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

Misc CNS agents Flashcards

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
Baclofen ADR's
drowsiness is most common | Others: dizziness, weakness, fatigue, confusion, headache, insomnia, nausea, constipation, urinary frequency
26
Baclofen patient education
may cause drowsiness, use caution avoid alcohol do not discontinue abruptly
27
Benztropine brand name
Cogentin
28
Benztropine indication/dosage
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
Benztropine mechanism
active inhibitor of cholinergic and histaminic receptors selective blockade of cholinergic receptors in parasympathetic NS. Structurally similar to atropine and diphenhydramine
30
Benztropine drug interactions
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
Benztropine CI/precautions
CI: patients with prostatic hypertrophy or bladder neck obstructions, myasthenia gravis, and children
32
Benztropine pregnancy category
C
33
Benztropine adverse effects
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
Benztropine patient education
may take with food or milk avoid alcohol and other CNS depressants do not discontinue abruptly avoid prolonged exposure to heat
35
buprenorphine + naloxone brand name
Suboxone
36
buprenorphine + naloxone indication/dosage
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
buprenorphine + naloxone dosage induction
begin using Subutex (does not contain naloxone), and aim to reach adequate maintenance dosing quickly to avoid opioid withdrawal symptoms
38
buprenorphine + naloxone mechanism
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
buprenorphine + naloxone drug interactions
3A4 inhibitors increase plasma concentrations. 3A4 inducers decrease plasma concentrations, benzodiazepines and buprenorphine together IV have resulted in coma and death
40
buprenorphine + naloxone CI/precautions
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
buprenorphine + naloxone pregnancy category
C | do not use in nursing mothers
42
buprenorphine + naloxone ADRs
headache, constipation, nausea, sweating | REPORT dizziness, confusion, jaundice, or SOB
43
buprenorphine + naloxone PATIENT EDUCATION
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
Carbamazepine brand names
Tegretol (XR) Carbatrol ER Equetrol ER
45
Carbamazepine indication/dosage
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
Carbamazepine mechanism
reduces polysynaptic responses and blocks post-tetanic potentiation
47
Carbamazepine drug interactions
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
Carbamazepine CI/precautions
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
Carbamazepine pregnancy category
C
50
Carbamazepine ADRs
dizziness, unsteadiness, N/V, drowsiness | Rare: aplastic anemia, agranulocytosis, SJS
51
Carbamazepine patient education
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
Carbidopa/Levodopa brand name
Sinemet (CR)
53
Carbidopa/Levodopa indication/dosage
Parkinson's Disease: individualized therapy, adjusted according to desired therapeutic response
54
Carbidopa/Levodopa mechanism
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
Carbidopa/Levodopa drug interactions
hydantoins and pyridoxine (B6) may decrease effectiveness | hypertensive crisis may occur if given with MAO-I
56
Carbidopa/Levodopa CI/precautions
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
Carbidopa/Levodopa pregnancy category
not established, use with caution in pregnancy and lactation
58
Carbidopa/Levodopa ADRs
dystonic or involuntary movements, depression, dementia, nausea
59
Carbidopa/Levodopa patient education
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
Carisoprodol brand name
Soma
61
Carisoprodol indication/dosage
relief of discomfort associated with acute, painful musculoskeletal conditions: 250-350mg TID at HS
62
Carisoprodol mechanism
centrally acting in spinal cord or descending reticular formation Exact mechanism unknown metabolite, meprobamate, has sedative and CNS relaxation properties
63
Carisoprodol drug interactions
additive toxic effects with alcohol and other CNS depressants
64
Carisoprodol CI/precautions
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
Carisoprodol pregnancy category
C
66
Carisoprodol ADRs
drowsiness, dizziness, headache, N/V/D or constipation
67
Carisoprodol patient education
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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