Neuro/Pysch Drugs Flashcards
MOA for Epinephrine in Tx Glaucoma?
Alpha agonist: decrease aqueous humor synthesis via vasoconstriction
MOA of Brimonidine in Tx glaucoma?
Decrease aqueous humor synthesis (a2 agonist)
Ade’s of epi?
Mydriasis; do not use in closed-angle glaucoma
Ade’s of brimonidine?
Blurry vision, ocular hyperemia, foreign body sensation, ocular allergic reactions, ocular pruritus
MOA of timolol, betaxolol, and carteolol in Tx of glaucoma?
aqueous humor synthesis
Ade of timolol, betaxolol, and carteolol?
No pupillary or vision changes
MOA of Acetazolamide in Tx of glaucoma?
Decrease aqueous humor synthesis via inhibition of carbonic anhydrase
Ade’s of acetazolamide?
No pupillary or vision changes
MOA of the direct and indirect cholinomimetics?
Increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork
Which drugs are direct cholinomimetics? Which are indirect?
Direct=(pilocarpine, carbachol)
Indirect=(physostigmine, echothiophate)
What can pilocarpine be specifically used for?
Use pilocarpine in emergencie; very effective at opening meshwork into canal of Schlemm
Ade’s of the cholinomimetics?
Miosis and cyclospasm (contraction of ciliary muscle)
MOA of Latanoprost (PGF2α) in Tx glaucoma?
Increase outflow of aqueous humor
Ade of latanoprost?
Darkens color of iris (browning)
What are the opioid analgesics?
Morphine, fentanyl, codeine, loperamide, methadone, meperidine, dextromethorphan, diphenoxylate.
MOA of opioids?
Act as agonists at opioid receptors (mu = morphine, delta = enkephalin, kappa = dynorphin) to modulate synaptic transmission—open K+ channels, close Ca2+ channels-> decrease synaptic transmission. Inhibit release of ACh, norepinephrine, 5-HT, glutamate, substance P.
Clinical use for opioids?
Pain, cough suppression (dextromethorphan), diarrhea (loperamide and diphenoxylate), acute pulmonary edema, maintenance programs for heroin addicts (methadone).
Opioids ades?
Addiction, respiratory depression, constipation, miosis (pinpoint pupils), additive CNS depression with other drugs.
Tolerance does not develop to miosis and constipation.
Toxicity treated with naloxone or naltrexone (opioid receptor antagonist).

Moa of butophanol?
Mu-opioid receptor partial agonist and kappa-opioid receptor agonist; produces analgesia.
What’s butophanol used for?
Severe pain (migraine, labor, etc.). Causes less respiratory depression than full opioid agonists.
Butorphanol ades?
Can cause opioid withdrawal symptoms if patient is also taking full opioid agonist (competition for opioid receptors). Overdose not easily reversed with naloxone.
Moa of tramadol?
Very weak opioid agonist; also inhibits serotonin and norepinephrine reuptake (works on multiple neurotransmitters—“tram it all” in with tramadol).
What’s tramadol used for?
Chronic pain
Ade’s of tramadol?
Similar to opioids. Decreases seizure threshold. Serotonin syndrome.
Drugs used to Tx absence seizures?
Ethosuximide (1st line), valproic acid, lamotrigine
Moa of ethosuximide?
Blocks thalamic T-type Ca2+ channels
Ade’s of ethosuximide?
“EFGHIJ”—Ethosuximide causes Fatigue, GI distress, Headache, Itching, and Stevens-Johnson syndrome
Moa of benzo’s (diazepam, lorazepam)?
Increase GABAa action
Ade’s with benzo’s
Sedation, tolerance, dependence, respiratory depression
For what kind of seizures would you use benzo’s?
Status epilepticus (1st line for acute). Also for eclampsia seizures (1st line is MgSO4)
Moa of phenytoin?
Increase Na+ channel inactivation; zero-order kinetics
Ade’s of phenytoin?
Nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, peripheral neuropathy, megaloblastic anemia, teratogenesis (fetal hydantoin syndrome) SLE-like syndrome, induction of cytochrome P-450, lymphadenopathy, Stevens- Johnson syndrome, osteopenia
When would you use phenytoin?
1st line for tonic clonic; 1st line prophylaxis for status epilepticus, also used for simple and complex. Note: Fosphenytoin for parenteral use
Moa of carbamazepine?
Increase Na+ channel inactivation
Ade’s of carbamazepine?
Diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver toxicity, teratogenesis, induction of cytochrome P-450, SIADH, Stevens-Johnson syndrome
Uses of carbamazepine?
1st line for simple, complex, and tonic clonic. Also 1st line for trigeminal neuralgia
Valproic acid moa?
Increase Na+ channel inactivation, increase GABA concentration
by inhibiting GABA transaminase
Ade’s of valproic acid?
GI, distress, rare but fatal hepatotoxicity (measure LFTs), neural tube defects in fetus (spina bifida), tremor, weight gain, contraindicated in pregnancy
Uses for valproic acid?
1st line for tonic clonic, also used for simple, complex and absence. Also used for myoclonic seizures and bipolar disorder
Moa Gabapentin?
Primarily inhibits high voltage activated Ca2+ channels; designed as GABA analog
Ade’s of gabapentin?
Sedation, ataxia
Uses of gabapentin?
Simple, complex, and tonic clonic. Also used for peripheral neuropathy, postherpetic neuralgia, migraine prophylaxis, bipolar disorder
Phenobarbital moa?
Increase GABAa action
Phenobarbital ade’s?
Sedation, tolerance, dependence, induction of cytochrome P-450, cardiorespiratory depression
Uses of phenobarbital?
Simple, complex, and tonic clonic. 1st line in neonates
Topiramate moa?
Blocks Na+ channels, and increases GABA action
Ades of topiamate?
Sedation, mental dulling, kidney stones, weight loss
What’s topiramate used for?
Simple, complex, and tonic clonic. Also used for migraine prevention
Lamotrigine moa?
Blocks voltage-gated Na+ channels
Uses for Lamotrigine?
Simple, complex, tonic clonic and absence
Lamotrigine ade’s?
SJS (must titrate slowly)
Levetiracetam moa?
Unknown; may modulate GABA and glutamate release
Uses for Levetiracetam?
Simple, complex, and tonic clonic
Tiagabine moa?
Increase GABA by inhibiting re-uptake
Uses for tiagabine?
Simple and complex
Vigabatrin moa?
Increase GABA by irreversibly inhibiting GABA transaminase
Uses for Vigabatrin?
Simple and complex
Primidone moa?
Metabolized to phenobarbital and phenylethylmalonamide
MOA of barbiturates (Phenobarbital, pentobarbital, thiopental, secobarbital)?
Facilitate GABAa action by increasing duration of Cl- channel opening, thus decreasing neuron firing (barbidurates increase duration). Contraindicated in porphyria.
Clinical use of barbiturates?
Sedative for anxiety, seizures, insomnia, induction of anesthesia (thiopental).
Barbiturates ades?
Respiratory and cardiovascular depression (can be fatal); CNS depression (can be exacerbated by EtOH use); dependence; drug interactions (induces cytochrome P-450).
Overdose treatment is supportive (assist respiration and maintain BP).
Moa of benzo’s (Diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam)?
Facilitate GABAa action by increasing frequency of
Cl- channel opening. Decrease REM sleep. Most have long half-lives and active metabolites (exceptions: triazolam, oxazepam, and midazolam are short acting and have higher addictive potential).
Uses for benzo’s?
Anxiety, spasticity, status epilepticus (lorazepam and diazepam), detoxification (especially alcohol withdrawal–DTs), night terrors, sleepwalking, general anesthetic (amnesia, muscle relaxation), hypnotic (insomnia).
Ades with benzo’s?
Dependence, additive CNS depression effects with alcohol. Less risk of respiratory depression and coma than with barbiturates.
Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine recep
What are the nonbenzo hypnotics?
Zolpidem (Ambien), Zaleplon, esZopiclone. “All ZZZs put you to sleep.”
MOA for nonbenzo hypnotics?
Act via the BZ1 subtype of the GABA receptor. Effects reversed by flumazenil
What are the nonbenzo hypnotics used for?
Insomnia
Ade’s of the nonbenzo hypnotics?
Ataxia, headaches, confusion. Short duration because of rapid metabolism by liver enzymes. Unlike older sedative-hypnotics, cause only modest day-after psychomotor depression and few amnestic effects. Lower dependence risk than benzodiazepines.