromocriptine has what side effect?
erythromelalgia
This is DOC for RLS
ropinirole
2 parkinson’s drugs used for:
monotherapy in mild PD
soothe response to l-dopa in late PD
ropinirole, pramipexole
DA Agonists
Which drug is used as a rescue for periods off l-dopa?
apomorphine
Which parkinson’s drug has the below SEs?
Nausea (Tx with Trimethobenzamide) Avoid Odansetron (5HT system) , Prochlorperazine (DA D2 Blocker)
apomorphine
Which parkinson’s drug has the below characteristics?
Early/Mild PD
Cause Livedo Reticularis (red/blue spotting of skin)
OD = Toxic Psychosis, Convulsions
amantadine
used for PD associated psychosis
Not approved for dementia/Alzheimers
pimavanserin
Which parkinson’s drugs?
Late stages - improves rigidity, tremor
Doesn’t help w. Bradykinesia
Effects increased by antidepressants/antihistamines
anticholinergics
Which alzheimer’s drugs?
QD to slow progression, increase brain activity/cognitive function
cholinesterase inhibitors:
donepezil, rivastigmine, galantamine
Which alzheimer’s drugs?
Use: Late Stage in combo w. AChEs
C/I: Use w. Meperidine, dxm
Memantine (NMDA Receptor Antagonist)
