Drugs Flashcards
Carbamazapine (Tegretol)
First line drug for focal / partial seizures. Ineffective against absences. May worsen myoclonic seizures. Site of action is the Na+ channel. Characteristic side effects include hyponatremia, agranulocytosis, and diplopia. It is an enzyme inducer (makes cytochrome p450 drugs get metabolized more quickly).
Phenytoin (Dilantin)
Na+ channel site of action. Treats partial seizures. Causes gingival hyperplasia, coarsening of facial features, and ataxia. It is an enzyme inducer (makes cytochrome p450 drugs get metabolized more quickly).
Valproic Acid (Depakote)
Na+ Channel/ GABA receptor site of action. Good for partial, generalized and absence seizures. Causes GI symptoms, tremor, weight gain, hair loss, hepatotoxicity, and thrombocyotpenia. Bad for pregnant women. CAN CAUSE NEURAL TUBE DEFECTS. Depakote is delicious to the liver–gets eaten first. Can increase levels of other hepatically metabolized drugs.
Can also cause extrapyramidal symptoms (tardive dyskinesias, parkinson-like symtoms).
Phenobarbital
GABA receptor site of action. Good for partial and generalized seizures. Causes sedation. It is an enzyme inducer (makes cytochrome p450 drugs get metabolized more quickly).
Ethosuximide
Type T Ca++ channel site of action. Good for absence seizures. Causes GI symptoms.
Gabapentin (neurontin)
Unknown MOA. Good for partial seizures. Causes sedation, ataxia.
Lamotrigine (Lamictal)
Na+ channel, glutamate receptor site of action. Good for partial and generalized seizures. Causes rash, and steven johnson syndrome. Good for pregnancy. (Lowers levels of OCPs as well.)
Topiramate (Topamax)
Na+ channel, GABA activity. Good for partial & generalized seizures. Causes word-finding difficulty, renal stones and weight loss. (Can also diminish levels of OCPs.)
Tiagabine (Gabitril)
GABA reuptake MOA. Good for partial seizures. Causes sedation.
Levetiracetam (Keppra)
MOA unknown. Good for partial and generalized seizures. Causes insomnia, anxiety irritability and psychosis.
Oxcabazepine (Trileptal)
MOA Na+ channel. Good for partial seizures. Causes sedation and HYPONATREMIA.
Zonisamide (Zonegran)
Unknown MOA. Good for partial and generalized seizures. Causes sedation, renal stones and weight loss.
Drugs to treat partial seizures (not good for generalized seizures)
Phenytoin (Dilantin) Carbanazepine (Tegretol) Gabapentin (Neurontin) Tiagabine (Gabitril) Oxcarbazepine (Trileptal)
Drugs to treat partial and generalized seizures
Valproic Acid (Depacote) Phenobarbital Lamotrigine (Lamictal) Topimarate (Topamax) Levetiracetam (Keppra) Zonisamide (Zonegran)
Drugs to treat absence seizures
Ethosuximide (Zarontin) Valproic Acid (Depakote)
Drugs to treat alzheimers
Donepezil (Aricept), fewer side effects than tacrine, equal efficacy.
Rivastigmine (Exelon); rare hepatic toxicity.
Tacrine: hepatic toxicity, check ALT every 2 weeks
Ibuprophen– targetting anti-inflammatory theory
Vitamin E
drugs to treat vascular dementia
Warfarin, aspirin, clopidogrel, dipyramadole.
Druges to trat Parkinson Disease
1) levodopa/carbidopa
2) trihexylphenidyl (anticholinergic)
3) benztropine (anticholinergic)
4) Amantadine (NMDA antagonist)
5) bromocriptine (dopamine agonist)
6) pergolide (dopamine agonist)
7) pramipexole (dopamine agonist)
8) ropinirole (dopamine agonist)
9) tolcapone (COMT inhibitor)
10) entacapone (COMT inhibitor)
levodopa/carbidopa
parkinson med–dopamine precursor. – anorexia, nausea, pschosis, hallucinations, orthostatic hypotension and eventually dykinesias.
trihexylphenidyl or benztropine
parkinson med. (anticholinergic)–dry mouth, constipation, urinary retention, confusion, hallucination, narrow-angle glaucoma
Amantadine
parkinson med. NMDA antagonist– hallucinations, leg edema, livedo reticularis.
bromocriptine or pergolide or pramipexole or ropinirole
parkinson med. Dopamine agonists. Nausea, orthostatic hypotension, psychosis, hallucinations, dyskinesia.
tolcapone or entacapone
Parkinson med. COMT inhibitor. nausea, vomiting, insomnia, orthostatic hypotension, confusion, dyskinesia.
MS drugs
1) Interferon beta 1a–avonex–(causes flu-like symptoms, anemia, depression, development of neutralizing antibodies)
2) Interferon beta 1 b–betaseron or rebif– (similar side effects as above, and also injection site reaction, depression, hematologic/liver abormalities.
3) glatiramer acetate– Copaxone– injection site reactions, injection related chest pain and shortness of breath.
AED enzyme inducers
carbamazepime, phenytoin, phenobarb. Lamotigrine also lowers OCP levels.
Valproic acid has the opposite effect. Can increase concentration of other drugs b/c is favored by the liver.
dexamethasone, methylprednisone or prednisone
corticosteroids– anti-inflammatory/antiimmune. Steroids can cause psychosis. Begins with agitation, sleep disturbance, and paranoia, and may end with the need for neuroleptics. Can cause weight gain, mood swings, acne, bloating.
Chronic high dose use use also assc’d with cataracts, hypertension, diabetes, osteoperosis.
bupropion
SNRI, lowers seizure threshold.
docitaxel, pacitaxel
chemotherapeutic agents, most common side effect is peripheral neuropathy.
cytosine arabinoside
chemotherapy agent for leukemia. Side effects include slurred speech, ataxic gait, incoordination of limbs. (Irreversible cerebellar ataxia). More common is peripheral neuropathies. May be associated with PRES.
atorvastatin
statins are assc’d with a range of musculoskeletal symptoms, including a myopathy which may have a normal or elevated CK.
halopaeridol
antipsychotic. Side effects can include dytonic reactions, extrapyramidal symptoms.
diphenydramine
benadryl– has anticholinergic effects (can help with dystonic reactions from medications that have anti-dopaminergic properties, like antipsychotics and antiemetics, for example.
isonaziad
Abx to treat TB. Peripheral neuropathy and CNS effects are associated with the use of isoniazid and are due to pyridoxine (vitamin B6) depletion, but are uncommon at doses of 5 mg/kg.
benztropine
a parkinson’s drug– anticholinergic. can cause anticholinergic excess (tachycardia, blurred vision, fever, mental status changes, voiding difficulties, etc)
erythromycin
Abx. can interact with the AEDs carbamazepine, phenytoin, oxcarbazepine, etc. Elevated levels of these AEDs are assc’d with ataxia nystagmus, and at higher levels, diplopia.
tacrolimus / cyclosporine
chemotherpeutic agents, also used for post-transplant immunosuppression. Can cause vascular injury with loss of autoregulation, hypertension, vasospasm, seizures, confusion and an MRI/CT picture of PRES/RPLS.
gentamicin
an aminoglycoside antibiotic. Symptoms of gentamicin toxicity include: Balance difficulty Bouncing, unsteady vision Ringing in the ears (tinnitus) Difficulty multi-tasking, particularly when standing
tolterodine
antimuscarinic drug to treat urinary incontinence
Can cause dry mouth, upset stomach, headache, constipation, dry eyes, sleepiness. Worse side effects include: allergic reaction, tachycardia/arrythmia
Xerostomia (dry mouth)
Decreased gastric motility (upset stomach)
Headache
Constipation
Dry eyes
Sleepiness
The following reactions have been reported in patients who have taken tolterodine since it has become available:
Allergic reactions including swelling
Rapid heartbeat or abnormal heartbeat
Accumulation of fluid in the arms and legs
Hallucinations
5-fluoruracil
chemotherapeutic agent, can cause cerebellar ataxia. May be associated with PRES.
metocloperamide
antiemetic, D-2 antagonist. Can cause extrapyramidal symptoms (tardive dyskinesias, parkinson-like symtoms). (Note valproic acid and amphteracin B can also cause similar symptoms.)
fluoxetine
SSRI– this is prozac.
amitriptyline, nortriptyline, imipramine
tricyclic antidepressants– can all cause significant anticholinergic effects. (mad as a hatter, hot as a hare, dry as a bone, red as a beet, etc)
