PHARM EXAM 4

MOA - TCA (antidepressant)

block reuptake of NE and serotonin into the nerves (2nd line)

Drugs - TCA (antidepressant)

Desipiramine, doxepin, clomipram

AE - TCA (antidepressant)

suicidal thoughts in youth

MOA - SSRI (antidepressant)

Block reuptake of serotonin in the nerves (1st line)

Uses for SSRIs

depression, OCD, panic disorder, PTSD, bulimenia

Drugs - SSRIs (antidepressant)

fluoxetine, sertraline, escitalopram

AE - SSRI (antidepressants)

taper w/d, serotonin syndrome, suicidal thoughts in youth

Common side effects of SSRIs (antidepressant)

weight gain, sexual dysfunction, CNS stimulations

MOA - SNRI (antidepressant)

block reuptake of NE and 5HT (1st line, more AE than SSRI)

Drugs - SNRI (antidepressant)

venlafaxine, desvenlafaxine, duloxetine

AE of SNRIs (antidepressant)

NO weight gain - suicidial thoughts in youth, seizures, hypotension, cardiotoxicity

MOA - MAOI (antidepressant)

block MAO, preventing breakdown of NE and 5HT (3rd line, life threatening side effects)

Drugs - MAOI (antidepressant)

phenelzine

AE - MAOI (antidepressant)

hypertensive crisis when used with NE releasing drugs (tachycardia, palpitations, MI, stroke)

Atypical antidepressant drugs

buproprion, mirtazepine

MOA bupropion (atypical antidepressant)

block reuptake of NE and DA

Use of buproprion

smoking cessation

MOA mirtazepine (atypical antidepressant)

causes release of NE and 5HT

AE of mirtazepine (atypical antidepressant)

drowsiness, weight gain

Stimulant classes

amphetamines, methylxanthines, misc

MOA - amphetamines

cause release of NE and DA, inhibit reuptake in CNS

Schedule of amphetamines

ll

Drugs - amphetamines

amphetamine, dextroamphetamine, methamphetamine, lisdexamphetamine

AE - amphetamines

cardiac stimulation and vasoconstriction

MOA of methylphenidate, dexymethylphenidate

same as Amphetamines; cause release of NE and DA, and inhibit reuptake in the CNS

AE of. methylphenidate and dexymethylphenidate

insomnia, decreased appetite, emotionally labile

Drugs - methylxanthines

caffeine

MOA - methylxanthines (caffeine)

increase cAMP & focus, decrease drowsiness, block adenosine receptors

AE - methylxanthines

nervousness, insomnia, tremors, dysrhythmias, risk of birth defects

Why is there a risk for birth defects for methylxanthines

crosses placenta, diuretic

What are methylxanthines used for in the hospital

neonatal apnea in newborns

MISC non-amphetamine stimulants

modafinil, armodafinil

MOA misc non-amphetamine stimulants

weaken inhibitors of DA reuptake, increasing DA levels

use of misc non-amphetamine stimulants

shift work disorder, obstructive sleep apnea

Modafinil vs armodafinil - which has a loger HL and is more expensive

armodafinil

AE - misc non-amphetamine stimulants

HA, N/V, decreased appetite, anxiety

Drugs - nonstimulants

Clonidine, guanfacine, amtomuxetine

Adrenergic agonist A2

clonidine, guanfacine (nonstimulants)

Approved for children and teens (nonstimulants)

clonidine, guanfacine

AE - clonidine and guanfacine

hypotensions, REBOUND hypertension if stopped abruptly

SNRI - nonstimulants

Atomuxetine

First NONstimulant approved for children and adults

atomuxetine

When is atomuxetine used?

When there is concern for stimulant abuse

MOA - 1st gen antipsychotics

block D2 dopamine receptors

Drugs - 1st gen antipsychotics

chlorpromazine, haloperidol

1st gen antipsychotic, low potency drug that increases sedation

chlorpromazine

1st gen antipsychotic drug, high potency that decreases sedation, increased extrapyramidal and prolongs QT

haloperidol

AE - 1st gen antipsychotic drugs

sedatino, metabolic effects, black block elderly dementia

Nemonic antipsychotic 2nd gen

A Crazy Old Remedy

MOA - antipsychotic 2nd gen

block D2 dopamine or serotonin receptors

Drugs - antipsychotic 2nd gen

Aripiprazole, clozapine, olanzapine, risperidone

this generation of antipsychotic drugs has less extrapyramidal effects but has greater metabolic effects

2nd gen

AE - antipsychotic 2nd gen

weight gain, sedation, orthohypo, black box elderly demetia

which antipsychotic 2nd gen drug may treat depression

aripipazole

what antipsychotic 2nd gen may cause fatal agranulocytosis

clozapine

Valbenzine - antipsychotic drug

first drug approved to treat TD (Tardive dyskinesia)

MOA - Barbiturates

Gaba receptor agonist with rapid onset, nonselective CNS effects

Drugs- Barbiturates

Thiopental

Barbiturates use

anesthesia (c-section), truth serum

AE - barbiturates

cardiac (increased BP), respiratory (decreased medullary respiratory centers)

MAO - benzodiazepines

Gaba receptor agonst, onset determined by lipid solubility

Drugs - benzos

Diazepam, alprazolam, midazolam, lorazepam

longest lasting benzo

diazepam

low use, diazepam

aniolytic

moderate use, diazepam

sedative

high use, diazepam

hypnotic

Use of alprazolam

anxiolytic

Midazolam use

PREOP anesthetic

Lorazepam use

anxiolytic used in patients with low liver function (not metabolized by liver)

What will increase levels of benzos

grapefruit

What treats benzo toxcitity

flumazenil

Benzo like drugs

Zolpidem, esZoplelone, Zaleplon

use of benzo like drugs

helps people fall asleep and stay asleep

Which type of sedative drugs are safe for pregnancy use

Benzo like drugs, non-gaba (BUSPIRONE ONLY)

Side effects of benzo like drugs

sleep walking, driving while asleep

Non-GABA drugs

Buspirone, Ramelton, Suvorexant

MOA - buspirone

serotonin receptor partial agonist

Use of buspirone

anxiolytic

MOA - ramelton

melatonin receptor agonist

use of ramelton

used for sleep, helps fall asleep faster

MOA - suvorexant

orexin receptor antagonist

use of suvorexant

promotes sleep by blocking wake signal

L-DOPA/Carbidopa MOA

supplies more L-Dopa to the brain to increase dopamine

What is the goal of antiparkinsons treatment

decrease dopamine, increase AcH

Food can decrease absorption in what drugs

L-DOPA/Carbidopa

AE L-DOPA/Carbidopa

N/V, orthohyp, dyskinesia, dark urine/sweat

1st line DA receptor agonists (antiparkinsons)

pramipexole, ropinirole

MOA of 1st line DA receptor agonists (pramiexole, ropinirole)

stimulate DA receptors directly *used with levodopa

AE 1st line DA receptor agonists (pramiexole, ropinirole

impulse control disorder

2nd line DA receptor agonists

Amantadin

2nd line DA receptor agonists (amantadine) MOA

stimulate release of DA, anticholinergic (block muscarinic receptors)

AE 2nd line DA receptor agonists (amantadin)

livedo reticularis

MAO-B inhibitors (antiparkinsons)

selegiline, rasagiline

MAO-B MOA

inhibit MAO-B, enter brain and prevent conversion of dopamine to inactive form

COMT inhibitors (antiparkinsons)

entacapone, tolcapone

COMT inhibtors (antiparkinsons) MOA

inhibits COMT, works in periphery and doesn’t cross BBB

Entacapone and tolcapone are only used with ?

levadopa, prevent wearing off

AE COMT inhibitors

colored urine

Centrally acting muscarinic (antiparkinson)

trihexyphenidyl, benztropine

What are centrally acting antimuscarinic drugs mainly used for

tremors