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52 Cards in this Set
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Zolpidem CR
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NBBRA
Sleep maintenance insomnia |
Intermediate-acting NBBRA
S/E: sleep walking, complex sleep behaviors (eating, driving) |
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Zolpidem
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NBBRA
Sleep onset insomnia |
Short-acting NBBRA
S/E: sleep walking, complex sleep behaviors (eating, driving) |
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Verapamil
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CCB
Cluster HA prophylaxis Migraine prophylaxis |
S/E: constipation, hypotension, edema, CHF, bradycardia, heart block
Moderate efficacy migraine prophylaxis |
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Valproate
(valproic acid, divalproex sodium) |
Classic AED
Postsynaptic CCB T channel blocker Absence seizures Bipolar disorder First line for generalized tonic-clonic seizures Migraine prophylaxis Myoclonic seizures Neuropathic pain Partial seizures with or without secondary generalization Status migrainous |
IV for status migrainous
Liver metabolism, enzyme inhibitor Highly bound to plasma proteins → competes with other drugs for binding C/I: pregnancy, liver disease Common S/E: sedation, nausea, vomiting, GI distress, tremor, parkinsonism, thrombocytopenia, liver toxicity Other S/E: weight gain, hair loss, hirsutism, neural tube defects, association with hyperandrogenism, polycystic ovary disease Idiosyncratic S/E: liver dysfunction Check LFTs before starting Perform regular platelet and coagulation tests High efficacy migraine prophylaxis |
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Trihexyphenidyl
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Muscarinic receptor blocker
Generalized dystonia Mild PD Tremor |
Effective only in mild PD
C/I: age > 65 years, cognitive impairment, glaucoma, BPH S/E: dry mouth, constipation, glaucoma, confusion |
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Trazodone
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Tetracyclic antidepressant
SSRI Depression with insomnia Insomnia |
S/E: sedation, nausea, priapism, OH
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Tramadol
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μ opioid receptor agonist
5-HT and NE reuptake inhibitor Cancer pain Diabetic neuropathic pain Nociceptive pain Post-op pain RLS |
S/E: constipation, sedation, impaired ventilation, dizziness, nausea, sweating, seizure
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Topiramate
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New AED
NaCB Postsynaptic CCB Cluster HA prophylaxis Generalized tonic-clonic seizures Migraine prophylaxis Partial seizures with or without secondary generalization Tremor |
Liver metabolism, enzyme inducer
Common S/E: sedation, fatigue, rash Other S/E: memory dysfunction, weight loss, paresthesia, tubular acidosis, nephrolithiasis, glaucoma, hyperthermia Idiosyncratic S/E: urinary tract calculi High efficacy migraine prophylaxis |
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Tolterodine
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Muscarinic M1, M2, and M3 receptor blocker
Overactive bladder |
C/I: age > 65 years, cognitive impairment, glaucoma, BPH
R/O: outlet obstruction, urinary retention |
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Tizanidine
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Adrenergic α2 agonist
Spasticity |
S/E: hypotension
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Sumatriptan
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Serotonin 5-HT1B/D agonist
Cluster HA abortion Migraine abortion Tension-type HA abortion |
SC for cluster HA prophylaxis
SC, oral tablets, or nasal spray for migraine abortion C/I: IHD, PVD, HTN, pregnancy, liver disease, recent use of 5-HT1 agonist (24 hr) or MAO blocker (2 wk), basilar or hemiplegic migraine Medium rebound HA potential |
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Succinylcholine
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NMJ blocker (depolarizing)
Muscle paralysis during surgery |
S/E: hypercalcemia, hyperkalemia
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Sodium oxybate (GHB; “date rape drug”)
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Cataplexy
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Date rape drug!
C/I: other CNS depressants, OSA, lung disease with hypoxia S/E: HA, dizziness, nausea, sleep walking, nocturnal confusion, respiratory depression |
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Sevoflurane
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Tissue relaxer
(↓ cell-cell coupling and other mechanisms) Inhaled anesthesia |
S/E: myocardial depression, respiratory depression, nausea, emesis, ↑ cerebral blood flow, malignant hyperthermia
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Selegiline
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MAOB inhibitor
PD (reduce motor fluctuations) |
S/E: minimal antiparkinson effect, insomnia, hypertensive crisis with tyramine ingestion or β-agonists
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Scopolamine
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Muscarinic M1 blocker
Motion sickness Vertigo |
Crosses BBB
C/I: age > 65 years, cognitive impairment, BPH, asthma, glaucoma, liver or kidney disease |
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Ropinirole
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Dopamine D2 agonist
Daily RLS First-line treatment in younger patients with moderately severe PD |
S/E: nausea, vomiting, OH, limited antiparkinson effect, hallucinations, dyskinesias, daytime sleepiness, impulse dyscontrol (gambling, shopping, sex addictions)
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Rivastigmine
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Reversible tertiary AChE inhibitor
LBD Mild to moderate AD |
Good oral absorption
Crosses BBB S/E: excessive salivation, nausea, abdominal cramps, diarrhea, bradycardia Do not stop abruptly (confusional state) |
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Rasagiline
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MAOB inhibitor
PD (reduce motor fluctuations) |
S/E: minimal antiparkinson effect, insomnia, hypertensive crisis with tyramine ingestion or β-agonists
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Pyridostigmine
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Reversible quaternary AChE inhibitor
Possible direct agonist effect MG OH |
Poor oral absorption
Does not cross BBB Active at NMJ S/E: excessive salivation, nausea, abdominal cramps, diarrhea, bradycardia, worsening weakness (nAChR desensitization; cholinergic crisis) |
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Propranolol
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Adrenergic β1 and β2 blocker
Migraine prophylaxis Tremor |
C/I: asthma, COPD, some heart diseases
High efficacy migraine prophylaxis |
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Propofol
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GABAA agonist
(and other mechanisms) IV anesthesia Refractory status epilepticus |
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Primidone
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Classic AED
Partial seizures with or without secondary generalization Tremor |
Liver metabolism, enzyme inducer
Common S/E: sedation, dizziness, ataxia, rash, contraceptive failure, osteoporosis Other S/E: behavioral and cognitive disturbance, diminished libido, impotence Idiosyncratic S/E: paradoxical hyperactivity |
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Pregabalin
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New AED
Presynaptic CCB (α2δ subunit) Diabetic neuropathic pain Seizures |
Renal excretion, no drug interactions
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Prednisone
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Glucocorticoid
MG Only during transitional phase of cluster HA treatment Temporal arteritis |
High dose for temporal arteritis
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Pramipexole
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Dopamine D2 agonist
Daily RLS First-line treatment in younger patients with moderately severe PD |
S/E: nausea, vomiting, OH, nasal stuffiness, edema, sedation, limited antiparkinson effect, hallucinations, dyskinesias, daytime sleepiness, impulse dyscontrol (gambling, shopping, sex addictions)
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Pralidoxime
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AChE reactivator
AChE toxicity (organophosphate insecticides, nerve gas) |
Effect most marked at NMJ
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Plasma exchange
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Remove circulating autoantibodies
AIDP (Guillain-Barré) MG acute attack MS acute attack |
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Phenytoin
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Classic AED
NaCB Class IB antiarrhythmic Diabetic neuropathic pain First-line for generalized tonic-clonic seizures First-line for partial seizures with or without secondary generalization First-line for status epilepticus prophylaxis Muscle spasms Neuropathic pain Trigeminal neuralgic pain |
Liver metabolism, P-450 enzyme inducer
Highly bound to plasma proteins → competes with other drugs for binding C/I: lymphadenopathy, hyperglycemia, pregnancy Common S/E: allergic reaction, rash, dose-related ataxia, slurred speech, sedation, nystagmus, diplopia, ataxia, chorea, liver toxicity, contraceptive failure, osteoporosis Other S/E: gingival hyperplasia, hirsutism, coarsening of facial features, peripheral neuropathy, SLE-like syndrome, megaloblastic anemia (↓ folate absorption), neural tube defects, malignant hyperthermia, atrioventricular conduction defect, ventricular automaticity Absorption reduced by antacids Do not stop abruptly (status epilepticus) |
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Phenobarbital
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Classic AED
Barbiturate GABAA agonist Anxiety disorders First-line for seizures in pregnant women and children Generalized tonic-clonic seizures Partial seizures with or without secondary generalization Refractory status epilepticus Tremor |
Liver metabolism, P 450 enzyme inducer
C/I: porphyria Common S/E: sedation, rash, contraceptive failure, osteoporosis Other S/E: tolerance, dependence, CNS depression, behavioral and cognitive disturbance, painful shoulder-hand syndromes Idiosyncratic S/E: paradoxical hyperactivity |
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Pentobarbital
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Barbiturate
GABAA agonist Refractory status epilepticus |
Liver metabolism, P 450 enzyme inducer
C/I: porphyria S/E: dependence, CNS depression |
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Pergolide
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Dopamine D1 and D2 agonist
PD Daily RLS |
Off US market
S/E: cardiac valvular damage |
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Oxygen inhalation
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Cluster HA abortion
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Face mask with patient seated, leaning forward
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Oxycodone
(Percocet = oxycodone + acetaminophen) |
μ and κ opioid receptor agonist
(1 MED) Cancer pain Nociceptive pain Post-op pain Refractory RLS |
S/E: constipation, sedation, impaired ventilation, liver toxicity, liver toxicity (acetaminophen), gastropathy (aspirin)
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Oxybutynin
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Muscarinic M1, M2, and M3 receptor blocker
Overactive bladder |
C/I: age > 65 years, cognitive impairment, glaucoma, BPH
R/O: outlet obstruction, urinary retention |
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Nortriptyline
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TCA
NE > 5-HT reuptake inhibitor NaCB Diabetic neuropathic pain Insomnia Major depression Migraine prophylaxis Neuropathic pain Panic disorder |
S/E: sedation, α-blocking effects, dry mouth, constipation, weight gain, tachycardia, urinary retention, convulsions, coma, cardiac arrhythmias
High efficacy migraine prophylaxis |
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Nitrous oxide
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Inhaled anesthesia
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S/E: myocardial depression, respiratory depression, nausea, emesis, ↑ cerebral blood flow, malignant hyperthermia
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Naproxen sodium
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NSAID
Migraine abortion Nociceptive pain Tension-type HA abortion |
C/I: end of third trimester of pregnancy
S/E: GI upset Low rebound HA potential |
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Morphine
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μ opioid receptor agonist
(10 mg IV = 30 mg oral) Cancer pain IV anesthesia Nociceptive pain Post-op pain |
S/E: sedation, CNS depression, respiratory depression, constipation, miosis, dependence
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Modafinil
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Dopamine reuptake inhibitor
Glutamatergic activator GABAergic inhibitor First-line for narcolepsy Shift work sleep disorder Sleep apnea |
S/E: HA, GI upset, nasal stuffiness
Reduces effectiveness of oral contraceptives |
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Midodrine
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Adrenergic α1 agonist
OH |
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Midazolam
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Benzodiazepine
GABAA agonist IV anesthesia for endoscopy Refractory status epilepticus |
S/E: post-op respiratory depression, hypotension, amnesia
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Methylprednisolone
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Glucocorticoid
MS acute attack |
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Methylphenidate (Ritalin)
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Stimulates NE vesicular release
ADHD Narcolepsy OH |
S/E: palpitations, anger, irritability, loss of attention, HTN, thought disorder, addiction
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Methoxyflurane
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Tissue relaxer
(↓ cell-cell coupling and other mechanisms) Inhaled anesthesia |
S/E: myocardial depression, respiratory depression, nausea, emesis, ↑ cerebral blood flow, malignant hyperthermia, nephrotoxicity
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Methadone
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μ opioid receptor agonist
(1-5 MED) Cancer pain Maintenance programs for addicts Nociceptive pain Post-op pain |
S/E: sedation, CNS depression, respiratory depression, constipation, miosis, dependence
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Meperidine (Demerol)
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μ opioid receptor agonist
(0.8 MED) AVOID USE Migraine abortion Tension-type HA abortion |
Toxic metabolite → seizures
C/I: end of third trimester of pregnancy S/E: sedation, CNS depression, respiratory depression, constipation, miosis, dependence High rebound HA potential |
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Memantine
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NMDA receptor blocker
Moderate to severe AD |
S/E: hallucinations, seizures
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Melatonin
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Natural peptide hormone
Cluster HA prophylaxis Delayed sleep phase disorder Insomnia RBD |
Non-prescription supplement
C/I: BPH, asthma, glaucoma |
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Meclizine
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Histamine H1 receptor blocker
Vertigo |
C/I: BPH, asthma, glaucoma
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Lorazepam
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Benzodiazepine
GABAA agonist Acute EtOH withdrawal Agitation Anxiety First-line for acute status epilepticus Seizures of eclampsia Vertigo |
C/I: history of drug addiction
S/E: sedation, tolerance, dependence, confusion, falls |
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Lidocaine
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NaCB amide
Cluster HA abortion Local anesthesia for minor surgery Nociceptive pain Spinal anesthesia |
Nasal drops for cluster HA abortion
Topical for pain C/I: liver disease S/E: CNS excitation, HTN, hypotension |
