cns exam 3 drugs

topiramate

topamax, topamax sprinkle, trokendi XR, qudexy XR

topiramate class

anticonvulsant

topiramate uses

partial seizures, tonic/clonic seizures, migraine prophylaxis

topiramate MOA

blocks voltage-dependent sodium channels, augments GABA activity, antagonizes glutamate receptors, inhibits carbonic anhydrase

topiramate dose

200 mg PO BID ER: 400 mg PO QD

topiramate contraindications

avoid abrupt withdrawal

topiramate BBW

none

lamotrigine

lamictal, lamictal XR

lamotrigine class

anticonvulsant, anti-mania

lamotrigine uses

bipolar disorder, partial seizures

lamotrigine MOA

inhibits voltage-dependent sodium channels, decreasing presynaptic glutamate and aspartate release

lamotrigine dose

varies significantly

lamotrigine contraindications

avoid abrupt withdrawal

lamotrigine BBW

serious rashes requiring hospitalization may develop

gabapentin

neurontin, horizant

gabapentin class

anticonvulsant

gabapentin uses

partial seizures, neuralgia

gabapentin MOA

blocks voltage-dependent calcium channels, modulating excitatory neurotransmitter release

gabapentin dose

300-1200 mg PO TID

gabapentin contraindications

none

gabapentin BBW

none

morphine sulfate

kadian, morphabond ER, MS contin

morphine sulfate class

opioid agonist

morphine sulfate uses

pain, moderate to severe

morphine sulfate MOA

binds to various opioid receptors, producing analgesia and sedation

morphine sulfate dose

varies significantly

morphine sulfate contraindications

MAOi use, respiratory depression, asthma, GI obstruction, seizure disorder, head injury, alcohol use

morphine sulfate BBW

high abuse potential - may lead to dependency and respiratory depression may occur even at accepted dosing. adverse CV events and death reported on misuse.

oxycodone

oxycontin, roxicodone, xtampza ER

oxycodone class

opioid agonist

oxycodone uses

pain, moderate to severe

oxycodone MOA

binds to various opioid receptors, producing analgesia and sedation

oxycodone dose

individualized dosing

oxycodone contraindications

MAOi use, respiratory depression, asthma, GI obstruction, seizure disorder, head injury, alcohol use

oxycodone BBW

high addiction/misuse risk, opioid analgesic REMS, life-threatening respiratory depression can occur, concomitant use with BZDP

hydrocodone/acetaminophen

lortab, norco

hydrocodone/acetaminophen class

opioid combination, narcotic + non-narcotic

hydrocodone/acetaminophen uses

pain, moderate to severe

hydrocodone/acetaminophen MOA

binds to various opioid receptors (opioid agonist) + centrally acting non-opioid analgesic

hydrocodone/acetaminophen dose

2.5-10 mg hydrocodone PO q4-6 hrs prn

hydrocodone/acetaminophen contraindications

respiratory depression, asthma, GI obstruction

hydrocodone/acetaminophen BBW

avoid doses of APAP > 4000 mg per day (associated with cases of acute liver failure)

pregabalin

lyrica, lyrica CR

pregabalin class

anticonvulsant

pregabalin uses

neuropathic pain, partial seizures, adjunct, fibromyalgia

pregabalin MOA

binds to alpha 2-delta subunit of calcium channels, reducing neurotransmitter release

pregabalin dose

IR: 50-100 mg PO TID ER: 165-330 mg PO QD

pregabalin contraindications

renal disease

pregabalin BBW

none

amitriptyline

only generic tablets available (this is not right lmao)

amitriptyline class

tricyclic antidepressants (TCAs)

amitriptyline uses

depression, neuropathic pain, migraine headaches, fibromyalgia

amitriptyline MOA

inhibits norepinephrine and serotonin reuptake

amitriptyline dose

50-150 mg PO QHS

amitriptyline contraindications

MI recovery, avoid abrupt withdrawal

amitriptyline BBW

may cause suicidal thoughts in children and young adults

nortiptyline

pamelor

nortriptyline class

tricyclic antidepressants (TCAs)

nortriptyline uses

depression

nortriptyline MOA

inhibits norepinephrine and serotonin reuptake

nortriptyline dose

50-150 PO QHS

nortriptyline contraindications

brugada syndrome, acute MI, avoid abrupt withdrawal

nortriptyline BBW

may cause suicidal thoughts in children/adolescents- not approved for pediatric use

tramadol

conzip, qdolo (ultram but whatever)

tramadol class

opioid agonist

tramadol uses

pain, moderate to moderate-severe

tramadol MOA

binds to mu opioid receptors and weakly inhibits norepinephrine and serotonin reuptake, producing analgesia (central opioid agonist)

tramadol dose

50-100 mg PO Q4-6 hrs

tramadol contraindications

MAOi use, respiratory depression, asthma, GI obstruction, seizure disorder, head injury, alcohol use

tramadol BBW

high addiction/misuse risk, opioid analgesic REMS, life-threatening respiratory depression can occur, concomitant use with BZDP

cyclobenzaprine

amrix, fexmid (flexeril but whatever)

cyclobenzaprine class

muscle relaxant

cyclobenzaprine uses

muscle spasm, fibromyalgia

cyclobenzaprine MOA

potentiates norepinephrine and binds to serotonin receptors, reducing spasticity (centrally acting muscle relaxant)

cyclobenzaprine dose

5-10 mg PO TID ER: 15 mg QD

cyclobenzaprine contraindications

elderly patients, MI patients, hepatic patients, arrythmia, heart block, CHF, avoid abrupt withdrawal

cyclobenzaprine BBW

none