Cns Pharm

Front 1

Antipsychotics

Back 1

Haloperidol, thioridazine, fluphenazine, chlorpromazine.

Block D2 rec
Neuroleptic malignant syndrome
Tardive Dyskinesia

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Atypical Antipsychotics

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Clozapine, Olanzapine, Risperdone

Block 5-HT2 and Dopamine rec
Tx pos and neg sx of schizoph.
Olanzapine for OCD
Clozapine - agranulocytosis

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Bipolar

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Lithium
Inhibition of phosphoinositol cascase -
SE - tremor, hypothyroid, polyuria, ADH antagonist, teratogen.

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Phenytoin

Back 4

incr Na channel inactivation
used for tonic clonic
Class 1B antiarhythmic
hirsuitism, megaloblastic anemia

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SSRi

Back 5

Fluoxetine, sertaline, citalopram, paroxetine
Use: endogenous depression, OCD

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MAOi
contraindications

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Phenelzine, tranylcypromine
Incr level of amines
Use - atypical depression, anxiety, hypochondria
contraindicated with SSRI, and beta agonists

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Heterocyclic antidepressants

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Treatment for major depression
Buproprion
Venlfaxine -inhibit NE, DA, Ser reup, generalized anxiety d/o
Mirtazipine alpha 2 antag (incr NE and Ser), potent 5HT2 and 5HT3 rec antag
Maprotiline - block NE reup
Trazadone - SE priapism

Front 8

Anesthetic general principle

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decr lipid solubility = faster induction and recovery = N2O
incr lipid solubility = incr potency = 1/MAC = Halothane high lipid solubility, slow induction high potentcy

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Inhaled anesthetics

Back 9

Halothane, Nitrous, enfluorane, isoflurane, sevoflurane, methoxyflurane
incr cerebral bloodflow, decr metabolic demand
SE -hepatotoxic (halothane), nephrotoxic (methoxyflurane), SZ (enflurane) - rare malignant hyperthermia

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IV anesthetics

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Barbs - thiopental - high potentcy, short surg procedures and induction of anesthesia
Benzo - midzolam - endoscopy
Arylcyclohexamines - ketamine
opiates
Propofol - rapid anesthesia induction and short procedures.

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Local Anesthetics
mechanism

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Esters - procaine, cocaine, tetracaine
Amides - lidocaine, bupivicaine, mepivicaine
Block Na channel
1. Infected tiss (acidic) requires more bc they are charged
2. Order of nerve block small diameter>large dia.
Myelinated> unmyelinated.
Size is more imp than myelination.
Order of loss pain>temp>touch>press
3. Given with EPI
Used for minor surgical, spinal anesthesia.
If allergic to esters give amides.
Severe cardiotoxicity with bupivicaine.

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Succinylchoine

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Depolarizing musc block
Reversal
Phase 1 - prolonged depol - no antidote - cholinesterase inhibitor potentiates effect
Phase 2 repolarized but blocked - antidote cholinesterase inhibitor (neostigmine)

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Nondepolarizing neuromusc block

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Tubocurarine, atracurium, mivacurium, pancurium, vecurium, rapacurium.
Compete with Ach for Rec
Reversal of block with cholinesterase inhibitors (neostigmine, edrophonium, etc)

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Dantrolene

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Prevents rls of Ca++ from SR of skeletal muscle cell.

Used for Tx of malignant hyperthermia from inhaled anesthetics (nitrous, halothane) and succinylcholine).

Also used for neuroleptic malignant syndrome (antipsychotic drugs)

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Mirtazipine

Back 15

heterocyclic antidepressant
major depression
alpha2 rec antag
potent 5HT2 and 5HT3 rec antag

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Maprotiline

Back 16

heterocylcic antidepressant
major depression
Ne reup inhibitor

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citalopram

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SSRI

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Sertaline

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SSRI

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Trazadone

Back 19

heterocyclic
inhibit Seratonin reuptake

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Olanzapine

Back 20

atypical antipsychotic
inhibits 5-HT2 and Dopamine rec
OCD, anxiety, depression, mania, tourettes.

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Chlorpromazine

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antipsychotic
blocks D2 rec

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SE of antispychotics

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Extrapyramidal Symptoms
4h - acute dystonia,
4d - akinesia
4wk - akathisia
4 mo - irrev Tardive Dyskinesia
Endocrine - dopa block se
Musc block - dry mouth, constipation
alpha - HoTN
his block- sedation

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SE of block dopa rec

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hyperprolactinemia -> gynecomastia

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Amitryptiline and nortriptyline

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TCA -
major depression

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doxepin

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TCA

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Clomipramine

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TCA
Major depression
OCD

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Deprenyl

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Selegiline
MAOBi
inhibits the degradation of DA
Parkinsons RX

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Bromocriptine
Pergolide

Back 28

Same class of Dopamine receptor agonists

Front 29

Poliomyelitis
Vit B12 def
Friedrich Ataxia
Werdnig Hoffman

Back 29

Polio and Werdnig Hoffman- LMN dz, destroyed Ant horn - flaccid paralysis
Vit B12 def and Friedrich Ataxia -demyelination of dorsal columns, LCST, Spinocerebellar tract, ataxic gait, hyperreflexia, impaired proprioception.
Friedrichs -ataxia in lower extremity that spreads to upper extremity followed by paralysis and contracture.

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Complete occlusion of ventral art

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only spares doral columns and tract of lissauer
complete paralysis

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MS

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mostly white matter of cervical region. random asymmetric lesions

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Analogue of myelin basic protein for MS

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Glatiramer Acetate
induces change in CMI

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Baclofen

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Muscle relaxant used in MS

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Mitoxantrone

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Suppresses CMI in secondary progression of MS

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Natilizumab

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antibody for specific adhesion molecules reducing leukocyte entry into CNS. Effective Tx for MS

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Marcus Gunn pupil

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Paradoxical Light reflex.
Nl light will make both eyes constrict
In a retinal detachment example because the affected pupil is not receiving enough light when shone with light in affected pupil both eyes will dilate to get as much light as possible.
atrophy of optic nerve will cause as well