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KMK Gen Pharm > 6 - CNS Drugs > Flashcards

6 - CNS Drugs Flashcards

1
Q

Acetaminophen

  • MOA
  • clinical indications
  • adverse effects
A

Not understood

Analgesia, antipyresis (fever)
Safe for all ages, incl infants
Safe during pregnancy

Hepatotoxicity

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2
Q

Cyclobenzaprine

  • MOA
  • clinical indications
  • adverse effects
A

Decr somatic (voluntary) motor activity by inhibiting tonic activity of alpha and gamma motor neurons

Treat muscle spasms

Drowsiness, loss of coordination, anticholinergic (dry eye, mydriasis, incr IOP) = caution in narrow angles

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3
Q

Tramadol

  • MOA
  • clinical indications
  • adverse effects
A

1) agonist at Mu receptor
2) inhibit serotonin + NE uptake within asceding pain pathways

More potent analgesic than acetaminophen (but less than opiates)

Dry mouth, sedation, dizziness, nausea
Miosis: less frequently than true opiates

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4
Q

Meperidine, Oxycodone

  • MOA
  • clinical indications
  • adverse effects
A

Agonist at Mu, Kappa, Delta opiate receptors

Potent analgesic, addictive properties

Miosis (pinpoint pupils, mydriasis with withdrawal)
Respiratory depression, drowsiness, sedation, nausea (reduced with promethazine)
Mep: excessive doses can result in build-up of normeperidine, a metabolite than can cause seizures, incr ICP, papilledema

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5
Q

List

  • non-opiate analgesics (3)
  • opiate analgesics (2)
A

NO: acetaminophen, cyclobenzaprine, tramadol

O: meperidine, oxycodone

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6
Q

Sumatriptan

  • MOA
  • clinical indications
  • adverse effects
A

5HT1B and 1D receptor agonist (serotonin subtype 1B + 1D) -> vasoconstriction and reduced inflammation in CNS

Migraine

All SE are related to systemic vasoconstriction: NAION, MI, ischemic stroke, retinal artery occlusions/venous thromboses

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7
Q

Phenothiazines: Chlorpromazine, Thioridazine

  • MOA
  • clinical indications
  • adverse effects
A

DA receptor antagonist

Antipsychotics

High doses can result in Parkinson-like effects
Ocular:
-pigment effects: corneal endo, anterior stellate ct, RPE hyperpig
-anticholinergic (dry eye, mydriasis, incr in IOP)
-oculogyric crisis (also cetirizine)

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8
Q

List

  • antipsychotics (2)
  • antiparkinsons (2)
  • ADHD meds
A

Pysch: chlorpromazine, thioridazine
-decr DA

Park: amantadine, bromocriptine
-incr DA

ADHD: methylphenidate, dextroamphetamine
-incr DA

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9
Q

Amantadine

  • MOA
  • clinical indications
A

Potentiates DA effects by blocking reuptake or augmenting release in brain

Parkinson’s

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10
Q

Bromocriptine

  • MOA
  • clinical indications
  • adverse effects
A

DA agonist

Prolactin-secreting pituitary adenomas
Parkinson’s

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11
Q

Parkinson’s characteristics

A

Due to DA deficiency

TRAP:
Tremor at rest
Rigidity (cogwheel)
Akinesia
loss of Postural reflexes (balance probs)
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12
Q

Methylphenidate, Dextroamphetamine

  • MOA
  • clinical indications
  • adverse effects
A

Incr release of DA

ADHD, narcolepsy, depression

High dose chronic tx -> mydriasis, dry eyes
Caution in narrow angles: mydriasis may lead to acute or subacute angle closure

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13
Q

Donepezil

  • MOA
  • clinical indications
  • adverse effects
A

CNS ACHase inhibitor

Alzheimer’s dementia

Ocular: cataracts, blurred vision, ocular irritation

  • lowers IOP due to effects as an indirect cholinergic/muscarinic agonist
  • sudden discontinuation of therapy may lead to incr IOP
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14
Q

Characteristics of antidepressants

A

4 classes: TCA, MAOI, SSRI, SNRI
-all incr serotonin concentrations

TCAs, MAOIs, and SNRIs also incr norepi

SE: fatigue/sedation, weight gain, sexual dysfunction

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15
Q

List

  • SSRIs (2)
  • SNRIs (2)
  • TCAs (2)
  • MAOIs (1)
A

SS: fluoxetine, excitalopram

SN: venlaxafine, duloxetine

TCA: amitriptyline, imipramine

MAOI: phenelzine

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16
Q

Fluoxetine, Excitalopram

  • MOA
  • clinical indications
  • adverse effects
A

Inhibits serotonin reuptake (SSRIs)

Depression

Fewer SE than other classes
Ocular: mydriasis, caution with narrow angles
Serotonin syndrome may occur if RXd with MAOIs or TCAs

17
Q

Serotonin syndrome

A

Due to excess serotonin activity in CNS

Change in mental status (anxiety, confusion), autonomic hyperactivity (incr BP, pulse, temp), neuromuscular problems (tremor, hyperreflexia)

18
Q

Venlafaxine, Duloxetine

  • MOA
  • clinical indications
  • adverse effects
A

Inhibits serotonin and norepi reuptake (SNRIs)

Depression, generalized anxiety disorder, panic disorder, social anxiety disorder

Risk of suicide, serotonin syndrome
Caution in pts with narrow angles or ACG: mydriasis

19
Q

Drug and MOA for depression and smoking cessation

A

Buproprion

NDRI: inhibits reuptake of DA and NE

20
Q

Amitriptyline, Imipramine

  • MOA
  • clinical indications
  • adverse effects
A

Inhibits NE and serotonin reuptake (TCAs)

Depression

Anticholinergic effects (dry eye, incr IOP, mydriasis)
Overdose is life-threatening, don’t rx to suicidal pt
21
Q

Phenelzine

  • MOA
  • clinical indications
  • adverse effects
A

Inhibits MAO: enzyme responsible for breaking down NE and serotonin

Depression

Ocular:
-glaucoma, nystagmus
-caution in narrow angles
Systemic:
-several interactions with other drugs/chemicals, foods with tyramine (wine, cheese, dried meats) -> lethal hypertensive crisis
22
Q

Additional SE of MAOIs and TCAs

A

Exacerbate systemic effects of topical ophthalmic phenyl (10%) and other adrenergic agonists

23
Q

Diazepam

  • MOA
  • clinical indications
  • adverse effects
A

Benzodiazepine that opens Cl- channels by binding to GABA receptors -> hyperpol of neurons in CNS

Acute anxiety, panic attacks, sedative/alcohol withdrawal
-decr SNS

Sedation, depression, bradycardia, dyspnea - fatal if combined with alcohol
Ocular: mydriasis (paradoxical), nystagmus
-contraindicated in narrow angle glaucoma

24
Q

Phenytoin

  • MOA
  • clinical indications
  • adverse effects
A

Acts on multiple NTMs, incl NE, ACh, GABA

Anticonvulsants

Nystagmus, diplopia, EOM palsies, ataxia, gingival hyperplasia

25
Q

List

-anticonvulsants

A

“Limit Debilitating Tremors”:
Luminal
Dilantin
Topiramate

26
Q

Phenobarbital

  • MOA
  • clinical indications
  • adverse effects
A

Reduces glutamate transmission by blocking AMPA receptors

Seizures and sedation

Ocular: mydriasis, inr IOP, cycloplegia
Systemic: sedation, respiratory depression

27
Q

Topiramate

  • MOA
  • clinical indications
  • adverse effects
A

Multiple CNS effects

Prevent seizures

Blur, diplopia, nystagmus, conj-itis, lacrimation changes, myopia shift, VF defects
-myopic shift + acute secondary ACG are caused by choroidal swelling -> moves uvea forward

KMK Gen Pharm (9 decks)

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