BENZODIAZEPINES

§        They are anti-anxiety agents, sedative/hypnotics, anti-convulsants, and skeletal muscle relaxants.  Minor tranquilizers.

§        Action- depress CNS by potentiating GABA

§        Physiological effects- relief of anxiety, sedation

§        Side effects common for all benzodiazepines: dizziness, drowsiness, lethargy

§        Check BP/pulse/respirations before giving

§         They are anti-psychotics

§         Action-  They work by altering the effects of dopamine in the CNS. They also work on the norepinephrine receptors. Block dopamine receptor sites= Dopamine Antagonists

§         Physiological effects- relief of psychosis, relief of anxiety, (some) provide relief from N/V and intractable hiccoughs

§         Side effects common for all phenothiazines: agranulocytosis, photosensitivity, blurred vision, dry mouth, dry eyes, sedation, constipation, hypotension, Extra pyramidal symptoms-*EPS

§         Check BP/pulse/respirations before giving

§         They are anti-psychotics that are mainly used for schizophrenia

§         Action- block serotonin and dopamine

§         Physiological effects- relief of psychosis (with minimal or no EPS), relief of anxiety, relief of acute mania

§         They have fewer side effects (specifically the anti-cholinergic effects) than the phenothiazines & less neurological S/E (EPS)

§         Side effects common for all the atypical anti-psychotics: NMS, TD, dizziness, constipation, sedation, hypotension and weight gain

§         Check the BP/pulse/respirations before giving

¨      DRUGS USED TO COUNTERACT SIDE EFFECTS OF ANTI-PSYCHOTICS CAB

1.       benztropine mesylate (Cogentin)- anti-parkinson agent that reduces rigidity and tremors. It increases psychosis, increases GI upset, and increases orthostatic hypotension.

2.       trihexphenidyl (Artane)- anti-parkinson agent that works by inhibiting acetylcholine, it reduces rigidity and tremors.

3.       diphenhydramine (Benadryl)- allergy/cold/cough remedy, antihistamine. Relieves allergic symptoms.

§         Anti-depressant action

§         Action- inhibit reuptake of serotonin, inhibit reuptake of norepinephrine, potentiating the effects of serotonin and norepinephrine

§         Physiological effects- reduce depression, relief of severe pain, prevent panic attacks

§         Side effects common with all tricyclics: fatigue, sedation, blurred vision, dry eyes/mouth, *arrhythmias, hypotension, constipation, sexual dysfunction, wt. gain, CNS depressant esp. for elderly.

§         Monitor BP and pulse before giving

¨      MAO INHIBITORS (MONOAMINE OXIDASE INHIBITORS)MAOIs

§         Anti-depressant action

§         Action- increase NE and serotonin by inhibiting the enzyme (monoamine oxidase) that degrades them.  Allows dopamine, epinephrine, serotonin and norepinephrine to accumulate in the body- Increases Epi, NE, SE, DA (epi, norepinephrine, serotonin, dopamine)

§         Physiological effects- reduce depression, control anxiety

§         Side effects common to all MAO’s are: seizures, headache, insomnia and restlessness, weakness, blurred vision. > *HTN crisis esp. with Tyramine (Aged foods)             

§         High B.P. , Tachycardia, stiff neck

§       High B.P. , Tachycardia, stiff neck

¨      SSRI’s (SELECTIVE SEROTONIN REUPTAKE INHIBITORS)

¨      Action- inhibits reuptake of serotonin, increasing the activity of serotonin in the brain.- Anti depressant action

¨      Physiological effects- reduce depression, control anxiety, control obsessions

§         Common side effects with all SSRI’s are: dizziness/drowsiness, headache, insomnia, diarrhea, dry mouth, nausea, sweating and tremors, >sexual dysfunction.

§         Fewer anticholinergic  / CV side effects than TCAs

§         No special precautions/interactions before giving

§         Used to treat ADHD and narcolepsy

§         Work by producing CNS/respiratory stimulation with weak sympathomimetic activity

§         Side effects common to all CNS stimulants: hyperactivity, insomnia, restlessness, tremor, tachycardia, palpitations, anorexia and nausea.   Work by paradoxical effects.

§         Monitor BP/pulse/respirations before giving

¨      ATYPICAL/MISCELLANEOUS ANTIDEPRESSANTS

§         Side effects common to all of these are: dizziness, drowsiness, headache, dry mouth, constipation, nausea and hypotension

§         Monitor BP and pulse for Trazodone, Venlafaxine and Nefazodone

¨      Anti-Convulsants / Tranquilizers / Mood Stabilzers

§         Used to stabilize moods, decrease seizure activity, and decrease manic behavior

§         All these drugs work differently

§         Common side effects for these drugs are: drowsiness, ataxia, nausea/vomiting, anorexia

¨      OTHER MEDS (SUBSTANCE ABUSE) 

1.       Ondansetron (Zofran)- antiemetic, decreses nausea and vomiting after chemotherapy by blocking serotonin at the 5-HT3 receptor sites.

2.       Naloxone (Narcan)- opioid anti-dote that reverses CNS depression, respiratory depression that is caused by opioid overdose.

3.       LAAM (Lalpha acetylmethadol)

4.       Buprenorphine (Buprenex, Subutex)- used for heroine addiction and severe pain

5.       Disulfiram (Antabuse)- used for alcoholism

6.       Buprenorphine/Naloxone (Suboxone)- a mix of #2 and #4 that is used for opioid dependence

7.       Naltrexone (Revia)- used for alcoholism, opioid toxicity and dependence

8.       clomipramine (Anafranil)

9.       acamprosate (Campril)

¨      OTHER MEDS (GERONTOLOGY)

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1.       Tacrine (Cognex)- anti-alzheimer cholinergic that increases cognitive functioning in Alzheimer patients. Side effects are: bradycardia, dizziness and GI bleeding. Check HR before you give this

2.       Donepezil (Aricept)- anti-alzheimer cholinergic that decreases dementia by inhibiting acetylcholinesterase.

3.       Rivastigmine (Exelon)- anti-alzheimer cholinergic that decreases dementia

4.       Selegiline (Eldepryl)- anti-parkinson MAO type B inhibitor that increases response to levodopa/dopamine therapy in Parkinson’s disease.

5.       Galantamine (Reminyl)- anti-alzheimer cholinergic that treats mild to moderate dementia.

6.       memantine (Namenda)- Anti-Alzheimer’s agent.  Action- prevents binding of glutamate, an excitatory neurotransmitter.  Decreases symptoms of dementia.  Does not slow progression of Alzheimer’s.

¨     BENZODIAZEPINES Voluptuous Xena After Kissing Lips Ate Bread

1.       diazepam (Valium)- old prototype

2.       alprazolam (Xanax)- typical benzodiazepine

3.       lorazepam (Ativan)- new prototype, used the most

4.       clonazepam (Klonopin)- also used as an anticonvulsant

5.       chlordiazepoxide (Librium)- also used for substance abusers

*Other antianxiety drugs

1.       hydroxyzine (Atarax, Vistaril)- antihistamine, sedative

2.       buspirone (Buspar)- only non-addictive benzodiazepine. Works differently than the other benzodiazepines because it binds to seretonin and dopamine receptors.

v     PHENOTHIAZINES Treat PMS- Never Have Less Men

1.       chlorpromazine (Thorazine)- also used as an anti-emetic to help nausea/vomiting

2.       fluphenazine (Prolixin)- typical anti-psychotic

3.       thioridazine (Mellaril)- specifically used for schizophrenia

4.       trifluoperazine (Stelazine)- typical anti-psychotic

*Other antipsychotic drugs (work the same as the phenothiazines)

1.       thiothixine (Navane)- specifically used for schizophrenia

2.       haloperidol (Haldol)- also used for behavioral problems and Tourette’s

3.       lozapine (Loxitane)- specifically used for schizophrenia

4.       molindone (Moban)- specifically used for schizophrenia

·        Also need to know Prolixin Decanote and Haldol Decanote

¨      ATYPICAL ANTI-PSYCHOTICS Abi Can Read Zebra Stories Great

1.       aripiprazole (Abilify)- typical atypical anti-psychotic.  Also used in acute bipolar mania.

2.       clozapine (Clozaril)- typical atypical anti-psychotic

3.       risperidone (Risperdal)- not just for schizophrenia, this one has the most side effects

4.       olanzepine (Zyprexa)- also used for manic episodes in bipolar patients

5.       quetiapine (Seroquel)- typical atypical anti-psychotic.  Also used in acute bipolar mania.

6.       ziprasidone (Geodon)- typical atypical anti-psychotic.  Also used in acute bipolar mania.

¨     TRICYCLIC ANTI-DEPRESSANTS TEA Never Stops A

1.       imipramine (Tofranil)- also has anti-cholinergic properties

2.       amitriptyline (Elavil)- also has anti-cholinergic properties

3.       nortriptyline (Aventyl, Pamelor)- typical tricyclic

4.       desipramine (Norpramin)- typical tricyclic

5.       doxepin (Sinequan)- also anti-anxiety, and has anti-cholinergic properties

6.       clomipramine (Anafranil)- mainly used for OCD, can cause seizures.

¨      MAO INHIBITORS (MONOAMINE OXIDASE INHIBITORS)MAOIs

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1.       isocarboxacid (Marplan)- typical MAOI

2.       phenelzine (Nardil)- typical MAOI

3.       tranylcypromine (Parnate)- typical MAOI

4.       selegiline (Eldepryl)- also used in management of Parkinson’s Disease.

¨      SSRI’s (SELECTIVE SEROTONIN REUPTAKE INHIBITORS)

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1.       fluoxetine HCL (Prozac)- also used for OCD and bulimia

2.       sertraline (Zoloft)- also used for OCD, panic disorder, and PTSD

3.       paroxetine (Paxil)- also anti-anxiety, is also used for OCD, panic/social anxiety disorder and GAD.

4.       fluvoxamine (Luvox)- also an anti-obsessive agent. Mainly used for OCD

5.       escitalopram (Lexapro)- typical SSRI

6.       citalopram (Celexa)- typical SSRI

¨      CNS STIMULANTS After Ritalin Please Sleep V.

1.       Amphetamines (Adderal, Concerta)- very addictive

2.       Methylphenidate (Ritalin)- typical CNS stimulant

3.       Modafini (Provigil)-  AWAKE PIlLL-specifically used for narcolepsy

4.       Atomoxetine (Strattera)- specifically used for ADHD

5.       lisdexamfetamine dimesylsate (Vyvanse)

¨      ATYPICAL/MISCELLANEOUS ANTIDEPRESSANTS

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1.       trazodone (Desyrel)- treats anxiety and major depression by altering the effects of serotonin in the brain.  Inhibits reuptake of serotonin. 

2.       bupropion (Wellbutrin, Zyban)- treats depression, aid in smoking cessation, decreases symptoms of ADHD. Action- inhibits reuptake of dopamine, serotonin, and norepinephrine.

3.       venlafaxine (Effexor)- relieves depression and anxiety and treats GAD. Action- inhibits reuptake of serotonin and norepinephrine (like an SSRI). It also antagonizes the alpha-adrenergic receptors.

4.       mirtazapine (Remeron)- a tetracyclic that works by potentiating the effects of serotonin and norepinephrine.

5.       eboxetine (Vestra)- speeds up the withdrawal process from heroine

6.       nefazodone  (Serzone) -treats anxiety and major depression by altering the effects of serotonin in the brain.  Inhibits reuptake of serotonin. 

7.       duloxetine  (Cymbalta) - relieves depression and pain of neuropathy. Action- inhibits reuptake of serotonin and norepinephrine (like an SSRI). It also antagonizes the alpha-adrenergic receptors.

8.       ketamine

¨      Anti-Convulsants / Tranquilizers / Mood Stabilzers

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1.       Lithium Carbonate (Eskalith/Lithane)- anti-manic that alters cation transport in nerves and muscles. Influences the reuptake of neurotransmitters. ALWAYS CHECK LITHIUM LEVELS BEFORE GIVING! --- 1.0 - 1.5mEq/L

2.       Clonazepam (Klonopin)- see the benzodiazepines (page 1

3.       Carbamazepine (Tegreatol)- anticonvulsant that works by decreasing synaptic transmission in the CNS. ALWAYS CHECK BLOOD LEVELS BEFORE GIVING!

4.       Valproic Acid (Depakote, Depakene)- decreases manic behavior (also helps prevent migraines) by increasing levels of GABA

Check Blood Levels before giving!

                           5.   Gabapentin (Neurontin)- action of this is not known, but it is also an  

                                  analgesic adjunct

5.       Lamotrigine (Lamictal)- anti-convulsant that inhibits sodium transport which stabilizes neuronal membranes. CHECK FOR RASH

6.       Levetiracetam (Keppra)- used specifically for epilepsy by inhibiting burst firing of neurons

7.       Tiagabine (Gabatril)

8.       Zonisamide (Zonegram)

9.       Oxcarbazepine (Trileptal)