Neurology Drug List Flashcards Preview

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Flashcards in Neurology Drug List Deck (60)
1

Typical D2 Antagonists

Chlorpromazine and Haloperidol
Haloperidol and the "azines"

2

Chlopromazine Side Effects (SE)

Dry mouth (antimuscarinic), orthostatic hypotension (a1 antagonist), and sedation (antimuscarinic and antihistamine). Low potency, but also weight gain and increased risk for diabetes.

3

Halperidol Side Effects (SE)

Extrapyramidal side effects (DA blockade), can cause tardive dyskinesias. Used to tx CNS stimulant psychosis.

4

Atypical D2/5HT Antagonists

Clozapine, Quetiapine, Olanpazine, Risperidone, Aripipazole. All cause weight gain.

5

Clozapine SE

Agranulocytosis. Neuroleptic Malignancy. For pts who are refractive to other drugs.

6

Quetiapine SE

Wt gain and Diabetes; decrease EPS

7

SSRIs

Fluoxetine, Paroxetine, Escitralopam, Setraline, and Citalopram. Wide interpatient variations; wt gain, sexual dysfunction, cognitive blunting, and withdrawal sx.

8

Fluoxetine and Paroxetine

blocks serotonin transporter and P450 inhibitor. Withdrawal sx.

9

Escitralopam

SSRI

10

NDRIs

Bupropion

11

Bupropion

Sedation, and potential for seizures at high doses. At high dose causes anxiety.

12

SNRIs

Venlafaxine

13

Venlafaxine

SNRIs. SE: HTN and anxiety, rapid withdrawal.

14

TCADs (Drugs and Uses)

Declining use; 2nd line agaents, antimuscarinic side effects, CV and seizures in overdose.
Amitriptyline.

15

Amitriptyline

TCADs; 2nd line agents for depression, has antimuscarinic SE. CV problems and seizures in overdose. Also has a sedative action.

16

MAOIs

Phenelzine

17

Phenelzine

SE: postural hypotension, seizure, shock, hyperthermia in overdose, hypertensive crisis with foods high in tyramine, +SSRIs --> serotonin syndrome.

18

Antimanic Agents

Lithium Carbonate*, Carpamazepine, Valproate, Olanzapine, Fluoxetine

19

Lithium Carbonate

Interference with PIP recycling. Enhance 5HT action/ decrease NE and DA effect. Use dependent (greatest activity in most active cells); narrow therapeutic index. Diuretics and NSAIDs will increase lithium levels. Can also cuase hypothyroidism, poluuria, and polydipsia.

20

Sedatives-Hypnotics-Anxiolytics

BDZs, Non-BDZ BDZ Agonists, Barbiturates, Melatonin Receptor Antagonist, Other (Diphenhydramine)

21

BDZs

"Lams and Pams"; sedative (a1) and anxiolysis (a2/a5); need much greater dosage increments to achieve CNS depression, increase margin of safety than compared to BARBs.

22

Flumazenil

BDZ receptor antagonists; used in BDZ overdose to relieve CNS depression.

23

Non-BDZ BDZ Agonists

Zolpidem, Eszopiclone, Zalepon, "Zzz drugs", only acts on a1 GABA receptors.

24

Zolpidem

"Ambien"; mild side effects and no hangover. Decrease sleep latency and nocturnal awakenings.

25

Eszopiclone

Longer half life than zolpedam; next day psychomotor impairment with higher doses (FDA requires lower dose for initiation); used for sleep maintenance.

26

Zalepon

Dizziness, HA, and somnolence. Decrease time for sleep onset.

27

Barbiturates

Phenobarbital.Anticonvulsant effects without severe sedation or effects on mental or motor activity.

28

Phenobarbital

Anticonvulsant effects without severe sedation or effects on mental or motor activity.

29

Alprazopam

rapid po; acute management of anxiety

30

Flurazepam

long half life --> result in daytime sedation.

31

Diazepam

rapid po; acute management of anxiety

32

Oxazepam

slow oral absorption; no P450 step, so metabolized to inactive glucuronides, short half life.

33

Triazolam

anterograde amnesia; also very rapid --> rebound insomnia because short half life.

34

Lorazepam

same as oxazepam, but rapid via IM

35

Midazolam

status epilepticus

36

Temazepam

intermediate half life; less anterograde amnesia than triazolam.

37

Flumazenil

BDZ receptor antagonist in the case of overdose

38

Melatonin Receptor Agonist

Ramelteon

39

Ramelteon

MT1- induces sleepiness, MT2- regulation of circadian rhythms.

40

Diphenhydramine

antihistamine and antimuscarinic; not recommended but is short term treatment for mild insomnia

41

Buspirone

alternative as anxiolytic, 5HT partial agonist (no sedation); for CNS depressant withdrawal.

42

CNS Stimulants

Cocaine, Amphetamine, Methamphetamine --> interaction with catecholamine NT system; elevation of mood; SE: SNS overactivity. Increase tolerance and dependence; mild withdrawal sx.

43

Tx for Withdrawal Symptoms from CNS stimulants

TCADs and bupropion (NDRI); both better with behavioral therapy. Topiramate (GABA inhibition in alcoholics)

44

CNS Depressants

Alcohol, Barbiturates, and Benzodiazepines; enhance GABA activity; euphoria and sedation --> coma and death. Tx overdose with supportive care or flumazenil (BDZ antagonist). Tolerance and dependence develop rapidly. Withdrawal= high morbidity and mortality.

45

Opiod Analgesics

Heroin: mu agonist; rush and euphoria (highly reinforcing because rapid), overdose (coma, respiratory distress, pinpoint pupils) = tx with naloxone. rapid tolerance and dependence.

46

Cannabinoids

endogenous CR1 receptor in the CNS; enhancement of sensory stimuli; tx with support therapy, little tolerance (if yes, goes away fast), 10% physical dependence

47

Drugs for Tx of Drugs of Abuse

- Methadone: tx opiod withdrawal
- Buprenorphine- tx opiod withdrawal
- Clonidine: tx opiod withdrawal
- Naltrexone: tx opiod withdrawal
- Disulfram: blocks aldehyde dehydrogenase --> reduce EtOH consumption.

48

Gaseous Anesthetics

Nitrous Oxide

49

Nitrous Oxide

Common use for dental procedures; less soluble, exhibits more rapid increase in its partial pressure in blood. No surgical anesthesia.

50

Volatile Anesthetics

Halothane: substitute of cyclopropane; for surgical anesthesia. Can cause malignant hyperthermia.

51

Grand Mal (Tonic-Clonic Seizures)

Phenytoin, Carbamazepine, Valproate, Levetiracetam

52

Phenytoin

Phenytoin- for partial and primary generalized tonic clonic, block VSSC (blockage use dependent)

53

Carbamazepine

block VSSC (blockade use dependent)

54

Valproate

potentiation on GABA function; limits activity of T-type Ca2+ channel. hepatotoxicity, contraindicated in pregnancy; 1st line.

55

Levetiracetam

lower rate for fetal malformation, 1st line in tonic clonic. Also used for partial seizure.

56

Broad Spectrum Anti-Epileptics

Phenobarbital, Olazepam, Valproate, Divalproex (similar to valproate)

57

Phenobarbital

enhance GABA inhibition, antagonize glutamate excitation, P450 inducer

58

Absence Seizures Tx

Ethosuximide- supresses brain activity; metabolized by CYP34A; drug of choice. And valproate.

59

Status Epilepticus

Diazepam, Lorazepam, Midazolam.

60

Trazodone

Mixed 5HT Reuptake Blocker/ Receptor Antagonist. . Sedating; used to improve sleep continuity in depression.