pharm pain + CNS

What is lorazepam (ativan)?

• Benzodiazepine (sedating)

  • Enhances GABA → CNS depression

• Used for acute anxiety, agitation, seizure control, pre-op sedation

What are some considerations for lorazepam (ativan)?

• Major risks:

  • Respiratory depression, oversedation

• In older adults:

  • Delirium, falls, paradoxical agitation

• Dependence & withdrawal possible

• Do not stop suddenly

What is alprazolam?

• Benzodiazepine (sedating)

  • CNS + respiratory depression

• Used for anxiety, panic attacks

• Fast onset = higher misuse/abuse

What are some considerations for alprazolam?

• CNS & respiratory depression possible with other sedatives

• Short-term use only

• Taper slowly

What is zolpidem?

• Non-benzodiazepine (hypnotic)

  • Promotes sleep via GABA receptors

• Used for short-term treatment of insomnia

What are some considerations for zolpidem?

• Risks:

  • Sleepwalking, sleep-driving, complex sleep behaviors

• Older adults:

  • Confusion, delirium, falls

• Take right before bed

• 7-8 hours sleep needed

What is morphine?

• Opioid

  • Severe pain management

• Respiratory depression risk

What are some considerations for morphine?

• Respiratory depression risk

• Hold if RR < 12

• Assess LOC & BP before administering

  • Avoid in hypotension

• Can cause constipation

What is naloxone?

• Opioid reversal agent

  • Reverse opioid overdose

• Given IV, IM, ID, SC

• Fast onset, short duration

What are some considerations for naloxone?

• Monitor respirations continuously

• May require repeat doses

What is fluoxetine?

• First-line SSRI

  • Increases serotonin in brain

• Used for depression, anxiety, OCD, PTSD, PMDD

• 4-6 weeks for full effect

What are some considerations for fluoxetine?

• Black box warning

  • Increased suicidal thoughts in young people

• Monitor for serotonin syndrome

  • Too much = medical emergency

• Taper drug

What is amitriptyline?

• TCA (tricyclic)

  • Older antidepressant

  • Strong sedation & anticholinergic effects

• Dangerous in overdose → cardiac toxicity

What are some considerations for amitriptyline?

• Adverse effects

  • Dry mouth, constipation, urinary retention, blurred vision

  • Anticholinergic 4 can’ts

• Orthostatic hypotension & fall risk

• Taper drug

What is phenelzine?

• Antidepressant

  • Raises norepinephrine, serotonin, dopamine

• Used when other antidepressants fail

What are some considerations for phenelzine?

• Many drug interactions

  • Avoid SSRIs, decongestants

• Requires tyramine-restricted diet

• Hypertensive crisis risk

What is lithium?

• Mood stabilizer

• Used for bipolar disorder

• Narrow therapeutic range

  • 0.6–1.2 mEq/L

What are some considerations for lithium?

• Signs of early toxicity

  • GI upset, tremor, confusion

• Require stable hydration + sodium intake

• Monitor

  • Lithium levels, kidney, thyroid function

What is haloperidol?

• Antipsychotic

  • Treats positive symptoms (hallucinations, delusions)

What are some considerations for haloperidol?

• High risk for EPS

  • Dystonia, akathisia, tardive dyskinesia

• Risk of neuroleptic malignant syndrome (NMS)

• Monitor QT prolongation

• Ongoing adherence critical

What is phenytoin?

• Anticonvulsant

  • Treats tonic-clonic seizures

What are some considerations for phenytoin?

• Narrow therapeutic range

• Signs of toxicity

  • Nystagmus, ataxia, slurred speech

• Causes gingival hyperplasia

• Never stop abruptly

What is lamotrigine?

• Anticonvulsant

  • Used for seizures, bipolar disorder, depression

What are some considerations for lamotrigine?

• Risk for stevens-johnson syndrome

  • Severe rash

• Titrate slowly

• Report any rash immediately

What is diazepam?

• Anticonvulsant

  • Used for acute seizures/status epilepticus

• Rapid onset

What are some considerations for diazepam?

• High risk for respiratory depression

• Use short-term only

What is levodopa/carbidopa?

• Neurologic/movement medication

  • Increases brain dopamine

What are some considerations for levodopa/carbidopa?

• Give on empty stomach

• Avoid high-protein/vitamin B6 meals

• Wearing-off effects

• Orthostatic hypotension risk

What is benztropine?

• Neurologic/movement medication

  • Anticholinergic for tremors/rigidity, EPS

What are some considerations for benztropine?

• Avoid overeating

• Caution in elderly

What is cyclobenzaprine?

• Short-term muscle spasm relief

• Strong sedating effect

What are some considerations for cyclobenzaprine?

• Strong sedating effect

• Fall risk

• Avoid alcohol/driving

What is baclofen?

• Muscle relaxant

  • Used for muscle spasticity control

• Sedation common

What are some considerations for baclofen?

• Sedation common

• Do not stop abruptly

• Monitor neurologic patients

What is propofol?

• Anesthetic

  • Rapid anesthesia/sedation

• Contraindicated in egg/soy allergy

What are some considerations for propofol?

• Hypotension & apnea risk

• Continuously monitor airway

• Do not use >24 hrs

• Green urine possible = organ damage

What is succinylcholine?

• Anesthetic

  • Rapid paralysis for intubation

What are some considerations for succinylcholine?

• Malignant hyperthermia risk

• Requires ventilator support

• Short duration only

What is sumatriptan?

• Migraine medication

  • Treats acute migraine

• Vasocontricts cranial blood vessels

What are some considerations for sumatriptan?

• Avoid in CAD/HTN

• Take at migraine onset