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Chapter 12
Pharmacology of GABAergic and Glutamatergic Neurotransmission
30
Pharmacology
Professional
03/29/2012

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Term
Tiagabine
Definition
Mech: Enhances GABA by blocking re-uptake into presynaptic neurons; INHIBITS GAT-1
APP: Focal tonic-clonic seizures (adjunct)
AE: Unexplained sudden death, psychosis, depression, sedation
Term
Vigabatrin
Definition
Mech: Blocks GABA Conversion (BLOCKS GABA TRANSAMINASE) and increases intracellular GABA and increased secretion of GABA into the synaptic cleft
APP: Focal tonic-clonis seizures (adjunct)
AE: Retinal Atrophy, angioedema
Term
Muscimol
Definition
Mech: Activates GABA receptor
APP: USED ONLY IN EXPERIMENTS
TC: derived from hallucinogenic Amanita Muscara mushrooms
Term
Gaboxadol
Definition
Mech: Activates GABA receptor
Investigational agent for treatment of insomnia
Term
Bicuculline and Gabazine
Definition
Mech: Competitive Antagonist of GABA receptor
APP: EXPERIMENTAL use only
TC: Produce epileptic convulsions
Term
Picrotoxin
Definition
Mech: Non-competitive Antagonist of GABA receptor
APP: EXPERIMENTAL use only
TC: Produce epileptic convulsions
Term
Clorazepate (short acting) and Chlordiazepoxide (long lasting)
Definition
Mech:Weak allosteric agonist of the GABA receptor (INCREASE THE FREQUENCY OF RECEPTOR OPENING)
APP: ALCOHOL WITHDRAWAL and ANXIETY
AE: RESPIRATORY DISTRESS, AGITATION, apnea desaturation in pediatric patients
Term
Midazolam (short acting)
Definition
Mech:Weak allosteric agonist of the GABA receptor (INCREASE THE FREQUENCY OF RECEPTOR OPENING)
APP: Focal and tonic-clonic seizures, Status epilepticus, and Amnesia induction
AE: RESPIRATORY DISTRESS, AGITATION, apnea desaturation in pediatric patients
Term
Short acting Benzodiazepine
Definition
Clorazepate, Midazolam, Triazolam, Zolpidem
Term
Zolpidem (slow), Estazolam and Temazepam (intermediate), and Flurazepam and Quazepam (long lasting)
Definition
Mech:Weak allosteric agonist of the GABA receptor (INCREASE THE FREQUENCY OF RECEPTOR OPENING
APP: Insomnia
AE: RESPIRATORY DISTRESS, AGITATION, apnea desaturation in pediatric patients
Term
Intermediate acting Benzodiazepine
Definition
Alprazolam, Estazolam, Lorazepam, Temazapam
Term
Alprazolam (Intermediate acting)
Definition
Mech: Weak allosteric agonist of the GABA receptor (INCREASE THE FREQUENCY OF RECEPTOR OPENING)
APP: Anxiety
AE: RESPIRATORY DISTRESS, AGITATION, apnea desaturation in pediatric patients
Contra: Glaucomas
TC: Decreased levels when used with Carbamazepine and phenobarbital
TC: Patients with impaired hepatic function may experience prolonged effects
Term
Lorazelam (Intermediate acting)
Definition
APP: Focal tonic-clonic seizures, STATUS EPILEPTICUS, Amnesia induction, Anxiety, INSOMNIA
Mech: Weak allosteric agonist of the GABA receptor (INCREASE THE FREQUENCY OF RECEPTOR OPENING)
AE: RESPIRATORY DISTRESS, AGITATION, apnea desaturation in pediatric patients
Contra: Glaucomas
TC: Decreased levels when used with Carbamazepine and phenobarbital
TC: Patients with impaired hepatic function may experience prolonged effects
Term
Clonazepam (long lasting)
Definition
APP: Absence seizures, Anxiety,
Mech: Weak allosteric agonist of the GABA receptor (INCREASE THE FREQUENCY OF RECEPTOR OPENING)
AE: RESPIRATORY DISTRESS, AGITATION, apnea desaturation in pediatric patients
Contra: Glaucomas
TC: Decreased levels when used with Carbamazepine and phenobarbital
TC: Patients with impaired hepatic function may experience prolonged effects
Term
Diazepam (long lasting)
Definition
APP: Focal clonic-tonic seizures, Amnesia induction, Anxiety, Alcohol withdrawal
Mech: Weak allosteric agonist of the GABA receptor (INCREASE THE FREQUENCY OF RECEPTOR OPENING)
AE: RESPIRATORY DISTRESS, AGITATION, apnea desaturation in pediatric patients
Contra: Glaucomas
TC: Decreased levels when used with Carbamazepine and phenobarbital
TC: Patients with impaired hepatic function may experience prolonged effects
Term
Flumazenil
Definition
Mech: Benzodiazepine antagonist
APP: Reverse effects of benzodiazepines
AE: Seizure, cardiac arrhythmias, and diaphoresis
CI: Trycyclic antidepressant overdose
CI: intracranial hypertension
TC: If patient is addicted to benzodiazepines then the drug can induce a severe withdrawal syndrome
Term
Methohexital and Thiopental
Definition
Mech: At high levels acts as a GABA receptor agonist
APP: Induction and maintenance of anesthesia
AE: SJ syndrome, bone marrow suppression, hepatotoxicity, osteopenia
CI: Porphyria, Severe liver dysfunction, respiratory disease
TC: Metabolism increased with P450 activators (thiopental)
Term
Pentobarbital
Definition
Mech: At high levels acts as a GABA receptor agonist
APP: Induction and maintenance of anesthesia, Insomnia, Status epileptics
AE: SJ syndrome, bone marrow suppression, hepatotoxicity, osteopenia
CI: Porphyria, Severe liver dysfunction, respiratory disease
TC: Metabolism increased with P450 activators (thiopental)
Term
Thiopental
Definition
Mech: At high levels acts as a GABA receptor agonist
APP: Induction and maintenance of anesthesia, Insomnia, and INCREASED INTRACRANIAL PRESSURE
AE: SJ syndrome, bone marrow suppression, hepatotoxicity, osteopenia
CI: Porphyria, Severe liver dysfunction, respiratory disease
TC: Metabolism increased with P450 activators (thiopental)
Term
Secobarbital
Definition
Mech: At high levels acts as a GABA receptor agonist
APP: Insomnia
AE: SJ syndrome, bone marrow suppression, hepatotoxicity, osteopenia
CI: Porphyria, Severe liver dysfunction, respiratory disease
TC: Metabolism increased with P450 activators (thiopental)
Term
Amobarbital
Definition
Mech: At high levels acts as a GABA receptor agonist
APP: Status epilepticus, Insomnia
AE: SJ syndrome, bone marrow suppression, hepatotoxicity, osteopenia
CI: Porphyria, Severe liver dysfunction, respiratory disease
TC: Metabolism increased with P450 activators (thiopental)
Term
Phenobarbital
Definition
Mech: At high levels acts as a GABA receptor agonist
APP: Refractory epilepsy (especially tonic-clonic seizures), Insomnia
AE: SJ syndrome, bone marrow suppression, hepatotoxicity, osteopenia
CI: Porphyria, Severe liver dysfunction, respiratory disease
TC: Metabolism increased with P450 activators (thiopental)
TC: Undergoes both renal and hepatic clearance
Term
Etomidate
Definition
Mech: modulation of ion channels in GABA
APP: Induction of anesthesia
AE: Cardiovascular and respiratory depression
TC: Mild cardiopulmonary depression
Term
Propofol
Definition
Mech: modulation of ion channels in GABA
APP: Induction and maintenance of anesthesia
AE: Cardiovascular and respiratory depression
TC: Mild cardiopulmonary depression
TC: USEFUL IN SHORT DAY-SURGERY
Term
Baclofen
Definition
Mech: GABA receptor agonist
APP: Spasticity
AE: Coma, seizures, constipation, and death after abrupt withdrawal
Term
Riluzole
Definition
Mech: NMDA receptor antagonist and black voltage-gated sodium channels
APP: ALS
AE: Neutropenia, cardiac arrest, hepatotoxicity, and respiratory depression
TC: Prolongs survival and decreases progression
Term
Memantine
Definition
Mech: NMDA receptor antagonist
APP: Alzheimer's Disease
AE: Hypertension, constipation, dizziness, and headache
TC: Slows progression
Term
Amantadine
Definition
Mech: NMDA receptor antagonist
APP: Parkinson's and Influenze A prophylaxis and infection
AE: Neuroleptic malignant syndrome, suicidal ideation, orthostatic hypotension, insomnia, and hallucinations
Term
Lamotrigine
Definition
Mech: NMDA receptor antagonist and black voltage-gated sodium channels
APP: Focal tonic-clonic seizures, atypical absence seizures, and Bipolar 1 disorders
AE: SJ syndrome, toxic epidermal necrolysis, bone marrow suppression, amnesia, and angioedema
TC: BLOCKS VOLTAGE GATED SODIUM CHANNELS (REDUCING CONDUCTANCE), 3rd DRUG OF CHOICE FOR ABSENCE SEIZURES
Term
Felbamate
Definition
Mech: NMDA receptor antagonist and black voltage-gated sodium channels
APP: Refractory epilepsy (especially focal tonic-clonic seizures)
AE: SJ syndrome, aplastic anemia, bone marrow suppression, hepatic necrosis, amnesia, and angioedema
TC: BLOCKS VOLTAGE GATED SODIUM CHANNELS (REDUCING CONDUCTANCE)
TC: Lacks the behavioral changes of other NMDA antagonists
TC: LIMITED TO PATIENTS WITH EXTREMELY REFRACTORY EPILEPSY
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