The Neurological System (Pharm Made Easy 3.0 Part 2)

Front 1

Drugs that treat anxiety disorder

Back 1

•Benzodiazepines

•Non-Benzodiazepines

Front 2

Benzodiazepines

Back 2

•Treats: anxiety, seizures, muscle spasms, anesthesia, acute alcohol withdrawal

•Examples (anti anxiety therapy drugs):

-Diazepam

-Alprazolam

-Lorazepam

-Chlordiazepoxide

-Clorazepate

-Oxazepam

•Enhance inhibitory effects of GABA and acts (anxiety treatment) on the limbic system responsible for perception and expression

•Side effects

-Drowsiness, slurred speech

-Impaired recalling of events (anterograde amnesia)

-Paradoxical reaction

-HYPOtension, tachycardia, respiratory depression

-Tolerance

-Overdose (reverse with I.V FLUMAZENIL)

-Intense withdrawal symptoms (taper drug in 1 to 2 weeks)

•Do NOT give to patients with glaucoma

•Do NOT give to patients in a coma or shock

•Do NOT give to neonates

•Do NOT give to labor & delivery patients

•Do NOT give to pregnant women (category D)

Front 3

Non-benzodiazepines

Back 3

•Treat: short term treatment of anxiety disorder (generalized anxiety disorder G.A.D)

•Example:

-Buspirone

•INHIBITS serotonin reuptake, agonist actions on dopamine receptors, does NOT cause sedation or POSE risk for dependence/ abuse

•Side effects

-Paradoxical effects (insomnia, anxiety, restlessness)

-G.I upset (Nausea)

-Headache, dizziness and lightheadedness

•Monitor for falls

•Therapeutic effectiveness takes a week

Front 4

Drugs for depression

Back 4

•Tricyclic antidepressant (TCA)

•Selective serotonin reuptake inhibitors (SSRI)

•Serotonin norepinephrine reuptake inhibitors (SNRI)

•Monoamine oxidase inhibitor (MAOI)

•Atypical antidepressant

Front 5

Tricyclic antidepressant (TCA)

Back 5

•Treat: second line drugs, improve mood, increase activity, reduces morbid feeling and restore appetite and sleep

•Examples:

-Amitriptyline

-Imipramine

-Doxepin

-Nortriptyline

-Amoxapine

-Trimipramine

•BLOCKS reuptake of norepinephrine and serotonin and it takes a few weeks to feel full effects

•Side effects

-Drowsiness, sedation

-Orthostatic hypotension

-Tachycardia

-Anticholinergic effects (dry mouth, constipation, urinary retention and blurred vision)

-Increased RISK for suicide ☆

-Withdrawal symptoms (taper in 1 to 2 weeks)

-High RISK for overdose

•Expect the drug to take 1 to 3 weeks for FULL EFFECT

•Encourage long term use (6 to 12 months)

•Do NOT give to children younger than 12 years

•Do NOT give to patients with recent acute myocardial infarction

•Do NOT give to patients with cardiac dysrhythmias

•Do NOT give to patients with seizure disorder history

•Do NOT give CONCURRENTLY with M.A.O.I

Front 6

Selective Serotonin Re-uptake Inhibitors

Back 6

•Treat: major depression, bipolar disorder, panic disorder, obsessive compulsive disorder (O.C.D), premenstrual dysphoric disorder and bulimia nervosa

•Examples:

-Fluoxetine

-Citalopram

-Escitalopram

-Paroxetine

-Sertraline

•BLOCK reuptake of serotonin and strengthen transmission of serotonin

•Side effects:

-Insomnia, nervousness, sexual dysfunction, headache

-Weight gain

-HYPOnatremia

-Increased risk for suicide

-Serotonin syndrome ☆

•Monitor serum periodically

•Monitor for increased depression/suicidal ideation ☆

•It takes 4 to 6 weeks to reach CLINICAL EFFECTIVENESS of med

•Do NOT give to children younger than 7 to 8 years (ONLY fluoxetine)

•Do NOT give CONCURRENTLY with M.A.O.I

Front 7

Serotonin norepinephrine Reuptake Inhibitors

Back 7

•Treat: major depression, social anxiety disorder and generalized anxiety disorder

•Examples:

-Venlafaxine

-Desvenlafaxine

-Duloxetine

•BLOCK neuronal reuptake of serotonin and norepinephrine

•Side effects

-Nausea, vomiting (take with food to reduce G.I upset)

-Anorexia

-Headache

-Hypertension

-Insomnia, nervousness

-HYPOnatremia

-Withdrawal symptoms

-Increased RISK for suicidal ideation

•Do NOT give to patients with suicidal ideation

•Do NOT give this med CONCURRENTLY with M.A.O.I or within 14 days of last dose

Front 8

Monoamine oxidase inhibitors

Back 8

•Treats: LAST CHOICE antidepressant; depression associated with bipolar disorder

•Examples:

-Phenelzine

-Isocarboxazid

-Tranylcypromine

-Selegiline (transdermal)

•BLOCKS MAO-A & MAO-B (ENZYMES that DEACTIVATE norepinephrine, serotonin and dopamine) so this med increases norepinephrine, serotonin and dopamine in the CNS

•Side effects

-Orthostatic hypotension (tell patient to rise slowly and change positions slowly)

-Constipation, nausea , vomiting and G.I symptoms

-Suicidal ideation (monitor and if necessary implement a suicide precaution program)

-M.A.O.I interacts with tyramine containing foods or caffeine containing beverages (give patient a list of these items to avoid)

•If hypertensive crisis occurs give I.V phentolamine or sublingual nifedipine

•Do NOT give to patients with suicidal ideation

•Do NOT give to patients with liver or renal failure

•Do NOT give to patients with cardiac disease or glaucoma

•Do NOT give to patients older than 60 years or younger 6 years

•Do NOT give to patients with alcohol and drug addiction

•Do NOT give to patients with pheochromocytoma

Front 9

Atypical Antidepressants

Back 9

•Treat: depressant, prevent seasonal affective disorder (SAD) and provide an adjunct for smoking cessation

•Examples:

-Bupropion hydrochloride

-Mirtazapine

-Reboxetine

•BLOCKS dopamine uptake

•Side effects

-Nausea, vomiting, weight loss

-Increased risk for seizures

-CNS effects (insomnia, agitation, tremors and headache)

-Psychosis, hallucinations and delusions

-Increased RISK for suicidal ideation

•Do NOT give to patients with seizures disorders

•Do NOT give to patients with suicidal ideation

•Do NOT give to patients with head trauma or tumor in CNS

•Do NOT take CONCURRENTLY with M.A.O.I antidepressant

•Do NOT give to patients with an eating disorder

Front 10

Psychotherapeutic drugs

Back 10

•Lithium

•Anti-epileptic drugs (anticonvulsants)

Front 11

Lithium

Back 11

•Treat: Acute mania, controls acute manic episodes with bipolar disorder (BPD)

•Example:

-Lithium carbonate

•Changes sodium ion transport, alter catecholamine (dopamine, serotonin & norepinephrine) and promotes the growth of neurons

•Side effects

-G.I effects (give with meals)

-Muscle weakness

-Drowsiness

-headache, confusion

-Polyuria (monitor I & O; DEHYDRATION and HYPOnatremia occurs)

-Goiter, HYPOthyroidism (monitor thyroid function tests)

-Tremors (made be side effect of TOXICITY) ☆

-Toxicity due to narrow therapeutic range

•Lithium blood level should be BELOW 1.4 mEq per liter

•Monitor sodium levels and kidney function test (creatinine & BUN)

•Do NOT give to patients with severe renal insufficiency

•Do NOT give to pregnant women (category D, lactating)

•Do NOT give to patients with moderate to severe cardiac disorders

•Do NOT give to dehydrated patients with decreased serum sodium or taking a DIURETIC or a low salt diet

•Do NOT give to patients with a history of ANGIOEDEMA from ACE inhibitors

Front 12

Psychotherapeutic drugs (Schizophrenia)

Back 12

•Conventional antipsychotics (FIRST GENERATION antipsychotics)

•Atypical (SECOND GENERATION antipsychotics)

Front 13

Conventional antipsychotic

Back 13

•Treats: schizophrenia, acute mania phase of bipolar disorder, nausea and vomiting and intractable hiccups

•Examples:

-Chlorpromazine

-Haloperidol

-Fluphenazine

-Thiothixene

•Block norepinephrine, acetylcholine, dopamine, histamine receptors

•Side effects

-Akathisia, acute dystonia (give benedryl or an anticholinergic) tardive dyskinesia (Parkinson’s like symptoms)

-Anticholinergic effect (dry mouth, constipation, urinary retention)

-Suppressed sexual drive, erectile dysfunction

-Severe cardiac dysrhythmias (monitor E.K.G & potassium levels)

-Dermatitis

-Neuroleptic malignant syndrome (TREAT this with Dantrolene or bromocriptine): HIGH fever, rigidity, vital sign instability, loss of consciousness (common with haloperidol & chlorpromazine)

•Do NOT give to patients with alcohol withdrawal

•Do NOT give to patients with bone suppression

•Do NOT give to patients with CNS depression

•Do NOT give to patients with Reye's syndrome

•Do NOT give to children younger than 6 months

Front 14

Atypical antipsychotic

Back 14

•Treats: schizophrenia, bipolar disorder and instability in patients with autism

•Examples:

-Risperidone

-Olanzapine

-Quetiapine

-Aripiprazole

-Ziprasidone

-Clozapine

•BLOCKS the receptors for dopamine but more strongly BLOCKS serotonin receptors

•Side effects

-Drowsiness, dizziness and other CNS effects (avoid activities that require high alertness)

-Extrapyramidal effects with higher doses of risperidone but less often than conventional antipsychotics

-Weight gain (increased cholesterol/onset or worsening of diabetes)

•Monitor weight, blood glucose, cholesterol and triglycerides levels periodically

•Mix antipsychotic oral solution with milk, juice, water or coffee

•Do NOT give to patients with severe CNS depression

•Do NOT give to patients with psychosis related to dementia

•Do NOT give to patients with INCREASED RISK for C.V.A

•Do NOT give to patients younger than 13 years old schizophrenia and do NOT give it to patients for autism who are even younger