Neurology Medications Clinical Medicine

Ergotamine

Migrane treatment; specific abortive tx

• Ex. Cafergot

• SA: rebound headache

• Contraindications: pregnancy and cardiovascular dz

Serotonin agonists- Triptans

Migraine treatment (specific abortive therapy), work as vasoconstrictors

• Ex. large med class of different preparations

  • Oral, rectal, nasal, sublingual, IM

  • SA: N/V, dizziness, fatigue

  • Contraindications: pregnancy, stroke, CV dz

Calcitonin Gene-Related Peptide (CGRP) antagonists

Migraine Treatment (specific abortive therapy); MC used in pts that cannot tolerate a triptan

• Ex. Ubrogepant (Ubrelvy), Rimegepant (Nurtec)

• Indicated for pts with CV dz or risks

Anti-nausea therapy

Adjunct Migraine therapy (nonspecific tx)

• Ex. prochlorperazine (Compazine)- rectal, IV, IM

  • Metoclopramide (Reglan)

  • Ondansteron (Zofran)

Lamsmiditan

Migraine treatment; 5-HT 1F receptor (acute abortive therapy)

• Ex. Reynow

• SA: sedation

• NOT contraindicated in CV dz

Anti-epileptics in prophylactic tx of migraine prophylaxis

Topiramate (Topamax), Valproic acid (Depakene)

Cardiovascular medication used to treat migraine prophylaxis

Candesartan (Atacand)- ARB, Propanolol- B-blocker, Verapamil- CCB

Antidepressants used to treat migraine prophylaxis

• TCAs (Amitriptyline-Elavil)

• SNRI (Venlafaxine- Effexor)

Monoclonal antibodies against calcitonin related peptide for migraine prophylaxis

• Epitenezumab (Vyepti)

• Erenumab (Aimovig)

• Fremanezumab (Ajovy)

• Galcanezumab (Emgality)

Corticosteroids are used for

cerebral edema

• Methylprednisone, dexamethasone

Cliostazol

anti platelet used in Asian populations to decrease hemorrhage risk

PCSK9 Inhibitor

used when statins aren’t enough and when a patient has had 2 events or 1 event and multiple risk factors and are at large risk for recurrence of another vascular event

• Evolocumab (Repatha)

• Alirocumab (Praulent)

Temozolamide

oral chemotherapy used for glios (astrocytoma and glioblastoma)

D/C seizure medication

• 2 yrs seizure free with epilepsy

• 3-6 mo seizure free after trauma

Levetiracetam (Keppra)

Anti-Epileptic

Used in the tx of generalized/focal seizure disorders

• this is what was listed as #1 most used in class

Lamotrigine (Lamictal)

Anti-Epileptic

Used in the tx of generalized/focal seizure disorders

• can also tx Bipolar disorder

Topiramate (Topamax)

Anti-Epileptic

Used in the tx of generalized/focal seizure disorders and prophylaxis of migraines

• Monitor: serum bicarbonate, BUN/Cr

Valproic Acid/Valproate (Depakene, Depakote)

Anti-Epileptic

Used in the tx of generalized/focal seizure disorders and 2nd line for absence seizures (all seizure types) and prophylaxis of migraines

• Monitor: CBC, lytes, LFTs

• Bad SA profile: teratogenic, liver toxicity, pancreatitis

Carbamazepine (Tegretol, Carbatrol)

Anti-Epileptic

Used in the treatment of generalized/focal seizures, 1st line med for trigeminal neuralgia and glossopharyngeal neuralgia

• SA: Leukopenia, agranulocytosis

• Monitor: CBC, LFTS, BUN/Cr, lytes

Oxcarbazepine (Trileptal)

Anti-Epileptic

Used in the treatment of focal seizures, 1st line med for trigeminal neuralgia and glossopharyngeal neuralgia

Phenytoin (Dilantin)

Anti-Epileptic

Used for the tx of focal and generalized seizures

• Also used in the tx of STATUS EPILEPTICUS

• Cause: Hirsutism, gingival hypertrophy, folic acid depletion

Gabapentin (Neurontin)

Anti-Epileptic

Used in the treament of focal/generalized seizures, 1st line in tx for post herpetic neuralgia

Pregablin

Anti-Epileptic

Lyrica

Used in focal seizure tx, 1st line tx in post herpetic neuralgia

Ethosuximide (Zarontin)

Anti-Epileptic

Specifically used for absence seizures, 1st line

• MOA: blocks calcium channel

Clonazepam (Klonopin)

Benzodiazepines- Anti-Epileptic

• Absence seizure 2nd line

Levodopa

Dopamine replacement

Mainstay of Parkinson’s treatment

Carbidopa

Dopamine replacement

Can be added to levodopa, diminishes break down of levodopa in the body

Can get Carbidopa/Levodopa combination meds

Dopamine replacement

• Sinemet, Dhivy, Parcopa

• Extended release: Rotary, Crexont

• Gel: Duopa, Vyalev

Side affects of Levodopa

• Early: N/V, somnolence, hypotension, cardiac arrhythmia, psychosis

• Late: chorea, athetosis, dystonia, tremor, tics, myoclonia

Do NOT prescribe Levodopa if pt

• previously dx with psychosis

• MAOI taken in last 2 weeks

• acute angle closure glaucoma

*Can cause neuroleptic malignant syndrome

On off Phase Levodopa

Motor fluctuation seen in Parkinson’s patients on chronic levodopa where they suddenly and unpredictably switch between:

• “On” phase → medication is working

• “Off” phase → medication is not working

Amantadine

Anti-viral

Used in pts with mild s/s of PD who do not want to start Levodopa right away

• Can also be used in addition to Levodopa for On/off phase

Anticholinergics (Benztropine-Cogentin, Trihexyphenydil-Artane)

Used in <70 yo with tremor but no other bradykinesia or gait disturbance

*Only use if tremor is present

Dopamine agonists (Pramiprexole, Ropinirole, Rotigotine, Apomorphine, Bromocriptine)

Monotherapy in early Parkinson’s Dz or combo in advanced Parkinson’s

• increased risk of impulse control problems

MAOB-I (Selegiline, Rasagiline, Safinamide)

Allow dopamine to stay in system longer, not used much anymore

COMT Inhibitor (Entacapone, Opicapone, Tolcapone)

potentiate/mitigate Levodopa, prolongs the effect

• add to Levodopa tx

Adenosine A2 receptor antagonist (Istradefylline)

given in adjunct to Levodopa for the “off” periods

Cholinesterase Inhibitors (Donepezil, Rivastigmine, Galantamine)

1st line mild/mod AD and all Lewy body dementia

NMDA receptor antagonist (Memantine-Namenda)

1st line mod/severe AD

Anti-Amyloid therapies (Lecanemab, Donanemab)

2nd line therapy in mild/mod AD

• use in early Alzheimer's with amyloid pathology

Monoclonal antibodies in MS

Natalizumab, ocrelizumab, rituximab, ofatumumab

• Chronic RRMS, SPMS, and PPMS tx

• Ocrelizumab (Ocrevus)- all 3 types

• PPMS- only Ocrelizumab

SIP receptor modulator (“mod”)

Fingolimod, siponimod, ozanimod, ponesimod

• Tx for RRMS or SPMS

Fumarates

Dimethyl fumarate, diroximel fumarate, monomethyl fumarate

• Tx for RRMS

Interferon beta-1

Tx of chronic RRMS, older tx not used as much

Dalfampridine

improve gait

SSRI- Selective serotonin reuptake inhibitors

1st line med for depression in all cases; Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Citalopram (Celexa), Escitalopram (Lexapro), Fluvoxamine (Luvox)

• Can cause QT prolongation

Fatigue

Modafinil, amantadine, pemoline, flouxtetine

Baclofen

Spasticity in MS and ALS

Ditropan

urinary incontinence

Tetrabenzine

Dopamine Blockers

HD with moderate/severe chorea, 1st line

• can cause depression and suicidality

Neuroleptics

Halodol, Olanzapine, Risperidone, Aripriprazole

• If HD pt isn’t responsive to tetrabenzine

Riluzole (Rilutek)

Slows progression of ALS, 1ST LINE MED

• often used in adjunct with Edavarone infusion

Absolutely contraindicated in Myasthenia Gravis

D-Penicillamine

Acetylcholinesterase Inhibitors

Pyridostigmine, Neostigmine

1st line treatment of Myasthenia gravis→ 2nd is prednisone