MBB1 Drugs- Vitor's Cards Flashcards
Venlafaxine
Class: Antidepressants (SNRIs (Seretonin and NE reuptake inhibitors))
Mechanism of Action: -Inhibit SERT and NET -Mechanism for analgesic effects is uncertain
Indications: -Neuropathic pain -Anxiety (GAD) -Depression
Primary Adverse Effects: -GI disturbances -Sedation -Sexual dysfunction Other Comments: Bolded Drug: Duloxetine
Capsaicin
Class: External analgesic Mechanism of Action: Depletes and prevents reaccumulation of substance P in peripheral sensory neurons Indications: Neuropathic pain Primary Adverse Effects: Other Comments:
Bethanechol
Class: mAChR agonist
Mechanism of Action: Stimulates mAChR in bladder -> emptying
Indications: Neurogenic bladder due to spinal cord injury or autonomic neuropathy
Primary Adverse Effects: mAChR Agonist side effects: GI side effects, hypersalivation, lacrimation, urinary urgency
Other Comments: May cause bronchospasm and wheezing.
Oxybutynin
Class: mAChR Antagonist
Mechanism of Action: Blocks mAChR in bladder -> less tone –> Less involuntary leakage
Indications: Neurogenic bladder due to spinal cord injury or MS
Primary Adverse Effects: mAChR antagonist side effects: Xerostomia, urinary retention, confusion, sedation
Other Comments:
Tolterodine
Class: mAChR Antagonist Mechanism of Action: Blocks mAChR in bladder –> Less bladder tone –> Less incontinence Indications: Neurogenic bladder due to spinal cord injury or MS Primary Adverse Effects: mAChR antagonist side effects: Xerostomia, urinary retention, confusion, sedation Other Comments:
Ephedrine
Class: Indirect sympathomimetics Mechanism of Action: Stimulate alpha1 receptors in bladder neck -> contraction -> more bladder storage capacity Indications: Neurogenic bladder due to spinal cord injury Primary Adverse Effects: alpha1 side effects: Increased HR and BP Other Comments:
Prazosin
Class: alpha1 antagonist Mechanism of Action: Blocks alpha1 receptors in bladder neck –> relaxation –> Emptying Indications: Neurogenic bladder due to spinal cord injury or autonomic neuropathy Primary Adverse Effects: alpha1 antagonist side effects: Orthostatic hypotension Other Comments:
Terazosin
Class: alpha1 antagonist Mechanism of Action: Blocks alpha1 receptors in bladder neck –> relaxation –> Emptying Indications: Neurogenic bladder due to spinal cord injury or autonomic neuropathy Primary Adverse Effects: alpha1 antagonist side effects: Orthostatic hypotension Other Comments:
Mirabegron
Class: beta3 agonist Mechanism of Action: Stiulates beta3 receptors in bladder –> less bladder tone –> Less incontinence Indications: Overactive bladder Primary Adverse Effects: Increased BP, UTI, headache Other Comments: -Caution in patients with HTN
Ondasetron
Class: 5-HT3 antagonists “Setrons” Mechanism of Action: Blocks 5-HT3 receptors on vagal afferents, GI tract, Chemoreceptor trigger zone, and Emetic center/Nucleus of solitary tract Indications: -Chemo-induced NV -Post-op induced NV -Radiation induced NV -Gastroenteritis induced NV Primary Adverse Effects: -Minor side effects (headache, dizziness) -Long QT interval Other Comments:
Dolasetron
Class: 5-HT3 antagonists “Setrons” Mechanism of Action: Blocks 5-HT3 receptors on vagal afferents, GI tract, Chemoreceptro trigger zone, and Emetic center/Nucleus of solitary tract Indications: -Chemo-induced NV -Post-op induced NV -Radiation induced NV -Gastroenteritis induced NV Primary Adverse Effects: -Minor side effects (headache, dizziness) -Long QT interval Other Comments: Bolded Drug: Ondansetron
Granisetron
Class: 5-HT3 antagonists “Setrons” Mechanism of Action: Blocks 5-HT3 receptors on vagal afferents, GI tract, Chemoreceptro trigger zone, and Emetic center/Nucleus of solitary tract Indications: -Chemo-induced NV -Post-op induced NV -Radiation induced NV -Gastroenteritis induced NV Primary Adverse Effects: -Minor side effects (headache, dizziness) -Long QT interval Other Comments: Bolded Drug: Ondansetron
Palonosetron
Class: 5-HT3 antagonists “Setrons” Mechanism of Action: Blocks 5-HT3 receptors on vagal afferents, GI tract, Chemoreceptro trigger zone, and Emetic center/Nucleus of solitary tract Indications: -Chemo-induced NV -Post-op induced NV -Radiation induced NV -Gastroenteritis induced NV Primary Adverse Effects: -Minor side effects (headache, dizziness) Other Comments: -Bolded Drug: Ondansetron -Doesn’t cause Long QT interval
Metoclopramide
Class: D2 Antagonists Mechanism of Action: Blocks D2 receptors in Chemoreceptor trigger zone and Emetic center/Nucleus of solitary tract Indications: -Chemo-induced NV -Post-op induced NV -Migrane induced NV -Gastroenteritis induced NV Primary Adverse Effects: -Extrapyramidal signs -mAChR Antagonist side effects Other Comments: -Good “general purpose” antiemetics
Prochlorperazine
Class: D2 Antagonists Mechanism of Action: Blocks D2 receptors in Chemoreceptor trigger zone and Emetic center/Nucleus of solitary tract Indications: -Chemo-induced NV -Post-op induced NV -Migrane induced NV -Gastroenteritis induced NV Primary Adverse Effects: -Extrapyramidal signs -mAChR Antagonist side effects Other Comments: -Bolded Drug: Metoclopramide -Good “general purpose” antiemetics
Promethazine
Class: D2 Antagonists Mechanism of Action: Blocks D2 receptors in Chemoreceptor trigger zone and Emetic center/Nucleus of solitary tract Indications: -Chemo-induced NV -Post-op induced NV -Migrane induced NV -Gastroenteritis induced NV Primary Adverse Effects: -Extrapyramidal signs -mAChR Antagonist side effects Other Comments: -Bolded Drug: Metoclopramide -Good “general purpose” antiemetics
Droperidol
Class: D2 Antagonists Mechanism of Action: Blocks D2 receptors in Chemoreceptor trigger zone and Emetic center/Nucleus of solitary tract Indications: -Chemo-induced NV -Post-op induced NV -Migrane induced NV -Gastroenteritis induced NV Primary Adverse Effects: -Extrapyramidal signs -mAChR Antagonist side effects Other Comments: -Bolded Drug: Metoclopramide -Good “general purpose” antiemetics
Scopolamine
Class: mAChR Antagonist Mechanism of Action: Blocks muscarinic receptor on vestibular afferents and Emetic center/Nucleus of solitary tract Indications: -Post-op induced NV -NV due to motion sickness or vestibular disorders -Vertigo Primary Adverse Effects: mAChR antagonists side effects Other Comments:
Diphenhydramine
Class: H1 antihistamine (first generation) Mechanism of Action: Blocks H1 receptors on vestibular afferents and Emetic center/Nucleus of solitary tract Indications: -Post-op induced NV -NV due to motion sickness or vestibular disorders -Vertigo -Insomnia Primary Adverse Effects: H1 Antagonist side effects (sedation, drowsiness)mAChR antagonists side effects Other Comments: -Routine use for insomnia is not recommended
Dimenhydrinate (NV)
Class: H1 antihistamine (first generation) Mechanism of Action: Blocks H1 receptors on vestibular afferents and Emetic center/Nucleus of solitary tract Indications: -Post-op induced NV -NV due to motion sickness or vestibular disorders -Vertigo Primary Adverse Effects: H1 Antagonist side effects (sedation, drowsiness)mAChR antagonists side effects Other Comments: Bolded Drug: Diphenhydramine
Meclizine
Class: H1 antihistamine (first generation) Mechanism of Action: Blocks H1 receptors on vestibular afferents and Emetic center/Nucleus of solitary tract Indications: -Post-op induced NV -NV due to motion sickness or vestibular disorders -Vertigo Primary Adverse Effects: H1 Antagonist side effects (sedation, drowsiness)mAChR antagonists side effects Other Comments: Bolded Drug: Diphenhydramine
Doxylamine
Class: H1 antihistamine (first generation) Mechanism of Action: Blocks H1 receptors on vestibular afferents and Emetic center/Nucleus of solitary tract Indications: -Post-op induced NV -NV due to motion sickness or vestibular disorders -pregnancy induced NV -Insomnia Primary Adverse Effects: mAChR antagonists side effects Other Comments: -Bolded Drug: Diphenhydramine -Approved for pregnancy induced NV -Routine use for insomnia is not recommended
Aprepitant
Class: NK1 Antagonist Mechanism of Action: Blocks NK1 receptors in Emetic center/Nucleus of solitary tract Indications: -Chemo-induced NV -Post-op induced NV Primary Adverse Effects: GI side effects (diarrhea, discomfort), fatigue Other Comments:
Netupitant
Class: NK1 Antagonist Mechanism of Action: Blocks NK1 receptors in Emetic center/Nucleus of solitary tract Indications: -Chemo-induced NV Primary Adverse Effects: GI side effects (constipation) Headache, weakness, fatigue Other Comments: -Only available as combination with Palonesetron (5-HT3 antagonist)
Dexamethasone
Class: Glucocorticoids Mechanism of Action: Inhibits PLA2 –> -Decreased synthesis of eicosanoids -Decreased synthesis of cytokines -Decreased movement of leukocytes to areas of injury Anti-Inflamatory Effect –>Improved function of damaged BBB -Unsure of NV mechanism of action. Indications: -Chemo induced NV -Post-op induced NV -Vasogenic cerebral edema Primary Adverse Effects: Short periods of use: insomnia, behavior changes, peptic ulcers. Long periods of use: Metabolic side effects (redistribution of fat, acne, weight gain), Cushings Syndrome. Other Comments: -Used together with 5-HT3 antagonist and NK1 antagonist for Nausea/Vomiting
Dronabinol
Class: Cannabinoids Mechanism of Action: Stimulate CB1 receptors in Emetic center/Nucleus of solitary tract Indications: Chemo-induced NV Primary Adverse Effects: CNS side effects (vertigo, euphoria, anxiety, increase appetite) Other Comments:
Nabilone
Class: Cannabinoids Mechanism of Action: Stimulate CB1 receptors in Emetic center/Nucleus of solitary tract Indications: Chemo-induced NV Primary Adverse Effects: CNS side effects (vertigo, euphoria, anxiety, increase appetite) Other Comments:
Lorazepam
Class: BZDs Mechanism of Action: Bind to allosteric site on GABAA receptor -> GABA mediated IPSP -Mechanism as vestibular suppressant poorly understood Indications: -Chemo and post op induced NV -Vertigo -Seizure -Insomnia Primary Adverse Effects: Sedation, Motor impairment, Amnesia, dependence Other Comments: Bolded Drug: Benzodiazepines -Very effective against status epilepticus (seizure lasting longer than 5 min and/or repetitive seizures in which person does not go back to normal inbetween)
Alprazolam
Class: Benzodiazepines Mechanism of Action: Bind to allosteric site on GABAA receptor -> GABA mediated IPSP -Mechanism as vestibular suppressant poorly understood Indications: -Chemo and post op induced NV -Vertigo -Essential Tremor -Anxiety (GAD, panic disorder) -Insomnia Primary Adverse Effects: Sedation, Motor impairment, Amnesia, dependence Other Comments: Bolded Drug: Benzodiazepines
Pyridoxine (Vitamin B6)
Class: Alternative therapies for NV Mechanism of Action: ?? Indications: Any form of NV Primary Adverse Effects: Other Comments: -Good for pregnancy induced NV
Ginger
Class: Alternative therapies for NV Mechanism of Action: ?? Indications: Any form of NV Primary Adverse Effects: Other Comments: -Good for Pregnancy-induced NV
Disulfiram
Class: Aldehyde dehydrogenase inhibitor Mechanism of Action: Inhibits Alcohol dehydrogenase -> more acetaldehyde in blood -> Nausea/vomiting, headache, weakness Indications: Management of Ethanol use disorder Primary Adverse Effects: Acetaldehyde syndrome -> Nausea/vomiting, headache, weakness Other Comments: Bolded Drugs: Naltrexone, Acamprosate-Gives negative experience for drinking alcohol
Acamprosate
Class: GABA analog (not effective in receptor) Mechanism of Action: GABA analog (not effective in receptor) Indications: Management of ethanol use disorder Primary Adverse Effects: Diarrhea, nervousness, fatigue Other Comments:
Nicotine
Class: nAChR agonist Mechanism of Action: Suppression of withdrawal and cravings in pts with nicotine use Indications: Management of smoking cessation Primary Adverse Effects: Headache, appetite stimulation Other Comments: -Available as patches, lozenges, gum, inhaler
Varenicline
Class: nAChR partial agonist Mechanism of Action: Suppression of withdrawal and cravings in pts with nicotine use Indications: Management of smoking cessation Primary Adverse Effects: Headache, Nausea, Insomnia, agitation, depression Other Comments:
Bupropion
Class: NDRI (NE and DA reuptake inhibitor) Mechanism of Action: Inhibition of NET and DAT. Inhibiting DA reuptake heps with cravings in pts with nicotine use disorder. Inhibition of NE reuptake may relieve withdrawal symptoms Indications: -Management of smoking cessation -Depression -ADHD Primary Adverse Effects: Insomnia, Headache, Aitiation, Xerostomia Other Comments: -No sexual dysfunction-Risk of seizures -Not as efficacious as stimulants
Fluoxetine
Class: SSRI Mechanism of Action: Inhibits SERT Indications: -Anxiety (PTSD, OCD, social anxiety disorder, panic disorder) -Depression Primary Adverse Effects: GI side effects Sexual dysfunction Motor restlessness Other Comments: -Few side effects and good therapeutic window
Sertaline
Class: SSRI Mechanism of Action: Inhibits SERT Indications: Anxiety (PTSD, OCD, social anxiety disorder, panic disorder) Primary Adverse Effects: GI side effects Sexual dysfunction Motor restlessness Other Comments: Bolded Drug: Fluoxetine
Paroxetine
Class: SSRI Mechanism of Action: Inhibits SERT Indications: -Depression-Anxiety (PTSD, OCD, social anxiety disorder, panic disorder) Primary Adverse Effects: GI side effects Sexual dysfunction Motor restlessness Other Comments: Bolded Drug: Fluoxetine -Few side effects and good therapeutic window
Citalopram
Class: SSRI Mechanism of Action: Inhibits SERT Indications: -Depression-Anxiety (PTSD, OCD, social anxiety disorder, panic disorder) Primary Adverse Effects: GI side effects Sexual dysfunction Motor restlessness Other Comments: Bolded Drug: Fluoxetine
Benzodiazepines
Class: BZD Mechanism of Action: Bind to Allosteric site on GABAA receptors –> Increases GABA-mediated IPSPs -Mechanism as vestibular suppressant poorly understood Indications: -Anxiety (GAD, panic disorder) -Spasticity due to cerebral palsy, MS, spinal cord injury, stroke, ect. -Essential Tremor -Chemo and post op induced NV -Vetigo -Seizures -IV Anesthetics - Preanesthetic sedation, Induction of general anesthesia, Conscious sedation -Insomnia Primary Adverse Effects: -Sedation -Motor Impairment -Amnesia -Physical dependence Other Comments: -Very effective against status epilepticus (seizure lasting longer than 5 min and/or repetitive seizures in which person does not go back to normal inbetween) -Slower sedation onset compared to Barbiturates (Thiopental) -Effects can be reversed with Flumazenil
Midazolam
Class: BZD Mechanism of Action: Bind to Allosteric site on GABAA receptors –> Increases GABA-mediated IPSPs Indications: -Anxiety (GAD, panic disorder) -IV Anesthetics - Preanesthetic sedation, Induction of general anesthesia, Conscious sedation Primary Adverse Effects: -Sedation -Motor Impairment -Amnesia -Physical dependence Other Comments: Bolded drug: Benzodiazepines -Slower sedation onset compared to Barbiturates (Thiopental) -Effects can be reversed with Flumazenil
Buspirone
Class: Partial agonist at 5-HT1A Mechanism of Action: Partial agonist at 5-HT1A Indications: Anxiety (GAD) Primary Adverse Effects: Dizziness, Non-specific chest pain Other Comments:
Imipramine
Class: TCAs (Tricyclic Antidepressants) Mechanism of Action: Inhibit NET and SERT Indications: Anxiety (Social anxiety disorder, panic disorder) Primary Adverse Effects: mAChR antagonist side effects.(zerostomia, urinary retention, confusion) alpha 2 antagonist side effects (orthostatic hypotension) H1 antagonist side effects (sedation, dizziness) Other Comments: -Bolded Drug: Amitriptyline Low therapeutic index. Overdose -> diagnostic triade (coma, seizures, ECG abnormalities)
Dextromethorphan + Quinidine
Class: Mechanism of Action: Dextromethorphan blocks NMDA receptors Quinidine blocks CYP2D6 –> Increases bioavailability of Dextromethorphan Indications: Pseudobulbar affect due to ALS (Spontaneous, exagerated expression of affect that may be incongruous with mood) Primary Adverse Effects: Nausea, headache, diarrhea, fatigue, dizziness Other Comments: Dextromethorphan has serotonergic effects and should be used cautiously or not at all with SSRIs
Sertraline
Class: SSRIs Mechanism of Action: Inhibit SERT Indications: -Depression Primary Adverse Effects: GI side effects Sexual Dysfunction Motor restlessness, Insomnia Other Comments: -Bolded Drug: Fluoxetine-Few side effects and good therapeutic window
Escitalopram
Class: SSRI Mechanism of Action: Inhibit SERT Indications: Depression Primary Adverse Effects: GI side effects Sexual dysfunction Motor restlesness, insomnia Other Comments: -Bolded Drug: Fluoxetine-Few side effects and good therapeutic window
Vortioxetine
Class: SSRI Mechanism of Action: Inhibit SERT, affects 5-HT receptors too Indications: Depression Primary Adverse Effects: GI side effect Other Comments: -Bolded Drug: Fluoxetine-Less likely to Cause sexual dysfunction
Desvenlafaxine
Class: SNRIs Mechanism of Action: Inhibit SERT and NET Indications: Depression Primary Adverse Effects: GI side effects Sexual dysfunction Sedation Other Comments: Bolded drug: Duloxetine
Levomilnacipran
Class: SNRIs Mechanism of Action: Inhibit SERT and NET Indications: Depression Primary Adverse Effects: GI side effects Sexual dysfunction Sedation Other Comments: Bolded drug: Duloxetine
Vilazodone
Class: Dual-Action antidepressant Mechanism of Action: Inhibit SERT and partial 5-HT1A agonist Indications: Depression Primary Adverse Effects: GI side effects Other Comments: Must take with food
Trazodone
Class: Heterocyclic antidepressant Mechanism of Action: Blocks 5-HT2A and weakly inhibits SERT Indications: -Depression -Insomnia Primary Adverse Effects: -H1 antagonist side effects (Sedation) -Priapism (persistant abnormal erection) Other Comments:
Nefazodone
Class: Heterocyclic antidepressants Mechanism of Action: Blocks 5-HT2A and weakly inhibits SERT Indications: Depression Primary Adverse Effects: H1 antagonist side effects (Sedation) Hepatic failure Other Comments:
Mirtazapine
Class: Heterocyclic antidepressants Mechanism of Action: Blocks presynaptic alpha2, and regular 5-HT2A and 5-HT3 receptors Indications: Depression Primary Adverse Effects: H1 antagonist side effects (sedation) Other Comments:
Desipramine
Class: TCAs Mechanism of Action: Inhibit NET and SERT Indications: Depression Primary Adverse Effects: anticholinergic side effects (xerostomia, urinary retention, confusion) Other Comments: -Bolded Drug: Amitriptyline -Overdose -> DIagnostic triad (Coma, seizures, ECG abnormalities)
Nortriptyline
Class: TCAs Mechanism of Action: Inhibit NET and SERT Indications: Depression Primary Adverse Effects: anticholinergic side effects (xerostomia, urinary retention, confusion) Other Comments: -Bolded Drug: Amitriptyline -Overdose -> DIagnostic triad (Coma, seizures, ECG abnormalities)
Phenelzine
Class: MAO-B inhibitors Mechanism of Action: Inhibit MAO-B in brain –> Increase t1/2 of dopamine, NE and 5-HT in brain Indications: -Depression Primary Adverse Effects: Nausea, Headache, sexual dysfunction Other Comments: Bolded Drug: Selegiline
Tranylcypromine
Class: MAO-B inhibitors Mechanism of Action: Inhibit MAO-B in brain –> Increase t1/2 of dopamine, NE and 5-HT in brain Indications: -Depression Primary Adverse Effects: Nausea, Headache, sexual dysfunction Other Comments: Bolded Drug: Selegiline
Lithium
Class: Mood Stabilizers Mechanism of Action: Inhibits multiple enzmes involved in generation of second messengers. Indications: Bipolar Disorder Primary Adverse Effects: Tremor, Weight gain, Diabetes Insipidus, GI side effects Other Comments: -Good for acute mania
Divalproex
Class: Antiepileptics Mechanism of Action: Prolonged inactivated state of Na+ channels and blocks T-type Ca2+ channels Indications: -Bipolar Disorder -Seizure Primary Adverse Effects: Weight gain, tremor, Teratogenic effects Other Comments: -Effective against a variety of seizure types, but a lot of adverse effects
Valproic acid
Class: Antiepileptics Mechanism of Action: Prolonged inactivated state of Na+ channels and blocks T-type Ca2+ channels Indications: -Bipolar Disorder -Seizures Primary Adverse Effects: Weight gain, tremor, Teratogenic effects Other Comments: Bolded Drug: Divalproex -Effective against a variety of seizure types, but a lot of adverse effects
Lamotrigine
Class: Antiepileptics (2nd generation) Mechanism of Action: Prolonged inactivated state of Na+ channels Blocks T-type Ca2+ channels Inhibits Glutamatergic transmission Indications: -Bipolar Disorder -Seizures Primary Adverse Effects: Rash, ataxia, headache, diplopia Other Comments: -Very effective against primary generalized tonic-clonic seizures -Second line drug for absence seizures
Quetiapine
Class: Second-gen. Antipsychotics Mechanism of Action: Blocks D2 and 5-HT2A receptors Indications: -Bipolar disorder -Schizophrenia Primary Adverse Effects: H1 antagonist side effects: Sedation, dizziness, Weight gain D2 antagonist side effects: Extrapyramidal symptomes (EPS) ex. Dystonia, Akathisia (inner restlessness), and Parkinsonism Other Comments:
Clozapine
Class: Second-gen Antipsychotics Mechanism of Action: Blocks D2 and 5-HT2A receptors Indications: -Bipolar Disorder -Schizophrenia Primary Adverse Effects: H1 antagonist side effects: Sedation, dizziness, Weight gain D2 antagonist side effects: Extrapyramidal symptomes (EPS) ex. Dystonia, Akathisia (inner restlessness), and Parkinsonism -Agranulocytosis (lowered WBC count) Other Comments: Bolded Drug: Quetiapine (Bipolar, Schizophrenia), Aripiprazole (Schizophrenia)
Lurasidone
Class: Second-gen Antipsychotics Mechanism of Action: Blocks D2 and 5-HT2A receptors Indications: -Bipolar Disorder -Schizophrenia Primary Adverse Effects: H1 antagonist side effects: Sedation, dizziness, Weight gain D2 antagonist side effects: Extrapyramidal symptomes (EPS) ex. Dystonia, Akathisia (inner restlessness), and Parkinsonism Other Comments: Bolded Drug: Quetiapine (Bipolar, Schizophrenia), Aripiprazole (Schizophrenia)
Fosphenytoin
Class: Antiepileptic (First generation) Mechanism of Action: Prolongs inacivated state of Na+ channels Indications: Seizures Primary Adverse Effects: -Acne -Facial coarsing -Teratogenic effects Other Comments: Bolded Drug: Phenytoin
Ethosuximide
Class: Blocks T-type Ca2+ Channels Mechanism of Action: Blocks T-type Ca2+ Channels Indications: Seizures Primary Adverse Effects: Sleep Disturbances, Rash Other Comments: -Effective only against absence seizures
Phenobarbital
Class: Barbituate Mechanism of Action: Binds to allosteric site on GABAA –> Increase GABA mediated IPSPs Indications: Seizures Primary Adverse Effects: Psychomotor impairment Tolerance and dependence Abuse potential Sedation Other Comments: -Good but not first line because of sedation
Oxcarbazepine
Class: 2nd gen Antiepileptic Mechanism of Action: Prolonged inactivated state of voltage-gated Na+ channels Indications: Seizures Primary Adverse Effects: Hyponatremia (worse than CBZ) Rash (Less than CBZ) Other Comments: -Bolded Drugs: Lamotrigine, Topiramate, Gabapentin, Levetiracetam -Similar to CBZ with fewer drug interactions and side effects
Eslicarbazepine
Class: 2nd gen. Antiepileptic Mechanism of Action: Prolonged inactivated state of voltage-gated Na+ channels Indications: Seizures Primary Adverse Effects: Hyponatremia Rash Other Comments: Bolded Drugs: Lamotrigine, Topiramate, Gabapentin, LevetiracetamIsomer of Oxcarbazepine
Zonisamide
Class: 2nd gen. antiepileptic Mechanism of Action: Prolonged inactivated state of voltage-gated Na+ channels, Blocks T-Type Ca2+ channels Indications: Seizures Primary Adverse Effects: Rash Kidney stones Weight loss Other Comments: -Bolded Drugs: Lamotrigine, Topiramate, Gabapentin, Levetiracetam -Effective against variety of seizures
Felbamate
Class: 2nd gen. Antiepileptic Mechanism of Action: Prolonged inactivated state of voltage-gated Na+ channels Blocks NMDA receptor (Glutamate transmission) Indications: Seizures Primary Adverse Effects: Weight loss Insomnia Other Comments: -Bolded Drugs: Lamotrigine, Topiramate, Gabapentin, Levetiracetam -3rd line drug b/c of possible rare side effects
Lacosamide
Class: 2nd gen. Antiepileptic Mechanism of Action: Prolonged inactivated state of voltage-gated Na+ channels Indications: Seizures Primary Adverse Effects: Headache Diplopia Other Comments: -Bolded Drugs: Lamotrigine, Topiramate, Gabapentin, Levetiracetam
Tiagabine
Class: 2nd gen. Antiepileptic Mechanism of Action: Inhibits GABA uptake Indications: Seizures Primary Adverse Effects: Behavioral Disturbances Other Comments: -Bolded Drugs: Lamotrigine, Topiramate, Gabapentin, Levetiracetam
Levetiracetam
Class: Antiepileptic (2nd gen) Mechanism of Action: Modifies exocytosis of glutamate and GABA Indications: Seizures Primary Adverse Effects: Psychosis Hallucinations Irritability Other Comments: -Used for all seizures -Second line for abscence seizures
Ezogabine
Class: Antiepileptic (2nd gen) Mechanism of Action: Opens voltage-gated K+ channels –> Stabilizes resting membrane potential –> less brain excitability -May enhance GABAergic transmission Indications: Seizures Primary Adverse Effects: Dizziness, fatigue, weakness, confusion, urinary retention Discoloration of skin, nails, sclera Vision loss, retinal abnormalities Other Comments: -Bolded Drugs: Lamotrigine, Topiramate, Gabapentin, Levetiracetam Metabolized in liver but NOT by CYPs
Perampanal
Class: 2nd gen. Antiepileptic Mechanism of Action: Blocks AMPA receptor (Glutamate transmission) Indications: Seizures Primary Adverse Effects: Hostility, aggression Dizziness, vertigo, irritability, ataxia GI side effects, weight gain Other Comments: -Bolded Drugs: Lamotrigine, Topiramate, Gabapentin, Levetiracetam
Thiopental
Class: IV Anesthetic - Barbituate Mechanism of Action: Binds to allosteric site on GABAA –> Increases GABA-mediated IPSPs Indications: General Anesthesia Primary Adverse Effects: Respiratory and CV depression Hyperalgesic effects Other Comments: Rapid onset
Propofol
Class: IV Anesthetics - GABAA targeted anesthetics Mechanism of Action: Binds to unknown site on GABAA receptor –> Increases GABA mediated IPSPs Indications: General Anesthessa Induction of general anesthesia Primary Adverse Effects: Respiratory and CV depression (less than Thiopental) Other Comments: Rapid onset and offset Antiemetic properties
Etomidate
Class: IV Anesthetics - GABAA targeted anesthetics Mechanism of Action: Binds to unknown site on GABAA receptor –> Increases GABA mediated IPSPs Indications: General Anesthessa Induction of general anesthesia Primary Adverse Effects: Post-op nausea/vomiting Less synthesis of adrenal corticosteroids Other Comments: Rapid onset and offset
Flumazenil
Class: IV Anesthetics - BDZ antagonist Mechanism of Action: Antagonist at allosteric site on GABAA receptor Indications: Reversal of BDZ-induced sedation following surgery Primary Adverse Effects: Other Comments:
Sufentanil
Class: IV Anesthetics - Opioid analgesic (full Mu agonist) Mechanism of Action: Stimulates Mu receptor in amygdala, substantia nigra, periaqueductal gray area, rostroventral meulla, and spinal cord. -> Act to inhibit activation of neuron Indications: -General Anesthesia, Induction of general anesthesia Primary Adverse Effects: -Sedation -Respiratory depression (less responsiveness to CO2) -Constipation -Nausea/vomiting -Urinary retention -Histamine release -> Allergic symptomes -Neuroendocrine effects -Psychological dependence and abuse Other Comments: Bolded Drug: Fentanyl -Opioids –> Miosis (constricted pupils) -Excellent analgesia -Rapid anesthesia onset and offset