Drug Management and the Central Nervous System

Vocabulary flashcards covering CNS depressants, sedatives, hypnotics, antiepileptics, anti-Parkinson's agents, and psychotropics from the lecture notes.

Sedatives

CNS depressants that produce a diminished responsiveness to stimuli without producing sleep.

Hypnotics

CNS depressants that have a more intense depressant effect than sedatives and usually produce sleep.

Phenobarbitol

A barbiturate class CNS depressant that is not commonly used due to a high risk of dependence and toxicity, and is no longer recommended for sleep induction.

Benzodiazepines

CNS depressants such as diazepam (Valium), lorezapam (Ativan), and midazolam (Versed) that function as sedatives, hypnotics, or anxiolytics by potentiating or mimicking GABA.

Flumazenil (Romazicon)

The specific antidote used to reverse the effects of benzodiazepines.

Eszopiclone (Lunesta)

A non-benzodiazepine sleep aid approved for long term use.

Zolpidem (Ambien)

A non-benzodiazepine sleep aid associated with somnambulism (sleep walking) that should be taken $30\,\text{minutes}$ before bed and requires $6\text{-}8\,\text{hours}$ of sleep.

Suvorexant (Belsomra)

An orexin receptor antagonist with a $12\,\text{hour}$ half-life that can cause daytime somnolence and unconscious nighttime behaviors, with side effects being more common in females.

Cyclobenzaprine (Flexeril)

An exemplar muscle relaxant that acts centrally in the CNS with no antidote, indicated for muscle spasms, low back pain, chronic disorders, and malignant hyperthermia.

Seizure

A general term that describes abnormal electrical activity in the nerve cells in the brain.

Convulsion

A more severe seizure involving involuntary spasmodic contractions of any or all muscles throughout the body.

Epilepsy

A chronic condition characterized by recurrent seizures due to excessive neuronal discharge.

Phenytoin (Dilantin)

An antiepileptic drug administered IV/PO that requires monitoring therapeutic blood levels ($10\text{-}20\,mcg/mL$) and mixing IV doses with normal saline only.

Gingival Hyperplasia

An oral side effect involving overgrowth of gum tissue, associated with antiepileptic drug therapy such as phenytoin.

Parkinson's Disease Chemical Imbalance

A neurological condition in which dopamine levels are reduced and acetylcholine is relatively overactive in the brain.

Carbidopa-levodopa (Sinemet)

A dopamine replacement medication that increases dopamine levels in the brain; it is the most commonly used drug for Parkinson's disease and should be taken with food $30\,\text{minutes}$ before high protein meals.

Benztropine (Cogentin)

An anticholinergic agent used in Parkinson's disease that selectively blocks cholinergic receptors; patients must avoid excess exercise or heat due to the risk of hyperthermia.

Rasagiline (Azilect)

An MAO-B inhibitor that prevents dopamine breakdown in the brain, used as monotherapy in early Parkinson's disease and combination therapy in late disease.

Amitriptyline (Elavil)

An exemplar tricyclic antidepressant (TCA) that inhibits the re-uptake of both norepinephrine and serotonin; patients must avoid St. John's Wort due to additive effects.

Selegiline (Eldepryl)

An exemplar monoamine oxidase inhibitor (MAOI) that inhibits the enzyme breaking down norepinephrine, dopamine, and serotonin; requires avoiding tyramine-rich foods and OTC antihistamines to prevent a hypertensive crisis.

Fluoxetine (Prozac)

An exemplar selective serotonin reuptake inhibitor (SSRI) that slows serotonin reuptake into pre-synaptic terminals, requiring $4\text{-}6\,\text{weeks}$ to achieve therapeutic effects.

Duloxetine (Cymbalta)

An exemplar serotonin-norepinephrine reuptake inhibitor (SNRI) that slows the reuptake of both serotonin and norepinephrine.

Serotonin Syndrome

A dangerous potential reaction that can occur when 2nd generation antidepressants (SSRIs or SNRIs) are combined with MAOIs or other antidepressants.

Alprazolam (Xanax)

A benzodiazepine anxiolytic indicated for anxiety, insomnia, alcohol withdrawal, and seizures, which has addictive potential and must be used judiciously at the lowest effective dose.