Neuro Pharmacology: Remember!!!
- Barbiturates INDUCE lipid soluble drugs metabolism, meaning, its effect last less than normal. Example of lipid soluble drugs: Oral Contraceptives (OCP), warfarin, phenytoin, carbamazepine.
- OCP DECREASES BZD metabolism.
- Anticonvulsants DECREASES OCP efficacy, bc of Cyt p450 induction, eg: Phenytoin, Carbamazepine, Phenobarbital.
- Women & Anticonvulsants: if pt wants to get pregnant, change to Phenobarbital (safest bc >protein bound); if pt don’t wanna get pregnant and is taking OCP, change to Valproic Acid (bc is a Cyt p450 inhibitor!)
- Avoid abrupt withdrawal of Anticonvulsants bc it can precipitate seizures and increases risk of status epilepticus!!!
- Carbamazepine SE: increased ADH secretion & Steven Johnson Sd.
- Phenytoin SE:
- Valproic Acid SE:
- Valproic Acid & Ethosuximide: abscense seizures.
- Atracurium, Mivacurium: drugs used in anesthesia as muscle relaxants, Nicotinic Antagonists, non depolarizing competitive drugs.
- Laudanosine is a metabolite of Atracurium (spontaneous inactivation) crosses BBB and can cause seizures.
- Halothene SE: malignant hyperthermia, hepatitis, <3 arrythmias
- Ketamine: dissociative anesthesia (pt is aware of pain, but gives zero fucks about it) stimulates CV function (good for elders with <3 problems)
- Ketamine SE: vivid nightmares, increase ICP
- Succynilcholine SE: Malginant hyperthermia, hyperkalemia, atypical pseudocholinesterase.
- Dantrolene: tx for malignant hyperthermia, Neuroleptic Malignant Sd (NMS)
- Opioid Acute Toxicity Classic Triad: CPR, Coma, Pinpoint pupils, Respiratory Depression
- Meperidine: is also antimuscarinic, pt won’t have miosis!!!!! (pt will also be tachycardic, no GI, GU gallblader spasm) Metabolized to Normeperidine (serotonin reuptake inhibitor, caution with Serotonin sd)
- NEVER GIVE O2 WHEN GIVING OPIATES -UNLESS YOUR PT IS MECHANICALLY VENTILATED- BC YOU TAKE AWAY THE HYPOXIC DRIVE (that thing that tells the body: “hey dude, you gotta breathe more cause your O2 is falling”) AND SINCE PTS TAKING OPIATES HAVE A DECREASE RESPONSE TO ↑PCO2, YOU’LL LEAVE PT WITH NOTHING
- When giving opiates as a long-term tx, it can cuase norepinephrine levels to decrease. As a response, the body makes more alpha1 & beta1 receptors. When long-term tx is stopped, a massive sympathetic response can happen, so, to prevent that, give clonidine (alpha2 agonist) that will decrease NE and cancel the sympathetic response.
- Methylnaltrexone: for opioid induced contispation (cancer pts)
Parkinson Disease Drugs
- Amantadine SE: livedo reticularis
- Thioridazine: cardiotoxicity (torsades), retinitis pigmentosa, ↓↓↓EPS
- Droperidol: NMS, Tardive Dyskinesia
- Fluphenazine: long acting injection (given e/ 2-3w), EPS.
- Haloperidol: NMS, Tardive Dyskinesia, torsades
- Chlorpromazine: NMS, corneal pigmentation, EPS
- Loxapine: last to be given, antagonist D1 to D2
- Tx for NMS: Bromocriptine, Dantrolene, Pergolide
- Clozapine: AGRANULOCYTOSIS (weekly WBC), increased salivation (wet pillow syndrome)
- Quetiapine: QT prolongation, drug monitoring
- Ziprasidone: elders w/ dementia increased mortality, IM
- Risperidone: Insomnia, PRL↑
- Aripiprazole: partial agonist D2 & 5HT1, antagonist 5HT-2, adjunct tx for depression, akathisia
- MAO inhibitors SE: tx w/ Phentolamine (alpha1 antagonist) or Chlorpromazine (antipsychotic)
- SSRI SE: anorgasmia :(, bruxism, weight loss
- Bupropion: DA reuptake inhibitor, associated w/ seizures, mimics drug addiction chemestry, bc increases DA in mesolimbic system.
- Varenidine: partial Nicotinic receptor agonist (Mnemonic: “Vane & Nadine are trying to quit smoking”)
- Both drugs are used in smoking cessation
oh dear God! you are awful but I miss you so much
- SNRI: Venlafaxine (no ANS side effects, bc is a nonselective 5HT, NE reuptake blocker), Desvenlafaxine, Duloxetine.
- Lithium: prevents recycling of inositol (decrease PIP2) and decrease cAMP; SE..
Tx NDI with amiloride, triamterene (don’t give thiazides, it decreases Li clearance)
- Never give Lithium to a pregnant women!!!!! If BD, change to Gabapentin & Clonazepam
- Methylphenidate: amphetamine-like
- Atomoxetine: NE reuptake inhibitor
- Do not stop this drugs abruptly! Withdrawal causes severe depression & suicide ideas