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Neurologic agents Flashcards

1
Q

alprazolam

A

Brand - Xanax

Class - C-IV, Benzodiazepine (short/intermediate acting)

Indication - Anxiety, panic disorder

Contraindications - Narrow-angle glaucoma, concurrent ketoconazole/itraconazole

Pregnancy - Data suggests Risk

Black Box - Concurrent use w/ opioids

Counseling - Drowsiness? Avoid alcohol, driving, crushing XR

MoA - Enhances the effect of GABA

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2
Q

amitriptyline

A

Brand - Elavil

Class - Tricyclic antidepressant

Indication - Depression

Contraindications - MAOI use in last 2w, during acute recovery period after MI, use of cisapride

Black Box - Suicidality; not approved for children <12y

Counseling - Avoid alcohol & CNS depressants, avoid sudden discontinuation, improvement may not be seen for weeks

MoA - Blocks reuptake of 5-HT & NE, subsequent downreg of adrenergic receptors

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3
Q

aripiprazole

A

Brand - Abilify

Class - Antipsychotic

Indication - Bipolar (mania), schizophrenia, depression (w/ antidepressant), Tourette syn, irritability (w/ autism)

Black Box - Dementia, sucidality

Counseling - Avoid discontinuation, alcohol. May impact mental alertness/coordination, impair heat regulation, lower seizure threshold. Report increased seizure activity, depression, thots of suicide, hyperglycemia, extrapyamidal effects, neuroleptic malignant syndrome.

MoA - Quinolinone derivative, partial agonist at DA2,3 & 5-HA1a receptors and antagonist at 5-HA2a

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4
Q

atomoxetine

A

Brand - Strattera

Class - NE reuptake inhibitor, CNS stimulant

Indication - ADHD

Contraindications - MAOIs use within 2w, narrow-angle glaucoma, pheochromocytoma, severe cardiovascular disorders where increases in BP/HR is dangerous

Pregnancy - Risk

Black Box - Suicidality in children/adolescents

Counseling - Beware mental alertness, monitor growth/weight in children for dose, report new psychiatric problems, chest pain, palpitations, dyspena, cardiac dysrhythmias, MI, or cerebrovascular accidents. Do not open capsules (dust irritates eyes).

MoA - Selective NE reuptake inhibitor for ADHD

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5
Q

bupropion

A

Brand - Wellbutrin (SR, XL), Aplenzin

Class - Monocyclic antidepressant

Indication - Depression, SAD, smoking cessation

Contraindications - Seizures, anorexia/bulimia, MAOI use within 2w, undergoing abrupt discontinuation of alcohol, benzodiazepines, barbituarates, or antiepileptics

Black Box - Suicidality, neuropsychiatric reactions

Counseling - Avoid alcohol, CNS depressants, activities w/ mental alertness. Tk at the same time (at bedtime). XL tab shell visible in stool.

MoA - Mild DA & NE uptake inhibitor, no direct effect on 5-HT receptors or MAO

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6
Q

buspirone

A

Brand - BuSpar

Class - Antianxiety

Indication - Anxiety

Counseling - Realize mental alertness, improvement may not be seen for weeks, avoid sudden discontinuation. Tk w/wo food but consistently. Avoid alcohol, grapefruit juice, and MAOI.

MoA - Selective 5-HT1a receptor partial agonist. Acts on DA2 autoreceptors and can DR B-adrenergic receptors. Does not have amnestic, anticonvulsant, muscle relaxant, or hypnotic effects like a benzodiazepines.

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7
Q

carbamazepine

A

Brand - Tegretol

Class - Anticonvulsant

Indication - Epilepsy, trigeminal neuralgia

Contraindications - Bone marrow depression, MAOIs, nefazodone

Black Box - Agranulocytosis, aplastic anemia, dermatological reactions (esp Asians), screen for HLA-B*15:02

Counseling - May decrease effectiveness of oral contraceptives (use condom), take with food but not alcohol or grapefruit, avoid abrupt discontinuation, realize mental alertness

MoA - Blocks firing of AP, decreases excitatory NT

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8
Q

carbidopa / levodopa

A

Brand - Rytary, Duopa

Class - Antiparkinsonian

Indication - Parkinson disease

Contraindications - Narrow-angle glaucoma, concurrent MAOI or linezolid

Pregnancy - Risk (carbidopa)

Counseling - Place disintegrating tablets on tongue

MoA - Carbidopa (does not cross BBB) allows more levodopa to reach CNS before decarboxylating so less is required and less side effects occur, levodopa turns into DA

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9
Q

citalopram

A

Brand - Celexa

Class - SSRI antidepressant

Indication - Depression

Contraindications - Concomitant use of pimozide or MAOIs

Pregnancy - Risk

Black Box - Suicidal ideation, not approved for children

Counseling - Realize mental alertness. Improvement may not be seen for several weeks, avoid abrupt discontinuation. Do not drink alcohol or use NSAIDs, report worsening depression or unusual bleeding.

MoA - Bicyclic selective/potent inhibitor of 5-HT reuptake

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10
Q

clonazepam

A

Brand - Klonopin

Class - C-IV, Benzodiazepine

Indication - Panic disorder, seizure

Contraindications - Liver disease, narrow-angle glaucoma

Black Box - Concurrent use w/ opioids, abuse/addiction

Counseling - May cause drowsiness, avoid alcohol. Allow disintegrating tab to dissolve on tongue.

MoA - Enhances the effect of GABA

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11
Q

dexmethylphenidate

A

Brand - Focalin

Class - C-II, CNS Stimulant

Indication - ADHD

Contraindications - MAOI use, drug dependence, glaucoma, tics or Tourette syn

Black Box - Abuse & dependence

Counseling - Avoid late doses (insomnia), may pour on applesauce and swallow whole if needed.

MoA - Increases CNS activity by inhibiting reuptake of NE & DA

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12
Q

dextroamphetamine

A

Brand - Dexedrine, {Adderall is dextroamphetamine&amphetamine salt}

Class - C-II, CNS Stimulant

Indication - ADHD, Narcolepsy

Contraindications - HSN, HTN, Advanced arteriosclerosis, Hyperthyroidism

Black Box - Cardiac events including sudden death, Abuse & dependence

Counseling - May cause anorexia, Report vocal or motor tics, Caution pt w/ history of seizure, Do not give at bedtime (insomnia), Report irregular HR

MoA - Amphetamines cause release of DA and NE at presynaptic nerve terminals and may block reuptake of NE and DA by competitive inhibition.

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13
Q

diazepam

A

Brand - Valium

Class - C-IV, Benzodiazepine

Indication - Alcohol withdrawal syndrome, anxiety, seizure

Contraindications - Narrow-angle glaucoma, severe liver disease, myasthenia gravis, sleep apnea, respiratory insufficiency, kids <6mo

Pregnancy - Risk

Black Box - Concurrent use w/ opioids

Counseling - May cause drowsiness, avoid alcohol, avoid driving.

MoA - Enhanced effect of GABA

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14
Q

divalproex Na+

A

Brand - Depakote

Class - Anticonvulsant

Indication -Seizures, manic bipolar disorder, migraine prophylaxis

Contraindications - Hepatic disease, urea cycle disorders

Pregnancy - Risk

Black Box - Hepatotoxicity, teratogenicity, pancreatitits, patients w/ mitochondrial disease

Counseling - May cause dizziness or somnolence, look for signs of liver dysfunction during first 6 mo, tk w/ food to avoid GI upset, do not discontinue abruptly, avoid alcohol

MoA - Sodium valproate/valproic acid increases GABA by inhibiting metabolism and limits repetitive neuronal firing through sodium channels

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15
Q

donepezil

A

Brand - Aricept

Class - Central cholinesterase inhibitor

Indication - Alzheimer disease, dementia

Contraindications - Hypersensitivity to piperidine derivatives

Counseling - Take at bedtime, allow tab to dissolve on tongue and follow w/ water. Report GI bleeding. Adverse effects tend to resolve w/ continued use.

MoA - Enhances ACe by reversibly inhibiting AChE (that hydrolyzes it), it is highly selective for the CNS, so less peripheral side effects

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16
Q

duloxetine

A

Brand - Cymbalta

Class - SNRI antidepressant

Indication - Anxiety, Depression, Diabetic peripheral neuropathy pain/fibromyalgia/musculoskeletal pain

Contraindications - MAOI, TCA, linezolid use, uncontrolled glaucoma

Pregnancy - Risk

Black Box - Suicidality, not approved for children

Counseling - Report withdrawal, may cause hepatoxicity and increased risk of bleeding, require several weeks for depression improvement, avoid alcohol.

MoA - Selectively inhibits reuptake of 5-HT & NE

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17
Q

escitalopram

A

Brand - Lexapro

Class - SSRI antidepressant

Indication - Depression, Generalized anxiety disorder

Contraindications - Concurrent MAOI use

Pregnancy - Risk

Black Box - Suicidality

Counseling - Improvement may not be seen for 6w, report worsening depression, avoid abrupt ddiscontinuation, do not drink alcohol or use NSAIDs

MoA - S-enatiomer of citaloprom and selective inhibitor of 5-HT reuptake

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18
Q

fluoxetine

A

Brand - Prozac

Class - SSRI antidepressant

Indication - Depression, OCD, Panic Disorder, Bulimia nervosa, Premenstrual dysphoric disorder

Contraindications - Concomitant pimozide, thiordazine, or MAOIs

Pregnancy - Risk

Black Box - Suicidality, approved children >7y

Counseling - Take before breakfast, do not drink alcohol or use NSAIDs, improvement may not be seen for several weeks, while adverse effects present in the first week, report worsening depression.

MoA - Bicyclic selective & potent inhibitor of 5-HT reuptake

19
Q

guanfacine

A

Brand - Intuniv

Class - Alpha2-adernergic agonist

Indication - ADHD (extended release), HTN (immediate release)

Counseling - Avoid alcohol, CNS depressants, caution driving, report signs of hypotension, hepatic dysfunction, edema; avoid abrupt discontinuation

MoA - Stimulates alpha receptors in the CNS by activating inhibitory neurons to decrease sympathetic outflow

20
Q

lamotrigine

A

Brand - Lamictal

Class - Phenyltriazine anticonvulsant

Indication - Bipolar I disorder, partial seizure

Black Box - Serious skin reactions

Counseling - Seek PCP if blistering rash, yellowing of skin/eyes, unusual bleeding, shortness of breath, or suicidal thoughts occur; avoid alcohol

MoA - Inhibits voltage Na+ channels, stabilizing membranes and reducing release of excitatory NT like glutamate and aspartate

21
Q

levetiracetam

A

Brand - Keppra (XR)

Class - Anticonvulsant

Indication - Myoclonic/partial/tonic-clonic seizure

Pregnancy - Risk

Counseling - Realize mental alert, report mood swings, agitation, avoid sudden discontinuation of drug

MoA - Pyrrolidine derivative that is unrelated to other AEDs

22
Q

lisdexamfetamine [dimestylate]

A

Brand - Vyvanse

Class - C-II, amphetamine

Indication - ADHD, binge eating disorder

Contraindications - hypersensitivity/idiosyncrasy to sympthomimetic amines; MAOIs; CV disease/advanced arteriosclerosis; mod-severe HTN; hyperthyroidism, glaucoma, agitated states, history of drug dependence

Pregnancy - Risk

Black Box - Risk of abuse/misuse/diversion

Counseling - Tk in morning; monitor growth rate/weight in children, report new psych problems, chest pain, palpitations, dyspnea, signs of cardiac dysrhythmia, AMI, cerebrovascular accident

MoA - Prodrug of dextroamphetamine > release DA & NE and block reuptake by competitive inhibition

23
Q

lithium

A

Brand - Eskalith (CR), Lithobid

Class - Antimanic

Indication - Bipolar disorder (maintenance or manic episode)

Contraindications - Severe debilitation, dehydration, Na+ depletion, CV disease, renal impairment, concomitant diuretic therapy

Pregnancy - Risk

Black Box - Lithium levels required

Counseling - Dispense medication guide. Maintain fluid and salt intake. Report signs of toxicity (diarrhea, vomiting, tremor, ataxia, drowsiness, muscle weakness, lack of coordination, giddiness, blurred vision, tinnitus, or large volumes of dilute urine.

MoA - Alters action of several second-messenger systems, cation transport across cell membrane and influence reuptake of 5-HT and/or NE, inhibited phosphatidylinositol cycle messangers

24
Q

lorazepam

A

Brand - Ativan

Class - C-IV, Benzodiazepine (short or intermediate act)

Indication - Anxiety, Insomnia (due to situational stress)

Contraindications - Narrow-angle glaucoma

Pregnancy - Risk

Black Box - Concurrent use w/ opioids

Counseling - Drowsiness, avoid alcohol, avoid driving

MoA - Enhance the effect of GABA

25
Q

memantine

A

Brand - Namenda

Class - NMDA receptor antagonist

Indication - Alzheimer disease

Pregnancy - Weigh risks/benefits

Counseling - Administer oral solution w/ dosing device

MoA - Noncompetitive antagonist of NMDA receptors normally activated by glutamate

26
Q

methylphenidate

A

Brand - Ritalin, Concerta

Class - C-II, CNS Stimulant

Indication - ADHD, narcolepsy

Contraindications - Anxiety, agitation, cocurrent MAOIs, drug dependence, glaucoma, tics or Tourette, HTN, angina, heart failure, concurrent halogenated anesthetics

Pregnancy - Moderate risk

Black Box - Abuse/dependence potential

Counseling - Avoid late doses (insomnia), avoid abrupt discontinuation. Patch: apply same time each day, alt hips, remove after 9 h.

MoA - Increases CNS activity by inhibiting reuptake of NE & DA

27
Q

mirtazapine

A

Brand - Remeron

Class - alpha2-antagonist, antidepressant

Indication - Depression

Contraindications - MAOIs use within 2w, linezolid or IV methylene blue use

Pregnancy - Moderate Risk

Black Box - Sucidality; not for use in children

Counseling - Take prior to sleep. Dissolve on tongue. Avoid alcohol. Report worsening depression. Realize mental alertness.

MoA - Antagonizes alpha2-adrenergic auto/heteroreceptors that release NE & 5-HT to increase activity with minimal adverse effects

28
Q

nortriptyline

A

Brand - Pamelor

Class - Tricyclic antidepressant

Indication - Depression

Contraindications - MAOI use within 2w, use during acute recovery period after MI, use of linezolid or IV methylene blue

Black Box - Sucidality

Counseling - May cause somnolence/dizziness. Report worsening depression or unusual bleeding. Avoid abrupt discontinuation, avoid alcohol.

MoA - Demethylated metabolite of amitriptyline, heterocyclic AD that blocks reuptake of NE and DR adrenergic receptors (not much activity on 5-HT).

29
Q

oxcarbazepine

A

Brand - Trileptal

Class - Dibenzazepine Carboxamide, anticonvulsant

Indication - Partial seizure

Pregnancy - Risk

Counseling - Tk w/ food, avoid alcohol and grapefruit. Shake well and prep dose immediately. Report signs of serious dermatologic reactions, myelosuppression, or hepatotoxicity. Avoid abrupt discontinuation, realize mental alertness.

MoA - 10-keto analogue of carbamezepine that works through an active 10-monohydroxy metabolite

30
Q

paroxetine

A

Brand - Paxil (CR)

Class - SSRI antidepressant

Indication - Depression, generalized/social anxiety or panic disorder, OCD, PTSD, premenstrual synd, menopause (vasomotor symp)

Contraindications - Concomitant use of thioridazine, MAOIs

Pregnancy - Contraindicated

Black Box - Suicidality

Counseling - Do not drink alcohol, caution w/ NSAIDs, avoid abrupt discontinuation, improvement may not be seen for weeks, realize mental alert. Shake suspension well, do not crush CR tabs.

MoA - Highly selective/potent inhibitor of 5-HT reuptake

31
Q

phenobarbital

A

Brand - Luminal

Class - C-IV, Long-acting Barbiturate

Indication - Epilepsy, Daytime sedation

Contraindications - Liver impairment, dyspnea/res obstruction, history of hypnotic addiction, family history of acute intermittent porphyria

Pregnancy - Risk

Counseling - May cause dizziness/somnolence, avoid alcohol, CNS depressants, driving, sudden discontinuation. Many drug interactions, check with HCP for new OTC.

MoA - Depresses CNS (sedation&raquo_space; gen anesthesia)

32
Q

phenytoin

A

Brand - Dilantin

Class - Hydantoin Anticonvulsant

Indication - Seizure

Contraindications - Sinus bradycardia, AV block

Black Box - Hypotension and arrhythmias (w/ IV admin)

Counseling - Report signs of pancytopenia, hepatotoxicity, systemic lupus erythematosus, or skin reaction. Many drug interactions, check w/ HCP for new OTC. Do not drink alcohol, realize mental alert, shake suspension well, do not crush XR tabs.

MoA - Suppresses spread of seizure by inhibiting synaptic posttetanic potentiation and blocking propagation of electric discharge (might decrease Na+ transport and block Ca2+ channels)

33
Q

pramipexole H2Cl2

A

Brand - Mirapex (ER)

Class - Dopamine agonist, Antiparkinson

Indication - Parkinson, Restless leg synd

Counseling - Tk w/ food if nausea, rise slowly from a sitting/lying position. Report new urges to gambling, sex, compulsive eating or buying, or worsening dyskinesia. Realize mental alertness, avoid alcohol and other CNS depressants. Do not discontinue abruptly (emergent hyperpyrexia/confusion)

MoA - Selective DA2,3 agonist but no activity at DA1. (DA2 important in Parkinson)

34
Q

pregabalin

A

Brand - Lyrica

Class - Anticonvulsant, Analgesic

Indication - Neuropathic pain, fibromyalgia, partial seizure, postherpetic neuralgia

Pregnancy - Moderate risk

Counseling - Solution must be used in 45d, avoid sudden discontinuation, alcohol, CNS depressants; realize mental alertness

MoA - GABA analogue binds to alpha2-delta site in CNS, reduces Ca2+ dependent release of NT

35
Q

quetiapine

A

Brand - Seroquel (XR)

Class - (atypical) Antipsychotic

Indication - Bipolar, Schizophrenia, Major Depressive disorder (w/ antidepressant)

Black Box - Mortality in dementia, suicidality, not approved for kids <10y

Counseling - Caution w/ increase temp. Tk w/ food, avoid alcohol and coordination activities. Rise slowly from sitting. Report signs of hyperglycemia, bradycardia, arrhythmia, tardive dyskinesia, neuroleptic malignant syndrome.

MoA - Antagonist of 5-HT1a,2; DA1,2; H1; A1,2. Combo of DA2 and 5-HT2 > bipolar/schizophrenia

36
Q

risperidone

A

Brand - Risperdal

Class - Benzisoxazole, Antipsychotic

Indication - Schizophrenia, Bipolar (acute manic/mixed), Autism (irritability)

Contraindications - Agents that increase QTc interval

Black Box - Mortality in dementia, DRESS?

Counseling - Tk w/ food. Caution w/ increasing core temp. Rise slowly from sitting. Report signs of hyperglycemia, arrhythmia, tardive dyskinesia, neuroleptic malignant syndrome. Realize mental alertness. Place on tongue and dissolve. Solution may be mixed w/ water/coffee/OJ/milk but not soda/tea.

MoA - Potent 5-HT2 and weak DA2 antagonist.

37
Q

ropinirole

A

Brand - Requip (XL)

Class - Dopamine agonist

Indication - Parkinson, Restless legs syndr

Pregnancy - Risk

Counseling - Tk w/ food (nausea). Rise slowly from sit, avoid sudden discontinuation, alcohol, other CNS depressant. Report dyskinesia, BP changes, fainting, or new urges. Realize mental alertness.

MoA - Higher specificity to DA3 than DA2&4, moderate affinity for opioid receptors (stimulates postsynaptic DA2 receptor in Parkinson)

38
Q

sertraline

A

Brand - Zoloft

Class - SSRI antidepressant

Indication - Depression, OCD, Premenstrual dyphoric disorder, Panic/PTSD/Social phobia disorders

Contraindications - Concomitant use of pimozide, thiordiazine, or MAOIs

Pregnancy - Risk

Black Box - Suicidality, not approved for kids (depression), must be >6y for OCD

Counseling - Improvement may not be seen for weeks, avoid abrupt discontinuation, report worsening depression or unusual bleeding. Avoid alcohol & NSAIDs. Realize mental alertness.

MoA - SSRI, indirectly DR Beta-adrenergic receptors.

39
Q

temazepam

A

Brand - Restoril

Class - C-IV, Benzodiazepine

Indication - Insomnia

Contraindications - Narrow-angle glaucoma, pregnancy

Black Box - Concurrent use w/ opioids

Counseling - Tk 30 min before bed. Causes drowsiness, avoid alcohol, driving. Sleepwalking has been reported!

MoA - Metabolite of diazepam, enhances effect of GABA

40
Q

topiramate

A

Brand - Topamax

Class - Anticonvulsant

Indication - Seizure (partial or tonic-clonic), migraine prophylaxis

Contraindications - For ER formulation: Alcohol use within 6 hours before/after

Pregnancy - Risk

Counseling - May cause dizziness, somnolence, diplopia, nervousness, confusion, decrease sweating (avoid hot temps), kidney stones (drink wawa), decrease oral contaceptives (use condom). Avoid alcohol and other CNS depressants, if more than 1 missed dose, consult HCP. Realize mental alertness.

MoA - Might block voltage Na+ channel, augment the activity of GABA-A receptor, and antagonize/inhibit other stuff

41
Q

trazodone

A

Brand - Desyrel

Class - Antidepressant

Indication - Depression

Contraindications - Use of MAOI within 2ws

Black Box - Suicidal ideation, not for kids

Counseling - May cause dizziness/somnolence, realize mental alert, report signs of pripism ASAP. Avoid alcohol, other CNS depressants, and sudden discontinuation.

MoA - Inhibits reuptake of 5-HT, and blocks H1 and alpha1-adrenergic receptors.

42
Q

venlafaxine

A

Brand - Effexor (XR)

Class - SNRI antidepressant

Indication - Generalized anxiety, depression, panic, and social anxiety disorders

Contraindications - MAOIs

Pregnancy - Risk

Black Box - Suicidal ideation

Counseling - Tk w/ food, no alcohol. Improvement may not be evident for weeks, do not discontinue. May cause dizziness/somnolence. Do not chew ER tabs.

MoA - Potent 5-HT & NE reuptake inhibitor

43
Q

zolpidem

A

Brand - Ambien, Intermezzo

Class - C-IV, Hypnotic (nonbarbiturate)

Indication - Insomnia (short-term)

Contraindications - History of sleepwalking

Pregnancy - Risk

Black Box - Risk of sleepwalking

Counseling - Tk on empty stomatch immediately before bedtime. May cause daytime drowsiness, avoid driving, alcohol, other CNS depressants. Warn patient of sleep-walking, partner should monitor irregular respiration.

MoA - Binds to benzodiazepine receptor somehow, increases chloride conductance and inhibition of AP

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