Neuro/Psych pharm

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Neuro/Psych pharm
2011-03-11 12:36:17
Neuro Psych pharm

Neuro/Psych pharm
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  1. Opioids
    • Morphine, fentanyl, codeine, heroin, methadone, meperidine, dextromethorphan
    • Agonists at opioid receptors - open K channels, close Ca channels -> decrease synaptic transmission
    • Pain, cough suppression, diarrhea, pulmonary edema, maintenance for addicts
    • Respiratory depression, constipation, miosis (pinpoint pupils), CNS depression
    • Treat toxicity with naloxone or naltrexone
  2. Butorphanol
    • Partial agonist at opioid mu receptors, agonist at kappa receptors
    • For pain
    • Less respiratory depression than full agonists
    • Causes withdrawal if on full opioid agonist
  3. Tramadol
    • Weak opioid agonist; inhibits 5-HT3 and NE uptake
    • Chronic pain
    • Toxicity similar to opioids; decreases seizure threshold
  4. First line for tonic-clonic seizures
    • Phenytoin
    • Valproic acid
    • Carbamazepine
    • (Peeing and Very Convulsive)
  5. First line for absence seizures
  6. First line for prophylaxis of status epilepticus
  7. First line for acute status epilepticus
    Benzodiazepines (diazepam or lorazepam)
  8. First line for trigeminal neuralgia
  9. First line for seizures in pregnant women, children
  10. Phenytoin
    • Block Na channels, increase refractory period, inhibit glutamate release
    • Tonic-clonic seizures (also class IB antiarrythmic)
    • SLE-like syndrome, induction of P450
    • Chronic use: gingival hyperplasia, peripheral neuropahy, hirsutism, megaloblastic anemia
  11. Thiopental
    • Barbituate
    • Increase duration of Cl channel opening -> increase GABA -> decrease neuron firing
    • Induction of anesthesia
    • Recovery from anesthesia is from redistribution in tissues
  12. Phenobarbital, pentobarbital, secobarbital
    • Barbituates
    • Increase duration of Cl channel opening, increase GABA action, decrease neuron firing
    • Anxiety, seizures, insomnia
    • Dependence, CNS depression w/alcohol, respiratory/CV depression, induction of P450
    • Contraindicated in porphyria
  13. Benzodiazepines
    • -zepams and alprazolam
    • Increase frequency of Cl channel opening
    • Anxiety, spasticity, status epilepticus (lorazepam and diazepam), alcohol withdrawal, general anesthetic
    • Dependence, CNS depression w/alcohol, less respiratory depression than barbs
    • Treat overdose with flumazenil
  14. Halothane
    • Inhaled anesthetic
    • Also -fluranes and nitrous oxide
    • Myocardial depression, respiratory depression, decreased cerebral blood flow
    • Hepatotoxicity (halothane), malignant hyperthermia
  15. Midazolam
    • Benzodiazepine used for endoscopy
    • Treat overdose with flumazenil
  16. Ketamine
    • IV anesthetic, blocks NMDA receptors
    • Cause disorientation, hallucination, bad dreams
  17. Opiates for IV anesthesia
    Morphine, fentanyl
  18. Propofol
    Rapid anesthesia induction and short procedures
  19. Local anesthetics
    • Esters: one I (procaine); amides: two Is (lidocaine)
    • Block Na channels in rapidly firing neurones
    • Order of sensory loss: pain, temp, touch, pressure
    • Used for minor surgical procedures and spinal anesthesia
  20. Succinylcholine
    • Depolarizing neuromuscular blocker
    • Rapid sequence intubation
    • Can cause hypercalcemia and hyperkalemia
    • Can be reversed after repolarization by neostigmine
  21. Tubocurarine
    • Nondepolarizing neuromuscular blocker
    • Compete with ACh for receptors
    • Reversed with cholinesterase inhibitors (neostigmine)
  22. Dantrolene
    • Treat malignant hyperthermia (cause by inhaled anesthetics + succinylcholine)
    • Also treats neuroleptic malignant syndrome (toxicity of antipsychotics)
    • Prevents release of Ca from SR
  23. L-dopa/carbidopa
    • Used in Parkinson's
    • Increases level of dopamine in brain; crosses BBB and is converted by dopa decarboxylase in CNS to dopamine
    • Carbidopa limits peripheral side effects (arrythmia)
    • Dyskinesia after administration and akinisia between doses
  24. Selegiline
    • Parkinson's dz
    • Selectively inhibits MAO-B increasing availability of dopamine (prevents dopamine breakdown)
  25. Bromocriptine
    Dopamine agonist used in Parkinson's
  26. Amantadine
    • Used in Parkinson's
    • Increases dopamine release
  27. Sumatriptan
    • 5-HT IB/ID agonist
    • Used for acute migraine and cluster headache attacks
  28. Methylphenidate
    • = Ritalin
    • Used in ADHD, mechanism unknown
  29. High potency antipsychotics/neuroleptics
    • Haloperidol, trifluoperazine, fluphenazine
    • Block dopamine D2 receptors
    • Positive symptoms of schizophrenia, psychosis, acute mania, Tourette's
    • Extrapyramidal side effects (dystonia, akinesia, akathisia, tardive dyskinesia)
    • Neuroleptic malignant syndrome: fever, encephalopathy, vitals unstable, elevated enzymes, rigidity of muscles
  30. Low potency antipsychotics
    • Thioridazine, chlorpromazine
    • Block D2 receptors
    • Positive symptoms of schizophrenia, psychosis, acute manie, Tourette's
    • Endocrine side effects - galactorrhea
    • No extrapyramidal side effects
  31. Atypical antipsychotics
    • It's atypical for old closets to quietly risper
    • Olanzapine, clozapine, quietapine, risperidone
    • Block 5-HT2, alpha, Ha and dopamine receptors
    • Positive and negative symptoms of schizophrenia
    • Olanzapine for OCD, anxiety disorder, depression, mania, Tourette's syndrome
    • Clozapine may cause agranulocytosis
  32. Lithium
    • Mood stabilizer for bipolar disorder - blocks relapse and acute manic events; treats SIADH
    • Nephrogenic DI, hypothyroidism, Ebstein's anomaly in pregnancy (apically displaced tricuspid valve, ASD, atrialization of RV)
  33. Buspirone
    • Stimulates %-HT1A receptors
    • Used for generalized anxiety disorder
    • Non-addictive, non-sedating alternative to barbs and benzos
  34. Amitriptyline, Imiprimine
    • Block reuptake of NE and serotonin
    • Major depression, OCD, fibromyalgia
    • Anticholinergic effects (tachycardia, urinary retention), Tri-Cs (Convulsions, Coma, Cardiotoxicity)
  35. SSRIs
    • Fluoxetine
    • Depression, OCD, bulimia, social phobias
    • Serotonin syndrome when combined with MAOIs: hyperthermia, muscle rigidity, CV collapse, flushing, diarrhea, seizures; treat with cyproheptadine
  36. MAOIs
    • Phenelzine, selegiline
    • Increase levels of amine neurotransmitters
    • Atypical depression, anxiety, hypochondriasis
    • Hypertensive crisis with tyramine ingestion (wine, cheese), serotonin syndrome when combined with SSRIs
  37. Buproprion
    • Smoking cessation
    • Can cause seizure in bulimic patients or those with existing seizure disorder