CNS Drugs & Anxiolytics Exam

• The final exam has a total of 100 points
• There will be 4 short answer questions (40 points total)
• There will be 3 mechanism of action questions (30 points total)
• There will be 55 multiple choice questions, but only 50 need to be answered (50 points total)

CNS Drugs

• Analgesics are a key topic.
• NSAIDs (Non-Opioid Analgesics) like Aspirin and Ibuprofen, inhibit cyclooxygenase (COX) enzymes
• The result of inhibiting cyclooxygenase enzymes is reduced inflammation, pain, and fever.
• Opioid Analgesics like Morphine and Fentanyl, bind to opioid receptors (Mu, Kappa) in the CNS
• The result of opioid analgesics binding to opioid receptors is blocked pain signals

Anxiolytics & Sedatives

• Anxiolytics & Sedatives are a key topic
• Benzodiazepines like Diazepam and Lorazepam, enhance GABAergic inhibition.
• The result of enhanced GABAergic inhibition is reduced neuronal excitability and the treatment of anxiety/insomnia.
• Barbiturates like Phenobarbital potentiate GABA activity
• The result of potentiating GABA activity, is CNS depression

Antipsychotics

• Antipsychotics are a key topic
• Typical (First-Generation) Antipsychotics like Haloperidol and Chlorpromazine, are dopamine D2 receptor antagonists
• The result of dopamine D2 receptor antagonism is effectiveness for positive symptoms of schizophrenia
• Atypical (Second-Generation) Antipsychotics like Risperidone and Clozapine, block both dopamine D2 and serotonin 5-HT2A receptors.
• The result of blocking both dopamine D2 and serotonin 5-HT2A receptors is the treatment of both positive and negative symptoms of schizophrenia
• Anticonvulsants are a key topic
• Anticonvulsants like Phenytoin and Valproic Acid inhibit sodium or calcium channels
• Inhibiting sodium or calcium channels prevents seizure propagation.
• CNS Stimulants are a key topic
• CNS stimulants like Methylphenidate and Amphetamines, increase norepinephrine and dopamine release
• Increasing norepinephrine and dopamine release is used in ADHD treatment.

ANS Drugs

• Autonomic Nervous System (ANS) Drugs are a key topic
• The Sympathetic Nervous System (Fight-or-Flight) is a key topic
• Adrenergic Agonists are a key topic
• Alpha-1 Agonists like Phenylephrine cause vasoconstriction
• Vasoconstriction treats hypotension and nasal congestion.
• Beta-1 Agonists like Dobutamine increase heart rate
• Increasing heart rate is used in heart failure or shock.
• Beta-2 Agonists like Albuterol cause bronchodilation
• Bronchodilation is used in asthma treatment.
• The Parasympathetic Nervous System (Rest-and-Digest) is a key topic
• Cholinergic Agonists are a key topic
• Cholinergic Agonists like Bethanechol stimulate muscarinic receptors
• Stimulating muscarinic receptors treats urinary retention and ileus.
• Cholinergic Antagonists (Anticholinergics) are a key topic
• Cholinergic Antagonists like Atropine block muscarinic receptors
• Blocking muscarinic receptors is used to treat bradycardia and reduce secretions during surgery.
• Adrenergic Antagonists (Beta-blockers, Alpha-blockers) are a key topic
• Beta-Blockers like Atenolol and Metoprolol block beta-1 receptors
• Blocking beta-1 receptors reduces heart rate and blood pressure.
• Alpha-1 Antagonists: Prazosin causes vasodilation
• Vasodilation is used in hypertension and benign prostatic hyperplasia (BPH) treatment.

GI Drugs

• Gastrointestinal (GI) Drugs are a key topic
• Peptic Ulcers are a key topic
• PPIs (Proton Pump Inhibitors) like Omeprazole and Pantoprazole inhibit H+/K+ ATPase
• Inhibiting H+/K+ ATPase reduces stomach acid.
• H2 Blockers like Ranitidine and Famotidine block histamine H2 receptors
• Blocking histamine H2 receptors reduces gastric acid secretion.
• Triple Therapy (for H. pylori) contains PPI + Clarithromycin + Amoxicillin or Metronidazole.
• GERD (Gastroesophageal Reflux Disease) is a key topic
• Antacids like Tums and Maalox neutralize stomach acid.
• H2 Antagonists like Cimetidine and Ranitidine decrease stomach acid production.
• Laxatives and Anti-Diarrheal are a key topic
• Laxatives like Bisacodyl and Psyllium stimulate bowel movements or add bulk.
• Anti-diarrheals like Loperamide and Diphenoxylate reduce peristalsis and increase water absorption in the colon.

Cardiovascular Drugs

• Cardiovascular Drugs are a key topic
• Angina is a key topic
• Nitroglycerin (Organic Nitrates) forms nitric oxide, dilates blood vessels.
• Dilation reduces heart oxygen demand.
• Beta-Blockers like Metoprolol and Atenolol reduce heart rate and oxygen consumption.
• Calcium Channel Blockers like Amlodipine and Verapamil dilate coronary arteries
• Dilation reduces heart rate.
• Hypertension is a key topic.
• ACE Inhibitors like Enalapril and Lisinopril inhibit conversion of angiotensin I to II, causing vasodilation.
• Diuretics like Hydrochlorothiazide and Furosemide reduce blood volume, lowering blood pressure.
• ARBs: Losartan, Valsartan block angiotensin II receptors, preventing vasoconstriction.
• Heart Failure is a key topic.
• ACE Inhibitors like Ramipril and Lisinopril improve cardiac output by vasodilation.
• Diuretics like Spironolactone and Furosemide reduce fluid overload in the body.

Endocrine Conditions

• Endocrine Conditions are a key topic
• Diabetes is a key topic
• Type 1 Diabetes treatment is Insulin (e.g., Insulin Glargine, Insulin Lispro) which regulates blood glucose.
• Type 2 Diabetes treatment is Metformin which reduces hepatic glucose production and increases insulin sensitivity
• Type 2 Diabetes treatment is Sulfonylureas like Glyburide which stimulate insulin release.
• Thyroid Disorders is a key topic
• Hypothyroidism treatment is Levothyroxine (T4) which is a synthetic thyroid hormone replacement.
• Hyperthyroidism treatment is Methimazole which inhibits thyroid hormone synthesis.
• Adrenal Disorders are a key topic
• Cushing's Syndrome treatment is Ketoconazole which inhibits cortisol synthesis.
• Addison's Disease treatment is Fludrocortisone which is a mineralocorticoid replacement.

Autoimmune Disorders

• Autoimmune Disorders are a key topic
• Rheumatoid Arthritis is a key topic
• Rheumatoid Arthritis is treated with Methotrexate which inhibits folate metabolism, reducing T-cell activation.
• Rheumatoid Arthritis is treated with Hydroxychloroquine which is an immunosuppressant, used for long-term control.
• Multiple Sclerosis is a key topic
• Multiple Sclerosis is treated with Interferon Beta which is immunomodulatory and reduces relapse rates.

Cancer Pharmacology

• Cancer Pharmacology is a key topic
• Antineoplastic Drugs are a key topic
• Methotrexate inhibits dihydrofolate reductase, impairing DNA synthesis.
• Cyclophosphamide is an alkylating agent that binds DNA, preventing replication.
• Monoclonal Antibodies like Rituximab and Trastuzumab target specific cancer cell markers.

Key Mechanisms of Action

• Antipsychotics block dopamine receptors (D2) in the mesolimbic pathway, affecting mood and cognition.
• Beta-Blockers block beta-1 adrenergic receptors in the heart, reducing heart rate and blood pressure.
• ACE Inhibitors inhibit the enzyme ACE, preventing conversion of angiotensin I to angiotensin II, resulting in vasodilation.
• Corticosteroids mimic cortisol, suppressing the immune system and inflammation.
• Alkylating Agents form DNA cross-links, preventing replication.
• Antimetabolites inhibit DNA/RNA synthesis by mimicking natural nucleotides.
• Insulin facilitates glucose uptake into cells, reducing blood glucose levels.

Side Effects To Remember

• Antipsychotics cause weight gain, sedation, extrapyramidal symptoms (EPS), and Neuroleptic Malignant Syndrome (NMS).
• Beta-blockers cause bradycardia, fatigue, and sexual dysfunction.
• Diuretics cause hypokalemia, dehydration, and dizziness.
• Methotrexate causes bone marrow suppression, liver toxicity, and mucositis.

Study Tips

• Classify Drugs and understand their primary uses (e.g., Beta-blockers for hypertension, Diuretics for heart failure).
• Focus on Mechanisms of Action and how drugs work at the receptor or enzyme level (e.g., Methimazole for hyperthyroidism, Metformin for diabetes).
• Link Side Effects with their common drugs (e.g., NSAIDs: gastrointestinal irritation, Corticosteroids: immune suppression).
• Practice Questions to reinforce drug categories and mechanisms.