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PT 862 > Pharmacology for Cognitive Issues > Flashcards

Pharmacology for Cognitive Issues Flashcards

1
Q

How do most drugs impact the CNS?

A

They cross the BBB and act by altering neurotransmission

Can have stimulant properties like excitement, euphoria, decreased fatigue, increased motor activity

Can have inhibitory properties like depression, sedation, fatigue and decreased motor activity

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2
Q

What does endogenous mean?

A

Having an internal cause or origin; growing or originating from within an (animal)*

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3
Q

What does exogenous mean?

A

Relating to or developing from external factors; growing or originating from outside an organism*

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4
Q

-mimetic

A

marked by simulation of another bodily process or disease; also used as a word termination indicating simulation of a function, process, etc., designated by the root to which it is affixed; “mimics”

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5
Q

-lytic

A

word termination denoting lysis of the substance indicated by the stem to which it is affixed

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6
Q

What do agonists and antagonists drugs do to the nervous system?

A

Drugs that stimulate a nervous system are called agonists
Drugs that inhibit a nervous system are called antagonists

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7
Q

What are “adrenergics” or “pressors”?

A

Any drugs that are agonists on the sympathetic nervous system sympathomimetics
Mydriasis, increased heart rate and blood pressure, bronchodilation

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8
Q

What are “beta blockers” or “alpha blockers”?

A

Any drugs that are antagonists on the sympathetic nervous system sympatholytics
Miosis, decreased heart rate and blood pressure, bronchoconstriction (in patients with bronchospastic disease)

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9
Q

What are “cholinergic agents”?

A

Any drugs that are agonists on the parasympathetic nervous system
parasympathomimetics
Miosis, decreased heart rate and blood pressure, bronchoconstriction (in patients with bronchospastic disease)
Increased tear production

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10
Q

What are “anticholinergic agents”

A

Any drugs that are antagonists on the parasympathetic nervous system
parasympatholytics
Mydriasis, increased heart rate and blood pressure, bronchodilation
Decreased tear production (dry eyes)

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11
Q

What are some drugs used for ADD or ADHD (all stimulants)

A

Methylphenidate: Ritalin, Methylin, Metadate, Concerta, Daytrana

Dexmethylphenidate: Focalin

Amphetamines: Adderall , Dexedrine, Dextrostat, Vyvanse

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12
Q

What are endogenous chemicals, what do they control and how are they impacted?

A

Control involuntary functions: heart rate, blood pressure, respiration, perspiration, digestion

Can be influenced by thought and emotion

Adjusts in response to stressful situations (trauma, fear, hypoglycemia, cold, exercise, emergency)

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13
Q

How are the four descriptors of drugs intertwined or how do they cross over?

A

Sympathomimetic = Parasympatholytics
Sympatholytic = Parasympathomimetic

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14
Q

How do ADD and ADHD medications work?

A

These drugs are psychomotor stimulants: they increase motor activity in patients with ADD or ADHD; if abused, they cause excitement and euphoria

Blockade of the reuptake of monoamines (norepinephrine, serotonin, dopamine)

Sympathomimetic

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15
Q

What are some Dopamine agonists?

A

Bromocriptine (Parlodel), pergolide (Permax)
Pramipexole (Mirapex), ropinirole (ReQuip)

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16
Q

What are Dopamine agonists used for and what do they do?

A

Uses: Parkinson’s disease; restless leg syndrome
These drugs increase dopamine in the CNS (not as effective as dopaminergics)

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17
Q

What are some side effects for stimulants?

A

What would happen if you’re scared:
Insomnia
Weight loss (due to decreased appetite)
Anxiety
Agitation
Cardiac arrhythmias
Tachycardia
Increased respiration
Dyspnea
Seizures
Tremors
Vertigo
Hypertension
Confusion
Nausea
Diarrhea
Addiction potential

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18
Q

Where does dopamine work in the brain?

A

Mesocortical: cognition, memory, attention, emotional behavior and learning

Nigrostriatial: movement and sensory stimulus

Mesolimbic: pleasure and reward, seeking behavior, addition, emotion and perception

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19
Q

What are some adverse effects specifically PTs should care about or be aware of for stimulants?

A

Postural hypotension
Dyskinesias: Ataxia, Facial & Extremity tics
Hallucination
Insomnia

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20
Q

What are some adverse effects for dopamine agonists?

A

Hallucination
Insomnia
Malaise
Nightmares
Dizziness
Dyskinesia
Confusion

21
Q

What are some common Anticholinergics?

A

Benztropine (Cogentin) trihexyphenidyl (Artane) biperiden ( Akineton ), diphenhydramine (Benadryl)

22
Q

What are Anticholinergics used for and how do they work?

A

Uses: used in Parkinson’s disease, and allergic reactions

These drugs inhibit central cholinergic activity

Parasympatholytics

23
Q

What are some adverse effects for Anticholinergics?

A

Confusion
Agitation
Tachycardia
Palpitations
Dry mouth
Urinary retention
Constipation
Blurred vision

24
Q

What are some common Alzheimer’s disease medications?

A

Acetylcholinesterase inhibitors: cholinergics donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne)

25
Q

What are Acetylcholinesterase inhibitors used for and how do they work?

A

In early, mild/moderate Alzheimer’s disease to improve cognitive function, and to slow the progression of AD

These drugs enhance cholinergic function by increasing the concentration of acetylcholine through reversible inhibition of its hydrolysis by acetylcholinesterase

Parasympathomimetic

26
Q

What are some common tri cyclic antidepressants (TCA) and what are the used for?

A

amitriptyline (Elavil), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline, (Pamelor, Aventyl), protriptyline (Vivactil), trimipramine (Surmontil)

Uses: depression, sleep, pain (nerve pain)

27
Q

How do tri cyclic antidepressants work?

A

TCAs block the reuptake of NE and/or 5-HT into noradrenergic or serotonergic nerve terminals, respectively
(have an impact on norepinephrine and serotonin)

Also block “dirty receptors”: muscarinic cholinergic receptors, α1 adrenergic receptors, and histamine H1 receptors what causes many of their side effects

28
Q

What are some common SSRIs (Selective Serotonin Reuptake Inhibitors)? and what are they’re uses?

A

Citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft)

Uses: depression, PTSD, PMDD, eating disorders

29
Q

Why are SSRIs so popular?

A

SSRIs have the highest affinity for the 5-HT transporter

30
Q

What are some “atypical” compounds of SSRIs?

A

SNRIs (serotonin norepinephrine reuptake inhibitors): duloxetine (Cymbalta) Cymbalta), venlafaxine (Effexor), desvenlafaxine (Pristiq)

NDRI (norepinephrine dopamine reuptake inhibitors): bupropion (Wellbutrin, SR, and XL)

SARIs (serotonin antagonist and reuptake inhibitors): nefazodone (Serzone), trazodone (Desyrel) also used for sleep

NaSSA (noradrenergic and specific serotonergic antidepressant)

SRI/5 HT1A (partial agonist serotonin reuptake inhibitor/serotonin 1A partial agonist)

31
Q

What three transmitters impact cognition, emotions and mood?

A

Noradrenaline, Serotonin and Dopamine

32
Q

How do SSRIs work?

A

Selective for serotonin and increase the amount of serotonin available

With no real impact on dopamine nor acetylcholine, nor norepinephrine

33
Q

What are some uses for “atypical” compounds of SSRIs and what do they do?

A

Uses: depression, anxiety syndromes, smoking cessation, sleep, peripheral neuropathy, pain syndromes, hot flashes

These drugs result in a relative increase in both norepinephrine and serotonin

34
Q

What are some adverse effects of SSRIs?

A

Sedation
Weight gain
Postural hypotension
Sexual dysfunction
Dizziness
Anxiety
Confusion

35
Q

What are some common (Anxiolytic) Benzodiazepines (BZDPs) and what are they used for?

A

Alprazolam (Xanax) Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin) Klonopin), diazepam (Valium) Valium), clorazepate (Tranxene), lorazepam (Ativan) Ativan), oxazepam

Flurazepam (Dalmane), temazepam (Restoril), triazolam (Halcion; marketed for sleep

LAM and PAM

Uses: sleep, muscle relaxers, amnesia, anxiety syndromes, seizure syndromes, alcohol withdrawal

36
Q

How do BZDPs work? and how long do they last?

A

Benzodiazepines bind to receptors to inhibit neurotransmitter release
Inhibits GABA throughout the CNS
Compounding inhibitory effect

**The duration of action of the BZDPs varies considerably, and the formation of active metabolites plays a major role in their effects

37
Q

What are some adverse effects of anxiolytics/BZDPs?

A

Drowsiness
Psychomotor impairment
Ataxia
Disorientation/confusion
Depression
Aggression
Irritability
Behavioral disinhibition
Anterograde amnesia

38
Q

What are some common sedatives/soporific agents and what are they used for?

A

Zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta)
“Z hypnotics”

Uses: to induce sleep

39
Q

How do sedatives/soporific agents work?

A

Acts on only one subset of benzodiazepine receptor family, BZ1

No anticonvulsant or muscle relaxant properties; no withdrawal effects; little/no tolerance (like BZDPs)

40
Q

What are some adverse effects forsedatives/soporific agents

A

Nightmares
Sleep eating
Sleep walking
Agitation
Dizziness
Daytime drowsiness

41
Q

What are some common antihistamines that are used for vertigo or balance disorders?

A

Diphenhydramine (Benadryl), hydroxyzine (Atarax, Visteril), chlorpheniramine (Chlor Trimeton), promethazine (Phenergan), doxylamine (in NyQuil), Meclizine (Antivert), brompheniramine (Dimetane), dimenhydrinate (Dramamine)

42
Q

When are antihistamines used (in regards to vestibular issues)?

A

Used in Type 1 hypersensitivity reactions (rhinitis, urticaria, conjunctivitis, anaphylaxis); prophylaxis for motion sickness and vestibular diseases

43
Q

How does an antihistamine work for vertigo or balance disorders?

A

These agents prevent motion sickness and reduce the severity of its symptoms, even if taken after the onset of symptoms
They may suppress vestibular responses through an effect on the CNS, although their mechanism remains unknown
All the antihistamines used for the control of vertigo have anticholinergic activity, and antihistamines that do not cross the BBB are not used to control vertigo

44
Q

What are some adverse reactions to antihistamines for vertigo or balance disorders?

A

Sedation
Confusion
Dry eyes
Dry mouth
Ataxia

45
Q

What are some common Opioid agonists (“narcotics”) that are used for pain management?

A

Morphine (MS Contin, Avinza, Kadian, MSIR)
Oxycodone (Oxycontin, Percocet)
Hydromorphone (Dilaudid)
Fentanyl (Duragesic, Actiq)
Codeine (Tylenol #3)
Hydrocodone and acetaminophen (Vicodin, Norco, Lortab)
Meperidine (Demerol)
Methadone (Dolobid)

46
Q

How does opioids work?

A

These drugs relieve pain and induce euphoria by binding to the opioid receptors (mu, delta, kappa) in the brain

They mimic the actions of endogenous opioid compounds: enkephalins, dynorphins, endorphins

47
Q

What are some adverse effects for opioids?

A

Sedation
Constipation
Confusion
Dizziness
Nausea/vomiting
Respiratory depression
Dysphoria
Euphoria
Hallucinations
Itching

48
Q

What are some common muscle relaxers and what are they used for?

A

Baclofen (Lioresal), carisoprodol (Soma) Soma), chlorzoxazone (Parafon Forte DSC, Remular S), cyclobenzaprine (Flexeril) Flexeril), diazepam (Valium), metaxalone (Skelaxin) Skelaxin), methocarbamol (Robaxin), orphenadrine (Norflex), tizanidine (Zanaflex)
Tramadol (Ultram)

Uses: for muscle spasms and hyper reflexia

49
Q

What are some adverse effects of muscle relaxers?

A

Mental depression
Drowsiness
Dizziness/lightheadedness
May impair mental and physical abilities
Driving and operating machinery not recommended
Trembling
Muscle weakness
Hypotension
Blurred vision
Drug interactions alcohol

PT 862 (13 decks)

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