CNS review Flashcards by Malorie Deakins

3 1st generation AEDs that are enzyme inducers

Phenytoin, Phenobarbital and Carbamazepine

How well did you know this?

Not at all

Perfectly

MOA of oxcarbazepine

Stabilizes inactivated Na channels

How well did you know this?

Not at all

Perfectly

The major inhibitory transmitter in the brain

GABA

How well did you know this?

Not at all

Perfectly

Treatment options for status epilepticcus `

IV benzodiazepine, phenytoin or phenobarbital

How well did you know this?

Not at all

Perfectly

The major excitatory neurotransmitter in the brain

Glutamate

How well did you know this?

Not at all

Perfectly

What is special about the metabolism of phenytoin

saturable metabolism

How well did you know this?

Not at all

Perfectly

What is special about the metabolism of carbamazepine

autoinduction

How well did you know this?

Not at all

Perfectly

Type of receptor that GABA-A receptor is

inotropic Cl channel

How well did you know this?

Not at all

Perfectly

Major toxicities of phenytoin

nystagmus, ataxia, gingival hyperplasia, osteomalacia

How well did you know this?

Not at all

Perfectly

Amount of oxcarbazepine that can induce OC metabolism

> 1200 mg/day

How well did you know this?

Not at all

Perfectly

Toxicities of oxcarbazepine

dizziness, diplopia, ataxia, hyponatremia

How well did you know this?

Not at all

Perfectly

toxicity with lacosamide

diplopia, HA, dizziness, nausea

How well did you know this?

Not at all

Perfectly

The most studied AED in pregnancy

Lamotrigine

How well did you know this?

Not at all

Perfectly

MOA of carbamazepine

Stabilizes inactivated Na Channels

How well did you know this?

Not at all

Perfectly

AED that was recently moved to pregnancy category D due to risk of low birth weights

topiramate

How well did you know this?

Not at all

Perfectly

Amount of topiramate that induces OC metabolism

> 200 mg/day

How well did you know this?

Not at all

Perfectly

Toxicities with lamotrigine

sedation, diplopia, ataxia, nausea, rash

How well did you know this?

Not at all

Perfectly

Toxicities associated with topiramate

difficulty concentrating, kidney stones, weight loss

How well did you know this?

Not at all

Perfectly

MOA of zonisamide

Stabilizes inactivated Na channels and acts on Ca channels

How well did you know this?

Not at all

Perfectly

Toxicities associated with zonisamide

somnolence, dizziness, kidney stones, weight lossq

How well did you know this?

Not at all

Perfectly

MOA of rufinamide

Stabilizes inactivated Na channels

How well did you know this?

Not at all

Perfectly

MOA of phenobarbital

GABA-A agonist

How well did you know this?

Not at all

Perfectly

Toxicities with phenobarbital

sedation, paradoxical hyperactivity, osteomalacia

How well did you know this?

Not at all

Perfectly

Seizure that involves brief episodes of staring, unable to respond

absence/ patit mal

How well did you know this?

Not at all

Perfectly

Black box warning for vigabatrin

irreversible visual field loss

MOA of vigabatrin

Irreversible inhibitor of GABA transaminase

SSRI that has potential for QTc prolongation

Citalipram

MOA of ethosuximide

Inhibits T-type Ca channels

Drug of choice for absence seizures

ethosuximide

MOA of tiagabine

decreases GABA reuptake into neurons and glial cells

MOA of valproic acid

Inhibits T-type Ca channels, weak effect of Na channels and increases GABA activity

1st generation AED that is an enzyme inhibitor

valproic acid

Type of receptor that GABA-B is

metaboltropic

Toxicities associated with gabapentin

fatigue, ataxia, dizziness

Major toxicities of carbamazepine

diplopia, dizziness, leukopenia, osteomalacia

MOA of pregabalin

Binds to alpha2-delta site of Ca channels

Toxicities associated with pregabalin

dizziness, ataxia, weight gain

MOA of levetiracitam

Binds to synaptic vesicle protein (SV2A)

Toxicities associated with ezogabine

dizziness, fatigue, diplopia, ataxia, urinary retention

What is notable about gabapentins metabolism

saturable absorption

QIDS score that indicates very severe depression

>20

MOA of ezogabine

potassium channel stabilizer

MOA of phenytoin

Stabilizes inactivated Na channels

MOA of perampanel

noncompetitive AMPA receptor antagonist

Black box warning with parampanel

suicidality and homocidality

MOA of topiramate

Stabilizes inactivated Na channels, GABA agonist and glutamate antagoinist

SSRI that is pregnancy category D

Paroxetine

Black box warning with ezogabine

bluish discoloration of the skin and ocular toxicity

QIDS score that indicates severe depression

16-20

Issue with felbamate that limits its use

hepatotoxicity

Seizure in 1 hemisphere in which consciousness is not impaired

Simple partial seizure

MOA of ketamine

NMDA antagonist

QIDS score that indicates mild depression

6-10

SSRI that has the highest rate of diarrhea

Sertraline

Location where norepinephrine is synthesized

locus ceruleus

Presynaptic NE autoreceptor that is important in feedback inhibition

Alpha2

The hormonal influence on seizures in women who are menstrating

Catamenial influence

Seizure in 1 hemisphere in which consciousness and memory are impaired

Complex partial seizure

Precursor for NE

Tyrosine

Precursor for serotonin

tryptophan

Length of an untreated major depressive episode

>6 months

Length of a typical treated major depressive episode

4-5 months

toxicities associated with valproic acid

weight gain, hair loss, tremor, thrombocytopenia

QIDS16 score that indicates remission

A diminished interest in activities

anhedonia

2nd line antidepressant pharmacotherapy options

TCAs, trazadone, nefazadone

QIDS score that indicates normal

0-5

QIDS score that indicates moderate depression

11-15

QIDS16 score that indicates a response

6-8

Return of symptoms meeting full criteria within 6-12 months of full and sustained remission from the index episode

Relapse

1st line options for antidepressant pharmacotherapy

SSRIs, SNRIs, buproprion, mirtazepine

Occurrence of a new episode following 6-12 months of full and sustained remission from the index episode

Reoccurance

3rd line antidepressant pharmacotherapy options

MAOIs

MOA of lacosamide

Stabilized inactivated Na channels

MOA of lamotrigine

Stabilizes inactivated Na channels and decreases glutamate release

SSRI with highest rate of sexual dysfunction

Paroxetine

Toxicities associated with levetiracitam

somnolence, dizziness, behavioral changes

5 most common residual symptoms of depression

insomnia, fatigue, pain, difficulty concentrating, lack of interest

MOA of Gabapentin

Binds to alpha2-delta site of Ca channels, decreasing neurotransmitter release

4 most common triggers of seizures

lack of sleep, stress, acute infections, missed medications

MOA of vilazodone

SSRI and partial 5HT1A receptor agonist

MOA of trazadone

weak SSRI and 5HT2A and 5HR2C antagonist

Black box warning for nefazodone

rare hepatic failure

Non-selective serotonin antagonist that is used to treat serotonin syndrome

Cyproheptidine

MOA of buproprion

Inhibits DA and NE reuptake

MOA of mirtazapine

alpha2-adrenergic antagonist, 5HT2A and 5HT3 antagonist and H1 antagonist

5 tertiary amine TCAs

amitriptyline, trimipramine, imipramine, clomipramine, doxepin

3 secondary amine TCAs

desipramine, nortriptyline, protriptyline

5 patient populations to use caution when using TCAs

1. underlying CV disease (QT prolongation) 2. seizures 3. glaucoma 4. urinary retention 5. elderly

3 major groups of SEs with TCAs (tertiary > secondary amines)

1. anticholinergic SEs 2. orthostatic hypotension 3. sedation

Antagonist of what receptor leads to orthostatic hypotension

alpha adrenergic receptor

3 non-selective MAO-A and MAO-B irreversible inhibitors

phenelzine,, tranylcypromine, isocarboxazid

A selective MAO-A irreversible inhibitor

Selegiline

Dietary restriction associated with MAO-Is

tyramine containing foods

Drug used to treat hypertensive crisis created by food or drug interactions with MAO-Is

phentolamine

4 major groups of SEs associated with MAO-Is

1. orthostatic hypotension 2. CNS stimulation (anxiety, insomnia) 3. weight gain 4. sexual dysfunction

Wash out period needed when switching from MAO-I to another antidepressant or vice versa

2 weeks

Length of time to see effect in GAD

2-4 weeks until effect, 4-6 weeks until max effect

Wash out period needed when switching between fluoxitine and another antidepressant

5 weeks

A transcription factor, whose levels are increased by antidepressants that leads to an increase in the neuronal growth factor BDNF

CREB

Area of the brain that processes threatening or taumatic stimuli

Hippocamous

1st line pharmacologic treatments in anxiety disorder

SSRIs and SNRIs

MOA of buspirone

5HT1A receptor partial agonist

Difference in dose of SRIs between treatment of depression and anxiety

use 1/2 the starting dose in anxiety

GABA-A receptor subunits that are required for BZD binding

alpha and beta

GABA-A receptor subunits that are required for GABA binding

alpha and gamma

3 preferred BZDs in liver disease

Lorazepam, oxazaepam and temazepam

Length of time of excessive anxiety/worry to qualify as generalized anxiety disorder

>6 months

GAD-7 Score that qualifies as mild GAD

5-9

GAD-7 score that qualifies as moderate GAD

10-14

Transtheoretical model for change phase that a patient is i when they are ready to quit within the next 30 days

Preparation

Transtheoretical model for change phase that a patient is i when they are ready to quit within the next 30 days

Preparation

GAD-7 score that qualifies as severe GAD

>15

Minimum length of treatment for GAD

12 months

Length of time of persistent worry about another panic attack to qualift as panic disorder

1 month

SSRI that is 2nd line for panic disorder

citalipram

Treatments that are NOT effective for panic disorder

propanolol, buspirone, antihistamines, antipsychotis

Time it takes to see max effect during treatment of manic disorder

6-12 weeks

Length of treatment for panic disorder

12-24 months

Length of fear of social situation to qualify as social anxiety disorder

>6 months

Treatment options for performance only SAD

propranolol, atenolol

Treatments that are not effective for general SAD

TCAs, buspirone monotherapy, atenolol

Length of medication trial in SAD

8-12 weeks

Length of treatment for SAD

usually long-term

Therapies that are not effective in PTSD

buspirone, buproprion, desimpramine

Time until treatment effect is seen in PTSD

8-12 weeks

Length of therapy in PTSD

Minimum 12 months after response

1st line options for OCD

SSRIs, clmipramine

Length of delay in treatment effect in OCD

10-12 weeks

Length of treatment for OCD

1-2 years, usually lifelong

3 best options for treating anxiety in pregnancy

citalopram, fluoxetine, sertraline

BZD to use if absolutely necessary in pregnancy

clonazepam and lorezapam

Timing of bright light therapy for advanced sleep phase sleeping disorder

Transthoretical model for change that a patient is in when they are thinking about quitting in the next 6 months

Contemplation

BZD antagonist that can reverse effects in overdose

flumazenil

SSRI that has been shown to be safetly used post-MI

Sertraline

GABA receptor subtype that Z-hypnotics preferentially bind to that creates sedative effects but no anxiolytic effects

Alpha-1

Area of the hypothalamus that controls circadian rhythm

suprahiasmatic nucleus

Where melatonin is synthesized

pineal gland

AA precursor of melatonin

tryptophan

MOA of ramelteon

M1 and M2 melatonin receptor agonist

Timing of melatonin therapy in advanced sleep phase disorder

dawn

Transtheoretical model of change stage that a patient is in when they are not yet ready to quit

Pre-contemplation

Location of the hypothalamus where histamine is produced

tuberomemmillary nucleus

Transthoretical model for change that a patient is in when they are thinking about quitting in the next 6 months

Contemplation

Inhibitory dopamine receptors

Type2 (D2, D3 and D4)

Hoehn and Yahr Parkinson's stage when motor dysfunction is bilateral with postural abnormalities

Stage IV

BZD antagonist that can reverse effects in overdose

flumazenil

TCA that is FDA approved for insomnia characterized by sleep maintenance issues

doxepin (silenor)

MOA of suvorexant

Orexin receptor (OX1 and OX2) antagonist

Transtheoretical model for change that patients are in when they are 6 or more months after their quit date and are now considered a former user

Maintenance

Peptide neurotransmitters implicated in wakefulness that are lost in patients with narcolepsy

Orexins A and B

FDA approved medications for sleep onset

BZDs Z-hypnotics Remelteon

Max trial of antidepressants that should be tried with no response

9 weeks

FDA approved medications for sleep maintenance

BZDs Z-hypnotics Silenor

3 sleep medications/classes that should not be taken with high fat meals due to decreased absorption

z-hypnotics ramelteon silenor

The best established pathway for reinforcement

dopaminergic projection from the ventral tagmental are (VTA) to the nucleus accumbens

Preferred class of sleep drugs in the elderly

Z-hypnotics

MOA of tolcapone

COMT inhibitor in the periphery and CNS

Transtheoretical model of change phase that patients are in when they are actively trying to quit and are still within 6 months of their quit date

Action

GABA receptor subtype that Z-hypnotics preferentially bind to that creates sedative effects but no anxiolytic effects

Alpha-1

5 A's for clinicians when dealing with substance abuse

``` Ask Advise Assess Assist Arrange ```

1st line therapy for alcohol withdraw

BZDs

4 vitamins given to patients with alcohol withdraw

Thiamine (B1) Folic Acid Phosphate Magnesium

The only 2 treatments that were found to be effective for alcohol dependance

Acamprosate | Naltrexone

MOA of disulfiram in treatment of alcohol dependance

increases acetyl aldehyde, creating a terrible rxn when patients drink

Hoehn and Yahr Parkinson's stage when motor dysfunction is bilateral but there are no postural abnormalities

Stage II

Initial symptoms that anticholinergics help to treat in Parkinson's disease

tremor and rigidity

Hoehn and Yahr Parkinson's stage when the disease is fully developed and the patient is bed or chair bound

Stage V

Treatment for the physical symptoms of cocaine intoxicatoin

phentoamine

Ferritin level that worents ferrous sulfate supplementation in RLS

1st line sleep therapy in children

Non-drug therapy

MAO of pramiprexole

D2 and D3 agonist

Area of the brain in which DA is too high, creating the positive symptoms in schizophrenia

mesolimbic pathway

MOA of naltrexone

opioid receptor antagonist

Timing of bright light therapy in delayed sleep phase type sleep disorder

30-60 min in the AM

MOA of phentolamine

alpha-1 blocker

1st line treatment for Parkinson's disease for a patient

Amantadine and MAO-B-Is

MOA of naloxone

mu-receptor antagonist

Hoehn and Yahr Parkinson's stage when motor dysfunction is unilateral

Stage I

MOA of carbidopa

peripheral dopa decarboxylase inhibitor

Location in the brain where dopamine is synthesized

substantia nigra

MOA of entacapone

COMT inhibitor in the periphery

High potency FGAs

Trifluoperazine, Fluphenazine, Haloperidol

2 anticholinergic medications that can be used to treat Parkinson's disease

trihexyphenidyl | benztropine

2 MAO-B inhibitors used to treat Parkinson's disease

Selegilline | Rasagiline

MAO of bromocriptine

D2 agonist and mild D3 antagonist

MAO of Ropinerole

D2 and D3 agonist

2 DA agonist used to treat Parkinson's Disease that may cause peripheral edema

amantadine | pramiprexole

MOA of apomorphine

D2 and D3 agonist and D4 antagonist

1st line treatment for Parkinson's disease for a patient

Dopamine agonist

MOA of all SGAs and FGAs

D2 receptor antagonists

1st line treatment for Parkinson's disease in a patient that has some cognitive impairment

Carbidopa/levodopa

Inability to sit still

choreiform

1st line treatment for Parkinson's disease for a patient

Anticholinergics or MAO-B-I

2 antipsychotics that have been studied in Parkinson's disease

Clozapine and quetiapine

MOA of caffeine

Adenosine A1 and A2 receptor antagonist

Low potency FGAs

Chlorpromazine, Thioridazine

MOA of guanfacine and clonidine

alpha-2 adrenergic agonists

Area of the hypothalamus that controls circadian rhythm

suprahiasmatic nucleus

Area of the brain in which DA is too low, creating the negative symptoms in schizophrenia

Mesocortical pathway

Schizophrenia + bipolar disorder

Schizoaffective disorder

2 TCAs that are preferred in the treatment of ADHD with depression

Imipramine and desipramine

Medium potency FGAs

Loxapine, Perphenazine, Thiothixene

Low potency SGAs

Clozapine, Quetiapine

High potency SGAs

Risperidone, Paliperidone

Receptor that SGAs block that gives them additional efficacy on negative symptoms

5HT2A

SGA that has the highest risk of akathisia (inner restlessness)

Aripiprazole

Antagonism of what receptor by antipsychotics causes anticholinergic SEs

Antagonism of this receptor leads to sedation created by antipsychotics

Antagonism of this receptor leads to hypotension created by antipsychotics

alpha-1

Antipsychotics that have the highest risk of DIMD

high potency, slow dissociation (FGAs)

Antipsychotics that have the highest risk of anticholinergic SEs and sedation

low potency

Antipsychotics that have the highest risk of hypotension

low potency and Iloperidone

Antipsychotics with the highest risk of hyperprolactinemia

FGAs, risperidone and paliperidone

Antagonism of this receptor leads to weight gain associated with antipsychotics

Antagonism of these 3 receptors is associated with lipid and glucose changes associated with antipsychotics

H1, M3, 5HT2C

SGAs that have the highest risk of metabolic issues

clozapine and olanzapine

SGAs that have the lowest risk of metabolic issues

ziprasidone, lurasidone, aripiprazole

Antipsychotics that have the highest risk of neuroleptic malignant syndrome

high potency

3 antipsychotics that are the most important not to abruptly discontinue

clozapine, quetiapine, iloperidone

Antipsychotic that has the highest risk of QT prolongation

Thioridizone

Antipsychotic that has the highest risk of seizures

clozapine

Antipsychotic that has the lowest seizure risk

quetiapine

Special dietary restriction with asenapine

no food or drink within 10-15 min

Dietary restriction with ziprasidone

must take with > 500 cal

Dietary restriction with lurasidone

must take with >300 cal

Antipsychotic medications that are both anti-manic and anti-depressive

quetiapine lorasidone olanzepine + fluoxitine

Order of increasing risk of mood switching for antidepressants used in bipolar disorder

bupropriod

AEDs used to treat bipolar disorder that are mainly anti-manic with slight anti-depressive effects

valproic acid carbamazepine oxcarbazepine

AED that is used in bipolar disorder that has mainly antidepressive effects

Lamotrigine

Treatment that tends to be the most effective for classic euphoric mania

Lithium

Treatment that tends to be the most effective for dysphoric mania

AEDs

What qualifies a HA as chronic

Occurs more days in a month than not

Best acute treatment for a cluster HA

100% O2 inhalation

Best treatment for an ice-pick HA (stabbing pain for a short period of time)

Indomethacin

Drug of choice for prophylactic treatment of tension type HAs

amitriptylline

MOA of triptans

5HT1B/1D receptor agonists

5 medications that are FDA approved for prophylaxis of migraines

``` valproic acid topiramate propranolol timolol anabotulinum toxin A ```

SGA that is a D2 receptor partial agonist

Aripiprazole

Classification when schizophrenia symptoms have lasted less than 6 months

Schizophreniform disorder

Antipsychotic that has superior efficacy in treating positive symptoms

Clozapine

Issue with tolcapone that limits its use

Increases risk of hepatic failure

Where melatonin is synthesized

pineal gland

AA precursor of melatonin

tryptophan

Excitatory dopamine receptors

Type 1 (D1 and D5)

Hoehn and Yahr Parkinson's stage when movement dysfunction is bilateral and there are mild postural abnormalities

Stage III

MOA of ramelteon

M1 and M2 melatonin receptor agonist

Timing of melatonin therapy in delayed sleep phase sleep disorder

At dusk, about 5 hours before bedtime

Timing of melatonin therapy in advanced sleep phase disorder

dawn

Transtheoretical model of change stage that a patient is in when they are not yet ready to quit

Pre-contemplation

Location of the hypothalamus where histamine is produced

tuberomemmillary nucleus

TCA that is FDA approved for insomnia characterized by sleep maintenance issues

doxepin (silenor)

MOA of rotigotine transdermal patch

D1, D2 and D3 agonist

MOA of suvorexant

Orexin receptor (OX1 and OX2) antagonist

Transtheoretical model for change that patients are in when they are 6 or more months after their quit date and are now considered a former user

Maintenance

FDA approved medications for sleep maintenance

BZDs Z-hypnotics Silenor

Preferred class of sleep drugs in the elderly

Z-hypnotics

Peptide neurotransmitters implicated in wakefulness that are lost in patients with narcolepsy

Orexins A and B

3 sleep medications/classes that should not be taken with high fat meals due to decreased absorption

z-hypnotics ramelteon silenor

Transtheoretical model of change phase that patients are in when they are actively trying to quit and are still within 6 months of their quit date

Action

5 A's for clinicians when dealing with substance abuse

``` Ask Advise Assess Assist Arrange ```

1st line sleep therapy in children

Non-drug therapy

The best established pathway for reinforcement

dopaminergic projection from the ventral tagmental are (VTA) to the nucleus accumbens

Timing of bright light therapy in delayed sleep phase type sleep disorder

30-60 min in the AM

Timing of melatonin therapy in delayed sleep phase sleep disorder

At dusk, about 5 hours before bedtime

FDA approved medications for sleep onset

BZDs Z-hypnotics Remelteon

Effect mediated by the mu opioid receptor

analgesia, sedation, inhibition of respiration and slowed GI transit

Effects mediated by the kappa opioid receptor

analgesia, dysphoria, slowed GI transit

G alpha receptor type for opioid receptors

MOA of morphine

mu-opioid receptor agonist

Inactive metabolite of morphine that has neuroexcitatory properties

morphine-3-glucuronide

Active metabolite of morphine that is more potent than the parent

Morphine-6-glucuronide

MOA of methadone

Mu and delta opioid receptor agonist, NMDA receptor antagonist, SNRI

MOA of fentanyl

mu-opioid receptor agonist

MOA of oxycodone

mu-opioid receptor agonist and kappa agonist

MOA of hydrocodone

mu-opioid receptor agonist

MOA of codeine

mu-opioid receptor agonist

MOA of tramadol

5HT/NE reuptake inhibitor and metabolite is a weak mu-opioid agonist

MOA of pentazocaine

partial mu-agonist and k-agonist

MOA of butorphanol

partial mu-agonist and kappa-agonist

MOA of nalbuphine

mu antagonist and kappa agonist

MOA of buphenorphine

partial mu agonist and possible k antagonist

The primary agent use for opioid overdose

naloxone

Effects mediated by the delta opioid receptor

analgesia

MOA of methylnaltrexone

peripherally acting mu-opioid receptor antagonist

FDA approved indication for methylnaltrexone

refractory opioid-induced constipation in patients with advanced illness receiving palliative care

2 effects of opioids that patients do not gain tolerance to

GI effects and pupillary constriction

MOA of aspirin

irreversible inhibition of COX via acetylation

Intrathercal spinal infusion of cone snail venom that is reserved for severe neuropathic pain and blocks presynaptic N-type Ca channels

Zoconitide

MOA of epinephrine that makes it useful when combined with local anesthetics

vasoconstrictor

Main MOA of local anesthetics

Block Na channel function

Alkaloid derived from plants of Solanaceae that activates TRPVI receptor of C fiber sensory neurons and then desensitizes it, depleting Substance P

Capsaicin

Normal processing of a stimulus

nociceptive

nociceptive pain due to damage to bone, muscle, ligament or skin

somatic

nociceptive pain due to damage to solid or hollow organs (liver, heart, spleen, kidney, GI tract)

Visceral

Abnormal processing on pain stimuli

neuropathic

Only FDA indication of lidocaine patches

Post herpetic neuralgia

The drug of choice for trigeminal neuralgia

Carbamazepine

MOA of ketamine, used for neuropathic pain

NMDA receptor antagonist

Opioid that is the most effective in neuropathic pain

methadone

4 1st line agents for neuropathic pain

TCAs Gabapentin/pregabalin lidocaine patch SNRIs

NSAID that has the lowest CV risk

naproxen

Most common therapy given to patients experiencing opioid-inducted constipation

Senna + docusate

Opioid with the worst nausea SE

Codeine

2 Opioids that it is most common to have a true allergy to

codeine + morphine

2 drugs that are the most common options to switch to if a patient has a true allergy to morphine

fentanyl or methadone

Dose of naloxone that should be given to a patient with a respiratory rate of

0.04 mg (diluted) IVP over 15 sec q1-3min

Dose of naloxone that should be given to a patient in respiratory arrest

0.4-2 mg

Opioid that should specifically be avoided in renal disease

Morphine

4 pain medications that can contribute to serotonin toxicity

fentanyl, methadone, meperidine, tramadol

MOA of tapntadol

weak mu agonist and NE reuptake inhibitor

Active metabolite of hydrocodone

hydromorphone

MOA of meperidone

strong mu agonist and NMDA agonist

Neurotoxic metabolite of hydromorphone

H3G

Non-active, non--toxic CYP3A4 metabolite of oxycodone

noroxycodone

Active CYP2D6 metabolite of oxycodone

oxymorphone

Cut off for non-opioid naive patients

>60mg/day MEQ for past 7 days

CNS review Flashcards

(319 cards)