Neuro Meds PDF

Classification Therapeutic Uses Mechanism of Adverse Effects Drug Exemplars Action DOPAMINE Reduce tremors & Promotes CNS effects: Levodopa/carbido AGONIST muscle rigidity of dopamine...

Classification Therapeutic Uses Mechanism of Adverse Effects Drug Exemplars Action DOPAMINE Reduce tremors & Promotes CNS effects: Levodopa/carbido AGONIST muscle rigidity of dopamine anxiety, pa (Duopa) (Dopaminergics) Parkinson’s disease synthesis, activate nervousness, Pramipexole dopamine headache, malaise, (Mirapex) receptors, prevent fatigue, confusion, dopamine mental changes breakdown, or including decrease psychosis, blurred degradation of vision, muscle levodopa twitching, and ataxia (clumsy), Trying to tell the dizziness, body there is numbness, dopamine, slow weakness down the process of getting rid of it Peripheral effects: anorexia, nausea, Help to restore vomiting, balance between dysphagia, dry inhibitory and mouth and stimulating constipation or neurotransmitters diarrhea; cardiac arrhythmias, Offer relief from sx orthostatic (tremor, rigidity, hypotension, and and bradykinesia); palpitations; DO NOT CURE bizarre breathing patterns; urinary retention; and flushing, increased sweating, and hot flashes Bone marrow depression & hepatic dysfunction a/e most commonly r/t these drugs are r/t systemic effects of dopamine, increased HR, increased BP, decreased GI activity, and  urinary retention ANTICHOLINERGI Parkinson’s Blocks effect of CNS effects r/t Benztropine C acetylcholine to blocking of central (Cogentin) Also used for enhance acetylcholine extrapyramidal dopamine/acetylch receptors: side effects of oline balance disorientation, some antipsychotic confusion, and meds like Trying to tell the memory loss, phenothiazines body it’s equally agitation, balanced between nervousness, acetylcholine and delirium, dopamine depression, dizziness, Have greater light-headedness, affinity for receptor and weakness may sites in CNS than also occur for those in peripheral nervous Peripheral system anticholinergic effects: dry mouth, nausea, vomiting, paralytic ileus, and constipation r/t decreased GI secretions and motility Tachycardia, palpitations, hypotension r/t blocking of suppressive cardiac effects of parasympathetic nervous system; urinary retention and hesitancy r/t blocking of bladder muscle activity and sphincter relaxation; blurred vision and photophobia r/t pupil dilation and blocking of lens accommodation; and flushing and reduced sweating r/t blocking of the cholinergic sites  that stimulate sweating and blood vessel dilation in the skin Indirect-Acting Slow memory loss Block R/t stimulation of Donepezil Cholinergic and cognitive acetylcholinestera parasympathetic (Aricept) Agonists decline in early se at the synaptic nervous system stages of cleft Pyridostigmine Alzheimer’s GI effects: nausea, (Mestinon, (Aricept) Allows the vomiting, cramps, Reginol) accumulation of diarrhea, increased Myasthenia Gravis ACh released from salivation, and (Pyridostigmine) the nerve endings involuntary defecation r/t Leads to increased increase in GI and prolonged secretions and stimulation of Ach, activity keep communicating CV effects: bradycardia, heart Increase muscle block, hypotension, strength by and even cardiac allowing ACh to arrest r/t accumulate in the cardiac-suppressin synaptic cleft at g effects neuromuscular junctions (MG) Urinary tract effects: sense of urgency related to stimulation of the bladder muscles and sphincter relaxation, incontinence Other effects: flushing and increased sweating 2nd to stimulation of the cholinergic receptors in the sympathetic nervous system, increased bronchial secretions, dysphagia Cholinergic effects: miosis and  blurred vision, headaches, dizziness, and drowsiness Cholinergic crisis (w/ OD): excessive muscarinic and nicotinic stimulation causes extreme sx: abd cramps, increased salivation, lacrimation, muscular weakness, paralysis, muscular fasciculation, diarrhea, blurry vision, and respiratory depression Blue = pyridostigmine Donepezil: insomnia, fatigue, rash, nausea, vomiting, diarrhea, dyspepsia, abdominal pain, muscle cramps Ergot Derivatives Vascular, cluster Block R/t drug-induced Ergotamine (episodic alpha-adrenergic vascular (Ergomar) unilateral), and and serotonin constriction migraine headache receptor sites in pain relief the brain to cause CNS effects: constriction of numbness, cranial vessels, tingling of decrease in cranial extremities, and artery pulsation, muscle pain decrease in hyperperfusion of CV effects: basilar artery bed pulselessness, weakness, precordial distress, chest pain, arrhythmias (tachycardia,  bradycardia), localized edema and itching, and MI GI effects: upset, nausea, vomiting, and diarrhea Ergotism: n/v, diarrhea, severe thirst, hypoperfusion, chest pain, BP changes, confusion, drug dependency (with prolonged use), and drug withdrawal syndrome Triptans Vasodilation Bind to selective CNS effects: Almotriptan, occurs during most serotonin receptor numbness, eletriptan (Relpax) migraine sites to cause tingling, burning headaches; vasoconstriction of sensation, feelings Sumatriptan medications such cranial vessels of coldness or (Imitrex) as triptans work to strangeness, REPORT ANGINAL constrict blood dizziness, CHEST PAIN FOR vessels weakness, SUMATRIPTAN myalgia, and Sumatriptan — vertigo acute migraine attacks AND GI effects: cluster headaches dysphagia and abdominal Almotriptan — discomfort acute migraine HA CV effects: can be severe and include blood pressure alterations and tightness or pressure in the chest Almotriptan reported to have fewer s/e than other triptans; and it is also thought that the longer  half-life of this drug (3-4 hours) will prevent the rebound headaches that may be seen with other triptans Calcitonin Migraine CGRP inhibitors: Lasmiditan: Eptinezumab-jjmr Gene-Related inhibit CGRP, a dizziness, fatigue, (Vyepti) Peptide (CGRP) potent vasodilator paresthesia, Inhibitors and chemical released sedation; Lasmiditan Serotonin Agonist during migraine SCHEDULE V med (Reyvow) — headache attacks SEROTONIN (decrease pause in CGRP inhibitors: AGONIST MORE blood flow causing risk of SELECTIVE THAN throbbing) hypersensitivity TRIPTANS SO LESS reactions LIKELY TO CAUSE Serotonin agonist: VASOCONSTRICTI has selective Gepant substances ON A/E S/E action on a specific (rimegepant and (maybe give to serotonin receptor; ubrogepant): someone with serotonin helping nausea HTN); w/ or w/o to communicate to aura the body Monoclonal antibodies (galcanezumab): injection site reactions;ONLY that can tx cluster too Hydantoins Epilepsy (SLE, Stabilize nerve Most common r/t Phenytoin seizures after membranes CNS depression: (Dilantin) neurosurgery) throughout CNS depression, directly by confusion, Fosphenytoin Phenytoin — influencing ionic drowsiness, (Cerebyx, tonic-clonic channels in cell lethargy, fatigue, Sesquient) seizures membranes, constipation, dry thereby decreasing mouth, anorexia, excitability, and cardiac hyperexcitability to arrhythmias and stimulation changes in blood pressure, urinary Trying to slow retention, and loss down brain of libido Reduce Effects r/t cellular tonic-clonic, toxicity: severe muscular, and liver toxicity, bone emotional marrow  responses to suppression, stimulation gingival hyperplasia, potentially serious derm reactions (hirsutism, SJS), frank malignant lymphoma Phenytoin: ataxia, dysarthria, slurred speech, mental confusion, dizziness, fatigue, tremor, HA, dermatitis, SJS, nausea, gingival hyperplasia, liver damage, hematopoietic complications, sometimes fatal; Nystagmus is possible at higher doses and w/ toxicity OLDER, COST EFFECTIVE LESS SEDATING AND LESS DEPENDENCY THAN BARBITURATES OR BENZOS Barbiturates SE (emergency) Inhibit impulse Most common r/t Phenobarbital conduction in CNS depression: (Solfoton, Long-term ascending RAS, depression, Luminal) tonic-clonic, depress cerebral confusion, cortical focal, cortex, alter drowsiness, NOTE THAT simple focale, cerebellar lethargy, fatigue, PHENOBARBITAL febrile seizures function, depress constipation, dry IS NOT APPROVED motor nerve output mouth, anorexia, BY THE FDA BUT cardiac MARKETED AND Stabilize nerve arrhythmias and DISTRIBUTED IN membranes changes in blood THE U.S. FOR throughout the pressure, urinary EMERGENCY CNS directly by retention, and loss SITUATIONS influencing ionic of libido  channels in the cell Since they depress membrane a nerve function, decrease they can produce excitability and sedation, hypnosis, hyperexcitability to anesthesia, stimulation respiratory depression, and deep coma Phenobarbital may be associated w/ physical dependence and withdrawal syndrome, linked to severe derm reactions and development of drug tolerance r/t changes in drug metabolism over time Phenytoin: somnolence, insomnia, vertigo, nightmares, lethargy, nervousness, hallucinations, insomnia, anxiety, dizziness, bradycardia, hypotension, syncope, nausea, vomiting, constipation, diarrhea, hypoventilation, respiratory depression, tissue necrosis at injection site, withdrawal syndrome BENZODIAZEPINE Anxiety, sedation Enhances GABA, Most common r/t Alprazolam S interfering with CNS depression: (Xanax) Antiepileptic neuron firing sedation, stabilizes drowsiness, Ativan postsynaptic cell) depression, lethargy, blurred CONTROLLED vision, “sleep SUBSTANCE driving” and other complex behaviors, headaches, apathy, light-headedness, amnesia, and confusion Paradoxical excitatory reactions during first 2 wks of therapy GI: dry mouth, constipation, nausea, vomiting, and elevated liver enzymes CV: hypotension, hypertension, arrhythmias, palpitations, and respiratory difficulties Hem: blood dyscrasias and anemia GU: urinary retention and hesitancy, loss of libido, and changes in sexual functioning May be associated w/ physical dependence and withdrawal syndrome (nausea; headache; vertigo; malaise; nightmares; and, if severe, seizures), especially with rapid reduction in dose; ALWAYS  TAPER Drugs that Cross use for Valproic acid All: CNS effects: Valproic Acid modulate the seizure disorders reduces abnormal weakness, fatigue, (Depakote) inhibitory or for bipolar electrical activity drowsiness, neurotransmitter disorders in the brain; may dizziness, and Carbamazepine GABA increase GABA paresthesias (Tegretol) Drug of choice for activity at myoclonic inhibitory Valproic acid and seizures; treatment receptors divalproex: of absence hepatotoxicity, seizures; also Divalproex (manic birth defects, GI effective in mania, episodes, tx of effects, HA, migraine absence and focal tinnitus, blurred headaches, and seizures, and vision, ataxia, complex focal prevention of hyperammonemia, seizures migraine thrombocytopenia, headaches): action pancreatitis, Carbamazepine: thought to be r/t DRESS (Drug generalized and increased GABA Reaction with focal seizures in levels in brain Eosinophilia and addition to Systemic trigeminal Acetazolamide Symptoms ) neuralgia (sulfonamide): alters electrolyte Acetazolamide and movement; RARELY zonisamide: rash, used for seizures derm changes Zonisamide Zonisamide: bone (sulfonamide): marrow inhibits suppression, renal voltage-sensitive calculi sodium and development, GI calcium channels, upset stabilizing nerve cell membranes Carbamazepine: and modulating drowsiness, calcium-dependent ataxia, dizziness, presynaptic release n/v, hepatitis of excitatory nystagmus, double neurotransmitters vision, vertigo, staggering gait, Carbamezapine: and headache; inhibits blood disorders polysynaptic (leukopenia, responses and anemia, and block sodium thrombocytopenia; channels to due to promotion prevent the of secretion of formation of ADH, it may cause repetitive action edema, HTN, and  potentials in the fluid overload, abnormal focus especially in patients with heart failure; dermatitis, rash, photosensitivity, and SJS have been noted Immune Keppra: Keppra: Keppra: dizziness, Levetiracetam Suppressants antiepileptic mechanism of weakness, fatigue, (Keppra) action not agitation, anxiety, Campath: MS completely depression, Alemtuzumab understood; may suicidal ideation (Campath, be r/t suppression (rare) Lemtrada) of rapid action potentials Campath: acute (repolarization) pulmonary edema (dyspnea, chest Number of effects pain, wheezing), on the which is associated inflammatory with severe fluid system; specific retention, and effects vary by cytokine release drug syndrome (flulike symptoms that can progress to third-spacing of fluids and shock), ever, chills, malaise, myalgia, nausea, diarrhea, vomiting, and increased susceptibility to infection and cancer development