FA neurology p367-374
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- drugs used for Parkinson's disease
-
BALSA:
Bromocriptine
Amantadine
L-dopa (with carbidopa)
Selegiline (and COMT inhibitors)
Antimuscarinics (Benztropine) -
L-Dopa:
Mech
Clin Use
Tox -
M: converted to DA in CNS
C: Parkinson's
T: arrhythmias; long-term use --> dyskinesia following administration, akinesia between doses -
Selegiline:
Mech
Clin Use
Tox -
M: selective MAO-B inhibitor
C: Parkinson's
T: enhance adverse effects of L-dopa -
Sumatriptan
Mech
Clin Use
Tox -
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
- phenytoin
- Tox: diplopia, ataxia, blood dyscrasias, liver tox, teratogenesis, induction of cyt P450
- carbamazepine
- Tox: Steven-Johnson syndrome
- Lamotrigine (SJ is so lame!)
- Tox: sedation, ataxia
- gabapentin
- tox: sedation, mental dulling, kidney stones, weight loss
- Topiramate (Dopamax - skinny, stupid, and sedated)
- tox: sedation, tolerance, dependence, induction of cyt P450
- phenobarbital
- 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
- ethosuximide
- se: sedation, tolerance, dependence
- benzodiazepines
- 1st line agent for tonic0clonic seizres
- phenytoin, carbamazepine, valproic acid
- first line agent for absence seizures
- ethosuximide
- first line agent for status epilepticus
- benzos
-
Phenytoin
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 - Dantrolene
-
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) - Bupropion
-
M: unknown
C: antidepressant, smoking cessation
T: stimultant effects, h/a, seizure in bulimics. NO SEXUAL side effects - venlafaxine
-
M: blocks reuptake of serotonin, NE, DA
C: antidepressant; also used in generalized anxiety d/o
T: stimulant effects, sedation, nausea, constipation, inc BP - Mirtazapine
-
M: alpha-2 antagonist (inc NE, serotonin)
C: antidepressant
T: sedation, inc appetite, wt gain, dry mouth - maprotiline
-
m: blocks NE reuptake
t: sedation, orthostatic hypotension - trazodone
-
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?
-
Haloperidol
Olanzapine - What drug can you give for generalized anxiety disorder?
- Venlafaxine
- 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?
-
TCAs
give nortriptyline to reduce anticholinergic effects - What antiepileptics induce cytochrome p450?
-
Phenytoin
Barbiturates
Carbabmazepine - 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?
- Buproprion
- 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 <