Drugs - Neurology Flashcards
Anticholinergics
Atropine
Tolterodine
Atropine class and indications?
Anticholinergic (antimuscarinic)
Anti-arrhythmic
Bradycardia - - Organophosphate poisoning
Atropine interactions, contraindications, cautions, adverse effects?
A/E: Dry mouth, tachycardia, palpitations, arrhythmias, mydriasis, photophobia, raised intraocular pressure.
Toxicity: Tachycardia, hyperpyrexia, restlessness, confusion, excitement, hallucination, delirium, may progress to circulatory failure + respiratory depression
INT: Quinidine, anti-depressants, some antihistamines -> additive anticholinergic effects
CI: Narrow angle glaucoma, Myesthenia gravis, Ulcerative colitis, Toxic megacolon, Acute hemorrhage w/ cardiovascular instability, Thyrotoxicosis
Tolterodine class and indications?
Anticholinergic
Urinary antispasmodic
Overactive bladder - - Urge urinary incontinence - - Urinary urgency and frequency
Competitive muscarinic receptor antagonist – similar to atropine – relaxes smooth mm
Tolterodine interactions, contraindications, cautions, adverse effects?
A/E: Dry mouth, chest pain, headache, somnolence, fatigue, dry skin, abdominal pain, constipation, dyspepsia, diarrhea, dizziness, anxiety, weight gain, abnormal vision, dry eyes, paresthesia, nervousness, urinary retention
INT: Macrolide abx, antifungals, vinblastine, cyclosporine -> Risk of overdose
Rivastigmine, Donepezil -> risk of cholinergic neurogenic hypersensitivity
CI: Urinary retention - - gastric retention
Pregnancy, BPH, Narrow angle glaucoma, Myesthenia gravis, Ulcerative colitis, Toxic megacolon
Sympathomimetics
Dextroamphetamine Methylphenidate Oxymetazoline Pseudoepinephrine Phenylephrine Phentermine
Dextroamphetamine class and indications?
Amphetamine – CNS Stimulant
Narcolepsy - - ADHD.
Amphetamines = non-catecholamine sympathomimetic amines.
Dextroamphetamine interactions, contraindications, cautions, adverse effects?
A/E: Appetite loss, insomnia, abdominal pain, palpitations, tachycardia, elevated BP, loss of libido
INT: Amphetamines, Tricyclics, MAOI, Norepinpehrine -> increase absorption of these
CI: Hyperthyroidism, glaucoma, hypertension, advanced arteriosclerosis, MAOI, agitated states
Methylphenidate class and indications?
SNRI - Piperidine derivative
ADHD - - Narcolepsy.
Increases release of norepinephrine → stimulates impulse transmission in respiratory system & CNS
Methylphenidate interactions, contraindications, cautions, adverse effects?
A/E: Decreased appetite, insomnia, headache, abdominal pain, nausea, vomiting
INT: Blood pressure medications may be less effective
Phenytoin and TCAs may have serum levels raised
CI: Within 2 weeks of MAOI - Heart issues - Glaucoma - Marked anxiety, tension, agitation
Oxymetazoline class and indications?
Decongestant (Vicks)
Sinusitis - Congestion - - nasal spray or drops to relieve congestion
Vasoconstrictor effect on mucosal blood vessels topically → reduces edema of nasal mucosa
Oxymetazoline interactions, contraindications, cautions, adverse effects?
A/E: Rebound congestion w/ prolonged use
Nasal spray -> stinging, burning, dry mouth/throat
Headache, insomnia, tachycardia, HTN, nervousness, nausea, dizziness, palpitation, arrhythmia
INT: None
CI: Glaucoma, hyperthyroidism, heart dz, hypertension
Pseudoephedrine class and indications?
Decongestant
Alpha and Beta adrenergic receptor agonist
Nasal congestion
Alpha-adrenergic receptor agonist → vasoconstriction by simulation of receptors of resp mucosa
Beta-adrenergic receptor agonist → bronchial relaxation, increased heart rate and contractility
Pseudoephedrine interactions, contraindications, cautions, adverse effects?
A/E: Rebound congestion and rhinorrhea, nervous issues, mood changes, confusion, hypotension, faint, flushing, heartrate changes, arrhythmias, Anginal pain
INT: MAOI co-admin -> Hypertensive crisis
Digoxin, Quinidine, TCA -> HTN, Arrhythmias risk
CI: Pheochromocytoma, Severe hypertension
Phenylephrine class and indications?
Decongestant - - Alpha (and weak Beta) adrenergic agonist
Nasal congestion spray - - Mydriasis eye dropper
Vasoconstriction of arterioles of nasal mucosa d/t alpha adrenergic receptor agonist stimulation
Phenylephrine interactions, contraindications, cautions, adverse effects?
A/E: Mood changes, nervous issues, confusion, heartrate changes, increased salivation, SOB
INT: Beta Blockers may have increased hypotensive fx
MAOI co-admin -> potentiates HTN
CI: Hypertension - V-tach - Angle Closure Glaucoma
Phentermine class and indications?
Sympathomimetic appetite suppressant
Obesity – short term use for moderate to severe obesity
Stimulates cerebral cortex → suppresses appetite
Phentermine interactions, contraindications, cautions, adverse effects?
A/E: Urticaria, heartrate changes, nervous issues, dry mouth, change in libido / impotence
INT: Antacids - TCA (risk of arrhythmia) - Phenytoin, Phenobarbital serum concentrations reduced
CI: Pulmonary HTN, Hypertension, CVD, Glaucoma, within 2 weeks of MAOI, Lactation
Cholinergic agonist
Nicotine
Nicotine class and indications?
Cholinergic agonist
Smoking cessation
Nicotine interactions, contraindications, cautions, adverse effects?
A/E: PATCH -> Skin rash - discontinue if severe, vasculitis - - Gum etc -> headache, nervous sx, dysmenorrhea, cold and flu, chest pain
INT: Nicotine patch + Bupropion = hypertension
CI: Recent stroke, acute MI, unstable angina, severe arrhythmias, occasional smokers
Acetylcholinesterase inhibitors
Donepezil
Rivastigmine
Donepezil class and indications?
Cholinesterase inhibitor
Alzheimer’s Dz (mild to moderate)
Inhibits cholinesterase in CNS - - increase acetylcholine transmission - - slows cognitive decline
Donepezil interactions, contraindications, cautions, adverse effects?
Same as Rivastigmine
A/E: M/C HA, Diarrhea, Nausea
GI sx -> Diarrhea, nausea, vomiting, increased acid - - bradycardia, vivid dreams causing insomnia
INT: Increases cholinergic effects, decreases anticholinergic effects
CI: RELATIVE CIs -> HR changes, Ht dz, asthma, copd, ulcers
Rivastigmine class and indications?
Cholinesterase inhibitor
Alzheimer’s Dz (mild to moderate)
Inhibits cholinesterase in CNS - - increase acetylcholine transmission - - slows cognitive decline
Rivastigmine interactions, contraindications, cautions, adverse effects?
Same as Donepezil
A/E: GI sx -> Diarrhea, nausea, vomiting, increased acid - - bradycardia, vivid dreams causing insomnia
INT: Increases cholinergic effects, decreases anticholinergic effects
CI: RELATIVE CIs -> HR changes, Ht dz, asthma, copd, ulcers
Benzodiazepines
Alprazolam
Diazepam
Alprazolam class and indications?
Xanax
Benzodiazepine anxiolytic
Anxiety – short term management - - Anxiolytic, muscle-relaxant, anticonvulsant, anti-depressant, sleep modifying effects. Binds to GABA specific sites throughout CNS → increases inhibitory effect of GABA on neuronal excitability (ie decreases neuronal excitability)
Alprazolam interactions, contraindications, cautions, adverse effects?
A/E: Drowsiness m/c - - also depression, HA, dry mouth, confusion, vertigo
INT: Potentiates alcohol and CNS depressants
CI: Pregnancy, lactation - Angle closure glaucoma - severe hepatic impairment - sleep apnea
Diazepam class and indications?
Valium
Benzodiazepine anxiolytic, anticonvulsant
Severe anxiety - - Insomnia w/ anxiety - - MM spasms - - Alcohol withdrawal sx - - Seizures - - RLS Anxiolytic, muscle-relaxant, anticonvulsant, anti-depressant, sleep modifying effects. Binds to GABA specific sites throughout CNS → increases inhibitory effect of GABA on neuronal excitability (ie decreases neuronal excitability)
Diazepam interactions, contraindications, cautions, adverse effects?
A/E: Dependence, withdrawal - Drowsiness - fatigue - confusion
INT: Increased clearance of Diazepam w/ anticonvulsants - may decrease Levodopa effectiveness - Hypothermia with Lithium - additive w/ alcohol or other CND depressant
CI: Pregnancy and lactation (D) - Myasthenia gravis - respiratory depression - hepatic impairment - angle closure glaucoma
Non benzodiazepine anxiolytics
Buspirone
Buspirone class and indications?
Non-benzodiazepine Anxiolytic
GAD Anxiety – short term management
No affinity for GABA receptors - - anxiolytic d/t affinity for serotonin receptors
Buspirone interactions, contraindications, cautions, adverse effects?
A/E: Dizziness, drowsiness, nausea, headache
INT: Alcohol/CNS depressants - MAOI combined leads to hypertension
CI: Epilepsy - hepatic or renal impairment - children under 18 - MAOI use
Insomnia
Zolpidem
Melatonin
Zolpidem class and indications?
Ambien
Non-barbiturate hypnotic
Insomnia – short term management - - Strong sedative, weak anxiolytic
Zolpidem interactions, contraindications, cautions, adverse effects?
A/E: Tolerance, dependence, rebound insomnia - confusion - abnormal thought/behavior
INT: TCA -> sedation and incoordination - - Alcohol -> sedation
CI: Severe hepatic insufficiency - Elderly - Driving - GERD
Melatonin class and indications?
Tryptamines
Insomnia – disturbed biorhythms, sleep disorders
Cancer
Melatonin interactions, contraindications, cautions, adverse effects?
A/E: Increased seizure activity - drowsiness - headache - disruption of circadian rhythm - may worsen depression
INT: None
CI: Immunosuppressive tx concurrently
Seizure drugs
Carbamazepine
Phenytoin
Gabapentin
Carbamazepine class and indications?
Anticonvulsant
CBZ → Cranial nerve (Trigeminal) neuralgia + Bipolar Disorder Prophylaxis + Zeizures
Carbamazepine interactions, contraindications, cautions, adverse effects?
A/E: Ataxia (lack of voluntary coordination of mm movements) - dizziness, drowsiness, dry mouth
MAY CAUSE: Lupus - SIADH
DEPLETIONS: Folate - Vitamin D + K
INT: Decreases effect of OCP - reduces tolerance to alcohol
CI: Pregnancy (D) (causes NTD) - Porphyria - Bone marrow depression - Jaundice - Hepatitis
Phenytoin class and indications?
Anticonvulsant
Epilepsy
Phenytoin interactions, contraindications, cautions, adverse effects?
A/E: Hirsutism - Acne - Osteomalacia - GI problems - Dizziness, insomnia, nervous sx
INT: Enhances lithium toxic effects
Decr. serum levels/effects -> acyclovir, antineoplastics, benzodiazepines, ciprofloxacin, CYP2C9 inducers (Carbamzepine), CYP2C19 inducers (Rifampin), folic acid
Incr. metabolism of antiarrhythmics, anticonvulsants, antipsychotics, beta blockers, CCB, Chloramphenicol, Corticosteroids, Doxycycline, Estrogens, HMG CoA reductast inhibitors, Methadone, Theophylline, TCA’s
Gabapentin class and indications?
GABAnergic Anticonvulsant
Epilepsy - - Neuropathic Pain - - Peripheral edema
Gabapentin interactions, contraindications, cautions, adverse effects?
A/E: Ataxia - Tremor - Sedation
INT: Absorption reduced w/ antacids
CI: Lactation
Gabanergic drugs
Gabapentin (similar structure GABA but not agonist or antagonist - MOA not known)
Pregabalin