neurology

donepezil: brand

[aricept]

donepezil [aricept]: class

reversible acetylcholinesterase inhibitors [AChE-I]; CNS-selective noncompetitive

donepezil [aricept]: indications

mild to severe alzheimers

donepezil [aricept]: MOA

blocks acetylcholinesterase and metabolism of acetylcholine

donepezil [aricept]: contraindications

not be used in patients w/ bradycardia, known cardiac conduction system disease due to risk of syncope, falls, fractures

donepezil [aricept]: BBW

none

donepezil [aricept]: common ADRs

cholinergic [SLUDGE: sialorrhea, lacrimation, urination, defecation, GI, emesis], CNS: headache, insomnia, vivid dreams; cardiac: bradycardia, syncope, heart block, hypotension; GI: anorexia, weight lost

donepezil [aricept]: rare ADRs

rhabdomyolysis, neuroleptic malignant syndrome

donepezil [aricept]: counseling

none

memantine: brand

[namenda]

memantine [namenda]: class

n-methyl-D-aspartate [NMDA] receptor antagonist

memantine [namenda]: indications

alzheimers

memantine [namenda]: MOA

uncompetitive NMDA receptor antagonist, blocks excessive glutamate-induced calcium influx by binding the NMDA channel pore, prevents excitotoxicity w/o affecting normal neurotransmission

memantine [namenda]: contraindications

caution in patients w/ a history of seizure disorder: may increase risk of seizures; use w/ caution w/ CV disease; renal impairment; hepatic impairment; may increase urine pH

memantine [namenda]: BBW

none

memantine [namenda]: common ADRs

headache, dizziness, diarrhea, constipation, confusion

memantine [namenda]: rare ADRs

none

memantine [namenda]: counseling

none

gabapentin: brand

[neurontin, gralise]

gabapentin [neurontin, gralise]: class

antiseizure agent, misc, GABA analog

gabapentin [neurontin, gralise]: indications

neuropathic pain

gabapentin [neurontin, gralise]: MOA

gabapentin looks like GABA, blocks calcium to calm excitory signals; hepls to control pain and seizure

gabapentin [neurontin, gralise]: contraindications

withdrawal, products aren't interchangeable, masthenia gravis, renal impairment, history of substane misuse

gabapentin [neurontin, gralise]: BBW

none

gabapentin [neurontin, gralise]: common ADRs

drowsiness, dizziness, peripheral edema, weight gain, dental disease, diarrhea, dyspepsia, nausea, vomiting, erectile dysfunction, abnormal gait, depression, memory impairment, diplopia, nystagmus

gabapentin [neurontin, gralise]: rare ADRs

respiratory depression, accidental injury, allergic reaction like rashes, drug reaction w/ eosinophilia and system symptoms [DRESS], sjs, toxic epidermal necrolysis, bullous pemphigoid, erythema multiforme, hypersensitivity anglitis, agitation

gabapentin [neurontin, gralise]: counseling

none

pregabalin: brand

[lyrica]

pregabalin [lyrica]: class

antiseizure agent, misc.; GABA analog

pregabalin [lyrica]: indications

neuropathic pain

pregabalin [lyrica]: MOA

calms the CNS by blocking calcium, not by acting on GABA

pregabalin [lyrica]: contraindications

angioedema, renal impairment, substance misuse, withdrawal

pregabalin [lyrica]: BBW

none

pregabalin [lyrica]: common ADRs

drowsiness, dizziness, edema

pregabalin [lyrica]: rare ADRs

respiratory depression, CNS depression: accidental injury, maculopapular rashes, DRESS, sjs, toxic epidermal necrolysis, peripheral edema, blurred vision, decreased visual acuity, diplopia, visual field loss, weight gain

pregabalin [lyrica]: counseling

none

metaxalone: brand

[skelexin]

metaxalone [skelexin]: class

skeletal muscle relaxant

metaxalone [skelexin]: indications

spasticity

metaxalone [skelexin]: MOA

not established

metaxalone [skelexin]: contraindications

CNS depression, serotonin syndrome, hepatic impairment, renal impairment

metaxalone [skelexin]: BBW

none

metaxalone [skelexin]: common ADRs

dizziness, drownsiness, headache

metaxalone [skelexin]: rare ADRs

serotonine syndrome

metaxalone [skelexin]: counseling

none

dexmethylphenidate: brand

[focalin]

dexmethylphenidate [focalin]: class

central nervous system stimulant

dexmethylphenidate [focalin]: indications

ADHD: stimulants

dexmethylphenidate [focalin]: MOA

Dexmethylphenidate = the active half of methylphenidate that boosts & blocks reuptake of NE and dopamine

dexmethylphenidate [focalin]: contraindications

misuse, abuse, substance use disorder, hypersensitivity, rare hereditary problems to galactose malaborption, or sucrose-isomaltase insufficiency

dexmethylphenidate [focalin]: BBW

concurrent use of MAO inhibitor, visual disturbance, amphetamines, ocular effects, peripheral vasculopathy, bipolar disorder, CV disorders, seizure disorder, tourette syndrome, preexisting severe GI narrowing conditions

dexmethylphenidate [focalin]: common ADRs

dizziness, headache, upset stomach, weight loss, anxiety, decreased appetite, insomnia, heartburn, nose/throat irritation, increased blood pressure/heart rate, palpitations, hyperhidrosis, decreased libido, bruxism, mood changes, tremor, restlessness, agitation

dexmethylphenidate [focalin]: rare ADRs

CV events, aute MI, sudden cardiac death, stroke, tachycardia, increaed BP, growth retardation, priapism, psychosis or mania

dexmethylphenidate [focalin]: counseling

none

dexmethylphenidate [focalin]: alternatives

- lisdexamfetamine [vyvanse]

- methylphenidate [ritalin, concerta]

guanfacine: brand

[estulic, tenex]

guanfacine [estulic, tenex]: class

alpha-adrenergic agonist; antihypertensive

guanfacine [estulic, tenex]: indications

ADHD

guanfacine [estulic, tenex]: MOA

calms the brain and body to improve focus without stimulation; decreases sympathetic outflow

guanfacine [estulic, tenex]: contraindications

severe coronary insufficiency, recent MI, history of bradycardia, CV disease, heart block, hypotension, syncope, CV disease, chronic renal or hepatic impairment

guanfacine [estulic, tenex]: BBW

dizziness, drowsiness, headache, constipation, xerostomia, impotence, fatigue, insomnia, abdominal pain, decreased appetite

guanfacine [estulic, tenex]: common ADRs

CV effects: AV block, bradycardia, hypotension, orthostatic hypotension, sinoatrial nodal rhythm disorder, and syncope may occur, drowsiness, insomnia, sedated state, headache, anxiety, rebound hypertension

guanfacine [estulic, tenex]: rare ADRs

none

guanfacine [estulic, tenex]: counseling

none

carbamazepine: brand

[tegretol]

carbamazepine [tegretol]: class

sodium channel blocker/modulator

carbamazepine [tegretol]: indications

anti-epileptic

carbamazepine [tegretol]: MOA

hepatic enzyme inducers

carbamazepine [tegretol]: contraindications

hypersensitivity, history of bone marrow depression, co-tretment w/ MAOIs, nefazodone, other NNRTIs that are CYP3A4 substrates

carbamazepine [tegretol]: BBW

agranulotcytosis, aplastic anemia, dermatological rxns such as sjs/ten [especially in asians]

carbamazepine [tegretol]: common ADRs

CNS depression, dizziness, diplopia, blurred vision, nausea, ataxia, hyponatremia, elevated LFTs

carbamazepine [tegretol]: rare ADRs

see BBW

carbamazepine [tegretol]: counseling

see ADRs

carbamazepine [tegretol]: alternatives

- oxcarbazepine [trileptal]

- lacosamide [vimpat]

- lamotrigine [lamictal]

- phenytoin [dilantin]

oxcarbazepine [trileptal]: contraindications

hypersensitivity

oxcarbazepine [trileptal]: common ADRs

CNS depression, dizziness, diplopia, nausea, ataxia, hyponatremia, weight gain, alopecia

oxcarbazepine [trileptal]: rare ADRs

agranulocytosis, dermatological rxn

oxcarbazepine [trileptal]: counseling

see ADRs

lacosamide [vimpat]: contraindications

hypersensitivity to lacosamide

lacosamide [vimpat]: common ADRs

CNS depression, dizziness, headache, nausea, diplopia, ataxia

lacosamide [vimpat]: rare ADRs

cardiac arrhythmias, hypersensitivit rxns

lacosamide [vimpat]: counseling

see ADRs

lamotrigine [lamictal]: contraindications

hypersensitivity to lamotrigine

lamotrigine [lamictal]: BBW

serious skin reactions [including sjs]

lamotrigine [lamictal]: common ADRs

CNS depression, nausea

lamotrigine [lamictal]: rare ADRs

see BBW, blood dyscrasias

lamotrigine [lamictal]: counseling

see ADRs, call doc if any new rash/skin changes, concomitant use with divalproex increased lamotrigine lvls: increases risk of serious skin rxns

phenytoin [dilantin]: contraindications

hypersensitivity to phenytoin, sinus bradycardia, AV block

phenytoin [dilantin]: BBW

hypotension, arrhythmias w/ IV administration

phenytoin [dilantin]: common ADRs

gingival hyperplasia, bone marrow hypoplasia, osteoporosis, CNS depression, ataxia, nausea, vomiting, rash, headaches, hormonal dysfunction, vit. K, and folate deficiencies

phenytoin [dilantin]: rare ADRs

blood dyscrasias, hepatotoxicity, delayed hypersensitivity rxns, local inj. site reaction

phenytoin [dilantin]: counseling

see ADRs

divalproex: brand

[depakote]

divalproex [depakote]: class

GABA modulator

divalproex [depakote]: contraindications

hypersensitivity to divalproex, hepatic disease, urea cycle disorders

divalproex [depakote]: BBW

hepatotoxicity, patients with mitochondrial disease, teratogenicity, pancreatitis

divalproex [depakote]: common ADRs

CNS depression, nausea, tremor, irritability, weight gain, alopecia, hair texture changes, hormone changes

divalproex [depakote]: rare ADRs

see ADRs

phenobarbital: brand

[luminal]

phenobarbital [luminal]: class

GABA receptor agonist [barbiturate]