Drugs acting on the nervous system Flashcards by George Smith

Sedative hypnotic anxiolytics - benzos
Name 2
MOA
something useful

alprazolam (Xanax) (-pams)
diazepam (Valium)
enhances effects of GABA
antidote is flumazenil

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Atypical anxiolytics (nonbarbituate)
Name 1
MOA
something useful

buspirone (BuSpar)
binds to serotonin and domamine receptors
dependency is unlikely, no sedation

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Selective Serotonin Reuptake Inhibitors (SSRI)
Name 3
MOA
something useful

paroxetine (Paxil)
fluoxetine (Prozac)
sertraline (Zoloft)
inhibits serotonin reuptake
may take up to 4 weeks for effects, use for depression and anxiety, SE of sexual disfunction

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Atypical antidepressants
Name 3
MOA
something useful

bupropion (Wellbutrin)
venlaflaxine (Effexor)
duloxetine (Cymbalta)
likely inhibits dopamine uptake
for depression, no sexual dysfunction and aid to quit smoking (bupropion)

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tricyclic antidepressants
Name 2
MOA
something useful

amitriptyline (Elavil)
imipramine (Tofranil)
block reuptake of NE and serotonin
anticholinergic effects

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anticholinergic effects:

can’t see, can’t spit, can’t pee, can’t sh*t

(blurred vision, dry mouth, urinary retention, constipation

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Monoamine oxydase inhibitors (MAOIs)
Name 4
MOA
something useful

phenelzine (Nardil)
isocarboxazid (Marplan)
tranylcypromine (Parnate)
selegiline (Emsam) patch
block MAO, thereby increasing NE, serotonin, DA
for depression
avoid tyramine (hypertensive crisis), and most other drugs

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major meds for anxiety disorders (3 categories)

benzos such as diazepam
atypical anxiolytics such as buspirone
some antidepressants such as paroxetine, sertraline (SSRIs), venlafaxine (SNRI)

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meds used less often for anxiety (4 categories)

TCAs such as amitriptyline, clomipramine
antihistamines such as hydroxyzine
beta blockers such as propranolol
anticonvulsants such as gabapentin

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4 classes of antidepressant meds

SSRIs, atypical antidepressants, TCAs, MAOIs

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main bipolar med

mood stabilizer - lithium

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additional classes used to treat bipolar disorder (4 categories)

AEDs such as valproate, carbamazapine, lamotrigine
atypical antipsychotics
anxiolytics such as clonazepam, lorazepam
antidepressants such as bupropion, sertraline

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mood stabilizer
Name 1
MOA
something useful

lithium
produces neurochemical changes in the brain, including serotonin receptor blockade
therapeutic level 0.6-1.4 mEq/L

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mood stabilizing anti epileptic drugs (AEDs)
Name 3
MOA
something useful

carbamazapine (Tegretol)
valproic acid (Depakote)
lamotrigine (Lamictal)
slow entrance of Na and Ca back into neuron, enhances GABA, inhibits glutamate (suppressing CNS excitation)
rash (Steven Johnson syndrome) in carba and lamo

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Positive symptoms related to schizophrenia

related to thought, behavior, and speech (agitation, delusions, hallucinations, tangential speech patterns)

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Negative symptoms related to schizophrenia

social withdrawal, lack of emotion, lack of energy, flattened affect, decreased motivation, decreased pleasure in activities

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first generation (conventional) antipsychotic meds control

mainly positive symptoms such as bizarre behavior

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second generation (atypical) antipsychotic meds are for (5)

clients receiving initial treatment and for treating breakthrough episodes
both positive and negative symptoms
less EPS including TD
less anticholinergic effects
less relapse

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antipsychotics - first generation (conventional)
Name 2
MOA
something useful

chlorpromazine (Thorazine)
haloperidol (Haldol)
block D2, Ach, histamine, and NE receptors in brain and periphery
AEs of EPS:
dystonia, parkinsonism, akathisia, TD
also neuroleptic malignant syndrome: high fever, BP fluctuations, muscle rigidity, change in LOC
and anticholinergic effects

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antipsychotics - second generation (atypical)
Name 3
MOA
something useful

risperidone (Risperdal)
clozapine (Clozaril)
aripiprazole (Abilify)
mainly block serotonin and to lesser degree, DA
also block NE, histamine, ACh
less EPS side effects and treats negative and positive symptoms

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meds used to treat behavioral disorders in children (5 categories)

TCAs, antipsychotics, nonbarbituate anxiolytics, CNS stimulants, NSRIs

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CNS stimulants used in children/adolescents
Name 2
MOA
something useful

methylphenidate (Ritalin)
amphetamine mixture (Adderall)
raise levels of NE, serotonin, and DA in the CNS
used for ADHD and narcolepsy, have substance abuse potential

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Norepinephrine selective reuptake inhibitor used for ADHD
Name 1
MOA
something useful

atomoxetine (Strattera)
block reuptake of NE
not a stimulant, minimal SE

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alpha2 adrenergic agonists (2) used for ADHD in children and possible MOA

guanfacine (Intuniv)
clonidine (Kapvay)
may active presynaptic alpha2 receptors in the brain

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meds to detox from alcohol

benzos such as chlordiazepoxide, diazepam, lorazepam

used to decrease seizures in alcohol detox

carbamazapine

decreases alcohol cravings during detox

propranolol

maintenance drugs after alcohol detox

disulfiram (Antabuse- can't abuse [makes you sick if you drink]) naltrexone - reduces cravings acamprosate - reduces anxiety

meds to support opioid withdrawal

methadone substitution clonidine - diarrhea, nausea and vomiting buprenorphine - decreases cravings, helps maintenance

meds to support nicotine withdrawal

bupropion - reduces craving | verenicline - promotes release of dopamine for pleasurable effects

cholinesterase inhibitors Name 2 MOA something useful

neostigmine (Prostigmin) pyridostigmine (Mestinon) prevent cholinesterase from inactivating ACh antidote is atropine neostigmine reverses neuromuscular blocking agents and treats myasthenia gravis

``` anti parkinson's meds: dopamine synthesis and DA agonist Name 2 MOA something useful ```

levodopa/carbidopa (Sinemet-combo) levodopa - crosses BBB synthesizes DA carbidopa - augments levodopa by decreasing amount of DA in intestine and periphery (more in CNS) relieve dyskinesias and improve ADLs

anti parkinson's meds: DA agonists Name 2 MOA

pramipexole (Mirapex) bromocriptine (Parlodel) activate DA receptors

anti parkinson's meds: dopamine releaser Name 1 MOA

amantadine (Symmetrel) | prevents DA reuptake

anti parkinson's meds: Catecholamine-O-methyltransferase (COMT) inhibitors Name 2 MOA

entacapone (Comtan) tolcapone (Tasmar) enhance the effect of levodopa by blocking its breakdown

Traditional anti epileptic drugs | Name 4

barbituate: phenobarbital (Luminal) hydantoin: phenytoin (Dilantin) carbamazapine (Tegretol) valproic acid (Depakote)

Newer AEDs | Name 4

lamotrigine (Lamictal) topiramate (Topamax) gabapentin (Neurontin) pregabalin (Lyrica)

benzos used as AEDs | Name 2

diazepam (Valium) | lorazepam (Ativan)

beta adrenergic blockers for eye disorders Name 1 MOA something useful

timolol (Timoptic) decrease IOP by reducing aqueous humor systemic affects of beta block could occur

alpha adrenergic blockers for eye disorders Name 2 MOA

brimonidine (Alphagan) apraclonidine (Iopidine) decreases production of aqueous humor

neuromuscular blocking agents Name 2 MOA something useful

depolarizing: succinylcholine (Anectine) nondep: pancuronium (antdote - neostigmine) block ACh at neuromuscular junction, resulting in relaxation, paralysis w/out loss of consciousness could cause malignant hyperthermia- use dantrolene

muscle relaxants and antispasmodics- centrally acting Name 2 MOA something useful

diazepam (Valium) baclofen (Lioresal) enhances GABA depressing spasticity AE- CNS depression

muscle relaxants and antispasmodics- peripherally acting Name 1 MOA something useful

dantrolene (Dantrium) acts directly on muscles by preventing release of Ca (inhibits muscle contraction) AE- CNS depression

muscarinic agonists related to bladder Name 1 MOA something useful

bethanechol (Urecholine) relaxes trigone and sphincter muscles and contraction of detrusor muscle go pee

muscarinic antagonists related to bladder Name 2 MOA something useful

oxybutynin (Ditropan) darifenacin (Enablex) inhibits receptors of detrusor muscle, prevents contraction and urge to void for overactive bladder, anticholinergic effects

sedatives and CNS depressants are used

to induce a sense of calm and decrease anxiety

hypnotics are

CNS depressants that induce sleep

3 types of sedative-hypnotics

benzos, barbs, and benzo-like meds

benzodiazepines Name 3 MOA something useful

``` triazolam (Hacion) alprazolam (Xanax) midazolam (Versed) enhance action of GABA in the CNS for anxiety, seizures, insomnia, induction of anesthesia, and more, risk of tolerance ```

nonbenzodiazepines Name 3 MOA something useful

``` zolpidem (Ambien) zaleplon (Sonata) eszopiclone (Lunesta) enhance GABA, increasing sleep duration and decreased awakenings low risk of tolerance ```

melatonin agonist used for sleep Name 1 MOA something useful

ramelteon (Rozerem) activates melatonin receptors for insomnia

IV anesthetics nonopiod agents barbituate

pentobarbitol (Nembutal)

Use for IV anesthetics

produce loss of consciousness and eliminate response to painful stimuli

IV anesthetics nonopioid agents benzodiazepines 2

midazolam, diazepam

IV anesthetics nonopioid agents others 2

propofol, ketamine

IV anesthetics | opioid agents 2

fentanyl (Sublimaze) | alfentanil (Alfenta)

opioid (narcotic agonists) Name 6 MOA something useful

``` morphine (Roxanol) hydromorphone (Dilaudid) codeine meperidine (Demerol) oxycodone (OxyContin) tramadol (Ultram) react w/ opioid receptors throughout the body to cause analgesia, sedation, or euphoria commonly used drugs, are controlled substances ```

narcotic (opioid) antagonist Name 2 MOA something useful

naloxone (Narcan) naltrexone (ReVia) bind to opioid receptors but do not activate them naloxone - antidote for opioid overdose naltrexone - adjunct treatment for alcohol or opioid dependence

antimigraine ergot derivative

ergotamine

antimigraine triptans

sumatriptan (Imitrex) all end in triptan

barbiturates Name 2 MOA something useful

phenobarbital (Luminal) secobarbital (Seconal) inhibit conduction in RAS, depress cerebral cortex, depress motor output higher SE and addictive

anticholinergic adjuncts for parkinsonism Name 2 MOA

benztropine (Cogentin) diphenhydramine (Benadryl) treatment of drug induced Parkinsonism

cholinesterase inhibitors that are used for dementia 3

donepezil (Aricept) rivastigmine (Exelon) galantamine (Razadyne)

drug that antagonizes the receptors that are thought to be overactive in dementia (NMDA receptor antagonist)

menantine (Namenda)

can be used to treat drug induced dystonias

antihistamines such as diphenhydramine

Drugs acting on the nervous system Flashcards

(65 cards)