Neuropharm

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lazzsant
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127865
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Neuropharm
Updated:
2012-01-26 20:30:02
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Neuropharm
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Neuropharm
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  1. Biogenic monoamine neurotransmitters
    • Derived from tyrosine, tryptophan, phenylalanine, and thyroid.
    • Histamine
    • Catecholamines: Dopamine, EPI, NEP
    • Tryptamines: Serotonin, melatonin
    • Trace amines
  2. Amphetamine
    • Stimulant for ADHD
    • MOA: inc DA & NE
  3. Contra: Drug abuser, hyperthyroid, HTN
  4. Amphetamine salts XR
    • Stimulant for ADHD
    • MOA: inc DA & NE


    Contra: drug abuser, hyperthyroid, HTN
  5. Lisdexamfetamine
    • Stimulant for ADHD
    • MOA: inc DA & NE

    • Contra: Drug abuser, hyperthyroid, HTN
  6. Methylphenidate
    • Stimulant for ADHD (SR-12hrs)
    • MOA: inc DA & NE

    • A/E: insomnia (narcolepsy)
  7. Methylphenidate hydrochloride (transdermal patch)
    • Stimulant for ADHD (9 hour wear ~to cocaine)
    • MOA: Inc DA & NE


    Contra: Not in adults
  8. Atomoxetine
    • Nonstimulant for resistant ADHD (1/day)
    • MOA: NE uptake inhibitor/ CYP450 metabolism

    CONTRA: tramadol, MAOI, drugs that inhibit CYP450
  9. Buproprion
    • Nonstimulant for resistant ADHD (also antidepressant)
    • MOA: inc NE & DA/ inhibits CYP 450

    A/E: peripheral NE & DA effects
  10. Guanfacine
    • Nonstimulant for resistant ADHD
    • MOA: A-2 receptor agonist in prefrontal cortex --> inc noradrenergic system (for tics and emotional bursts)

    CONTRA: sedative drugs, phenobarbital and phenytoin (may dec plasma level)
  11. Carbamazepine (1st generation)
    FOR: All the partial seizures

    MOA: Na channel inactivation

    Enzyme inducer

    best risk/benefit ratio
  12. Phenytoin (1st generation)
    FOR: All partial seizures

    • MOA: slows Na channel recovery
    • 5-10X enhances GABA

    Enzyme inducer

    Inhibits Warfarin metabolism
  13. Phenobarbital (1st generation)
    FOR: status epilepticus, Generalized t-c, partial seizures

    MOA: Inc GABA


    Enzyme inducer

    Teratogen
  14. Ethosuximide (1 st generation)
    FOR: Partial Seizures

    MOA: Prodrug

    Enzyme inducer

    No Warfarin interference
  15. Gabapentin(2nd generation)
    FOR: Partial & generalized seizures

    MOA: Inc GABA via Ca2+ channel

    No enzyme induction

    A/E: ataxia & fatigue
  16. Pregabalin (2nd generation)
    FOR: Partial and generalized seizures

    MOA: Inc GABA via Ca2+ channel


    ataxia & fatigue
  17. Ezogabine (2nd generation)
    FOR: Resistant partial seizures

    MOA: K channels
  18. Valproic acid (1st generation)
    FOR: Partial, absence, and myoclonic seizures

    • MOA: Na inactivation
    • Inc GABA
    • Reduces T-type Ca2+ current


    Inhibits liver enzymes

    Teratogen
  19. Clonazepam (1st generation) benzodiazepine
    FOR: Absence, Lennox-Gastaut syndrome w/ myoclonic seizures

    MOA: Inc GABA A opening frequency

    A/E: Lethargy Cognitive effects
  20. Lamotrigine (2nd generation)
    FOR: All partial, Lennoz-Gastut syndrome, general T-C, absence

    • MOA: Na channel inactivation
    • inhibit glutamate release

    (used with Valproic in drug resistant epilepsy)

    Aggravates myoclonie seizures
  21. Levetiracetam (2nd generation)
    FOR: Partial, generalized, myoclonic seizures

    MOA: Unkonwn

    No enzyme induction

    asthenia
  22. Topiramate (2nd generation)
    FOR: All partial & Lennox-Gastut Syndrome

    • MOA: Red Na current
    • activate K hyperpolarization
    • enhance GABA
    • Limits glutamate receptor
    • Inhibit Brain Carbonic anhydrase

    Enzyme inducer
  23. Felbamate (2nd generation)
    FOR: Partial and generalized & Lennox-Gastut syndrome

    • MOA: inhibits NMDA response
    • Potentiate GABA response

    w/ other anticonvulsants --> rash & toxicities
  24. Zonisamide
    FOR: Partial, generalized T-C(except myoclonic)

    • MOA: Inhibits Ca channel
    • Prolongs Na channel inactivation
    • inhibits Carbonic anhydrase
  25. Drug for Status epilepticus
    • IV lorazepam
    • Diazepam followed by phenytoin
    • phenobarbital & phenytoin
  26. Imipramine
    Tricyclic for Depression

    MOA: inhibits 5-HT and NEP reuptake sites
  27. Amitriptyline
    Tricyclic for Depression

    MOA: inhibits 5-HT and NEP reuptake sites
  28. Clomipramine
    Tricyclic for Depression

    MOA: inhibits 5-HT and NEP reuptake sites
  29. Phenelzine
    MAOI for depression

    MOA: inhibits breakdown of the 3 monoamines

    Irreversible nonselesctive MAOI
  30. Selegiline Patch
    MAOI for depression

    MOA: inhibits breakdown of the 3 monoamines

    Irreversible MAO-B inhibitor
  31. Fluoxetine
    SSRI for depression

    MOA: block reuptake sites --> downregulate auto-receptors

    inhibits P450 enzymes

    can be used in kids
  32. Paroxitine
    SSRI for depression

    MOA: Block 5HT reuptake site --> autoreceptor downregulate

    inhibits P450 enzyme

    Used in kids
  33. Escitalopram
    SSRI for depression

    MOA: block reuptake sites-> downregulate auto-receptors

    • Strong efficacy
    • tolerability
    • OK for kids
  34. citalopram
    SSRI for depression

    MOA: block reuptake site -> downregulate autoreceptor

    • tolerability
    • OK for kids
  35. Sertaline
    SSRI for depression

    MOA: block reuptake site -> downregulate autoreceptor

    • Great efficacy
    • tolerable
    • Ok for kids

    TERATOGEN
  36. Serotonin Syndrome
    Hyperkinetic, tremor, clonus, hyper-reflexia, agitation, tachycardia
  37. Duloxetine
    SNRI for depression

    Ok For kids

    Liver concerns
  38. Venlafaxine
    SNRI for depression

    • good efficacy
    • ok for kids

    No P450 interaction
  39. Desvenlafaxine
    SNRI for depression

    • ok for kids
    • No P450 interaction
  40. Trazodone
    Atypical for depression

    • MOA: presynaptic alpha2 receptor blocker
    • block 5-HT2A and 2c autoreceptor
  41. Buproprion
    Atypical for depression

    MOA: NE & Da uptake inhibitor


    • tolerable
    • Ok with kids
    • Safe in cardiac patients
  42. Mirtazapine
    Atypical for depression

    MOA: H1 antagonism

    Blocks 5-HT3 sites -> anti-nausea

    • good efficacy
    • ok with kids
  43. Agomelatine
    Atypical for depression

    MOA: 5-HT2C antagonist & MT1/MT2 agonist

    Restores circadian rhythms and improves sleep quality
  44. First line treatment in Depression
    • SSRI
    • SNRI
    • Buproprion
    • CBT
    • interpersonal therapy
  45. Barbituates
    1st generation sedative hypnotic (for anxiety)

    Inc time channel is open

    • Teratogen
    • Abuse risk
  46. Phenobarbital
    Barbituate Anxiety (long acting)

    MOA: inc time channel is open

    • Increased pain perception
    • Respiratory depression
  47. Pentobarbital & secobarbital
    Barbituates (intermediate)

    MOA: inc time GABA channel is open

    For: surgery, anesthesia, & sleep induction
  48. Thiopental
    Barbituate (short acting)

    MOA: Inc time GABA channel is open

    Supports anesthesia
  49. Benzodiazepine
    2nd generation

    MOA: Inc frequency of GABA channel opening

    • Teratogen
    • No coma or death
    • active metabolite accumulation
  50. Chlordiazapoxide
    Benzodiazepine (long acting)

    MOA: inc opening frequency of GABA channels

    Hypnotic
  51. Diazepam
    Benzodiazepine (long acting)

    MOA: inc open frequency of GABA channel

    dec sleep latency, inc total sleep time, but dec REM

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