CNS Agents

What are the most common ADRs of psychotropic drugs

autonomic

What is the ANS

involuntary nervous system that modifys smooth muscle, glands, cardiac tissue, metabolism, etc.

What are the 2 aspects of the ANS

SNS and PSNS

How does the SNS activate

tends to discharge as a unit, producing a diffuse activation of target organs

How does the PSNS activate

can discretely activate specific target tissues

What is the autonomic effects on the pupil

SNS: dilation

PSNS: constriction

What is the autonomic effects on the blood vessels

SNS: VC

PSNS: VD

What is the autonomic effects on CO

SNS: increased

PSNS: decreased

What is the autonomic effects on HR

SNS: increased

PSNS: decreased

What is the autonomic effects on bronchioles

SNS: dilation

PSNS: contraction

What is the autonomic effects on RR

SNS: increased

PSNS: decreased

What is the autonomic effects on urination and defecation

SNS: decreased

PSNS: increased

What are examples of sympathetic stimulants

adrenergics, adrenergic agonists, and sympathomimetrics

What are examples of sympathetic blockers

antiadrenergics, adrenergic antagonists, sympatholytics

What are examples of parasympathetic stimulants

Cholinergics, cholinergic agonists, parasympathomimetics

What are examples of parasympathetic blockers

anticholinergics, cholinergic antagonists, parasympatholytics

What are the predictable ADRs for sympathetic stimulants/parasympathetic blockers

high blood pressure, urinary retention, constipation, perspiration, sexual problems, tremor, anxiety

What are the predictable ADRs for sympathetic blockers/parasympathetic stimulants

decreased CO, decreased BP, constriction of pupils, increased GI function, increased salvation, postural hypotension, decreased energy/motivation/performance

NTs of psychotropic pharmacology

serotonin, NE, DA, GABA

How does a MoA of altering the synthesis/storage/release of NT effect on NT concentration

increase or decrease

How does a MoA of blocking the reuptake of a NT effect on NT concentration

increase

How does a MoA of inhibiting the degradation of a NT effect on NT concentration

increase

How does a MoA of activating/blocking NT receptors effect on NT concentration

increase or decrease

Define sedative drugs

an agent that relieves anxiety and/or produced a calming effect

Define hypnotic drugs

an agent that promotes drowsiness and/or sleep

What kind of drugs does the sedative hypnotic drugs classify

anxiolytic (anti-anxiety), sedatives, sleeping pills, anticonvulsants

How do sedative hypnotic drugs work

they depress the CNS

sedative hypnotic drugs duration of action

varies widely (from a couple of hours to nearly 2 days)

examples from the anxiolytic drug group

Benzodiazepines, barbiturates, non-sedation anxiolytics, alchohol

Anxiolytic indications

relief of anxiety, adjunct to antidepressants for mood disorders, insomnia, muscle relaxation, seizures

MoA for benzodiazepines

facilitate and endurance the activity of GABA at various sites in the neuraxis

indications for anxiolytics

anxiety disorders, insomnia, muscle spasms, seizure disorders, spasticity

what are the side effects of benzos

impaired judgment, loss of self control, amnesia due to disinhibiting suppressed behavior and produce euphoria

What is the suffix common for benzos generic name

pam’s & Iam’s

What are the benzos on the top 200 list that have active metabolites

Diazepam, alprazolam, midazolam

brand name for diazepam

valium

brand name for alprazolam

xanax

brand name for midazolam

versed

What is the indication for diazepam

anxiety, muscle relaxation

What is the indication for alprazolam

anxiety, panic disorder

What is the indication for midazolam

very fast acting, anesthesia

What are the benzos on the top 200 list that do not have active metabolites

clonazepam, lorazepam

brand name for clonazepam

klonopin

brand name for lorazepam

ativan

indications for clonazepam

anxiety, seizures

indications for lorazepam

anxiety, seizures

ADRs for benzos

motor incoordination, dizziness, drowsiness, cognitive impairment, reduction of behavioral inhibitions, dependence/abuse, mild hypotension and respiratory depression

Why is it recommended not to drink while taking benzos and barbs

alcohol potentiates the ADRs

What is the memory tool for nonbenzodiazepines

z-drugs

What are the generic names for nonbenzos

zolpidem, zaleplon, eszopiclone

brand name for zolpidem

ambien

brand name for eszopiclone

lunesta

What are nonbenzos

they are drugs that are not structurally benzos, but act in a very similar manner

What is the indication for nonbenzos

insomnia (effective/non-groggy sleeping pill)

MoA for barbiturates

enhance the effects of GABA to depress the CNS

Why are benzos more commonly used over barbiturates

barbs are an NTI drug due to not having a ceiling effect like benzos. This makes it very easy to OD

Due to having no ceiling effect, what are barbs used for

in mixture for chemical homicide/death sentence

What is the memory tool for barbiturates

barb

How are barbs classified

based on duration of action

What is the generic name for long acting barbs

phenobarbital

indication for phenobarbital

seizures

What is the generic name for intermediate acting barbs

amobarbital

What is the generic name for short acting barbs

pentobarbital and secobarbital

indication for amobarbital

“truth serum”

indication for pentobarbital

pre-op sedation/anesthesia or insomnia

indication for secobarbital

pre-op sedation/anesthesia or insomnia

Barb ADRs

motor incoordination, dizziness, drowsiness, cognitive impairments, reduction of behavioral inhibitions, dependence/abuse, significant respiratory depression

Generic name for non-sedating anxiolytics

buspirone

MoA of non-sedating anxiolytics

partail antagonist at serotonin (1A) receptors

indications for non-sedative anxiolytics

relieves anxiety without euphoria

differences between non-sedating anxiolytics in comparison to benzos/barbs

no euphoria = decreased dependency issues

less CNS depression

What is the most widely used (and abused) sedative hypnotic drug

alcohol

What are some symptoms to watch for during PT with sed/hypos

decreased alertness, motor control dysfunction, weakness, increased response time, altered central processing, impaired functional ability, amnesia

What is the biogenic amine hypothesis

mood disorders result from abnormalities in 5-HT, NE, and/or DA transmission

What is the goal of antidepressant drugs

to increase 5-HT, NE, and/or DA neurotransmission

What are the 4 groups of antidepressants

tricyclic antidepressants (TCAs)

SSRIs

MAOIs

misc. (newer) agents

What NTs do TCAs adjust

NE and 5-HT

What NTs do SSRIs adjust

5-HT

What NTs do MAOIs adjust

NE and 5-HT

What NTs do misc. agents adjust

NE and DA

MoA for TCAs

inhibition of NE and 5-HT reuptake mechanisms (sympathetic stimulant)

clinical indications for TCAs

depression (with or without organic disease) and Bipolar

How is TCA a dirty drug

poor receptor selectivity = lots of ADRs

ADRs for TCA

sedation, orthostatic hypotension, arrythmias, fatal in overdose, myoclonic twitches, tremor

Generic names for TCAs

amitriptyline, desipramine, impramine, nortiptyline

brand name for amitriptyline

elavil

MoA for SSRIs

block the reuptake of 5-HT without affecting reuptake of any other amine NTs

What are the pros and cons of SSRIs

pros: very well tolerated and fewer ADRs

cons: sleep disturbances and/or sexual dysfunction

generic names for SSRIs

citalopram, escitalopram, fluoxetine, paroxetine, sertraline

clinical indications for SSRIs

depression, OCD, panic disorder, PTSD, PMDD, and social anxiety disorder

brand name for citalopram

celexa

brand name for escitalopram

lexapro

brand name for fluoxetine

prozac

brand name for paroxetine

paxil

brand name for setraline

zoloft

MoA for MAOIs

prevent metabolic breakdown of monoamines (NE, 5-HT, and some DA)

Who typically prescribes MAOIs and why

psychiatrists in refractory cases of depression due to its many, many drug/drug interactions

example of misc agents

bupropion, venlafaxine, duloxetine, trazodone

brand name for bupropion

welllbutrin or zyban

MoA of bupropion

NE and DA reuptake inhibitor