Neuro Pharm Flashcards
Linezolid
For: Serious Gram + infections, VR Enterococcus, MRSA
Toxicity: Serotonin Syndrome, when combined with SSRI, or SNRI
MOA: ….Weak MAOI
Clindamycin
For: Clostridium Difficile
Serotonin Syndrome
Neuromuscular excitation: Hyperreflexia, CLONUS, myoclonus, rigidity
Autonomic Stimulation: Hyperthermia, tachycardia, diaphoresis, vomiting/diarrhea
Altered mental status: Agitation, confusion
Often occurs w/ addition of MAOI or excess tryptophan (converted to 5-HT)
Treat w/ serotonin R antagonists - cyproheptadine or short acting anti-hypertensives
Vancomycin
Toxicity: Red Man Syndrome (flushing, erythema, pruritis)
What side effects continue after carbidopa is added to levodopa?
Anxiety and agitation (hot flashes, tacharrythmias, nausea/vomiting, postural hypertension would all decrease)
Clozapine
For: Schizophrenia (Better in treatment resistant patients)
MOA: Acts on D4 receptors
Toxicity: Agranulocytosis (monitor with CBC to look at WBC), seizures
Ziprasidone
Toxicity: Prolonged QT (monitor w/ ECG)
Carbamazepine
For: Seizures (complex partial), trigeminal neuralgia, and mania.
Toxicity: Mild rise in liver enzymes (monitor w/ LFT)
Lithium
For: manic and depressive episodes, maintenance
MOA: modify adenyl cyclase and PIP pathways
Toxicity: Hypothyroidism (monitor w/ TSH and T3/T4 assays), diabetes, tremor, and Ebstein’s anomaly (tricuspid doesn’t work)
Atropine
For: Bradycardia (many others)
MOA: Blocks Muscarinic Receptors (dec vagal influence)
Toxicity: Mydriasis in eye may cause acute close-angled glaucoma
Zolpidem
For: Insomnia
MOA: binds GABA-A, enhances GABA, non-benzodiazepine hypnotic
less dependence, not anticonvulsant, not muscle relaxant
Modafinil
For: Narcolepsy (1st line), daytime sleepiness
B-Blockers
Decrease aqueous humor synthesis (for glaucoma); no pupil changes
Cholinomimetics
Increase aqueous humor outflow (for glaucoma); Miosis - opens trabecular meshwork
Penicillins/Cephalosporins
Irreversibly bind penicillin-binding proteins aka transpeptidases
Resistance: Change in protein structure; B lactamases break down the rings
Valproic Acid
For: Absence (2nd line), myoclonic and Tonic Clonic seizures. also treats mania (mood stabilizer) and trigeminal neuralgia (2nd line).
Toxicity: hepatotoxicity and neural tube defects
Ethosuxamide
For: Absence (1st line)
MOA: reduces Ca++ currents in T type Ca++ channels in neurons, inhibiting propagation
Prophylaxis for Nisseria Meningitidis
Rifampin
SSRI most common side effect
Sexual Dysfunction
CYP 450 Inducers
Chronic alcohol use, Modafinil, St. John’s Wort, Phenytoin, Phenobarbital, Nevirapine, Rifampin, Griseofulvin, Carbamazepine
CYP 450 Inhibitors
Acute alcohol use, Gemifibrozil, Ciprofloxacin, Isoniazid (can cause full blown hepatitis), Grapefruit Juice, Quinidine, Amiodarone, Ketoconazole, Macrolides, Sulfonamides, Cimetidine, Ritonavir
Carbamazepine’s BIG side effects
Aplastic anemia (monitor CBC), agranulocytosis, hyponatremia, neural tube defects.
Citalopram’s BIG side effect (SSRI)
Sexual Dysfunction
Clozapine’s BIG side effects
Agranulocytosis and seizures
Lamotrigine
For: refractory partial, tonic clonic seizures. depressed phase of bipolar
Toxicity: STEVEN JOHNSON SYNDROME
Risperidone’s BIG side effect
Hyperprolactinemia, EPS
Trazodone’s BIG side effects
Priapism (painful erection), orthostatic hypotension, sedation
Lithium’s BIG side effects
Hypothyroidism, Nephrogenic diabetes insipidus, Congenital anomalies (preggers problems)
Phenelzine
For: atypical depression characterized by mood reactivity, rejection sensitivity, and increased sleep and appetite; first line didn’t work
MOA: MAOI
Tranylcypromine
For: atypical depression characterized by mood reactivity, rejection sensitivity, and increased sleep and appetite; first line didn’t work
MOA: MAOI
On Off Phenomenon
Characteristic of advanced Parkinson, unpredictable and dose dependent. sudden loss of L-dopa effects leads to hypokinesia and rigidity.
Levodopa
For: Parkinson
MOA: crosses BBB, increases dopamine levels in brain
Toxicity: arrhythmias, dyskinesia from long term use
Contra: vitamin B6 which increases its peripheral metabolism
Lorazepam
For: active seizures, acute anxiety, and alcohol withdrawal
MOA: enhances GABA affinity for its R by increasing the frequency of chloride channel openings
Olanzapine
For: psychotic and mood disorders
MOA: 2nd gen antipsychotic
Tox: weight gain, metabolic syndrome, lower seizure threshold
Sertraline
For: major depression, OCD, anxiety.
MOA: SSRI
Short Acting Benzodiazepines
Alprazolam, Triazolam, Oxazepam, Midazolam
less drowsiness or risk of fall. highest risk of dependence
Long Acting Benzodiazepines
Chlordiazepoxide, Clorazepate, Diazepam, Flurazepam
greater daytime drowsiness and risk of fall. lower risk of dependence
Bupropion
For: major depression, tobacco dependence, hypoactive sexual disorder
MOA: inhibits presynaptic reuptake of DA and NE (more DA)
Tox: seizures (esp. in those with AN or BN)
Vitamin E
Antioxidant and neuroprotective agent that may slow functional losses in alzheimers
Memantine
For: Alzheimers
MOA: NMDA R antagonist
Donepezil, Galantamine, Rivastigmine
ACh esterase inhibitors
For: Alzheimers
Baclofen
For: trigeminal neuralgia (2nd line)
Tiagabine
For: refractory partial seizures
MOA: inhibits GABA reuptake
Topiramate
For: refractory partial seizures
MOA: blocks Na channels and enhances effect of GABA
Vigabatrin
For: refractory partial seizures
MOA: inhibits GABA transaminase and increases GABA concentration
Gabapentin
For: refractory partial seizures
MOA: increases brain GABA concentration