Neuro Medications PDF

Neuro Medications CLASSIFICATION THERAPEUTIC USES MECHANISM OF ACTION ADVERSE EFFECTS DRUG EXEMPLARS Parkinson’s DOPAMINE AGONIST Reduce tremors & muscl...

Neuro Medications CLASSIFICATION THERAPEUTIC USES MECHANISM OF ACTION ADVERSE EFFECTS DRUG EXEMPLARS Parkinson’s DOPAMINE AGONIST Reduce tremors & muscle ​Promote dopamine synthesis, CNS effects levodopa/carbidopa (Dopaminergics) rigidity of Parkinson’s activate dopamine receptors, Peripheral effects (Duopa) Pramipexole disease prevent dopamine breakdown, or Bone marrow depression (Mirapex) decrease degradation of levodopa Hepatic dysfunction ​Help to restore balance between inhibitory and stimulating neurotransmitters ANTICHOLINERGIC​ SA. Also used for Blocks effect of acetycholine to CNS effects benztropine (Cogentin) extrapyramidal side enhance dopamine/ acetylcholine Peripheral anticholinergic effects effects of some balance. Tachycardia, palpitations, antipsychotic meds hypotension Have greater affinity for receptor sites Urinary retention and hesitancy in CNS than for those in peripheral Other effects nervous system Alzheimer’s Disease and Myasthenia Gravis Indirect-Acting Slow memory loss and ​Block acetylcholinesterase at the Related to stimulation of donepezil (Aricept) Cholinergic Agonists cognitive decline in early synaptic cleft parasympathetic nervous system stages of Alzheimers ​§Allows the accumulation of ACh GI effects Pyridostigmine (Mestinon, released from the nerve endings CV effects Reginol) Myasthenia Gravis Urinary tract effects  ​§Leads to increased and prolonged Other effects stimulation of Ach Cholinergic crisis Migraines Ergot Derivatives Vascular, cluster, and Block alpha-adrenergic and serotonin CNS effects-dizziness, vertigo, ergotamine (Ergomar)​ migraine headache pain receptor sites in the brain to cause tingling sensation (warm) sumatriptan (Imitrex) relief constriction of cranial vessels, decrease CC effects-hypertension in cranial artery pulsation, decrease in GI effects-abdominal pain, N/V hyperperfusion of basilar artery bed Ergotism Triptans Bind to selective serotonin receptor CNS effects- drowsiness, Almotriptan, eletriptan sites to cause vasoconstriction of headache, paresthesia (Relpax) cranial vessels GI effects- dry mouth, nausea, abdominal pain, dysphagia CV effects- coronary artery vasospasm, MI, ventricular arrhythmias Almotriptan reported to have fewer side effects than other triptans Calcitonin CGRP inhibitors: Inhibit CGRP, a potent Lasmiditan: dizziness, fatigue, Eptinezumab-jjmr (Vyepti) Gene-Related Peptide vasodilator chemical released during paresthesia, sedation (CGRP) Inhibitors and migraine headache attacks Serotonin Agonist CGRP inhibitors: risk of Lasmiditan (Reyvow) Serotonin agonist: Has a selective hypersensitivity reactions action on a specific serotonin receptor Gepant substances: nausea Monoclonal antibodies: injection site reactions  Seizures Hydantoins Epilepsy ​Stabilize nerve membranes ​Most common relate to CNS Phenytoin (Dilantin) throughout CNS directly by depression Fosphenytoin (Cerebyx, influencing ionic channels in cell ​Effects related to cellular Sesquient) membranes, thereby decreasing toxicity: severe liver toxicity, excitability and hyperexcitability to bone marrow suppression, stimulation gingival hyperplasia, ​Reduce tonic–clonic, muscular, and potentially serious emotional responses to stimulation dermatological reactions, frank malignant lymphoma Barbiturates ​Inhibit impulse conduction in ​ Most common relate to CNS Phenobarbial (Solfoton, ascending RAS, depress cerebral depression Luminal) cortex, alter cerebellar function, ​ Phenobarbital depress motor nerve output May be associated with ​Stabilize nerve membranes physical dependence and throughout the CNS directly by withdrawal syndrome influencing ionic channels in the cell Linked to severe membrane à decrease excitability dermatological reactions and and hyperexcitability to stimulation development of drug tolerance *mointor for vital signs,m have resuscitation equipment at bedside BENZODIAZEPINES Anxiety, Sedation Enhances GABA ​ Most common relate to CNS alprazolam (Xanax) depression Antiepileptic ​ May be associated with physical dependence and withdrawal syndrome, especially with rapid reduction in dose Drugs that modulate Cross use for seizure ​Valproic acid: reduces abnormal ​ All: CNS effects valproic acid (Depakote)​ the inhibitory disorders or for bipolar electrical activity in the brain; may ​ Valproic acid and divalproex carbamazepine (Tegretol) neurotransmitter disorders increase GABA activity at inhibitory §Liver toxicity, GABA receptors hyperammonemia, ​Divalproex: action thought to be thrombocytopenia, related to increased GABA levels in pancreatitis brain §DRESS ​Acetazolamide: alters electrolyte ​ Acetazolamide and movement zonisamide: Rash; ​Zonisamide: inhibits dermatological changes voltage-sensitive sodium and ​ Zonisamide: Bone marrow calcium channels suppression, renal calculi development, GI upset ​Mechanism of action not ​Dizziness, weakness, fatigue, Levetiracetam (Keppra) completely understood; may be agitation, anxiety, depression, related to suppression of rapid suicidal ideation (rare) action potentials Multiple Sclerosis Immune ​ Number of effects on the ​ Alemtuzumab (Campath, Suppressants inflammatory system; specific Lemtrada) effects vary by drug ​ See Table 17.2 for usual indications for specific drugs