MT2 Medications

Memantine

Dementia

MOA: NMDA antagonist → Blocks excessive excitatory activity

Use: Dementia symptoms

SE: GI disturbances, headaches

Donepezil

Dementia

MOA: AChE inhibitor → Decrease ACh breakdown

Use: Dementia symptoms

SE: GI disturbances, headaches

Amitriptyline

Antidepressant, TCA

MOA: Non-specific NT reuptake blocker

Use: Depression

SE: Anti-cholinergic effects, sedation, weight gain, postural hypotension, etc. So many due to lack of specificity

Nortriptyline

Antidepressant, TCA

MOA: Non-specific NT reuptake blocker

Use: Depression

SE: Anti-cholinergic effects, sedation, weight gain, postural hypotension, etc. So many due to lack of specificity

Mirtazapine

Antidepressant, TECA

MOA: Non-specific NT reuptake blocker

Use: Depression

SE: Sedation

Fluoxetine

Antidepressant, SSRI

MOA: Blocks serotonin reuptake → Serotonin in cleft longer

Use: Depression

SE:

Early = Nausea, anxiety, agitation, insomnia

Late = Weight gain, weakness, sexual dysfunction, withdrawal syndrome

Sertraline

Antidepressant, SSRI

MOA: Blocks serotonin reuptake → Serotonin in cleft longer

Use: Depression

SE:

Early = Nausea, anxiety, agitation, insomnia

Late = Weight gain, weakness, sexual dysfunction, withdrawal syndrome

Paroxetine

Antidepressant, SSRI

MOA: Blocks serotonin reuptake → Serotonin in cleft longer

Use: Depression

SE:

Early = Nausea, anxiety, agitation, insomnia

Late = Weight gain, weakness, sexual dysfunction, withdrawal syndrome

Citalopram

Antidepressant, SSRI

MOA: Blocks serotonin reuptake → Serotonin in cleft longer

Use: Depression

SE:

Early = Nausea, anxiety, agitation, insomnia

Late = Weight gain, weakness, sexual dysfunction, withdrawal syndrome

Escitalopram

Antidepressant, SSRI

MOA: Blocks serotonin reuptake → Serotonin in cleft longer

Use: Depression

SE:

Early = Nausea, anxiety, agitation, insomnia

Late = Weight gain, weakness, sexual dysfunction, withdrawal syndrome

Venlafaxine

Antidepressant, SNRI

MOA: Blocks reuptake of serotonin and NorE

Use: Depression, anxiety, chronic nerve pain

SE: Dry mouth, insomnia, blurry vision, increase BP

Desvenlafaxine

Antidepressant, SNRI

MOA: Blocks reuptake of serotonin and NorE

Use: Depression, anxiety, chronic nerve pain

SE: Dry mouth, insomnia, blurry vision, increase BP

Duloxetine

Antidepressant, SNRI

MOA: Blocks reuptake of serotonin and NorE

Use: Depression, anxiety, chronic nerve pain

SE: Dry mouth, insomnia, blurry vision, increase BP, seizures

Buproprion

Antidepressant, NDRI

MOA: Block reuptake of dopamine and NorE

Use: Depression, smoking cessation

SE: Dry mouth, nausea, insomnia

Zyban

Antidepressant, NDRI

MOA: Block reuptake of dopamine and NorE

Use: Smoking cessation

SE: Dry mouth, nausea, insomnia

Tradazone

Antidepressant

MOA: 5-HT2a antagonist and 5-HT1a agonist

Use: Depression, insomnia

SE: Dry mouth, fatigue, sedation

Selegiline

Antidepressant, movement disorders

MOA: MAO-B inhibitor → Decreases dopamine metabolism

Use: Depression, Parkinson’s

SE: Nausea, headache, avoid using with medications that could contribute to serotonin syndrome

Haloperidol

Antipsychotic, 1st generation

MOA: Selectively blocks D2 receptors

Use: Mood disorders

SE: Dry mouth, extrapyramidal symptoms → tardive dyskinesia

Clozapine

Antipsychotic, 2nd generation

MOA: Blocks D2, 5-HT2a, alpha, muscarinic, and histamine receptors

Use: Mood disorders

SE: Seizures, agranulocytosis

Risperidone

Antipsychotic, 2nd generation

MOA: Blocks D2, 5-HT2, and NorE

Use: Positive and negative symptoms of mood disorders

SE: Sedation, elevated prolactin

Olanzapine

Antipsychotic, 2nd generation

MOA: Bocks D2, 5-HT2a, alpha, muscarinic, and histamine receptors

Use: Negative symptoms of mood disorders and antinausea (chemo)

SE: Weight gain, dry mouth

Ziprasidone

Antipsychotic, 2nd generation

MOA: Analog of risperidone, less weight gain

Use: Positive and negative symptoms of mood disorders

SE: Restlessness, drowsiness, rash, dizziness

Quetiapine

Antipsychotic, 2nd generation

MOA: Blocks D2, 5-HT2a, alpha, muscarinic, and histamine receptors

Use: Mood disorders

SE: Sedation, orthostatic hypotension

Aripirazole

Antipsychotic, 2nd generation

MOA: Partial dopamine agonist → Blocks excess dopamine in one area and will stimulate dopamine activity in another

Use: Schizophrenia

SE: N/V, constipation, dizziness

Lithium Carbonate

Antipsychotic

MOA: Exact unknown, may strengthen neuronal connection to regulate mood, thinking, and behavior. Decreases NorE release and increases 5-HT synthesis

Use: Bipolar disorder

SE: LOW therapeutic index

Carbamezepine

Anticonvulsant and antipsychotic

MOA: Na+ channel blocker → Inhibits AP, MOA for antipsychotic unknown

Use: Seizures, rapidly oscillating bipolar

SE: Rash, Steven Johns Syndrome, weight gain

Levadopa

Movement disorder

MOA: Converted into dopamine

Use: Parkinson’s

SE: Effects diminish after 2-5 years

Carbidopa

Movement disorder

MOA: Peripheral DOPA decarbocylase inhibitor → More conversion of L-DOPA in CNS

Use: Parkinson’s

SE: Dizziness, loss of appetite, N/V, trouble sleeping, effects diminish after 2-5 years

Pramipexole

Movement disorder

MOA: Dopamine agonist, acts directly on postsynaptic receptors

Use: Used before L-DOPA to delay SEs

SE: Not advised to use in patients of psychotic illness, nausea, dizziness

Ropinirole

Movement disorder

MOA: Dopamine agonist, acts directly on postsynaptic receptors

Use: Used before L-DOPA to delay SEs

SE: Not advised to use in patients of psychotic illness, nausea, dizziness

Amantadine

Movement disorder

MOA: Antiviral agent, NMDA antagonist

Use: Parkinson’s

SE: Muscle stiffness

Benztropine

Movement disorder

MOA: Muscarinic antagonist in basal ganglia → Improve tremors and stiffness

Use: Parkinson’s

SE: Restlessness, dry mouth, anti-muscarinic SEs

Tetrabenazine

Movement disorder

MOA: Keeps dopamine out of vesicles and antagonizes receptors

Use: Huntington’s

Diazepam

Anxiolytic, anticonvulsant

MOA: Longer acting, increases binding of GABA to GABAa receptors → More Cl- into neurons

Use: Anxiety and seizures

SE: Drowsiness, discontinued use can cause rebound anxiety and insomnia

Clonazepam

Anxiolytic, anticonvulsant

MOA: Longer acting, increases binding of GABA to GABAa receptors → More Cl- into neurons

Use: Anxiety and seizures

SE: Drowsiness, discontinued use can cause rebound anxiety and insomnia

Lorazepam

Anxiolytic

MOA: Medium acting, increases binding of GABA to GABAa receptors → More Cl- into neurons

Use: Anxiety and epileptics

SE: Drowsiness, discontinued use can cause rebound anxiety and insomnia

Temazepam

Anxiolytic

MOA: Medium acting, increases binding of GABA to GABAa receptors → More Cl- into neurons

Use: Anxiety and epileptics

SE: Drowsiness, discontinued use can cause rebound anxiety and insomnia

Alprazolam

Anxiolytic

MOA: Short acting, increases binding of GABA to GABAa receptors → More Cl- into neurons

Use: Anxiety and epileptics

SE: Drowsiness, discontinued use can cause rebound anxiety and insomnia

Flumazenil

Anxiolytic

MOA: Benzodiazepine antagonist, blocks electrophysical and behavior effects

Use: BZD OD and reversal of sedative effects

SE: May precipitate withdrawal

Buspirone

Anxiolytic, atypical

MOA: Partial 5-HT1a receptor agonist, takes about 3-4 weeks for effects

Use: Anxiety

SE: Dizziness, drowsiness, GI distress

Sympathetic blockers

Anxiolytic, atypical

MOA: Beta blockers and alpha2 agonists

Use: Anxiety

Eszopiclone

Hypnotic

MOA: Selective for GABA BZD site, high lipid solubility, half-life 6 hrs

Use: Insomnia

SE: Daytime sedation, GI upset

Zolpidem

Hypnotic

MOA: Increases GABA signaling, half-life 2 hrs

Use: Insomnia

SE: GI upset

Ramelteon

Hypnotic

MOA: Melatonin analog

Use: Insomnia

SE: Daytime sedation, GI upset

Phenytoin

Anticonvulsant

MOA: Na+ channel blocker → Inhibit AP

Use: Seizures

SE: CYP3A4 substrate → Can compete with other drugs for elimination

Lamotrigine

Anticonvulsant

MOA: Na+ channel blocker → Inhibit AP

Use: Seizures

SE: CYP3A4 substrate → Can compete with other drugs for elimination

Gabapentin

Anticonvulsant

MOA: Ca2+ channel blocker → NT release inhibited

Use: Seizures

SE: Dry mouth, drowsiness, blurry vision, weight gain, lack of concentration

Pregabalin

Anticonvulsant

MOA: Ca2+ channel blocker → NT release inhibited

Use: Seizures

SE: Dry mouth, drowsiness, blurry vision, weight gain, lack of concentration

Levetiracetam

Anticonvulsant

MOA: Ca2+ channel blocker and binds to SV2A to prevent vesicle fusion and glutamate release

Use: Seizures

SE: Behavioral changes

Phenobarbital

Anticonvulsant, barbituate

MOA: Increases GABA channel activity

Use: Seizures

SE: CNS depression

Tiagabine

Anticonvulsant

MOA: Inhibits GABA reuptake

Use: Seizures

SE: Neurotoxic effects

Valproic acid

Anticonvulsant

MOA: Increases GABA production and decreases its metabolism, Ca and Na channel inhibition

Use: Seizures

SE: Hepatotoxicity

Topiramate

Anticonvulsant

MOA: Inhibits Na, Ca, AMPA receptors and increases GABA receptor activity

Use: Seizures

SE: Neurotoxic effects

Ethosuximide

Anticonvulsant

MOA: Reduces Ca2+ threshold in neurons

Use: Absent seizures (DOC)

SE: N/V, decreased appetite, weight loss

Perampanel

Anticonvulsant

MOA: Non-competitive AMPA antagonist

Use: Seizures

SE: Psychiatric and behavior changes

Vigabatrin

Anticonvulsant

MOA: GABA transaminase inhibitor → Inhibits GABA degradation

Use: Seizures

SE: Vision loss

Zonisamide

Anticonvulsant

MOA: Targets everything at once

Use: Seizures

SE: Neurotoxic effects

Cannabidiol

Anticonvulsant

MOA: Reduces APs

Use: Seizures

SE: Lethargy, increase appetite, sleep disorders

Morphine

Opioid, natural (schedule II)

MOA: Binds to μ receptor → Block Ca channels → Decrease AP and control pain

Use: Pain Tx

SE: Respiratory depression, drowsiness, N/V, constipation, dizziness

Hydromorphone

Opioid, semi-synthetic

MOA: Binds to μ receptor → Block Ca channels → Decrease AP and control pain, derived from morphine

Use: Pain Tx

SE: Respiratory depression, drowsiness, N/V, constipation, dizziness

Hydrocodone/APAP

Opioid, semi-synthetic

MOA: Binds to μ receptor → Block Ca channels → Decrease AP and control pain, derived from codeine, combined with acetaminophen

Use: Pain Tx

SE: Respiratory depression, drowsiness, N/V, constipation, dizziness

Oxycodone

Opioid, semi-synthetic

MOA: Binds to μ receptor → Block Ca channels → Decrease AP and control pain

Use: Pain Tx

SE: Respiratory depression, drowsiness, N/V, constipation, dizziness

Oxycodone/APAP

Oxycodone + acetaminophen = Percocet

Fentanyl

Opioid, synthetic

MOA: Binds to μ receptor → Block Ca channels → Decrease AP and control pain,

Use: Pain Tx, most potent of all opioids

SE: Respiratory depression, drowsiness, N/V, constipation, dizziness

Meperidine

Opioid, synthetic

MOA: Binds to μ receptor → Block Ca channels → Decrease AP and control pain

Use: Pain Tx

SE: Respiratory depression, drowsiness, N/V, constipation, dizziness

Tramadol

Opioid

MOA: Weak μ agonist, blocks 5-HT and NorE

Use: Pain Tx, schedule IV

SE: Respiratory depression, drowsiness, N/V, constipation, dizziness

Buprenorphine

Opioid

MOA: Weak μ agonist, blocks 5-HT and NorE, can act as antagonist in presence of other opioids

Use: Pain Tx

SE: Respiratory depression, drowsiness, N/V, constipation, dizziness

Diphenoxylate

Opioid

MOA: Slows intestinal contractions

Use: Diarrhea

SE: Constipation

Loperamide

Opioid

MOA: Acts on μ receptors in large intestine

Use: Diarrhea

SE: Constipation

Dextromethorphan

Opioid

MOA: Decrease sensitivity of cough receptors

Use: Cold/flu

SE: Drowsiness, N/V, constipation

Codeine

Opioid

MOA: Decrease sensitivity of cough receptors, thins and loosens mucus

Use: Cold/flu

SE: Drowsiness, N/V, constipation

Narcan

Opioid antagonist

MOA: Binds and blocks opioid receptors

Use: Opioid OD

SE: Only treat in the moment OD, need withdrawal Tx

Isoflurane

General anesthetic

MOA: Increase GABA signaling, K+ conductance, and inhibit NMDA → Hyperpolarize neurons in CNS, lower B/G coefficient (less toxic and more potent, improvement on halothane)

Use: Anesthesia, inhaled

SE: Malignant hyperthermia, N/V, muscle spasms

Desflurane

General anesthetic

MOA: Increase GABA signaling, K+ conductance, and inhibit glutamate NMDA → Hyperpolarize neurons in CNS, more rapid acting than isoflurane, most common

Use: Anesthesia, inhaled

SE: Malignant hyperthermia, muscle spasms, pulmonary irritant (bronchospasm)

Halothane

General anesthetic

MOA: Increase GABA signaling, K+ conductance, and inhibit glutamate NMDA → Hyperpolarize neurons in CNS

Use: Anesthesia, inhaled

SE: Malignant hyperthermia, N/V, muscle spasms

Enflurane

General anesthetic

MOA: Increase GABA signaling, K+ conductance, and inhibit glutamate NMDA → Hyperpolarize neurons in CNS

Use: Anesthesia, inhaled

SE: Malignant hyperthermia, N/V, muscle spasms

Nitrous Oxide

General anesthetic

MOA: Increase GABA signaling, K+ conductance, and inhibit glutamate NMDA → Hyperpolarize neurons in CNS, low B/G coefficient and high MAC

Use: Anesthesia, inhaled, low potency so used in combination with other anesthetics

SE: Malignant hyperthermia, N/V, muscle spasms

Propofol

General anesthetic

MOA: Increases Cl- through GABAa receptors, most common

Use: Anesthesia, IV

SE: CNS depression

Thiopental

General anesthetic

MOA: Increases Cl- through GABAa receptors, fast acting (highly lipid soluble) and short duration

Use: Anesthesia, IV, barbituate

SE: Respiratory depression

Methohexital

General anesthetic

MOA: Increases Cl- through GABAa receptors, similar to thiopental but more potent, faster acting, shorter duration, and clears 3x faster

Use: Anesthesia, IV, barbiturate

SE: Respiratory depression

Midazolam

General anesthetic

MOA: Increases Cl- through GABAa receptors

Use: Anesthesia, IV, benzodiazepine

SE: CNS depression

Lorazepam

General anesthetic

MOA: Increases Cl- through GABAa receptors

Use: Anesthesia, IV, benzodiazepine

SE: CNS depression

Etomidate

General anesthetic

MOA: Increases Cl- through GABAa receptors, used for quick pain procedures

Use: Hypnotic (no true anesthetic effect), IV

SE: CNS depression

Ketamine

General anesthetic

MOA: NMDA antagonist, pt does not appear anesthetized

Use: Anesthesia, IV

SE: Distortions of reality

Lidocaine

Local anesthetic

MOA: Block Na+ channels → No APs

Use: Regional procedures, chronic pain

SE: Dizziness, bradycardia, hypotension

Bupivacaine

Local anesthetic

MOA: Block Na+ channels → No APs, slower onset but longer duration

Use: Regional procedures, chronic pain

SE: Cardiotoxic (binds Na+ strongly)

Tetracaine

Local anesthetic

MOA: Block Na+ channels → No APs

Use: Ocular anesthetic

SE: Cornea cell death