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Pharmacology > Unit 9: Neurological/Psych > Flashcards

Unit 9: Neurological/Psych Flashcards

1
Q

First line treatment for tension headaches

A

Acetaminophen and aspirin

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2
Q

Second line treatment for tension headaches

A

NSAIDs and excedrin

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3
Q

Prophylactic treatment for tension headaches

A

Antidepressants–amitriptyline

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4
Q

First line treatment for mild to moderate migraine

A

NSAIDs and aspirin

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5
Q

First line treatment for moderate to severe migraine

A

Triptans

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6
Q

Triptans

A

5-HT1 receptor agonists

Cause cerebral vasoconstriction and can treat both pain and nausea of migraine

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7
Q

Opioids for migraine

A

Used as rescue medication for severe migraines that do not respond to other medications
Used sparingly
Butorphanol, tramadol, acetaminophen + caffeine

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8
Q

Steroids for migraine

A

Can be used as rescue medication until patient is free for 24 hours

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9
Q

Prophylactic drugs for migraine

A

Anticonvulsants, beta blockers, triptans, ACEI, ARB, ca channel blocker, TCA, SSRI/SNRI, antihistamines, botox

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10
Q

First line therapy for partial seizures

A

Carbamazepine, phenytoin, fosphenytoin, valproic acid, lamotrigine, lacosamide, topiramate, oxcarbazepine

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11
Q

First line therapy for generalized tonic clonic seizures

A

Carbamazepine, lacosamide, phenytoin, valproic acid, fosphenytoin

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12
Q

First line therapy for absence seizures

A

Ethosuximide, valproic acid, lamotrigine

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13
Q

First line therapy for atypical absence, myoclonic, and atonic seizures

A

Valproic acid

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14
Q

Hydriantoins

A

Phenytoin + fosphenytoin
Most commonly used anti seizure meds
Increases efflux and decreases influx of Na

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15
Q

SE of phenytoin

A

gingival hyperplasia, hirsutism, rash, peripheral neuropathy

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16
Q

Benzodiazepines used for seizures

A

Clobazam, clonazepam, lorazepam (SE), diazepam

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17
Q

First line therapy for status epilepticus

A

IV benzodiazepine

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18
Q

4 common strategies for modifying drug therapy for major depressive disorder

A

increase dose, switch to different drug in same class, switch to different class, augment current drug, combine meds

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19
Q

Examples of SSRIs

A

Fluoxetine, citalopram, fluvoxamine, paroxetine, sertraline, escitalopram

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20
Q

Common SE of SSRI

A

Sexual dysfunction, potential to induce anxiety/insomnia–decreases REM sleep

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21
Q

Abrupt withdrawal of SSRI

A

flu like symptoms, insomnia, GI effects, anxiety

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22
Q

SNRIs

A

venlafaxine, desvenlafaxine, duloxetine, levomilnacipran

Indicated for more severe or resistant depression

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23
Q

SE of SNRI

A

More anticholinergic effects

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24
Q

TCA’s

A

-triptyline or -amine
Same efficacy as SSRI but worse SE- Anticholinergic effects, weight gain, life threatening cardiac conduction abnormalities, hypotension, sedation

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25
Atypical antidepressants
Amoxapine, buproprion, maprotiline, mirtazapine, nefazodone, trazodone
26
MAO Inhibitors
Decrease degradation of NE, 5-HT, and dopamine Increased SE and potential for hypertensive crises Limited use Phenelzine
27
Major neurotransmitters studied in anxiety pharmacology
NE, serotonin, GABA
28
Ideal anxiolytic therapy
Should promote calmness without resulting in daytime sedation and drowsiness and without producing physical or psychological dependence
29
What drugs are indicated in anxiety
Antidepressants, benzodiazepines, azapirones, novel anti-anxiety meds, and atypical antipsychotics
30
First line therapy for chronic management of anxiety disorders
Antidepressants SSRI: citalopram, escitalopram, fluvoxamine, paroxetine, sertraline SNRI: venlafaxine, duloxetine TCAs: Imipramine
31
What drugs are indicated for short term management of anxiety
Benzodiazepines 2-4 weeks Also used for acute exacerbations
32
Examples of benzodiazepines used for anxiety
``` Alprazolam: Xanax Clonazepam Diazepam Lorazepam: Ativan Oxazepam ```
33
What drug is used in benzodiazepine OD
Flumazenil
34
Azapirones
Buspirone Partial agonist at 5-HT1a receptor Used as adjunct therapy for anxiety
35
MAOI in anxiety
Effective for panic attacks but not GAD
36
First line treatment for GAD
SSRI or SNRI | Must give benzo initially until anti depressant begins to work
37
Second line treatment for GAD
Imipramine or buspirone
38
First line treatment for panic disorder
SSRI or venlafaxine
39
First line treatment for social anxiety
SSRI and venlafaxine
40
Drugs used to manage insomnia
Benzodiazepines, orexin receptor agonists, melatonin receptor agonist, first generation H1 blocker
41
Benzodiazepines for insomnia
Bind to GABA in ascending RAS: blocks thalamus, hypothalamus, and limbic arousal
42
Flurazepam
Long acting and rapid onset--used for sleep initiation
43
Temazepam and Lorazepam
Intermediate acting | Used for sleep maintenance
44
Benzodiazepine Receptor Agonists
Selective for alpha 1 of GABA A receptor--induces sleepiness but not anxiolysis or muscle relaxation Long term use not recommended Can increase parasomnias
45
Examples of benzodiazepine receptor agonists
Eszoplicone, zolpidem (ambien), and zaleplon
46
Orexin receptor antagonists
Suvorexant Blockage of orexin neuropeptides--causes severe sleepiness Achieves sleep initiation and maintenance
47
Melatonin receptor agonists
Ramelteon High affinity for MT1 and MT2 receptors Shorten latency to sleep onset
48
Antihistamines for insomnia
Diphenhydramine: Benadryl | Competitively inhibits H1 receptor causing sedative and anticholinergic effects
49
Antidepressants for insomnia
Mirtazapine, Trazadone, Doxepin | Sedating antidepressants for use with co-morbid depression
50
First line therapy for short term insomnia
Benzodiazepines, benzo receptor agonist, ramelteon
51
Meds for restless leg syndrome
Dopaminergic agonists, opioids, benzos, anticonvulsants
52
Dopaminergic agonists for restless leg syndrome
Ropinirole + pramipexole, low dose cardidopa-levodopa
53
Narcoleptic triad
Excessive daytime sleepiness, cataplexy, sleep related hallucinations, sleep paralysis
54
Diagnosis of narcolepsy
Presence of excessive sleepiness, levels of hypocretin in CSF, and multilatency sleep test
55
Psychostimulants for narcolepsy
Modafenil + Armodafinil | Increase release of NE in subregions of hippocampus, centro lateral nucleus of thalamus and central nucleus of amygdala
56
Amphetamines for narcolepsy
Methylpenidate | Stimulates CNS activity and blocks reuptake of NE
57
Sodium oxybate
Approved to treat excessive daytime sleepiness and cataplexy
58
ADHD pathophys
Decreased volume and functionality in prefrontal cortex/caudate and cerebellum--deficits in cognition, attention, motor planning, and processing speed Problems with dopamine and NE
59
First line treatment for ADHD
Stimulants
60
Second line treatment for ADHD
Non stimulants
61
Third line treatment for ADHD
Buproprion
62
Stimulant medications
methylphenidate + amphetamines Inhibit re-uptake of dopamine and NE amphetamines also directly cause release of dopamine and NE from presynaptic cell
63
SE of stimulant meds for ADHD
Sleep disturbances, decreased appetite, weight loss, agitation, nervousness
64
Nonstimulants for ADHD
Used if patient has CI to stimulant | Atomexetin, guanfacine, clonidine, buproprion
65
Atomexitine
Nonstimulant | Selectively inhibits reuptake of NE by inhibiting presynpatic NE transporter
66
alpha 2 agonists
Guanfacine + Clondidine Decreases NE release Decreases hyperactivity, impulsivity, and distractibility
67
Pathophys of Alzheimer Disease
ACh levels are decreased and excessive stimulation of glutamate
68
First line tx for AD
``` Cholinesterase inhibitors Or Memantine (more severe forms) or combo ```
69
Cholinesterase inhibitors
Tx of cognitive symptoms Donepezil, rivastigmine, galantamine SE are cholinergic: DUMBBELSS
70
Memantine
NMDA antagonist Decreases glutamate tx of cognitive symptoms inhibits neuronal degeneration
71
Antipsychotics for noncognitive symptoms of AD
Atypical antipsychotics preferred due to decreased EPS symptoms
72
Benzos for AD
Tx of anxiety of episodic agitation Lorazepam or Alprazolam Long term use may worsen symptoms of AD
73
Antidepressants for AD
Sertraline or Citalopram first line
74
Drug induced parkinsonism may be due to
Typical antipsychotics or neuroleptic drugs | -Chlorpromazine, promazine, haloperidol, perphenazine, fluphenazine, pimozide, metoclopramide, valproic acid, methyldopa
75
Symptoms of parkinson disease are due to
Decrease in dopamine--leads to breakdown of communication to motor regulators within the brain
76
Hallmark signs of parkinson disease
Bradykinesia, resting tremor, cogwheel rigidity, difficulty maintaining balance
77
Mild potency drugs for PD
Anticholinergics, amantadine, MAO-B inhibitors
78
Anticholinergics for PD
Useful for treating drooling and tremor Trihexyphenidyl + Benztropine SE: anticholinergic
79
Amantadine
May inhibit NMDA receptor
80
MAO-B inhibitors
Modest improvement of motor symptoms Selegiline + Rasagiline Inhibits MAO-B metabolism of dopamine
81
Moderate potency drugs for PD
Dopamine agonists
82
Dopamine agonists
Less effective than levodopa but less dyskinesia seen | Pramipexole, ropinirole, rotigutine
83
High potency drugs for PD
Levodopa and catechol-o-methyltransferase inhibitors
84
Levodopa
Most effective tx for symptomatic relief of PD Fastest onset of action Can cross bbb and then converted to dopamine Administered with carbidopa to limit peripheral breakdown
85
Catechol-o-methyltransferase inhibitors
Entacapone + Tolcapone Used in combo with levodopa to decrease wearing off effect Can increase risk of dyskinesia Decreases peripheral breakdown of levodopa

Pharmacology (56 decks)

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