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34 Cards in this Set
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Haloperidol (Haldol)
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Class: Antipsychotic
MOA: Binds to receptors in all central dopamine pathways Indications: Schizophrenia Effects: Alleviate positive symptoms, hallucinations, delusions No effect on interpersonal withdrawal, loss of drive, flattened affect Adverse: Binds to D2 receptors in the basal ganglia Extrapyramidal – dystonia-dyskinetic movements due to disordered tonicity of muscle, akinesia-absence or poverty of movement, Tardive dyskinesia- continual chewing motions with intermittent darting movements of the tongue, facial grimacing, nose twitching Pituitary Gland – Increase prolactin secretion, amenorrhea, false positive pregnancy test, gynecomastia, decreased libido Antagonism of peripheral muscarinic receptors – anticholinergic effects, dry mouth, constipation, difficulty urinating, orthostatic hypertension |
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Clozapine (Clozaril)
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Class: Atypical Antipsychotic
MOA: Binds to receptors in mesolimbic and mesocortical dopaminergic pathways (more selective than older drugs), greater affinity for dopamine receptor subtypes found in these areas, D4 and D3, fewer extrapyramidal side effects Indications: Schizophrenia Effects: Alleviates positive and negative symptoms, binds to serotonin receptor – negative effects of schizophrenia Adverse: weight gain – leads to non-compliance, anticholinergic effects, hyper-salivation, 1% of patients develop agranulocytosis, blood counts every 2 weeks, interact with any drug that causes CNS depression – benzos, opiates, ethanol, antihistamines |
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Olanzapine (Zyprexa)
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Class: Atypical Antipsychotic
MOA: Binds to receptors in mesolimbic and mesocortical dopaminergic pathways (more selective than older drugs), greater affinity for dopamine receptor subtypes found in these areas, D4 and D3, fewer extrapyramidal side effects Indications: Schizophrenia Effects: Alleviates positive and negative symptoms, binds to serotonin receptor – negative effects of schizophrenia Adverse: weight gain – leads to non-compliance, anticholinergic effects, interact with any drug that causes CNS depression – benzos, opiates, ethanol, antihistamines, patients 10 times more likely to develop diabetes or exacerbation of diabetes, prolonged QT interval (unknown if vasoconstrictors have an effect. Med consult), |
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Risperidone (RIsperdal)
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Class: Atypical Antipsychotic
MOA: Binds to receptors in mesolimbic and mesocortical dopaminergic pathways (more selective than older drugs), greater affinity for dopamine receptor subtypes found in these areas, D4 and D3, fewer extrapyramidal side effects Indications: Schizophrenia Effects: Alleviates positive and negative symptoms, binds to serotonin receptor – negative effects of schizophrenia Adverse: weight gain – leads to non-compliance, anticholinergic effects, interact with any drug that causes CNS depression – benzos, opiates, ethanol, antihistamines |
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Ouetiapine (Seroquel)
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Class: Atypical Antipsychotic
MOA: Binds to receptors in mesolimbic and mesocortical dopaminergic pathways (more selective than older drugs), greater affinity for dopamine receptor subtypes found in these areas, D4 and D3, fewer extrapyramidal side effects Indications: Schizophrenia Effects: Alleviates positive and negative symptoms, binds to serotonin receptor – negative effects of schizophrenia Adverse: weight gain – leads to non-compliance, anticholinergic effects, interact with any drug that causes CNS depression – benzos, opiates, ethanol, antihistamines |
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*Ziprasidone (Geodon)
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Class: Atypical Antipsychotic
MOA: moderately inhibits the reuptake of serotonin and norepi. Indications: Schizophrenia Effects: Adverse: prolonged QT interval, xerostomia, orthostatic hypotension, tongue edema, dysphagia, tooth disorder |
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Aripiprazole (Abilify)
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Class: Atypical antipsychotic
MOA: Partial agonist activity at dopamine and serotonin 5-HT 1A receptors and antagonist activity at 5-HT 2A receptors Indications: schizophrenia, bi-polar and depression Effects: Adverse: interact with any drug that causes CNS depression – benzos, opiates, ethanol, antihistamines |
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Sinemet (Carbidopa/Levodopa)
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Class: anti parkinson’s, dopamine agonist
MOA: Levadopa crosses the blood brain barrier, metabolized by dopa decarboxylase to dopamine in the CNS, also metabolized in the GI and the peripheral tissues before it reaches the brain Carbidoopa is a dopa decarboxylase inhibitor that does not cross the BBB Indications: Parkinson’s disease Effects: increases supply of dopamine, suppresses acetylcholine actions, unlabeled-restless leg syndrome (unlabeled) Adverse: abnormal involuntary movements of the orofacial muscles (abnormal mouth movements, protrusion and retraction of the tongue, chewing motions, facial grimacing), Oral problems (inflammation, damage to oral structures, movement of anterior teeth and difficulty wearing dentures), dry mouth |
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Ropinirole (Requip)
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Class: D2 receptor agonist
MOA: stimulation of postsynaptic dopamine D2 type receptors within the caudate putamen in the brain Indications: Parkinson’s Effects: mimics dopamine, decreases bp Adverse: abnormal involuntary movements, confusion, psychosis and dry mouth, compulsive behavior?? Spending sprees, gambling |
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Entacapone (Comtan)
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Class: dopamine metabolism inhibitor
MOA: Inhibition of COMT Indications: Parkinson’s Effects: sustains levodopa levels Adverse: orthostatic hypotension, altered taste |
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Rasagiline (Azilect)
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Class: dopamine metabolism inhibitor
MOA: inhibition of MAO-B,. Indications: Parkinson’s Effects: decreases dopamine degredation Adverse: approved doses of .5-1 mg daily should not inhibit type-A MAO, Nonselective MAO inhibition at higher doses and/or in certain sensitive individuals. Overdose leads to cardiotoxicity- arrhythmias, MIs Severely depressed pts have been known to commit suicide with TCAs Drugs – meperidine, methadone, tramadol. Avoid use of vasoconstrictors due to possibility of hypertensive episodes. |
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Selegiline (Emsam)
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Class: MAOI
MOA: 6 mg/24 hr patch – inhibit MAO in brain (MAO-B) for antidepressant effect, preserving MAO-A in the digestive tract to break down tyramine. 9 mg/24 hr patch and 12 mg/24 hr patch – dietary modifications are required Indications: depression Effects: Inhibit serotonin degradation.Take 3 weeks to have effect Adverse: Brain hemmorage Contraindicated in CVD, epilepsy, bronchitis, HTN, asthma Diet restrictions – no food that contains tyramine (red wine, cheese, smoked meat, overripe fruit, beer, avocados, chocolate, yougurt. Dental adverse effects – dry mouth, orthostatic hypotension |
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Amitriptyline (Elavil)
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Class: TCA
MOA: NE and serotonin reuptake inhibitor, block muscarinic receptors and alpha 1 adrenergic receptors Indications: depression, anxiety, obsessive compulsive disorder, chronic pain Effects: reuptake inhibitors Adverse: dry mouth, orthostatic hypotension Drug interactions – increased effects of direct acting sympathomimetics like epi. (use epi with restraint and caution), increased anticholinergic effect of antihistamines and muscarinic blockers, doxycycline may increase TCA level, Xanax and Erythromycins may decrease TCA level, CNS depressants |
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Flumazenil (Romazicon)
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Class: Benzo receptor antagonist (antidote)
MOA: competitively inhibits the activity at the benzodiazepine receptor site on the GABA/benzo receptor complex. Indications: managing overdose and hastening recovery after diagnostic procedure or minor surgery Effects: reverses sedation in 1-2 minutes after administration, half-life much shorter than benzos so there may be a requirement for multiple doses Adverse: seizures |
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Diazepam (Valium)
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Class: Benzodiazepam
MOA: GABA receptor modulator, enhances GABA mediated inhibition (binds to benzo receptors on postsynaptic GABA neuron). Indications: Antianxiety, sedative-hypnotic, amnesic, anticonvulsant, skeletal muscle relaxant, alcohol withdrawal Effects: sedation, antianxiety Adverse: Drowsiness, sedation, respiratory depression, psychological dependence (schedule 4), overdose does not cause death unless combined with other CNS depressant (alcohol), metabolized by CYP liver enzymes lots of drug interactions, erythromycin, clarithromycin and azole antifungals – inhibit hepatic metabolism of benzos |
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Zolpidem (Ambien)
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Class: GABA receptor modulator
MOA: Agonist at central benzo sites on the GABA receptor Indications: Insomnia, drug of choice for sedation in pregnant women Effects: sedation Adverse: Lorazepam increases effect, you may get out of bed and do something then not remember what you did in the morning. |
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*Eszopiclone (Lunesta)
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Class: GABA receptor modulator
MOA: interaction with the GABA receptor close to benzo receptor Indications: Insomnia Effects Sedation Adverse: Lorazepam increases effect, ketoconazole, itraconazole, clarithromycin increase effect, you may get out of bed and do something then not remember what you did in the morning. |
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Venlafaxine (Effexor)
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Class: SNRIs
MOA: blocks serotonin and norepi reuptake Indications: Depression, anxiety, panic disorder Effects: prolongs effect of serotonin and norepi Adverse: dry mouth (12-22%), Blocks Norepi – vasoconstrictor administered with caution, xerostomia and taste perversion, may impair platelet aggregation (aspirin and NSAIDs), blocks serotonin |
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Duloxetine (Cymbalta)
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Class: SNRIs
MOA: Blocks both serotonin and norepi reuptake Indications: Depression, Neuropathic Pain Effects: prolongs effect of serotonin and norepi Adverse: dry mouth (5-15%), suicide Blocks Norepi – vasoconstrictor administered with caution, xerostomia and taste perversion, may impair platelet aggregation (aspirin and NSAIDs) |
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Bupropion (Wellbutrin)
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Class: SNRIs
MOA: Block norepi and dopamine reuptake, weakly blocks serotonin reuptake Indications: Depression, Nicotine withdrawal Effects: antidepression Adverse: dry mouth (17-26%) Blocks Norepi – vasoconstrictor administered with caution, xerostomia and taste perversion, may impair platelet aggregation (aspirin and NSAIDs) |
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Fluoxetine (Prozac)
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Class: SSRIs
MOA: reuptake inhibitors Indications: depression, bulimia, OCD, social anxiety disorder, panic disorder, PTSD, chronic pain Effects: Adverse: Prolonged QT interval (unknown what effect vasoconstrictors have, bruxism, xerostomia, may impair platelet aggregation. No significant toxicity with overdose. The pt cannot commit suicide with these drugs. Interacts with macrolide antibiotics and tramadol |
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Trazodone (Desyrel)
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Class: SARI
MOA: serotonin 2 antagonist, serotonin reuptake inhibitor and blocker Indications: Depression that causes sleep disturbances, weak antidepressant effect, chronic pain, diabetic neuropathy, burning mouth syndrome Effects: antidepression Adverse: not used alone, orthostatic hypotension, usually given at night, drowsiness, headache, anticholinergic effects, Contraindications – recovery phase of MI, convulsive disorders, prostatic hypertrophy Interactions – CNS depressants |
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Baclofen
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Class: GABA b Receptor Agonist
MOA: GABA b located principally in the spinal cord, increase K+ efflux: inhibitory post synaptic signals, decrease Ca2+: inhibition of presynaptic neurotransmitter release Indications: MS, Spinal cord injuries, Pts who have had strokes, spasticity, flexor spasm and concomitant pain, muscular rigidity Effects: muscle relaxant Adverse: Sedation |
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Gabapentin (Neurotonin)
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Class: Calcium channel inhibitor
MOA: interacts with voltage gated calcium channels to reduce activity Indications: adjunct for treatment of partial seizures, management of postherpetic neuralgia (PHN) in adults, neuopathic pain, diabetic peripheral neuropathy, fibromyalgia, postoperative pain, bipolar disorder, social phobia Effects: mood stabilizer, anticonvulsant Adverse: fatigue, dizziness, headaches, nausea |
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*Pregabalin (Lyrica)
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Class: calcium channel inhibitor
MOA: binds to alpha2-delta subunit of voltage-gated calcium channels Indications: neuropathic pain associated with diabetic peripheral neuropathy, postherpetic neuralgia, partial onset seizures, fibromyalgia Effects: inhibits excitatory neurotransmitter release Adverse: dry mouth, dizziness, may decrease platelet count, CNS depression |
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Lithium carbonate (Lithobid)
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Class: Antimaniac agent
MOA: Alters sodium transport in nerve and muscle cells, effects a shift toward intraneuronal metabolism of catecholamines Indications: Mania, mood swings, appetite and sleep disturbances abate Effects: mood swings, appetite, and sleep disturbances abate Adverse: Toxicity – (early signs) diarrhea, vomiting, drowsiness, muscular weakness, and lack of coordination (higher levels) – ataxia, giddiness, tinnitus, blurred vision, a large output of dilute urine Interacts with pilocarpine – causes continuous seizures when administered with lithium, NSAIDs decrease the excretion of lithium and co-administration can lead to toxicity |
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Carbamazepine (Tegretol)
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Class: Sodium channel inhibitor
MOA: sodium channel blocker inhibiting neuronal discharge, induces P4503A4 Indications: Seizure disorder, bi-polar, neuralgias, migraines Effects: mood stabilizer, anticonvulsant Adverse: Sedation |
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*Phenytoin (Dilantin)
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Class: Sodium channel inhibitor
MOA: Binds to sodium channels to slow recovery from the inactivated state to the closed state Indications: Seizure disorder, bi-polar, neuralgias, migraines Effects: Adverse: Sedation, gingival hyperplasia, gingival bleeding |
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*Valporic Acid (Depakote)
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Class: Sodium channel inhibitor
MOA: Indications: Seizure disorder, bi-polar, neuralgias, migraines Effects: Adverse: Sedation |
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*Topiramate (Topamax)
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Class: Sodium channel inhibitor
MOA: Indications: Seizure disorder, bi-polar, neuralgias, migraines Effects: Adverse: Sedation, gingivitis, dysphagia, glossitis, gum hyperplasia, xerostomia |
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Lamotrigine (Lamictal)
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Class: anticonvulsant
MOA: inhibits release of glutamate, inhibits voltage-sensative sodium channels, which stabilizes neuronal membranes, weak inhibitory effect on the 5-HT3 receptor, Indications: Bi-polar Effects: mood stabilizer Adverse: xerostiomia |
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Levetiracetam (Keppra)
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Class: anticonvulsant
MOA: inhibition of voltage-dependent N-type calcium channels, facilitation of GABA-ergic inhibitory transmission through displacement of negative modulators, binding to synaptic proteins which modulate neurotransmitter release Indications: bipolar disorder, treatment of partial onset, myoclonic, and/or primary generalized tonic-clonic seizures Effects: reduces seizures Adverse: |
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Memantine (Namenda)
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Class: NMDA receptor blocker
MOA: uncompetitive antagonist, excessive glutamate release in progression of Alzheimer’s disease, slows rate of deterioration, uncompetitive antagonist Indications: Alzheimer’s Effects: slows rate of deterioration Adverse: |
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Amantadine
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Class: NMDA receptor blocker
MOA: Noncompetitive blocker of NMDA receptor Indications: Parkinson’s Effects: decreases severity of dyskinesia Adverse: |
