CNS drugs

  1. Phenobarbital's Drug class?
  2. Butabarbital's drug class?
  3. Clinical use of barbiturates and bezodiazepines?
    Calm effect, decrease anxiety, sleep-like state, depression. Small therapeutic index.
  4. What are the three sedative-hypnotic drug classes?
    Barbiturates, Benzodiazepines, and NBRAs
  5. Adverse effects of barbiturates and benzodiazepines?
    • behaviors changes
    • respiratory depression
    • amnesia
    • tolerance/addiction/dependence/withdrawal
    • rebound anxiety
    • residual effect (hangover-highly lipid soluble leads to peripheral storage)
    • associaed with falls/traumatic hip fxs.
    • Caution with prescribed use in pts who we identify as having increased risk
  6. Temazepam?
  7. Triazolam?
  8. diazepam?
  9. ativan?
  10. clonazepam?
  11. Alprazolam?
  12. Zolpidem?
  13. Zaleplon?
  14. eszopiclone?
  15. Use of NBRA?
    Decreases adverse effects of benzos and barbs
  16. What are the five anti-depressant drug classes?
    • Tricyclic antidepressants
    • SSRI
    • Heterocyclics (2nd gen)
    • Heterocyclics (3rd gen)
    • MAO inhibitors
  17. Amitriptyline?
    Tricyclic antidepressant
  18. Nortriptyline?
    Tricyclic antidepressant
  19. Tricyclic antidepressant and heterocyclics adverse effects?
    • Antimuscarinic:
    • mydriasis and cycloplegia, confustion/delirium/sedation, GI distress, dry mouth, constipation and urinary retention, decreased sweating and hyperthermia

    • Cardiovascular:
    • postural hypotension exacerbated by antihypertensive

    • SIADH release:
    • increase ADH, increase arrhythmias and BP
  20. Fluoxetine?
  21. Sertraline?
  22. Paroxetine?
  23. SSRI adverse effects?
    • Serotonin syndrome (with MAO inhibitors present, akathisia, dyskinesia, dystonia, seizures and coma with
    • gross OD)
    • pseudoparkinsonism
    • SIADH release (increases ADH)
    • osteoporosis

    withdrawl syndrome: nausea, dizziness, anxiety, tremor, palpitations, insomnia, sexual dysfunction, agitation, headache. Rigidity not velocity dependent.
  24. amoxapine?
    2nd gen heterocyclic
  25. bupropion?
    • 2nd gen heterocyclic
    • to quit smoking
    • works on dopamine not NE
  26. trazadone?
    2nd gen heterocyclic

    short half life
  27. Duloxetine?
    3rd gen heterocyclic
  28. Venlafaxine?
    3rd gen heterocyclic
  29. Mirtazapine?
    3rd gen heterocyclic
  30. Mirtazapine (3rd gen heterocyclic) side effects?
    • alpha-2 antagonist
    • congnitive changes (confusion, dreams)
    • drowsy and dizzy
    • increased appetite and BMI
    • GI distress
    • myalgia and arthralgia
  31. Clinical uses of Heterocyclic (3rd gen)?
    • alpha 2 receptor antagonist
    • increased release 5-HT and NE
    • Block some 5-HT receptors
  32. Phenelzine?
    MAO inhibitor
  33. Tranylcypromine?
    MAO inhibitor
  34. Selegiline?
    MAO inhibitor (patch)
  35. Clinical uses of MAO inhibitors?
    • Break down NE and epinephrine
    • depression = shortage of epinephrine/seratonin
  36. Side effects of selegiline specifically?
    Tyramine and/or sympathomimetic consumption and cause HTN crisis.

    In absence of alpha 1agonist, may cause hypotension.
  37. 3 drug classes for affective disorders?
    • Antipsychotics, classic, 1st gen
    • Antipsychotics, newer agents, 2nd gen
    • Bipolar drugs
  38. Phenothiazines (chlorpromazine, fluphenazine, thioridazine)?
    Antipsychotics, classic, 1st gen
  39. haloperidol?
    Antipsychotics, classic, 1st gen
  40. trifluoperazine?
    Antipsychotics, classic, 1st gen
  41. clozapine?
    Antipsychotics, newer agent, 2nd gen
  42. olanzapine?
    Antipsychotics, newer agent, 2nd gen
  43. Aripiprazole?
    Antipsychotics, newer agent, 2nd gen
  44. Lithium?
    bipolar drug
  45. Carbamazepine?
    bipolar drug
  46. Clonazepam?
    bipolar drug
  47. Olanzapine?
    bipolar drug
  48. Valproic acid?
    bipolar drug
  49. Clinical uses of antipsychotics, classic, 1st gen?
    • help with schitzophrenia (dopamine)
    • D2 receptor affinity
  50. Side effects of low potency antipsychotics, classic, 1st gen?
    • Mydriasis and cycloplegia
    • confusion/delirium/sedation
    • tachycardia
    • constipation and urinary retention
    • decrease in sweating and hyperthermia
  51. Side effects of high potency antipsychotics, classic, 1st gen?
    • Malignant neuroleptic syndrome (MNS)
    • Orthostatic hypotension exacerbated by antihypertensives.

    extrapyramidal effects related: muscle rigidity and high fever, dystonic reactions, akathisia, pseudoparkinsonism, tardive dyskinesia (facial), disuse supersensitivity/up-regulation, may be irreversible.
  52. clinical uses of Antipsychotics, newer agents, 2nd generation?
    • 5-HT2 or other receptor affinity
    • better at treating adverse affective symptoms
    • partial D2 agonist
    • decreases parkinsonism adverse effects
  53. Side effects of Antipsychotics, newer agents, 2nd generation?
    • Orthostatic hypotension
    • Anticholinergic effects
    • Sedation and weight gain (associated with
    • diabetes type II)
    • malignant neuroleptic syndrome
    • increased mortality in geriatric patients and dementia (equivalent risk for conventional drugs)
  54. 4 types of seizures drugs help?
    • Tonic-clonic and partial seizures
    • absence seizures
    • myoclonic seizures
    • Back-up and adjunctive drugs
  55. What seizures are carbamazepine used for?
    Tonic-clonic and partial seizures
  56. What seizures are Phenytoin used for?
    tonic-clonic and partial seizures
  57. What seizures are valproic used for?
    • tonic-clonic and partial seizures
    • absence seizures
  58. What seizures are lamotrigine used for?
    • tonic-clonic and partial seizures
    • absence seizures
  59. Clinical uses of all seizures drugs?
    • Decrease neuronal firing
    • most have short half life
    • there are peak periods you should try to avoid
  60. Side effects of all seizure drugs?
    GI distress, sedation, fatigue, dizziness, nystagmus, ataxia, dysarthria, bradykinesia, cardiac arrhythmia and CHF, lupus erythematosus, urticaria, bleeding (# platelet function), hair loss.
  61. What seizures does ethosuximide treat?
    absence seizures
  62. What seizures does clonazepam treat?
    • absence seizures
    • myoclonic seizures
  63. felbamate?
    Back-up and adjunctive drug
  64. gabapentin?
    Back-up and adjunctive drug
  65. lamotrigine?
    Back-up and adjunctive drug
  66. levetiracetam?
    Back-up and adjunctive drug
  67. Phenobarbital?
    Back-up and adjunctive drug for infants
  68. Tiagabine?
    Back-up and adjunctive drug
  69. topiramate?
    Back-up and adjunctive drug
  70. vigabatrin?
    Back-up and adjunctive drug
  71. Zonisamide?
    Back-up and adjunctive drug
  72. 7 parkinson's disease drug classes?
    • Dopamine precursor
    • dopamine agonists
    • indirect acting dopaminergics
    • indirect acting MAO inhibitors
    • COMT inhibitors
    • COMT inhibitors
    • Muscarinic Antagonists
    • combination therapy
  73. Levodopa?
    Dopamine precursor
  74. clinical use of dopamine precursor (levodopa)?
    Treats all PD symptoms but very effective with bradykinesia
  75. dopamine precursor side effects?
    GI (anorexia, nausea, emesis), orthostatic hypotension, arrhythmias, dyskinesia, behavioral changes, tolerance, end-of-dose akinesia, on-off phenomenon
  76. bromocriptine?
    Dopamine agonist
  77. pramipexole?
    Dopamine agonist
  78. Ropinirole?
    Dopamine agonist
  79. rotigotine?
    Dopamine agonist
  80. apomorphine?
    Dopamine agonist
  81. Clinical use of dopamine agonists?
    Assist endogenous dopamine (peak plasma levels 1-2 hours, built up slowly over 2-3 months)
  82. side effects of dopamine agonists?
    Nausea and emesis, orthostatic hypotension, confusion and hallucinations
  83. amantadine?
    Indirect acting dopaminergic
  84. Clinical use of indirect acting dopaminergics?
    Facilitate release ofdopamine (indirectly), glutamate antagonist

    not as effective as L-dopa
  85. Side effects of indirect acting dopaminergics?
    • CNS cognitive disturbances (confusion, hallucination, depression, insomnia), peripheral edema/orthostatic
    • hypotension
  86. Selegiline?
    indirect acting MAO inhibitor
  87. Rasagiline?
    indirect acting MAO inhibitor
  88. Clinical uses of indirect acting MAO inhibitors?
    • Prolongs endogenous dopamine activity
    • metabolite amphetamine derivative
    • irreversible inhibitor
  89. Side effects of indirect acting MAO inhibitors?
    • Similar to dopamine agonists, insomnia common.
    • Do not consume tyramine containing food
    • should not be taken with TCAs
    • SRRI leads to risk acute toxic interactions
  90. Entacapone?
    COMT inhibitor
  91. Tolcapone?
    • COMT inhibitor
    • associated with hepatotoxicity
  92. Clinical uses of COMT inhibitors?
    • Decrease peripheral metabolism L-dopa
    • increases dopamine indirectly
  93. Side effects of COMT inhibitors?
    Similar to L-dopa (dyskinesias, hypotension, confusion, GI distress)
  94. Benztropine?
    Muscarinic antagonist
  95. Biperiden?
    Muscarinic antagonist
  96. Side effects of Muscarinic antagonists?
    • Mydriasis and cycloplegia
    • hypertension and tachycardia
    • confusion/delirium/ sedation
    • GI distress and dry mouth
    • constipation and urinary retention
    • decrease sweating and hyperthermia
  97. Name the combination therapy for parkenson's disease?
    • Sinemet: L-DOPA + CarbiDOPA
    • Stalevo: entacapone + sinemet
  98. Clinical uses of combination parkenson's drug therapy?
    • Increases conversion of dopamine in brain
    • decreases the breakdown of dopamine
Card Set
CNS drugs