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FA neurology p367-374


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drugs used for Parkinson's disease
L-dopa (with carbidopa)
Selegiline (and COMT inhibitors)
Antimuscarinics (Benztropine)
Clin Use
M: converted to DA in CNS
C: Parkinson's
T: arrhythmias; long-term use --> dyskinesia following administration, akinesia between doses
Clin Use
M: selective MAO-B inhibitor
C: Parkinson's
T: enhance adverse effects of L-dopa
Clin Use
M: 5-HT (1D) agonist. Causes vasoconstriction.
C: acute migraine, cluster h/a attacks
t: coronary vasospasm, mild tingling
drugs ok for partial seizures
phenytoin, carbamazepine, lamotrigine, gabapentin, topiramate, phenobarbital, valproic acid
SE: nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, megaloblastic anemia, teratogenesis, SLE-like syndrome, induction of cyt P450
Tox: diplopia, ataxia, blood dyscrasias, liver tox, teratogenesis, induction of cyt P450
Tox: Steven-Johnson syndrome
Lamotrigine (SJ is so lame!)
Tox: sedation, ataxia
tox: sedation, mental dulling, kidney stones, weight loss
Topiramate (Dopamax - skinny, stupid, and sedated)
tox: sedation, tolerance, dependence, induction of cyt P450
GI distress, rare but fatal hepatotox, NTD in fetus (spina bifida), tremor, wt gain
Valproic acid
SE: GI distress, lethargy, H/A, urticaria, Stevens-Johnson syndrome
se: sedation, tolerance, dependence
1st line agent for tonic0clonic seizres
phenytoin, carbamazepine, valproic acid
first line agent for absence seizures
first line agent for status epilepticus
M, C, T
M: use-dependent blockage of Na+ channels; inhibits glu release from excitatory presynaptic neuron
C: Tonic-clonic seizures
T: nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, megaloblastic anemia, teratogenesis, SLE-like syndrome, induction of P450
Barbiturates M, C, T
inc DURATION of Cl- channel opening --> faciliates GABAa action
C: sedative for anxiety, seizures, insomnia, induction of anesthesia (thiopental)
T: dependence, additive CNS depression with OH, resp or CV depression, induction of P450
Benzodiazepines M,C,T
M: inc FREQUENCY of Cl- channel opening --> facilitates GABAa action
C: anxiety, spasticity, status epilepticus, detox for DT, night terrors, sleepwalking
T: dependence, additive CNS effects with OH
for malignant hyperthermia, neuroleptic malignant syndrome
M: prevents release of Ca2+ from SR of skeletal muscle
Antipsychotics (neuroleptics) M,C,T
M: block dopamine D2 receptors
C: schizophrenia, psychosis, acute mania, Tourette syndrome
T: EPS side effects, endocrine SE (gynecomastia), SE from blocking muscarinic, alpha, and histamine receptors
Neuroleptic malignant syndrome - rigidity, myoglobinuria, autonomic instability, hyperpyrexia
Tardive dyskinesia - stereotypic oral-facial movements
Atypical antipsychotics M,C,T
M: Block 5-HT2 and DA receptors
C: schizophrenia. Olanzapine also used: OCD, anxiety d/o, depression, mania, Tourette syndrome
T: fewer EPS and anticholinergic than typicals. clozapine --> agranulocytosis
Lithium M,C,T
M: unknown (inhibits phosphoinositol cascade)
C: mood stabilizer for bipolar affective d/o
T: movement (tremor), nephrogenic DI, hypOthyroidism, Pregnancy problems
SSRI: drugs, M,C,T
drugs: fluoxetine, sertraline, paroxetine, citalopram
M: Serotonin-specific reuptake inhibitors
C: depression, OCD
T: GI distress, sexual dysf(x); "serotonin syndrome" with MAOi - hyperthermia, muscle rigidity, CV collapse
TCA: drugs, MCT
drugs: imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin
M: blocks reuptake of NE, Serotonin
C: major depression, bedwetting (imipramine), OCD (clomipramine)
T: Tri-C's (convulsions, coma, cardiotox)
M: unknown
C: antidepressant, smoking cessation
T: stimultant effects, h/a, seizure in bulimics. NO SEXUAL side effects
M: blocks reuptake of serotonin, NE, DA
C: antidepressant; also used in generalized anxiety d/o
T: stimulant effects, sedation, nausea, constipation, inc BP
M: alpha-2 antagonist (inc NE, serotonin)
C: antidepressant
T: sedation, inc appetite, wt gain, dry mouth
m: blocks NE reuptake
t: sedation, orthostatic hypotension
m: blocks serotonin reuptake
t: sedation, nausea, priapism, postural hypotension
MAO inhibitors
phenelzine, tranylcypromine
m: nonselective MAO inhibitors (inc NE, 5-HT)
C: atypical depression, anxiety, hypochondriasis
T: hypertensive crisis with tyramine ingestion and meperidine; contraindicted with SSRI or beta-agonists to prevent serotonin syndrome
inhaled anesthetics
halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, NO
M: unknown. lower solubility in blood --> faster induction and recovery
effects: myocardial depression, resp depression, nausea/emesis, inc cerebral blood flow
t: hepatotox (halothane)
nephrotox (methoxyflurane)
proconvulsant (enflurane)
malignant hyperthermia (rare)
iv anesthetics
barbiturates (thiopental - high potency, used for induction of anesthesia and short surgeries)
Benzodiazepines - midazolam for endoscopy
Ketamine - dissociative anesthetics
Opiates - morphine, fentanyl during general anesthesia
Propofol - rapid anesthesia induction and short procedures.
Local anesthetics
Esters - procaine, cocaine, tetracine; amides- lidocaine, mepivacaine, bupivacaine
M: block Na+ channels
C: minor surgical procedures, spinal anesthesia.
T: CNS excitation, severe CV tox (bupivacaine), HTN, hypotension, arrhythmias (cocaine)
Neuromuscular blocking drugs
Used for muscle paralysis. Selective for motor nicotinic receptor.
Depolarizing: Succinylcholine
Nondepolarizing: -curium, -curoniu,, tubocurarine
M: competitive - compete with ACh for receptors
What 2 drugs can be used for Tourette's syndrome?
What drug can you give for generalized anxiety disorder?
What class of drugs would you give for spinal anesthesia?
Local anesthetics (esters, amides)
What anesthetic would you use for mechanical ventilation?
Neuromuscular blocking drugs (e.g. succinylcholine)
If your patient is allergic to tetracaine, what's another anesthetic you can use?
Amides (lidocaine, mepivacaine, bupivacaine)
How long does it take for antidepressants to take effect?
2-3 weeks
Your patient is on an antidepressant and has been having side effects such as fast heart rate and inability to urinate. What drug is she on?
give nortriptyline to reduce anticholinergic effects
What antiepileptics induce cytochrome p450?
What inhaled anesthetic can you give for rapid induction and low potency?
Nitrous Oxide (N2O)
What antidepressant can you give your patient who is worried about sexual side effects?
What drugs are contraindicated in patients taking MAO inhibitors?
SSRIs, beta-agonists
What is atypical depression and what do you use to treat it?
Depression with psychotic or phobic features
Tx: MAO inhibitors
Your patient comes in a month later after given a prescription with the perception of not being able to sit still. What psychiatric drug must she be on?
Typical Antipsychotics
> 4 wk akathisia <

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