Neurologic and Psychiatric Drugs Flashcards
What are the drugs used for headaches?
NSAIDS
Ergots
5-HT Agonists
NSAIDS
MOA: Inhibits cyclooxygenase, reduces prostaglandin and thromboxane synthesis
Result: decrease pain
Drugs: ibuprofen, naproxen, diclofenac
ERGOTS
Indications: abortive (you have it and need to get rid) migraine (ergot in name)
MOA: stimulates vascular 5HT1D receptors, may also affect dopamine and alpha-adrenergic receptors
Result: Constricts cranial and peripheral blood vessels, may decrease neurogenic inflammation
Drugs: ergotamine, dihyroergotamine
5-HT agonists
(…triptan)
Indications: migraine abortive, cluster headache abortive
MOA: Activates vascular serotonin 5HT1 receptors (selective serotonin agonist)
Result: Produces vasoconstriction, reduces inflammatory process along trigeminal nerve pathway
Drugs: sumatriptan, rizatriptan, zomitrapitan, frovatriptan, eletriptan
Drugs used for seizures (anti-epileptics) work by either
- Stopping seizure spread and/or
- Raising seizure threshold
-Affecting excitatory neurotransmitters
T/F Not all drugs are used in all types of seizures because some can help seizures while worsening others and oftem times have drug-drug interactions
True
Benzos
(…zepam)
Indications: seizure disorder, status epilepticus (seizures you can’t break – continuous), GAD (generalized anxiety disorder)/panic disorders, sedation, muscle spasms, acute alcohol withdrawal (titrate it so pt wont have seizures) , sleep terrors, sleep walking, RLS – abortive treatment
MOA: binds to benzodiazepine receptors, enhances GABA effects, poorly understood
Drugs: diazepam, lorazepam, clonazepam
Addictive
Sulfamate-substituted monosaccharide
Indications: seizure prevention, migraine prophylaxis, sleep-related eating disorders, PTSD nightmares, alcohol dependence
MOA: Not totally clear, blocks sodium channels, augments GABA activity, antagonizes glutamate receptors
Drugs: Topiramate
Carboxylic acid derivatives
Indications: seizure prevention, bipolar disorder (acute manic), migraine prophylaxis
MOA: Exact mechanism unknown, increases GABA effects, questionable inhibition of glutamate/NMDA receptor-mediated neuronal excitement and membrane stabilization
Drug: Valproic acid, valproate, divaloproex
Iminostilbenes
Indications: seizure disorder (tonic-clonic, partial), bipolar disorder, trigeminal neuralgia***
MOA: thought to allow enhancement of sodium channel inactivation by reducing high-frequency repetitive firing of action potentials and has action on synaptic transmission, other MOA unclear
Result: reduces seizure spread or neuromuscular transmission
Drug: carbamazepine
Phenyltriazine
Indications: seizure prevention, bipolar I maintenance, migraine with aura prophylaxis
MOA: exact mechanism unknown, inhibits voltage-dependent sodium channels, decreases presynaptic glutamate and aspartate release
Result: may result in inhibition of excitatory neurotransmitters
Drug: Lamotrigine
1-(aminomethyl) cyclohexane acetic acids
Indications: partial seizure prevention, neuropathic pain, fibromyalgia, post-herpetic neuralgia, alcohol dependence
MOA: exact mechanism unknown, may bind to carrier protein and act on unknown receptor to elevate GABA (does not act at GABA receptor, affect GABA uptake, or interfere with GABA transaminase) , blocks voltage-dependent calcium channels,
Result: modulates excitatory neurotransmitter release
Drug: gabapentin
Hydatoins
Indications: Seizure disorder
MOA: modulates neuronal voltage-dependent sodium and calcium channels during generation of nerve impulses
Result: Stabilizes nerve cells preventing overexcitation, stops spread of seizure activity by working in motor cortex of brain (prop. + abortive treatment)
Drug: Phenytoin, Fosphenytoin
Other anticonvulsants
Indications: partial seizure prevention, primary generalized tonic-clonic seizure prevention
MOA: exact mechanism unknown, selectively prevents hypersynchronization (for seizures to spread) of epileptiform burst firing
Drug: levetiracetam
Drugs used for parkinsons
Anticholinergic drugs
Aka parasympatholytics
Indications: Early stages Parkinsons as monotherapy, later disease as adjunct to levodopa
Dopaminergic drugs
Many drugs in this class
Chemically unrelated
Mainstay is levodopa
Result in increase of dopamine concentration and/or enhancing neurotransmission of dopamine
Anticholinergic drugs
Aka parasympatholytics
Indications: Early stages Parkinsons as monotherapy, later disease as adjunct to levodopa (something other than tremor: skip this part)
MOA: inhibit Ach at receptors in parasympathetic nervous system
Result: Decreases tremors
Drugs/types: tertiary amines i.e. benztropine
Dopaminergic drugs
Indications: Parkinsons, RLS, sleep-related eating disorder
MOA: Crosses blood-brain barrier and acts as dopamine precursor, inhibits peripheral dopamine decarboxylation
-Levodopa is converted to dopamine in brain thereby increasing dopamine concentrations in basal ganglia
-Carbidopa enhances levodopa’s effectiveness by blocking peripheral conversion of levodopa allowing more to get to the brain
Result: Counteracts the depletion of striatal dopamine in extrapyramidal centers and decreases rigidity, akinesia (slow to get up), rest tremor, and improves posture/balance (improves the walking in block)
Drugs: levodopa***/carbidopa (not active – giving only this = not treatment. Give with levodopa)
Non-ergot Dopamine agonists
Indications: Parkinsons, RLS, sleep-related eating disorder, REM sleep behavior disorder
MOA: Dopamine agonists, stimulates dopamine receptors
Result: Improves rest tremor, rigidity, and voluntary muscle control
Drug: ropinirole, pramiprexole
COMT inhibitors
Catechol-o-methyl transferase inhibitors (…-capone)
Indications: adjunct to levodopa in Parkinsons
MOA: Prevents catechol-O-methyl transferase (COMT) from deactivates levodopa in the body before it is absorbed into the bloodstream
Result: Prevents levodopa from wearing off too quickly
Drugs: Tolcapone, entacapone
Drugs used for CVA/TIA
Antiplatelets
Indication: thrombotic stroke prevention with prior TIA or CVA
MOA: Dipyridamole inhibits adenosine uptake by platelets and increases cGMP production + ASA
Result: Reduces platelet aggregation and dilates coronary arteries
Drug: Aspirin/dipyridamole
SSRI’s
Selective serotonin reuptake inhibitors
Indications: first line treatment Depression, anxiety and panic disorders
MOA: Inhibit the neuronal reuptake of serotonin
Drugs: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft)
SNRI’s
Selective serotonin-norepinephrine reuptake inhibitor
Indications: depression, anxiety, chronic pain syndromes (fibromyagia)
MOA: potentiates neurotransmitter activity by inhibiting the neural reuptake of serotonin and norepinephrine
Drugs: venlafaxine (Effexor), duloxetine (Cymbalta)
Buproprion
Indications: treats depression, and aids in smoking cessation
MOA: Dopamine and norepinephrine reuptake-blocker
Decreases cravings for nicotine and symptoms of nicotine withdraw
Drugs: buproprion (Wellbutrin, Zyban)
TCA’s
Tricyclic Antidepressants
Indications: Depression, bipolar disorder, panic disorders, OCD, (lots of side affects for psych) chronic pain**
MOA: Prevent the reuptake into the storage granules in the presynaptic nerves which increases the amount of norepinephrine and serotonin in the synapses
Drugs: doxepin, amitriptyline hydrochloride (Elavil), imipramine (Tofranil), nortriptyline (Pamelor)
