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aNeuro exam 4: Lindsey's > Drugs to know > Flashcards

Drugs to know Flashcards

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1
Q
  • CNS stimulant
  • agonist at nicotinic neuronal receptor
  • some people have a gene that impairs metabolism, protecting them addiction
  • use common in schizo
A

Nicotine

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2
Q
  • benzo
  • *** for status epilepticus via slow IVP
  • *** for seizures in CNS stimulant OD
  • *** for anti-anxiety
  • adjunctive in atonic and absence szs
  • tolerance develops
  • long half life
  • rapid oral but poor IM
A

Diazepam (Valium)

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3
Q
  • blocks voltage dependent sodium channels (VSSC)
  • reduces repetitive sz firing
  • good for tonic-clonic and partial sz’s
  • food enhances absorption and reduces GI upset
  • *** Strong inducer of P450
  • nystagmus
  • additive to other CNS depressants
  • rash
  • *** gingival hyperplasia
  • OD = death
  • inhibited by valproic acid
  • vitamin K deficiency in newborn
A

Phenytoin (Dilantin)

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4
Q

Methylphenidate (Ritalin)

A
  • CNS stimulant for ADHD
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5
Q

Divalproex (Depakote)

A
  • anti-mania
  • rapid loading
  • a lot like valproic acid
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6
Q

Amitriptyline (Elavil)

A
  • TCAD
  • anti-M (blurred vision, constipation, dry mouth, urinary hesitancy, fuzzy thinking, aggravates glaucoma, paralytic ileus, delirium)
  • anti-adrenergic SEs
  • weight gain
  • sexual dysfunction
  • Orthostatic hypotension (α1 blockade)
  • OD = BAD! sudden cardiac death, sz’s
  • ***highly sedating
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7
Q

Diazepam (Valium)

A
  • benzo
  • *** for status epilepticus via slow IVP
  • *** for seizures in CNS stimulant OD
  • *** for anti-anxiety
  • adjunctive in atonic and absence szs
  • tolerance develops
  • long half life
  • rapid oral but poor IM
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8
Q
  • antagonist at the benzodiazepine binding site –> reverse CNS effects of benzos (OD or for to hasten surgery recovery)
A

Flumazenil (Romazicon)

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9
Q
  • Mixed postsynaptic antagonist-serotonin reuptake inhibitor
  • ***very strong sedative – good for sleep aid in depressed pts
  • dizziness, nausea, agitation
  • orthostasis (via alpha-adrenergic blockade), ESP IN ELDERLY
  • priapism
  • OD = minor problems
A

Trazodone (Desyrel)

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10
Q
  • atypical antipsychotic
  • tx of negative symptoms
  • ***agranulocytosis
  • ***hypersalivation
  • *** lowers sz threshold
  • weight gain
  • try other drugs first!
A

Clozapine (Clozaril)

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11
Q

Ramelteon (Rozerem)

A
  • Agonist at melatonin MT1 and MT2 (superchiasmatic nucleus of the thalamus)
  • induces sleep and regulates circadian rhythms
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12
Q

Nitrous oxide

A
  • inorganic gas (volatile) inhaled general anesthetic
  • low potency (MAC = 105%)
  • adjunctive agent
  • analgesic and anxiolytic
  • rapid onset and recovery
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13
Q

Heroin

A
  • Opioid agonist
  • Naltrexone (Revia) and Buprenorphine (Subutex) block reinforcing effects but don’t change cravings
  • death by respiratory depression
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14
Q

Carbamazepine (Tegretol)

A
  • blocks voltage dependent sodium channels (VSSC)
  • suppresses repetitive AP
  • *** Strong inducer of P450
  • dosed 2-3x daily
  • *** tx for partial sz and mania
  • inhibited by valproic acid
  • vitamin K deficiency in newborn
  • diplopia, ataxia, nausea/vomiting, drowsiness,
  • ***hyponatremia
  • *** Stevens-Johnson syndrome
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15
Q

Phenobarbital (Luminal)

A
  • BARB
  • enhances GABA inhibition
  • ***inhibits glutamate via antagonism (VSCC)
  • ***valproic acid inhibits this drug!
  • *** causes resp. depression when used with diazepam
  • *** inducer of CYP450
  • irritability
  • sedation
  • ***interferes with learning
  • a tx for partial seizures, generalized tonic-clonic seizures, and neonatal status epilepticus
  • *** causes fetal malformations
  • *** vitamin K deficiency in newborns
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16
Q

Clozapine (Clozaril)

A
  • atypical antipsychotic
  • tx of negative symptoms
  • ***agranulocytosis
  • ***hypersalivation
  • weight gain
  • try other drugs first!
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17
Q
  • atypical antipsychotic
  • ***best tx for bipolar depression
  • sedation
  • weight gain
A

Quetiapine (Seroquel)

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18
Q
  • BARB
  • enhances GABA inhibition
  • ***inhibits glutamate via antagonism (VSCC)
  • ***valproic acid inhibits this drug!
  • *** causes resp. depression when used with diazepam
  • *** inducer of CYP450
  • irritability
  • sedation
  • ***interferes with learning
  • tx for partial seizures, generalized tonic-clonic seizures, and neonatal status epilepticus
  • *** fetal malformations
  • *** vitamin K deficiency in newborns
A

Phenobarbital (Luminal)

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19
Q
  • binds to and inhibits function of synaptic vesicle protein SV2A in Ca++-mediated neurotransmitter release; VSCC
  • ***tx for grand mal and partial sz
  • No P450 drug metabolism, minimal drug interactions
A

Levetiracetam (Keppra)

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20
Q
  • TCAD
  • anti-M (blurred vision, constipation, dry mouth, urinary hesitancy, fuzzy thinking, aggravates glaucoma, paralytic ileus, delirium)
  • anti-adrenergic SEs
  • weight gain, sexual dysfunction
  • Orthostatic hypotension (α1 blockade)
  • OD = BAD! via sudden cardiac death, sz’s
  • ***highly sedating
A

Amitriptyline (Elavil)

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21
Q
  • blocks T-type Ca++ channels
  • *** first line for absence sz c
  • omplete metabolism by CYP3A4
  • gastric distress
  • HA
  • dizziness
  • gum hypertrophy
A

Ethosuximide (Zarontin)

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22
Q
  • benzo
  • long half life
  • minimal tolerance
  • *** can accumulate in elderly/ hepatic problems
  • *** daytime sedation
A

Flurazepam (Dalmane)

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23
Q

Escitralopram (Lexapro)

A
  • SSRI
  • no sedation
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24
Q
  • agonist at CB1 receptor
  • can increase heart rate, precipitate seizures in epileptics, increase potential for ketoacidosis in diabetics
  • cognitive impairments
  • withdrawal minimal
  • psychosis (induces and makes existing worse)
  • tx for pain, appetite loss, nausea/vomiting, MS, glaucoma
A

Marijuana

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25
Methamphetamine
* CNS stimulant * acts upon locus ceruleus * increases NE release * reverses DA transporter to release DA * makes schizo worse
26
* SSRI * no sedation
Escitralopram (Lexapro)
27
* NMDA antagonist * dissociative anesthetic- IV * allows responsivity and reflexes with catatonia, amnesia, and analgesia, esp. in kids * worsens schizo
ketamine
28
* binds to GABA receptor to PROLONG its action AND directly initiates chloride current to depress glu * \*\*\*induction phase of general anesthesia * decrease delta sleep * decrease duration of REM * high risk of tolerance (fast- 1 week) * low safety margin in therapeutic range: antianxiety, anticonvulsant, muscle relaxant, sedative, and hypnotic * \*\*\* induce CYP450 * lethal OD
Barbiturates
29
Zolpidem (Ambien)
* Z drug (binds to alpha-1 subunit of GABA-Cl channel ONLY) * half life = 2 hours --\> short duration of action * \*\*\*reduces sleep latency and nocturnal awakenings * first line for insomnia * minimal tolerance * \*\*\*no rebound insomnia
30
* benzo * short half-life * less daytime sedation but + rebound insomnia * rapid oral * anterograde amnesia * confusion * bizzare behavior * agitation * hallucinations
Triazolam (Halcion)
31
Clonidine (Catapres)
* α2 adrenergic agonist * alleviates symptoms of SNS overactivity (nausea / vomiting, cramps, sweating, tachycardia, and increased blood pressure) that occur during acute OPIOID withdrawal (3-4 doses/day)
32
Alcohol
* CNS depressant * cross-dependence with benzos and barbs * enhances GABA activity * \*\*\* decreases glu at high doses * most commonly abused and misused drug in the US * metabolized in liver at constant rate * moderately rapid tolerance
33
* Agonist at melatonin MT1 and MT2 (superchiasmatic nucleus of the thalamus) * induces sleep and regulates circadian rhythms
Ramelteon (Rozerem)
34
* typical antipsychotic * low potency * less EPS but high ANS SEs: * anti-M (dry mouth, sedation) * α1-blockade (hypotension) * antihistamine (sedation)
Chlorpromazine (Thorazine)
35
* CNS stimulant * acts upon locus ceruleus * increases NE release * reverses DA transporter to release DA * makes schizo worse
Methamphetamine
36
Flumazenil (Romazicon)
* antagonist at the benzodiazepine binding site --\> reverse CNS effects of benzos (OD or for to hasten surgery recovery)
37
* SSRI * \*\*\* inhibits P450 (CYP2D6) * longer half life * mild sedation
Fluoxetine (Prozac)
38
Bupropion (Wellbutrin, Zyban)
* NDRI and smoking cessasion tx * dizziness, dry mouth, tremor, insomnia * \*\*\*anxiety * \*\*\*aggravates psychosis * \*\*\*potential for sz's * \*\*\* NO sexual SEs or weight gain
39
Fluoxetine (Prozac)
* SSRI * \*\*\* inhibits P450 (CYP2D6) * longer half life * mild sedation
40
* partial agonist at mu opioid receptor * blocks reinforcing effects of heroin * no ups and downs * lose cravings
Buprenorphine (Subutex)
41
Cocaine
* CNS stimulant * blocks DA reuptake (and possibly 5HT, NE) * makes schizo worse
42
Buprenorphine (Subutex)
* partial agonist at mu opioid receptor * blocks reinforcing effects of heroin * no ups and downs * lose cravings
43
Marijuana
* agonist at CB1 receptor * can increase heart rate, precipitate seizures in epileptics, increase potential for ketoacidosis in diabetics * cognitive impairments * withdrawal minimal * psychosis (induces and makes existing worse) * tx for pain, appetite loss, nausea/vomiting, MS, glaucoma
44
Barbiturates
* binds to GABA receptor to PROLONG its action AND directly initiates chloride current to depress glu * \*\*\*induction phase of general anesthesia * decrease delta sleep * decrease duration of REM * high risk of tolerance (fast- 1 week) * low safety margin * in therapeutic range: antianxiety, anticonvulsant, muscle relaxant, sedative, and hypnotic * \*\*\* induces CYP450 * lethal OD
45
Zaleplon (Sonata)
* Z drug (binds to alpha-1 subunit of GABA-Cl channel ONLY) * half life = 1 hour --\> short duration of action * dizziness, HA, somnolence * \*\*no rebound insomnia * \*\* decreases time to sleep onset --\> sleep aid for middle of the night awakenings
46
Halothane (Fluothane)
* Fluorinated hydrocarbon * general anesthetic- inhaled * \*\*\*high solubility in blood - moderately/high potency (MAC = 0.75%) * not good analgesic * respiratory and CV failure * \*\*\*can cause liver damage * \*\*\*can trigger malignant hyperthermia
47
Amphetamines
* CNS stimulant * acts upon locus ceruleus * increases NE release * reverses DA transporter to release DA * makes schizo worse
48
Triazolam (Halcion)
* benzo * short half-life * less daytime sedation but + rebound insomnia * rapid oral * anterograde amnesia * confusion bizzare * behavior * agitation * hallucination
49
* blocks VSSC and T-type Ca++ channels --\> potentiation of GABA function * tx for tonic-clonic sz, partial, absence, atypical sz * inhibits metabolism of phenytoin, lamotrigine, phenobarbital, carbamazepine, ethosuximide * \*\*\*fetal malformations
Valproate
50
* anti-manic, bipolar depression tx * bad taste * tremor * \*\*\* narrow therapeutic window * \*\*\* diabetes insipidus * \*\*\* hypothyroidism * 10-21 day onset * \*\*\* diuretics and NSAIDs increase its plasma levels * \*\*\* increased Na+ decreases its plasma levels
Lithium carbonate
51
* MAOI * \*\*\* tyramine reaction --\> HTN crisis * \*\*\* postural hypotension * OD = BAD! sz, shock, hyperthermia * \*\*\* good for atypical depression * dry mouth, constipation, urinary retention, sexual dysfunction, weight gain
Phenelzine (Nardil)
52
Benzodiazepines
* binds to GABA receptor to INTENSIFY its action via opening of chloride channels --\> raise AP threshold * NO induction of general anesthesia * sleep and anxiolytic, panic disorder, generalized anxiety, social phobia, anticonvulsant * daytime sedation, rebound insomnia * performance impairment * anterograde amnesia * dependence/tolerance (slow) * antagonist = Flumazenil (Romazicon)
53
Midazolam (Versed)
* benzo * not much to note
54
Methadone
* long acting opioid agonist * substitute for heroin to alleviate symptoms (no ups and downs, lose cravings)
55
* blocks voltage dependent sodium channels (VSSC) * suppresses repetitive AP * \*\*\* Strong inducer of P450 * dosed 2-3x daily * \*\*\* tx for partial sz and mania * inhibited by valproic acid * vitamin K deficiency in newborn * diplopia, ataxia, nausea/vomiting, drowsiness * \*\*\*hyponatremia * \*\*\* Stevens-Johnson syndrome
Carbamazepine (Tegretol)
56
* benzo * slow oral absorp. * intermediate half life * less depression of REM sleep
Temazepam (Restoril)
57
Levetiracetam (Keppra)
* binds to and inhibits function of synaptic vesicle protein SV2A in Ca++-mediated neurotransmitter release; VSCC * \*\*\*tx for grand mal and partial sz * No P450 drug metabolism, minimal drug interactions
58
Haloperidol (Haldol)
* typical antipsychotic * high potency * tx of positive symptoms * \*\*\*high EPS SEs (dystonia, akathisia, pseudoparkinsons, tardive dyskinesias)
59
CNS stimulant for ADHD
Methylphenidate (Ritalin)
60
* Z drug (binds to alpha-1 subunit of GABA-Cl channel ONLY) * half life = 1 hour --\> short duration of action * dizziness, HA, somnolence * \*\*\*no rebound insomnia * \*\*\* decreases time to sleep onset --\> sleep aid for middle of the night awakenings
Zaleplon (Sonata)
61
Temazepam (Restoril)
* benzo * slow oral absorp. * intermediate half life * less depression of REM sleep
62
* benzo * direct metabolism (no P450) * short half life * \*\*\* good for elderly and hepatic dysfunction * slow oral absorp., good IM * good for EtOH withdrawal, anti-anxiety, status epilepticus
Lorazepam (Ativan)
63
* opioid receptor antagonist * blocks reinforcing actions of heroin but has no effect on craving * reduces alcohol craving, consumption, and relapse rates when used in combination with psychotherapy * can precipitate opioid withdrawal
Naltrexone (Revia)
64
* anti-mania * rapid loading * a lot like valproic acid
Divalproex (Depakote)
65
ketamine
* NMDA antagonist * dissociative anesthetic- IV route * allows responsivity and reflexes with catatonia, amnesia, and analgesia, esp. in kids * worsens schizo
66
Nicotine
* CNS stimulant * agonist at nicotinic neuronal receptor * some people have a gene that impairs metabolism, protecting them from addiction * use common in schizo
67
* α2 adrenergic agonist * alleviates symptoms of SNS overactivity (nausea / vomiting, cramps, sweating, tachycardia, and increased blood pressure) that occur during acute OPIOID withdrawal (3-4 doses/day)
Clonidine (Catapres)
68
Oxazepam (Serax)
* benzo * direct metabolism (no P450) * short half life * \*\*\* good for elderly and hepatic dysfunction * slow oral absorp.
69
* Z drug (binds to alpha-1 subunit of GABA-Cl channel ONLY) * half life = 2 hours --\> short duration of action * \*\*\*reduces sleep latency and nocturnal awakenings * first line for insomnia * minimal tolerance * \*\*\*no rebound insomnia
Zolpidem (Ambien)
70
* antagonist at Histamine H1 and muscarinic cholinergic receptors * sedation * antimuscarinic in elderly * \*\*\* treatment for acute dystonia (an EPS)
Diphenhydramine (Benadryl)
71
Disulfiram (Antabuse)
* inhibits aldehyde dehydrogenase (AIDH) * causes 5-10x fold increase in acetaldehyde levels --\> nausea/vomiting, respiratory and cardiovascular collapse, convulsions
72
* benzo * direct metabolism (no P450) * short half life * \*\*\* good for elderly and hepatic dysfunction * slow oral absorp.
Oxazepam (Serax)
73
* SNRI * \*\*\*HTN * \*\*\*anxiety * \*\*\* more rapid withdrawal symptoms * nausea, somnolence, sweating, dizziness, sexual dysfunction
Venlafaxine (Effexor)
74
Eszopiclone (Lunesta)
* Z drug (binds to alpha-1 subunit of GABA-Cl channel ONLY) * half life = 6 hours (long) * insomnia tx * \*\*\*next-day psychomotor impairment * \*\*\* NO tolerance
75
Trazodone (Desyrel)
* Mixed postsynaptic antagonist-serotonin reuptake inhibitor * \*\*\*very strong sedative -- good for sleep aid in depressed pts * dizziness, nausea, agitation * orthostasis (via alpha-adrenergic blockade), ESP IN ELDERLY * priapism * OD = minor problems
76
* benzo * rapid oral absorp. * short half-life and effects * good for elderly * tx for panic disorder, acute anxiety
Alprazolam (Xanax)
77
Quetiapine (Seroquel)
* atypical antipsychotic * \*\*\*best tx for bipolar depression * sedation * weight gain
78
* CNS depressant * cross-dependence with benzos and barbs * enhances GABA activity * \*\*\* decreases glu at high doses * most commonly abused and misused drug in the US * metabolized in liver at constant rate * moderately rapid tolerance
Alcohol
79
* NDRI and smoking cessasion tx * dizziness, dry mouth, tremor, insomnia * \*\*\*anxiety * \*\*\*aggravates psychosis * \*\*\*potential for sz's * \*\*\* NO sexual SEs or weight gain
Bupropion (Wellbutrin, Zyban)
80
Ethosuximide (Zarontin)
* blocks T-type Ca++ channels * \*\*\* first line for absence sz * complete metabolism by CYP3A4 * gastric distress, HA, dizziness, gum hypertrophy
81
Paroxetine (Paxil)
* SSRI * short half life * \*\*\* withdrawal symptoms = flu-like/neurologic * \*\*\* inhibits P450 (CYP2D6) * mild sedation
82
Valproate
* blocks VSSC and T-type Ca++ channels --\> potentiation of GABA function * tx for tonic-clonic sz, partial, absence, atypical * inhibits metabolism of phenytoin, lamotrigine, phenobarbital, carbamazepine, ethosuximide * \*\*\*fetal malformations
83
* inhibits aldehyde dehydrogenase (AIDH) * causes 5-10x fold increase in acetaldehyde levels --\> nausea/vomiting, respiratory and cardiovascular collapse, convulsions
Disulfiram (Antabuse)
84
* CNS stimulant * blocks DA reuptake (and possibly 5HT, NE) * makes schizo worse
Cocaine
85
* Z drug (binds to alpha-1 subunit of GABA-Cl channel ONLY) * half life = 6 hours (long) * insomnia tx * \*\*\*next-day psychomotor impairment * \*\*\* NO tolerance
Eszopiclone (Lunesta)
86
Diphenhydramine (Benadryl)
* antagonist at Histamine H1 and muscarinic cholinergic receptors * sedation * antimuscarinic in elderly * \*\*\* treatment for acute dystonia (EPS)
87
* long acting opioid agonist * substitute for heroin to alleviate symptoms (no ups and downs, lose cravings)
Methadone
88
* binds to GABA receptor to INTENSIFY its action via opening of chloride channels --\> raise AP threshold * NO induction of general anesthesia * sleep and anxiolytic, panic disorder, generalized anxiety, social phobia, anticonvulsant * daytime sedation, rebound insomnia * performance impairment * anterograde amnesia * dependence/tolerance (slow) * antagonist = Flumazenil (Romazicon)
Benzodiazepines
89
Naltrexone (Revia)
* opioid receptor antagonist * blocks reinforcing actions of heroin but has no effect on craving * reduces alcohol craving, consumption, and relapse rates when used in combination with psychotherapy * can precipitate opioid withdrawal
90
* Fluorinated hydrocarbon * general anesthetic- inhaled * \*\*\*high solubility in blood - moderately/high potency (MAC = 0.75%) * not good analgesic * respiratory and CV failure * \*\*\*can cause liver damage * \*\*\*can trigger malignant hyperthermia
Halothane (Fluothane)
91
* inorganic gas (volatile) * inhaled general anesthetic * low potency (MAC = 105%) * adjunctive agent * analgesic and anxiolytic * rapid onset and recovery
Nitrous oxide
92
Phenelzine (Nardil)
* MAOI * \*\*\* tyramine reaction --\> HTN crisis * \*\*\* postural hypotension OD = BAD! sz, shock, hyperthermia * \*\*\* good for atypical depression * dry mouth, constipation, urinary retention, sexual dysfunction, weight gain
93
* CNS stimulant * acts upon locus ceruleus * increases NE release * reverses DA transporter to release DA * makes schizo worse
Amphetamines
94
* typical antipsychotic * high potency * tx of positive symptoms * \*\*\*high EPS SEs (dystonia, akathisia, pseudoparkinsons, tardive dyskinesias)
Haloperidol (Haldol)
95
* Opioid agonist * Naltrexone (Revia) and Buprenorphine (Subutex) block reinforcing effects but don't change cravings * death by respiratory depression
Heroin
96
CNS stimulant for ADHD
d-Amphetamine (Adderall)
97
Chlorpromazine (Thorazine)
* typical antipsychotic * low potency * less EPS but high ANS SEs: * anti-M (dry mouth, sedation) * α1-blockade (hypotension) * antihistamine (sedation)
98
Lorazepam (Ativan)
* benzo * direct metabolism (no P450) * short half life * \*\*\* good for elderly and hepatic dysfunction * slow oral absorp., good IM * good for EtOH withdrawal, anti-anxiety, status epilepticus
99
Lithium carbonate
* anti-manic, bipolar depression * tx bad taste * tremor * \*\*\* narrow therapeutic window * \*\*\* diabetes insipidus * \*\*\* hypothyroidism * 10-21 day onset * \*\*\* diuretics and NSAIDs increase blood lithium levels * \*\*\* increased Na+ decreases lithium levels
100
* a benzo * not much to note
Midazolam (Versed)
101
Flurazepam (Dalmane)
* long half life * minimal tolerance * \*\*\* can accumulate in elderly/ hepatic problems * \*\*\* daytime sedation
102
Alprazolam (Xanax)
* benzo * rapid oral absorp. * short half-life and effects * good for elderly * tx for panic disorder, acute anxiety
103
d-Amphetamine (Adderall)
CNS stimulant for ADHD
104
* SSRI * short half life * \*\*\* withdrawal symptoms = flu-like/neurologic * \*\*\* inhibits P450 (CYP2D6) * mild sedation
Paroxetine (Paxil)
105
Venlafaxine (Effexor)
* SNRI * \*\*\*HTN * \*\*\*anxiety * \*\*\* more rapid withdrawal symptoms * nausea, somnolence, sweating, dizziness, sexual dysfunction
106
Phenytoin (Dilantin)
* blocks voltage dependent sodium channels (VSSC) * reduces repetitive sz firing * good for tonic-clonic and partial sz's * food enhances absorption and reduces GI upset * \*\*\* Strong inducer of P450 * nystagmus * additive to other CNS depressants * rash * \*\*\* gingival hyperplasia * OD = death * inhibited by valproic acid * vitamin K deficiency in newborn

aNeuro exam 4: Lindsey's (37 decks)

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