Term
| Diphenhydramine (Benadryl or Unisom) |
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Definition
| First generation Antihistamine with a high degree of muscarinic blocking activity (useful for allergy prevention), sedation, and antimotion sickness effects. Can be used in Parkinson's disease to decrease the effects of aCh and improve the symptoms of this disease. First generation antihistamines present a fall risk in the elderly, and are thus long term use is contraindicated in this population (STOPP criteria). |
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Term
| Hydroxyzine (Atarax or Vistaril) |
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Definition
| First generation antihistamine primarily used to treat itching, allergies, hyperalgesia, motion sickness, and insomnia. Should be used with EXTREME caution upon administration with depressants as it can exacerbate the effects of these drugs. First generation antihistamines present a fall risk in the elderly, and are thus long term use is contraindicated in this population (STOPP criteria). |
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Term
| Scopolamine (Transderm Scop) |
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Definition
| Antimuscarinic drug used in motion sickness. Can cause sedation and short term memory block (anterograde amnesia) |
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Term
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Definition
| Antimuscarinic drug used to relieve urinary and bladder difficulties primarily. Decreases smooth muscle spasms of the bladder. Selective for M1 and M3 receptors, but this selectivity largely applies to the parotid gland, not the bladder. Contraindicated in the elderly who have dementia or prostatism (STOPP criteria) |
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Term
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Definition
| Antimuscarinic drug used to relieve urinary and bladder difficulties primarily. Decreases smooth muscle spasms of the bladder. Targets all of the muscarinic receptors, however it is highly effective for the bladder and thus lower doses are required to relieve detrusor overactivity. Contraindicated in the elderly who have dementia or prostatism (STOPP criteria) |
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Term
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Definition
| Antimuscarinic drug selective for M3 receptors, decreasing the urge to urinate. This selectivity has not been proven to be more effective than other antimuscarinics used for this purpose. (M1=glands, M2=SA and AV nodes, M3=smooth muscle and blood vessels). Contraindicated in the elderly who have dementia or prostatism (STOPP criteria) |
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Term
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Definition
| Antihistamine used primarily as an antiemetic. HIGHLY effective in this regard. It is also not as sedative as other drugs in the same class. Antagonist at H1 receptors. |
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Term
| Dimenhydrinate (Dramamine) |
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Definition
| Antihistamine (blocks H1 mainly, as well as having an antimuscarinic effect on the CNS causing sedation) that is very useful in treating nausea, vomiting, and dizziness. May cause profound drowsiness and has largely been replaced by meclizine clinically. Produces effects slower than that of diphenhydramine and is less potent. |
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Term
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Definition
| SSRI antidepressant with similar efficacy to TCAs without many of the side effects. Toxicity=serotonin syndrome (increased HR, shivering, sweating, dilated pupils, myoclonus, hyperthermia, and can even cause renal failure and DIC). Can increase levels of benzos due to p450 inhibition. |
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Term
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Definition
| opioid agonist used to treat diarrhea. Often combined with atropine to prevent abuse. Contraindicated in the elderly when used to treat infective gastroenteritis (bloody diarrhea, high fever, severe systemic toxicity) as well as those who are prone to falling. |
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Term
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Definition
| Tricyclic antidepressant which nonspecifically blocks serotonin and NE re-uptake. Side effects are muscarinic activity and alpha blockade. Toxicity is the 3Cs (coma, convulsions, and cardiotoxicity). Can cause hypertensive crisis when combined with MAOs and serotonin syndrome with SSRIs, MAOs, or meperidine. According to STOPP criteria, TCAs are contraindicated in the elderly who have dementia, cardiac conductive abnormalities, constipation, and prostatism or a history of urinary retention. |
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Term
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Definition
| first generation antihistamine. Indicated as a sedative. Has some alpha blocking effects as well as local anesthetic action. First generation antihistamines present a fall risk in the elderly, and are thus long term use is contraindicated in this population (STOPP criteria). |
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Term
| Prochlorperazine (Compazine) |
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Definition
| Dopamine (D2) receptor antagonist. This receptor is Gi coupled, decreasing intracellular cAMP. Therefore, this drug would increase intracellular cAMP levels. This is useful in the treatment of vertigo because D2 receptors are found in the chemoreceptor trigger zone (CTZ), thus preventing emesis. This is a highly potent typical antipsychotic, and can cause tardive dyskinesia. Can also cause neuroleptic malignant snydrome (NMS). |
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Term
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Definition
| Dopamine (D2) receptor antagonist and 5-HT3 rceptor antagonist/5-HT4 agonist. This drug is contraindicated in pheochromocytoma and should be used with caution in Parkinson's disease as its dopamine antagonism may worsen symptoms. This may also worsen the mental state of patients with clinical depression. The gastroprokinetic effects of this medication make it contraindicated with a suspected bowel obstruction. |
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Term
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Definition
| 5-HT3 receptor antagonist used mainly as an antiemetic often following chemotherapy. Not effective in avoiding motion sickness. Serotonin receptors are found in the terminals of the vagus nerve and brain, thus decreasing the activity of the vagus can avoid emesis by stopping the activation of serotonin receptors in the CTZ. |
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Term
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Definition
| Nonbenzodiazepine that acts as an agonist of the BZ1 binding site of the GABAa complex. Because of its lower effects on BZ2, it has less effects on cognitive function. In the case of overdose, flumazenil can be used to reverse its effects (benzodiazepine antagonist). Has less abuse liability and less tolerance than benzos. Can be dangerous in the elderly as a fall risk especially when used long term (fall risk; STOPP criteria) |
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Term
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Definition
| Bronchodilator via the inhibition of phosphodiesterase (PDE) which causes an increase in cAMP. Also antagonizes the bronchoconstricting action of adenosine. Has a narrow therapeutic window and has many drug interactions (increased toxicity with erthromycin, cimetidine, and fluoroquinolones). Contraindicated as a monotherapy in the elderly (STOPP criteria). |
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