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4. CNS agents (depression, psych, anxiety, etc.) > Misc CNS agents > Flashcards

Misc CNS agents Flashcards

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1
Q

Amphetamine/Dextroamphetamine salts brand names

A

Adderall (XR)

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2
Q

Amphetamine/Dextroamphetamine salts indication/dosage

A

ADHD in kids >5y: 5-10mg daily, titrate by 5mg weekly
Adults: Adderall XR 20mg/day
Narcolepsy: 5-60mg/day in divided doses

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3
Q

Amphetamine/Dextroamphetamine salts mechamism

A

mechanism unknown

In adults, causes CNS stimulation by direct action on adrenergic receptors, releasing NE from storage sites

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4
Q

Amphetamine/Dextroamphetamine salts drug interactions

A

effects increased when used with MAO-I’s and furazolidone
urine alkalinizing agents (sodium bicarb) increase reabsorption while GI alkalinizing agents increase absorption
may decrease effects of antihypertensives

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5
Q

Amphetamine/Dextroamphetamine salts CI/precautions

A

CI: advanced arteriosclerosis, CV disease, moderate HTN, hyperthyroidism, agitated states, glaucoma, and within 14 days of use of MAO-I
do not use in patients with known history of drug abuse
caution in patients with midl HTN

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6
Q

Amphetamine/Dextroamphetamine salts pregnancy category

A

C

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7
Q

Amphetamine/Dextroamphetamine salts ADR’s

A

restlessness, dizziness, insomnia, euphoria, tremor, headache, palpitations, tachycardia, dry mouth, unpleasant taste, diarrhea or constipation, and anorexia

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8
Q

Amphetamine/Dextroamphetamine salts patient education

A

caution when performing activities that require coordination
may be habit forming
Adderall XR can be swallowed whole or opened and sprinkled on applesauce, which should be immediately swallowed whole without chewing.

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9
Q

Atomoxetine brand name

A

Strattera

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10
Q

Atomoxetine indication/dosage

A

ADHD with or without comorbid anxiety disorder:
children up to 70kg: start with 0.5mg/kg in AM or divided AM/late afternoon. After 3 days may increase to 1.2mg/kg with max dose of 100mg/day
Children >70kg: start with total daily dose of 40mg. Increase after min 3 days to target total daily dose of 80mg either daily or divided BID. Same max dose

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11
Q

Atomoxetine mechanism

A

Selective inhibition of pre-synaptic NE transporter

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12
Q

Atomoxetine metabolism

A

CYP2D6 metabolism

98% of drug is protein bound

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13
Q

Atomoxetine drug interactions

A

MAO-I coadmin may produce serious reactions resembling NMS
with oral/IV albuterol may compromise CV system
inhibition of 2D6 may increase serum levels (paroxetine, fluoxetine, quinidine)

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14
Q

Atomoxetine CI/precaution

A

CI: MAO-I use in past 14 days, narrow-angle glaucoma, and hypersensitivity
MAY INCREASE SUICIDAL THOUGHTS/ACTIONS IN CHILDREN/TEENS/YOUNG ADULTS
caution: HTN, tachycardia, CV disease, cerebrovascular disease (increased BP and HR), urinary retention

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15
Q

Atomoxetine pregnancy category

A

C

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16
Q

Atomoxetine ADRs

A

Children: dyspepsia, nausea, vomiting, fatigue, appetite suppression, dizziness, mood swings
Adults: dry mouth, constipation, impotence, urinary retention, insomnia, ejaculatory problems, decreased libido, dysmenorrhea

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17
Q

Atomoxetine patient education

A

without regard to meal

may impair cognitive and motor performance

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18
Q

Baclofen brand name

A

Lioresal

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19
Q

Baclofen indication/dosage

A

S/S of spasticity resulting from MS, particularly for relief of flexor spasms and concomitant pain, clonus, and muscle rigidity: start at 5mg TID, titrate by 5mg per dose every 3 days.
Normal dosage is 10-20 3-4x/day

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20
Q

Baclofen max dosage

A

80mg/day (20mg QID)

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21
Q

Baclofen mechanism

A

analog of GABA, works at spinal cord level to reduce flexor and extensor spasms. May be due to hyperpolarization of afferent terminals resulting in inhibition of monosynaptic and polysynaptic reflexes

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22
Q

Baclofen drug interactions

A

CNS depressants

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23
Q

Baclofen CI/precautions

A

CI: hypersensitivity
caution: impaired renal function, epilepsy, history of stroke
do not discontinue abruptly (hallucinations and seizures)
Phenylketonurics (people who build up phenylalanine in the body genetically) should be warned that ODT’s contain phenylalanine

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24
Q

Baclofen pregnancy category

A

C

caution in nursing mothers

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25
Q

Baclofen ADR’s

A

drowsiness is most common

Others: dizziness, weakness, fatigue, confusion, headache, insomnia, nausea, constipation, urinary frequency

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26
Q

Baclofen patient education

A

may cause drowsiness, use caution
avoid alcohol
do not discontinue abruptly

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27
Q

Benztropine brand name

A

Cogentin

28
Q

Benztropine indication/dosage

A

control of extrapyramidal disorders (excluding TD) due to neuroleptic drugs: 1-4mg once or twice daily
adjunct in therapy for all forms of Parkinsonism: 0.5-6mg daily in 2-4 doses or a single dose at HS
NOT RECOMMENDED for children

29
Q

Benztropine mechanism

A

active inhibitor of cholinergic and histaminic receptors
selective blockade of cholinergic receptors in parasympathetic NS.
Structurally similar to atropine and diphenhydramine

30
Q

Benztropine drug interactions

A

may decrease effects of phenothiazines and Haldol. Use with these or TCA’s has caused paralytic ileus, hyperthermia, and heat stroke.
may cause TD when used with Haldol

31
Q

Benztropine CI/precautions

A

CI: patients with prostatic hypertrophy or bladder neck obstructions, myasthenia gravis, and children

32
Q

Benztropine pregnancy category

A

C

33
Q

Benztropine adverse effects

A

dry mouth, blurred vision, constipation, nausea, numbness of fingers, depression, nervousness
may decrease with prolonged use
more serious effects: tachycardia, toxic psychosis, heart abnormalities

34
Q

Benztropine patient education

A

may take with food or milk
avoid alcohol and other CNS depressants
do not discontinue abruptly
avoid prolonged exposure to heat

35
Q

buprenorphine + naloxone brand name

A

Suboxone

36
Q

buprenorphine + naloxone indication/dosage

A

treatment of opioid dependence: recommended target dose is a single daily sublingual dose of 16mg. Doses can be as low as 4mg or as high as 24mg

37
Q

buprenorphine + naloxone dosage induction

A

begin using Subutex (does not contain naloxone), and aim to reach adequate maintenance dosing quickly to avoid opioid withdrawal symptoms

38
Q

buprenorphine + naloxone mechanism

A

buprenorphine: partial opioid agonist at mu-opioid receptors, and antagonist. Produces opioid agonist effects similar to methadone and hydromorphone, but with a ceiling effect.
Naloxone: produces opioid antagonist effects and can precipitate withdrawal

39
Q

buprenorphine + naloxone drug interactions

A

3A4 inhibitors increase plasma concentrations.
3A4 inducers decrease plasma concentrations,
benzodiazepines and buprenorphine together IV have resulted in coma and death

40
Q

buprenorphine + naloxone CI/precautions

A

CI: hypersensitivity
caution: compromised respiratory function
buprenorphine can be abused IV
other CNS depressants increase CNS depression
caution in decreased hepatic function, increased ICP, myxedema or hypothyroidism, adrenal cortical insufficiency (addison’s), toxic psychoses, prostatic hypertrophy or urethral stricture, acute alcoholism, delerium tremens, or kyphosclerosis

41
Q

buprenorphine + naloxone pregnancy category

A

C

do not use in nursing mothers

42
Q

buprenorphine + naloxone ADRs

A

headache, constipation, nausea, sweating

REPORT dizziness, confusion, jaundice, or SOB

43
Q

buprenorphine + naloxone PATIENT EDUCATION

A

may cause drowsiness, use caution where appropriate
do not discontinue abruptly
dissolve tablet on tongue, do not swallow
avoid alcohol and other CNS depressants
may be habit forming
IN AN EMERGENCY notify ER staff of suboxone use and dependence on opioids (bracelet, med alert, etc.)

44
Q

Carbamazepine brand names

A

Tegretol (XR)
Carbatrol ER
Equetrol ER

45
Q

Carbamazepine indication/dosage

A

partial seizures with complex symptomatology, generalized tonic-clonic seizures, mixed seizure patterns of the above listed, that are refractory to other anticonvulsants
Adult and children >12y dosing: 200mg BID, gradually increasing by 200mg/day in 3-4 doses. Maintenance dose usually 800-1200mg/day in 3-4 doses
Children 6-12y: 100mg initially, titrating up. usual maintenance is 400-800mg/day in divided doses
Children

46
Q

Carbamazepine mechanism

A

reduces polysynaptic responses and blocks post-tetanic potentiation

47
Q

Carbamazepine drug interactions

A

may decrease effectiveness of oral anticoagulants, VPA, or pancuronium
cimetidine, isoniazid, diltiazem, fluoxetine, propoxyphene, primidone, verapamil, danazol, or MACROLIDES may increase serum levels
hydantoins may decrease serum levels
may decrease serum levels of doxycycline and Haldol
heurotoxicity may occur when used with lithium
grapefruit juice may increase plasma levels
antineoplastic drugs increase risk of suicidal thoughts/behaviors

48
Q

Carbamazepine CI/precautions

A

CI: hypersensitivity to drug or tricyclic compounds in patients with bone marrow depression
caution: MAO-I use in 14 days, increased IOP, cardiac disorders, renal/hepatic impairment, history of adverse heme reactions to any drug
rare: aplastic anemia and agranulocytosis reported
report fever, sore throat, mouth ulcers, easy bruising
Asian patients should be tested for HLA-B*1502 - higher risk of serious skin reactions (SJS and toxic epidermal necrolysis)
AED patients should be monitored for depression, suicidal thoughts/behavior, unusual changes in mood/behavior

49
Q

Carbamazepine pregnancy category

A

C

50
Q

Carbamazepine ADRs

A

dizziness, unsteadiness, N/V, drowsiness

Rare: aplastic anemia, agranulocytosis, SJS

51
Q

Carbamazepine patient education

A

take with food
drink full glass of water with chewable tablets
may cause drowsiness, use caution where appropriate
avoid alcohol
swallow XR tabs whole
REPORT fever, sore throat, mouth ulcers, bruising, skin rash

52
Q

Carbidopa/Levodopa brand name

A

Sinemet (CR)

53
Q

Carbidopa/Levodopa indication/dosage

A

Parkinson’s Disease: individualized therapy, adjusted according to desired therapeutic response

54
Q

Carbidopa/Levodopa mechanism

A

levodopa converted to dopamine in basal ganglia of extracereberal tissue
Carbidopa prevents conversion of levodopa to dopamine in periphery, increasing availability to CNS, decreasing side effects from high peripheral dopamine

55
Q

Carbidopa/Levodopa drug interactions

A

hydantoins and pyridoxine (B6) may decrease effectiveness

hypertensive crisis may occur if given with MAO-I

56
Q

Carbidopa/Levodopa CI/precautions

A

CI: narrow-angle glaucoma, suspicious undiagnosed skin lesion or history of melanoma, MAO-I use in last 14 days
caution: present or past psychosis, severe CV or pulmonary disease, peptic ulcer, broncial asthma, and renal/hepatic/endocrine disease.
Discontinue current levodopa therapy before starting Sinemet

57
Q

Carbidopa/Levodopa pregnancy category

A

not established, use with caution in pregnancy and lactation

58
Q

Carbidopa/Levodopa ADRs

A

dystonic or involuntary movements, depression, dementia, nausea

59
Q

Carbidopa/Levodopa patient education

A

may be taken with food
avoid vitamins containing B6
Sinemet CR can be given whole or in half, but should not be crushed or chewed

60
Q

Carisoprodol brand name

A

Soma

61
Q

Carisoprodol indication/dosage

A

relief of discomfort associated with acute, painful musculoskeletal conditions: 250-350mg TID at HS

62
Q

Carisoprodol mechanism

A

centrally acting in spinal cord or descending reticular formation
Exact mechanism unknown
metabolite, meprobamate, has sedative and CNS relaxation properties

63
Q

Carisoprodol drug interactions

A

additive toxic effects with alcohol and other CNS depressants

64
Q

Carisoprodol CI/precautions

A

CI: acute intermittent porphyria
caution: liver or renal dysfunction, elderly patients, debilitated patients
Rare: immediate but temporary idiosyncratic reactions (extreme weakness, dizziness, vision loss, euphoria, confusion), stop if this occurs

65
Q

Carisoprodol pregnancy category

A

C

66
Q

Carisoprodol ADRs

A

drowsiness, dizziness, headache, N/V/D or constipation

67
Q

Carisoprodol patient education

A

take with meals
may cause drowsiness, use caution performing activities requiring alertness
Report extreme weakness, vision loss, or euphoria occur

4. CNS agents (depression, psych, anxiety, etc.) (3 decks)

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