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Phenobarbital's Drug class?
barbiturate
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Butabarbital's drug class?
barbiturate
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Clinical use of barbiturates and bezodiazepines?
Calm effect, decrease anxiety, sleep-like state, depression. Small therapeutic index.
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What are the three sedative-hypnotic drug classes?
Barbiturates, Benzodiazepines, and NBRAs
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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
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Temazepam?
Benzodiazepines
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Triazolam?
Benzodiazepines
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diazepam?
Benzodiazepines
-
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clonazepam?
Benzodiazepines
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Alprazolam?
Benzodiazepines
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-
-
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Use of NBRA?
Decreases adverse effects of benzos and barbs
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What are the five anti-depressant drug classes?
- Tricyclic antidepressants
- SSRI
- Heterocyclics (2nd gen)
- Heterocyclics (3rd gen)
- MAO inhibitors
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Amitriptyline?
Tricyclic antidepressant
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Nortriptyline?
Tricyclic antidepressant
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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
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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.
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amoxapine?
2nd gen heterocyclic
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bupropion?
- 2nd gen heterocyclic
- to quit smoking
- works on dopamine not NE
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trazadone?
2nd gen heterocyclic
short half life
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Duloxetine?
3rd gen heterocyclic
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Venlafaxine?
3rd gen heterocyclic
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Mirtazapine?
3rd gen heterocyclic
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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
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Clinical uses of Heterocyclic (3rd gen)?
- alpha 2 receptor antagonist
- increased release 5-HT and NE
- Block some 5-HT receptors
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Phenelzine?
MAO inhibitor
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Tranylcypromine?
MAO inhibitor
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Selegiline?
MAO inhibitor (patch)
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Clinical uses of MAO inhibitors?
- Break down NE and epinephrine
- depression = shortage of epinephrine/seratonin
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Side effects of selegiline specifically?
Tyramine and/or sympathomimetic consumption and cause HTN crisis.
In absence of alpha 1agonist, may cause hypotension.
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3 drug classes for affective disorders?
- Antipsychotics, classic, 1st gen
- Antipsychotics, newer agents, 2nd gen
- Bipolar drugs
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Phenothiazines (chlorpromazine, fluphenazine, thioridazine)?
Antipsychotics, classic, 1st gen
-
haloperidol?
Antipsychotics, classic, 1st gen
-
trifluoperazine?
Antipsychotics, classic, 1st gen
-
clozapine?
Antipsychotics, newer agent, 2nd gen
-
olanzapine?
Antipsychotics, newer agent, 2nd gen
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Aripiprazole?
Antipsychotics, newer agent, 2nd gen
-
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Carbamazepine?
bipolar drug
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-
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Valproic acid?
bipolar drug
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Clinical uses of antipsychotics, classic, 1st gen?
- help with schitzophrenia (dopamine)
- D2 receptor affinity
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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
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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.
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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
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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)
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4 types of seizures drugs help?
- Tonic-clonic and partial seizures
- absence seizures
- myoclonic seizures
- Back-up and adjunctive drugs
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What seizures are carbamazepine used for?
Tonic-clonic and partial seizures
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What seizures are Phenytoin used for?
tonic-clonic and partial seizures
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What seizures are valproic used for?
- tonic-clonic and partial seizures
- absence seizures
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What seizures are lamotrigine used for?
- tonic-clonic and partial seizures
- absence seizures
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Clinical uses of all seizures drugs?
- Decrease neuronal firing
- most have short half life
- there are peak periods you should try to avoid
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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.
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What seizures does ethosuximide treat?
absence seizures
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What seizures does clonazepam treat?
- absence seizures
- myoclonic seizures
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felbamate?
Back-up and adjunctive drug
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gabapentin?
Back-up and adjunctive drug
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lamotrigine?
Back-up and adjunctive drug
-
levetiracetam?
Back-up and adjunctive drug
-
Phenobarbital?
Back-up and adjunctive drug for infants
-
Tiagabine?
Back-up and adjunctive drug
-
topiramate?
Back-up and adjunctive drug
-
vigabatrin?
Back-up and adjunctive drug
-
Zonisamide?
Back-up and adjunctive drug
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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
-
Levodopa?
Dopamine precursor
-
clinical use of dopamine precursor (levodopa)?
Treats all PD symptoms but very effective with bradykinesia
-
dopamine precursor side effects?
GI (anorexia, nausea, emesis), orthostatic hypotension, arrhythmias, dyskinesia, behavioral changes, tolerance, end-of-dose akinesia, on-off phenomenon
-
bromocriptine?
Dopamine agonist
-
pramipexole?
Dopamine agonist
-
Ropinirole?
Dopamine agonist
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rotigotine?
Dopamine agonist
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apomorphine?
Dopamine agonist
-
Clinical use of dopamine agonists?
Assist endogenous dopamine (peak plasma levels 1-2 hours, built up slowly over 2-3 months)
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side effects of dopamine agonists?
Nausea and emesis, orthostatic hypotension, confusion and hallucinations
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amantadine?
Indirect acting dopaminergic
-
Clinical use of indirect acting dopaminergics?
Facilitate release ofdopamine (indirectly), glutamate antagonist
not as effective as L-dopa
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Side effects of indirect acting dopaminergics?
- CNS cognitive disturbances (confusion, hallucination, depression, insomnia), peripheral edema/orthostatic
- hypotension
-
Selegiline?
indirect acting MAO inhibitor
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Rasagiline?
indirect acting MAO inhibitor
-
Clinical uses of indirect acting MAO inhibitors?
- Prolongs endogenous dopamine activity
- metabolite amphetamine derivative
- irreversible inhibitor
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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
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Entacapone?
COMT inhibitor
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Tolcapone?
- COMT inhibitor
- associated with hepatotoxicity
-
Clinical uses of COMT inhibitors?
- Decrease peripheral metabolism L-dopa
- increases dopamine indirectly
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Side effects of COMT inhibitors?
Similar to L-dopa (dyskinesias, hypotension, confusion, GI distress)
-
Benztropine?
Muscarinic antagonist
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Biperiden?
Muscarinic antagonist
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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
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Name the combination therapy for parkenson's disease?
- Sinemet: L-DOPA + CarbiDOPA
- Stalevo: entacapone + sinemet
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Clinical uses of combination parkenson's drug therapy?
- Increases conversion of dopamine in brain
- decreases the breakdown of dopamine
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