Neurologic Agents Flashcards

Question

# What is the common brand name(s) for: duloxetine | (doo-LOX-e-teen)

Answer 1

Cymbalta | Class: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) ## Footnote **Indication:** Depression; generalized anxiety disorder; chronic pain **MOA:** Inhibits reuptake of norepinephrine and serotonin, and dopamine. **Side effects:** anxiety; nausea; weight changes; sexual dysfunction **Contraindications:** Within 14 days or concurrent use of an MAO inhibitor **Considerations:** * Higher withdrawal symptoms risk. * Avoid in pregnancy and breastfeeding unless essential. * Reduce dose in hepatic impairment.

Answer 2

Lexapro | Class: Selective serotonin reuptake inhibitor (SSRI) ## Footnote **Indication:** Generalized anxiety disorder; major depressive disorder **MOA:** Prevents presynaptic serotonin reuptake. **Side effects:** anxiety; constipation; QT interval increase; rare seizures **Contraindications:** Within 14 days or concurrent use of an MAO inhibitor **Considerations:** * Avoid in pregnancy and breastfeeding unless essential. * Reduce dose in hepatic impairment.

Answer 3

Lunesta | Class: Hypnotic ## Footnote **Indication:** Insomnia (short-term use) **MOA:** Thought to bind to GABA receptors, potentiating its effect. **Side effects:** drowsiness; coordination difficulty; bizarre sleep-related behaviors **Contraindications:** Patients with complex sleep behaviors after taking eszopiclone **Considerations:** * Schedule IV controlled substance. * Monitor for bizarre sleep-related behaviors. * Use for short-term only.

Answer 4

Zarontin | Class: Anticonvulsant ## Footnote **Indication:** Absence (petit mal) seizures **MOA:** Inhibits T-type calcium channels in thalamic neurons. **Side effects:** dizziness; GI distress; blood dyscrasias; elevated LFTs **Contraindications:** Hypersensitivity to drug or any of its components **Considerations:** * Can cause neonatal sedation if used in breastfeeding. * Discuss use in pregnancy with a specialist. * Monitor LFTs.

Answer 5

Luvox | Class: Selective serotonin reuptake inhibitor (SSRI) ## Footnote **Indication:** Obsessive-compulsive disorder (OCD) **MOA:** Selectively inhibits serotonin reuptake. **Side effects:** nausea; headache; insomnia; reduced libido **Contraindications:** Within 14 days or concurrent use of an MAO inhibitor **Considerations:** * Initiate at a low dose. * Full therapeutic effect may take weeks. * Caution in elderly and hepatic impairment.

Answer 6

Prozac | Class: Selective serotonin reuptake inhibitor (SSRI) ## Footnote **Indication:** Depression; bulimia nervosa; major depressive disorder; OCD; bipolar disorder; panic disorder **MOA:** Prevents presynaptic serotonin (5-HT) reuptake, having a high affinity for serotonin transporters. **Side effects:** anxiety; palpitations; chills; blurred vision; tinnitus; tremor; QT-prolongation; diarrhea; dizziness; arthralgia; constipation; asthenia **Contraindications:** Within 14 days or concurrent use of an MAOI **Considerations:** * Fluoxetine is the only SSRI that could possibly be used safely in pregnancy (with caution). * Fluoxetine has the least weight gain potential of all SSRIs. * Avoid stopping therapy suddenly due to withdrawal effects.

Answer 7

Neurontin | Class: Anticonvulsant ## Footnote **Indication:** Focal (partial) seizures; postherpetic neuralgia **MOA:** Precise mechanism remains unknown; hypothesis: binds voltage-gated Ca2+ channels to decrease release of excitatory transmitters. **Side effects:** anxiety; decreased appetite; nausea and vomiting; cough; insomnia; increased infection risk; dizziness; constipation; depression **Contraindications:** Hypersensitivity to drug or any of its components **Considerations:** * Avoid in pregnancy and breastfeeding if possible due to toxicity. * Half life is 5–7 hours in those without renal impairment. * Overdose is generally managed by managing symptoms and providing supportive care, but those with renal impairment may require hemodialysis. * A history of substance abuse warrants caution.

Answer 8

Razadyne | Class: Cholinesterase inhibitors ## Footnote **Indication:** Delays global cognitive impairment and slows the progression of Alzheimer disease **MOA:** Crosses the blood-brain barrier and acts to increase the concentration of Ach at central cholinergic synapses; improves cholinergic neurotransmission. **Side effects:** risk of bradycardia and AV block; nausea; vomiting; anorexia; weight loss; anxiety; aggression; agitation; hallucination; sleep disorders **Contraindications:** Hypersensitivity to drug or any of its components **Considerations:** * Avoid in breastfeeding; use with caution in pregnancy. * Avoid in severe renal impairment. * Anticholinergic drugs inhibit effects of galantamine.

Answer 9

Haldol | Class: Antipsychotic, Typical - 1st generation ## Footnote **Indication:** Schizophrenia; agitation associated with psychiatric disorders, substances or organic causes; hyperactivity; behavioral disorders, nonpsychotic (in children only after failure to other medications); Tourette syndrome **MOA:** A high potency dopamine receptor antagonist, especially to D2 receptor; blocking dopamine signaling across the mesolimbic pathway reduces positive symptoms of psychosis. **Side effects:** cardiac arrhythmia (prolonged QT, torsades de pointes); anticholinergic effects (xerostomia, dizziness, blurred vision, drowsiness, flushing, tachycardia, constipation, heat stroke, delirium); blood dyscrasias (neutropenia, leukopenia); extrapyramidal symptoms (pseudoparkinsonism, acute dystonic reactions, akathisia, tardive dyskinesia); hyperprolactinemia; amenorrhea; poikilothermia; pigmentary retinopathy **Contraindications:** CNS depression; comatosed states; Parkinson disease; Lewy body dementia **Considerations:** * ECG monitoring may be required if history of cardiovascular disease. * First generation antipsychotics may lower seizure threshold. * Increased mortality in elderly patients with dementia-related psychosis. * Barbiturates and carbamazepine decrease and quinidine increases serum levels.

Answer 10

Tofranil | Class: Tricyclic Antidepressant (TCA), Tertiary Amine ## Footnote **Indication:** Major depressive disorder (MDD); childhood enuresis **MOA:** Inhibits the reuptake of norepinephrine and serotonin, increasing their levels in the synaptic cleft. **Side effects:** dry mouth; blurred vision; constipation; urinary retention; sedation; orthostatic hypotension; weight gain; cardiac arrhythmias; headache; confusion; agitation **Contraindications:** Recent myocardial infarction; use of MAOI within 14 days **Considerations:** * Start at a low dose and gradually titrate upward. * Baseline and periodic ECGs are advisable, especially in patients with underlying heart disease or the elderly. * Metabolized by the cytochrome P450 system, so be cautious with concomitant medications that may affect its levels. * Advise patients to rise slowly from sitting or lying positions to minimize dizziness.

Answer 11

Ketalar | Class: General anesthetic ## Footnote **Indication:** Dissociative anesthesia (IV), most often used in pediatric patients and is given in combo with a benzodiazepine for anesthesia during minor surgical or diagnostic procedures **MOA:** Non-competitive antagonist of glutamate at NMDA receptors, preventing sensitization in neurons in dorsal horns; also inhibits nitric oxide synthase, decreasing transmission of pain signals. **Side effects:** dissociative anesthesia: analgesia; reduced sensory perceptions; immobility; amnesia; during recovery: delirium; hallucinations; irrational behavior; hypersalivation; tachycardia; hypertension; increased BP **Contraindications:** Conditions that increase blood pressure **Considerations:** * Reduce dose in hepatic failure. * Avoid memantine, as this increases risk of CNS side effects.

Answer 12

Vimpat | Class: Anticonvulsant ## Footnote **Indication:** Partial (focal) seizures; generalized tonic-clonic seizures **MOA:** Enhances inactivation of voltage-gated sodium channels, resulting in stabilization of hyperexcitable neuronal membranes and inhibition of repetitive neuronal firing. **Side effects:** dizziness; syncope; cerebellar syndrome; tinnitus; nausea; vomiting; diarrhea; constipation; anemia; neutropenia; xerostomia; cardiac effects (prolonged PR interval, bradycardia, AV block) **Contraindications:** Hypersensitivity to drug or any of its components **Considerations:** * Caution should be exercised in patients with pre-existing cardiac conduction disorders or those on other medications that may affect cardiac. * Often used as adjunctive therapy. * Dose adjustments may be necessary in patients with significant renal or hepatic impairment. * Could affect daily activities such as driving or operating machinery.

Answer 13

Lamictal | Class: Anticonvulsant ## Footnote **Indication:** Focal (partial) seizures; generalized onset (tonic-clonic) seizures; bipolar disorder **MOA:** Precise mechanism remains unknown; hypothesis: blocks voltage-sensitive Na+ channels and interferes with neuronal membrane conduction, alongside release of excitatory neurotransmitters such as glutamate. **Side effects:** common: nausea and vomiting; diarrhea or constipation; xerostomia; drowsiness; headache; aggression; irritability; tremor; weight gain; upper respiratory symptoms; skin rash → Stevens-Johnson syndrome (rare); less common: blood dyscrasias of variable types; hemophagocytic lymphohistiocytosis (LHL); DRESS syndrome; suicidal ideation **Contraindications:** Hypersensitivity to drug or any of its components **Considerations:** * Only use in pregnancy if benefits outweigh risk. * Acceptable in breastfeeding, as although present in breast milk, it has no proven effect on the fetus. * Use caution in renal or hepatic impairment. * Important: Taper withdrawal over >2 weeks to avoid severe skin reactions. * Risk of hyponatremia when given with desmopressin. * Serum levels are decreased by carbamazepine and phenytoin and increased by valproate.

Answer 14

Keppra | Class: Anticonvulsant ## Footnote **Indication:** Focal (partial) seizures; generalized onset (tonic-clonic) seizures; off-label uses for seizure prophylaxis in traumatic brain injury; subarachnoid hemorrhage **MOA:** Precise mechanism remains unknown; hypothesis: binds to a synaptic vesicle protein (SV2A), reducing vesicular packaging of GABA and impending neurotransmission across synapses. **Side effects:** anxiety; asthenia; depression; diarrhea; dizziness; headache; drowsiness; nausea and vomiting; rash; rare: renal failure; agranulocytosis; psychotic disorder; suicidal tendencies; rhabdomyolysis; severe skin reactions may occur (Stevens-Johnson syndrome) **Contraindications:** Hypersensitivity to drug or any of its components **Considerations:** * Avoid in breastfeeding as it is present in breast milk. * Monitor mother and fetal growth carefully if used in pregnancy. * Avoid in severe hepatic impairment. * Reduce dose in renal impairment.

Answer 15

Vyvanse | Class: CNS stimulant ## Footnote **Indication:** ADHD; binge eating disorder **MOA:** Prodrug of dextroamphetamine, which prevents norepinephrine and dopamine reuptake in neurons. **Side effects:** decreased appetite; xerostomia; weight loss; diarrhea; constipation; anxiety; altered mood; hyperhidrosis; insomnia; tremor; tachycardia; palpitations; headache; rare: depression (although very common in children); altered taste; cardiomyopathy; psychotic disorders; seizures **Contraindications:** MAOI use within 14 days **Considerations:** * Schedule II controlled substance. * Avoid in pregnancy unless essential. * Avoid in breastfeeding as it is present in breastmilk. * Avoid abrupt withdrawal; taper off dose. * Monitor children for weight loss. * Do not exceed 50 mg daily in renal impairment. * Avoid cannabinoids such as Nabilone due to increased risk of cardiovascular side effects.

Answer 16

Lithobid | Class: Lithium salt, Mood stabilizer ## Footnote **Indication:** Bipolar disorder **MOA:** Exact mechanism is unknown. Suppresses the formation of second messengers involved in neurotransmitter signal transduction, reducing neuronal response to serotonin and norepinephrine. **Side effects:** drowsiness; weight gain; fine hand tremor; polyuria; hypothyroidism; overdose can lead to neurotoxicity and cardiac toxicity **Contraindications:** Severe cardiovascular or renal disease; severe debilitation; sodium depletion; concurrent use with diuretics **Considerations:** * Long-term use can cause thyroid disease and memory impairment. * Levels should be monitored, especially with changes in renal function. * NSAIDs and diuretics decrease lithium clearance and increase lithium levels.

Answer 17

Ativan | Class: Benzodiazepine ## Footnote **Indication:** Anxiety; status epilepticus **MOA:** Binds to GABA receptors, increasing their inhibitory effects and reducing excitatory CNS stimulus. **Side effects:** arrhythmias; ataxia; reduced alertness; drowsiness; fatigue; mood alteration; weight gain; hypotension; palpitations; anterograde amnesia; paradoxical effects; drug dependency; respiratory depression; aggression **Contraindications:** Acute narrow-angle glaucoma **Considerations:** * Schedule IV controlled substance. * Risk of dependency with long-term use; use shortest duration appropriate. * Do not stop abruptly due to withdrawal risk. * Avoid combining with other CNS depressants. * Rifampin decreases serum levels.

Answer 18

Latuda | Class: Atypical antipsychotic ## Footnote **Indication:** Schizophrenia in adults and adolescents ≥13 years; depressive episodes associated with bipolar I disorder **MOA:** Blocks D₂ receptors and acts as a serotonin 5-HT₂A antagonist, with activity at 5-HT₇ and partial agonism at 5-HT₁A receptors. **Side effects:** akathisia; extrapyramidal symptoms; somnolence; nausea; vomiting; dizziness; anxiety; insomnia; modest weight gain; mild metabolic changes **Contraindications:** Concomitant use with strong CYP3A4 inhibitors or inducers **Considerations:** * Administer with food ≥350 kcal. * Avoid grapefruit/grapefruit juice. * Black box warnings.

Answer 19

Antivert | Class: First‑generation antihistamine (piperazine derivative); antiemetic/antivertigo agent ## Footnote **Indication:** Prevention and treatment of motion sickness; management of vertigo **MOA:** Competitive H₁‑receptor antagonist with central anticholinergic effects, suppressing vestibular labyrinth excitability. **Side effects:** drowsiness; fatigue; dry mouth; blurred vision; headache; dizziness; constipation; nausea; vomiting; hypersensitivity reactions; severe CNS depression **Contraindications:** Hypersensitivity to drug or its components **Considerations:** * Avoid alcohol and other CNS depressants. * May cause drowsiness; caution with driving or operating machinery.

Answer 20

Namenda | Class: NMDA receptor antagonist ## Footnote **Indication:** Alzheimer disease; dementia (off-label) **MOA:** Non-competitive antagonist at NMDA receptors, blocking glutamate neurotransmission. **Side effects:** confusion; dizziness; drowsiness; headache; insomnia; balance impairment; dyspnea **Contraindications:** Hypersensitivity to drug or its components **Considerations:** * Avoid in pregnancy and breastfeeding. * Avoid in severe hepatic and renal impairment. * Avoid amantadine and ketamine due to CNS toxicity risk.

Answer 21

Ritalin | Class: CNS Stimulants ## Footnote **Indication:** ADHD; narcolepsy **MOA:** Prevents reuptake of norepinephrine and dopamine, increasing their efflux in synapses, similar to amphetamines. **Side effects:** alopecia; anxiety; decreased appetite; depression; nausea; vomiting; weight loss; sleep disorders; arrhythmias; erectile dysfunction; hyperhidrosis **Contraindications:** MAO inhibitor use within 14 days **Considerations:** * Schedule II controlled substance. * Avoid in pregnancy unless essential. * Avoid in breastfeeding. * Monitor regularly for side effects and psychiatric disorders. * Avoid rapid withdrawal; taper dose. * Monitor children for weight loss. * Take in mornings to minimize insomnia. * Avoid MAO inhibitors due to hypertensive crisis risk.

Answer 22

Remeron | Class: Alpha-2 Antagonist ## Footnote **Indication:** Depression **MOA:** Blocks presynaptic alpha a2 adrenergic receptors, increasing norepinephrine and serotonin release; also antagonizes 5-HT2 and 5-HT3 receptors. **Side effects:** akathisia; anticholinergic effects; arrhythmias; weight gain; serotonin syndrome; seizures **Contraindications:** Use within 14 days or concurrent use of an MAO inhibitor **Considerations:** * Ideally avoid in pregnancy unless essential. * Acceptable in breastfeeding if essential. * Taper off dose to avoid withdrawal effects. * Anticholinergic effects are more profound in elderly. * Caution in renal or hepatic impairment.

Answer 23

Provigil | Class: CNS stimulant ## Footnote **Indication:** Narcolepsy; shift work sleep disorder; obstructive sleep apnea-related excessive daytime sleepiness **MOA:** Increases catecholamines in synapses and inhibits dopamine reuptake. **Side effects:** nausea; anxiety; arrhythmias; headaches; rare cases of hallucination and Stevens-Johnson syndrome **Contraindications:** Hypersensitivity to drug or any of its components **Considerations:** * Schedule IV controlled substance. * Use contraception during therapy and for >2 months afterwards. * Avoid in pregnancy and breastfeeding.

Answer 24

Amerge | Class: Serotonin 5-HT1B,1D Receptor Agonist ## Footnote **Indication:** Migraine **MOA:** Stimulates 5-HT1B/1D receptors causing vasoconstriction and reduces neuropeptide release. **Side effects:** paresthesias; dizziness; coronary vasospasm; myocardial ischemia; serotonin syndrome **Contraindications:** Ischemic cardiac disease; cerebrovascular syndromes; basilar migraine; uncontrolled hypertension; severe renal or hepatic impairment **Considerations:** * Onset slower but longer half-life than sumatriptan. * Avoid concomitant triptans/ergot derivatives within 24 hours. * Limit use to ≤10 days/month to prevent medication-overuse.

Answer 25

Pamelor | Class: Tricyclic antidepressant (TCA), Secondary amine ## Footnote **Indication:** Depression **MOA:** Blocks norepinephrine and serotonin reuptake; also inhibits histamine and acetylcholine. **Side effects:** anticholinergic effects; neuropsychiatric effects; suicidal ideation; orthostatic hypotension; rare seizures **Contraindications:** Acute heart failure; recovery phase of myocardial infarction; MAO inhibitor use within 14 days **Considerations:** * Acceptable in pregnancy; avoid if possible. * Avoid abrupt discontinuation. * Anticholinergic effects more profound in elderly.

Answer 26

Zyprexa | Class: Antipsychotic, Atypical - 2nd generation ## Footnote **Indication:** Schizophrenia; bipolar disorder; major depressive disorder; agitation/aggression **MOA:** Chemical analog of clozapine, blocks 5-HT2, D2, D3, and D4 receptors. **Side effects:** weight gain; CNS depression; anticholinergic effects; extrapyramidal symptoms; hyperglycemia; hepatic failure **Contraindications:** Hypersensitivity to drug or its components **Considerations:** * Monitor neonates for extrapyramidal effects if taken in 3rd trimester. * ECG monitoring may be required for cardiovascular disease history.

Answer 27

Trileptal | Class: Anticonvulsant ## Footnote **Indication:** Used to treat focal (partial) seizures and generalized onset (tonic-clonic) seizures. **MOA:** Prodrug of carbamazepine; blocks VGSCs in neuronal membranes, inhibiting abnormal discharges. **Side effects:** drowsiness; fatigue; nausea; dizziness; ataxia; blurry vision; agranulocytosis; cardiovascular issues **Contraindications:** Hypersensitivity to the drug or its components **Considerations:** * Acceptable in breastfeeding. * Monitor during pregnancy. * Avoid in hepatic impairment. * Avoid oral contraceptives.

Answer 28

Ditropan | Class: Overactive‑bladder agent / urinary antispasmodic ## Footnote **Indication:** Treats overactive bladder and neurogenic bladder in children ≥6 years **MOA:** Competitive antagonist at M₁ and M₃ muscarinic receptors, reducing bladder contractions and delaying urge to void. **Side effects:** dry mouth; constipation; blurred vision; dizziness; urinary retention; heat stroke **Contraindications:** Urinary retention; gastric retention; uncontrolled narrow-angle glaucoma **Considerations:** * Transdermal routes reduce systemic anticholinergic effects. * Impairs sweating; avoid excessive heat. * Caution with driving or alcohol use.

Answer 29

Paxil | Class: Selective serotonin reuptake inhibitor (SSRI) ## Footnote **Indication:** Used for depression; anxiety; OCD; PTSD; vasomotor symptoms of menopause; panic disorder **MOA:** Inhibits serotonin reuptake, increasing its concentration. **Side effects:** anxiety; arrhythmias; QT-prolongation; sexual dysfunction; serotonin syndrome **Contraindications:** Use within 14 days of an MAO inhibitor **Considerations:** * Sexual dysfunction may persist after therapy. * Highest weight gain potential among SSRIs. * Avoid in pregnancy unless essential.

Answer 30

Luminal | Class: Anticonvulsant, Barbiturate ## Footnote **Indication:** Used for sedation and seizures **MOA:** Binds and potentiates GABA-A receptors; inhibits Ca2+ channels, reducing neurotransmitter release. **Side effects:** ataxia; dizziness; drowsiness; cognitive impairment; respiratory depression **Contraindications:** Hepatic impairment; dyspnea; airway obstruction; porphyria **Considerations:** * Schedule IV controlled substance. * Avoid in breastfeeding. * Avoid abrupt withdrawal. * Category D pregnancy.

Answer 31

Adipex-P | Class: Sympathomimetic agent ## Footnote **Indication:** Used as an appetite suppressant for short-term obesity treatment **MOA:** Potentiates norepinephrine release in the hypothalamus, binding to beta-2 receptors. **Side effects:** hypertension; tachycardia; dizziness; insomnia; valvular heart disease **Contraindications:** Glaucoma; hyperthyroidism; cardiovascular disease; agitated states; pregnancy **Considerations:** * Schedule IV controlled substance. * Use only for short-term. * Avoid in pregnancy and breastfeeding.

Answer 32

Dilantin | Class: Anticonvulsant ## Footnote **Indication:** Treats partial seizures; generalized tonic-clonic seizures; status epilepticus **MOA:** Binds voltage-sensitive Na+ channels, prolonging their inactivation and reducing neuronal firing. **Side effects:** megaloblastic anemia; ataxia; diplopia; gingival hyperplasia; severe skin reactions **Contraindications:** Use with delavirdine; prior hepatotoxicity to phenytoin **Considerations:** * Discontinue if rash occurs. * Avoid in pregnancy. * Increased cardiovascular risk with rapid infusion.

Answer 33

Mirapex | Class: Dopamine D2-agonist, non ergot ## Footnote **Indication:** Used for Parkinson's disease and restless leg syndrome **MOA:** Dopamine D2 receptor agonist, also affecting D3 and D4 receptors. **Side effects:** drowsiness; insomnia; xerostomia; nausea; dyskinesia; orthostatic hypotension; mood changes **Contraindications:** Hypersensitivity to the drug or its components **Considerations:** * Monitor for EPS and mood changes. * Do not stop abruptly due to risk of NMS.

Answer 34

Lyrica | Class: Anticonvulsant, GABA Analog ## Footnote **Indication:** Treats seizures; neuropathic pain; postherpetic neuralgia; fibromyalgia; pain after spinal cord injury **MOA:** Increases GABA release and inhibits L-type calcium channels. **Side effects:** abdominal distension; asthenia; nausea; confusion; dizziness; rhabdomyolysis (rare) **Contraindications:** Hypersensitivity to the drug or its components **Considerations:** * Schedule V controlled substance. * Avoid abrupt withdrawal. * Reduce dose in renal impairment.

Answer 35

Compazine | Class: Antipsychotic, Typical - 1st generation ## Footnote **Indication:** Used for migraines; severe nausea/vomiting; anxiety **MOA:** Dopamine receptor antagonist, especially D2, with antiemetic effects through serotonin type 3 receptor blocking. **Side effects:** cardiac arrhythmia; anticholinergic effects; blood dyscrasias; extrapyramidal symptoms **Contraindications:** Children <2; CNS depression; chronic heavy alcohol use **Considerations:** * ECG monitoring may be required. * First-generation antipsychotics may lower seizure threshold.

Answer 36

Phenergan | Class: Phenothiazine Antihistamine ## Footnote **Indication:** Used for motion sickness; sedation; nausea; peripartum management **MOA:** Competitive H₁-receptor antagonist, blocking muscarinic, α-adrenergic, and dopamine-D₂ receptors. **Side effects:** sedation; dizziness; dry mouth; blurred vision; respiratory depression **Contraindications:** Age <2 years; concurrent large doses of CNS depressants **Considerations:** * Additive CNS/respiratory depression with alcohol. * Sun protection and hydration advised.

Answer 37

Seroquel | Class: Antipsychotic, Atypical - 2nd generation ## Footnote **Indication:** Used for schizophrenia; mania during bipolar disorder; bipolar disorder **MOA:** Hypothesized to block D2 and 5HT-2A receptors, reducing positive symptoms of psychosis. **Side effects:** CNS depression; anticholinergic effects; extrapyramidal symptoms; QT prolongation; hyperglycemia **Contraindications:** Hypersensitivity to the drug or its components **Considerations:** * Monitor neonates for extrapyramidal effects if taken during 3rd trimester. * ECG may be required if history of cardiovascular disease.

Answer 38

Rozerem | Class: Melatonin Receptor Agonist ## Footnote **Indication:** Used for sleep-onset insomnia **MOA:** Binds to melatonin receptors, increasing melatonin levels to aid sleep onset. **Side effects:** dizziness; fatigue; somnolence; bizarre sleep behaviors (rare) **Contraindications:** Concomitant use with fluvoxamine **Considerations:** * Unique as it binds to MT1 and MT2 receptors. * Very low side effect profile. * Educate patients about rare but dangerous sleep behaviors.

Answer 39

Azilect | Class: Monoamine - oxidase B inhibitor ## Footnote **Indication:** Used as monotherapy or adjunct in Parkinson's treatment **MOA:** Irreversibly inhibits MAO-B, decreasing dopamine breakdown. **Side effects:** angina; postural hypotension; conjunctivitis; CNS effects; increased melanoma risk **Contraindications:** Concurrent MAO inhibitor use; medications increasing 5HT receptors within 14 days **Considerations:** * Avoid in breastfeeding. * Caution in liver disease. * Do not stop abruptly.

Answer 40

Risperdal | Class: Second‑generation (atypical) antipsychotic ## Footnote **Indication:** Schizophrenia; acute manic or mixed episodes of bipolar I disorder; irritability associated with autistic disorder **MOA:** Antagonist at D2 and 5-HT2A receptors. **Side effects:** CNS depression; anticholinergic effects; extrapyramidal symptoms; QT prolongation; hypotension; blood dyscrasias; hyperprolactinemia; neuroleptic malignant syndrome; sudden death syndrome **Contraindications:** Hypersensitivity to drug or any of its components **Considerations:** * Paliperidone is the major active metabolite of risperidone. * ECG may be required for monitoring if history of cardiovascular disease. * Monitor weight/BMI, fasting glucose & lipids, BP, prolactin, EPS/TD, and mental status at baseline and periodically. * Advise limited alcohol/CNS depressant use; maintain adequate hydration. * Boxed warnings: elderly dementia psychosis mortality and suicidality in young patients—use only when benefits outweigh risks and monitor closely.

Answer 41

Exelon | Class: Cholinesterase inhibitors ## Footnote **Indication:** Alzheimer disease; Parkinson disease dementia **MOA:** Crosses the blood-brain barrier and acts to increase the concentration of Ach at central cholinergic synapses, improving cholinergic neurotransmission. **Side effects:** risk of bradycardia and AV block; nausea; vomiting; anorexia; weight loss; anxiety; aggression; agitation; hallucination; sleep disorders **Contraindications:** Hypersensitivity to drug or any of its components **Considerations:** * Avoid in breastfeeding; use with caution in pregnancy. * Avoid in severe renal impairment. * Anticholinergic drugs inhibit effects. * Nicotine increases oral clearance.

Answer 42

Requip | Class: Dopamine receptor agonist ## Footnote **Indication:** Parkinson disease; restless leg syndrome **MOA:** Selective D2 agonist. **Side effects:** orthostatic hypotension; syncope; drowsiness; insomnia; nausea; vomiting; xerostomia; URI symptoms; mood changes; confusion; hallucinations; dyskinesia; increased risk of melanomas; edema; pleural/retroperitoneal fibrosis **Contraindications:** Hypersensitivity to drug or any of its components **Considerations:** * Taper dose/do not stop abruptly to avoid NMS-like syndrome. * Dose adjustment in ESRD. * Ciprofloxacin increases serum levels.

Answer 43

Eldepryl | Class: Monoamine - oxidase B inhibitor ## Footnote **Indication:** Early or mild Parkinson disease; depression (transdermal patch) **MOA:** Increases dopamine by inhibiting the breakdown via monoamine oxidase type B (MAO-B) inhibition, increasing dopamine levels in the basal ganglia. **Side effects:** postural hypotension; nausea; diarrhea; xerostomia; dysgeusia; weight loss; nasal congestion; urinary retention; skin rash; CNS effects; dyskinesia; psychiatric dysfunction; suicidal thoughts; serotonin syndrome **Contraindications:** Concurrent MAO inhibitor use; SSRI or tramadol; methadone; clomipramine; imipramine; SSRI; SNRI; or other medications that increase 5HT receptors within 14 days; pheochromocytoma; patients less than 12 years of age **Considerations:** * Avoid in breastfeeding. * Caution in liver disease. * Do not stop abruptly (taper dose to reduce withdrawal symptoms). * Caution in renal and hepatic impairment.

Answer 44

Zoloft | Class: Selective serotonin reuptake inhibitor (SSRI) ## Footnote **Indication:** Depression; PTSD; OCD; anxiety; panic disorder; premenstrual dysphoric disorder **MOA:** Selectively inhibits serotonin (5-HT) reuptake, resulting in increased concentrations in synapses. **Side effects:** anxiety; chest pain; depression; vasodilation; arrhythmias; blurred vision; QT-prolongation; diarrhea; dizziness; fever; hemorrhage; weight changes **Contraindications:** Within 14 days or concurrent use of an MAO inhibitor; use with disulfiram **Considerations:** * Preferred in elderly patients as its elimination is less affected by aging. * Absorption is increased when taken with food. * Reduce dose in hepatic impairment. * Avoid anticoagulants due to increased risk of hemorrhage.

Answer 45

Vesicare | Class: Antimuscarinic (anticholinergic) urinary antispasmodic ## Footnote **Indication:** Overactive bladder; neurogenic detrusor overactivity **MOA:** Competitively inhibits M₃ muscarinic receptors on detrusor smooth muscle, reducing spontaneous and reflex contractions. **Side effects:** dry mouth; constipation; blurred vision; dyspepsia; UTI; headache; dry eyes; dizziness; acute urinary retention; severe constipation/ileus; angio-edema or anaphylaxis; QT-interval prolongation **Contraindications:** Urinary retention; gastric retention; uncontrolled narrow-angle glaucoma **Considerations:** * Decrease dose in renal impairment (CrCl < 30 mL/min), moderate hepatic impairment (Child-Pugh B), or with strong inhibitors. * May cause drowsiness/blurred vision.

Answer 46

Restoril | Class: Benzodiazepine ## Footnote **Indication:** Insomnia **MOA:** Binds to the postsynaptic chloride ion pore on the GABA receptors within the CNS, increasing the duration in which they remain open, leading to hyperpolarization and potentiating inhibitory effects. **Side effects:** arrhythmias; ataxia; reduced alertness; drowsiness; fatigue; mood alteration; weight gain; hypotension; palpitations; anterograde amnesia; bizarre sleep-related behaviors; paradoxical effect; drug dependency; respiratory depression; aggression **Contraindications:** Acute pulmonary insufficiency; marked neuromuscular respiratory weakness; chronic psychosis; myasthenia gravis; history of substance abuse; concurrent use of CNS depressants **Considerations:** * Schedule IV controlled substance. * Risk of dependency with long-term use; use shortest duration appropriate. * Do not stop abruptly due to risk of withdrawal (seizures) if chronically taken. * Avoid prescribing with other CNS depressants such as opiates due to profound sedation risk. * Alcohol and other CNS depressants potentiate effects. * Cimetidine increases and rifampin decreases serum levels.

Answer 47

Topamax | Class: Anticonvulsant ## Footnote **Indication:** Migraine prevention; seizures **MOA:** Precise mechanism remains unknown; hypothesis includes blocking voltage-gated Na channels (VGNCs); binding and potentiating GABA-A receptors; antagonizing glutamate receptors; inhibiting carbonic anhydrase. **Side effects:** GI upset; dysgeusia; anorexia; renal calculi; UTI; fatigue; drowsiness; hyperammonemia; tremor; skin reactions; decreased serum bicarbonate; upper respiratory infections; myalgias **Contraindications:** Recent alcohol use; metabolic acidosis **Considerations:** * Avoid in pregnancy as it increases the risk of congenital malformations in the neonate. * Avoid in breastfeeding. * Reduce dose in renal impairment and avoid in severe hepatic impairment. * Increased side effects in elderly.

Answer 48

Oleptro | Class: Serotonin reuptake inhibitor ## Footnote **Indication:** Major depressive disorder **MOA:** Selectively inhibits the neuronal reuptake of serotonin and acts as an antagonist at the 5-HT2A receptor. **Side effects:** sedation; orthostatic hypotension; agranulocytosis; hypernatremia; priapism; QT prolongation; serotonin syndrome; suicidal ideation; SIADH **Contraindications:** Concurrent use with MAO inhibitor or within 14 days **Considerations:** * Caution in severe renal impairment. * Take shortly after a meal or light snack to enhance absorption. * Additive serotonergic effect with SSRIs/SNRIs, triptans, tramadol, St John’s wort, etc. – watch for serotonin syndrome.

Answer 49

Depakote | Class: Anticonvulsant ## Footnote **Indication:** Focal (partial) seizures; generalized tonic-clonic seizures; status epilepticus **MOA:** Precise mechanism remains unknown; hypothesis includes inhibiting VGSCs and potentially inhibiting GABA transaminase; also purported to inhibit GABA reuptake by neurons. **Side effects:** abdominal pain; alopecia; hepatic impairment; menstrual cycle irregularities; tremor; thrombocytopenia; nausea and vomiting; diarrhea; confusion **Contraindications:** Severe hepatic impairment; urea cycle disorders; known mitochondrial disorders caused by POLG or POLG-related disorder in children less than 2 years old **Considerations:** * Avoid in pregnancy unless essential*

Answer 50

Chantix | Class: Nicotinic acetylcholine‑receptor partial agonist ## Footnote **Indication:** Smoking cessation **MOA:** Acts as a partial agonist at nicotinic acetylcholine receptors in the brain, binding to and activating the receptors to a lesser extent than nicotine. **Side effects:** nausea; insomnia or vivid/abnormal dreams; headache; constipation; flatulence; vomiting; depressed mood; suicidal ideation; seizures; sleep disturbance **Contraindications:** Hypersensitivity to drug or any of its components **Considerations:** * Caution in renal impairment. * Caution with alcohol.

Answer 51

Effexor | Class: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) ## Footnote **Indication:** Depression; generalized anxiety disorder; social anxiety; panic disorder **MOA:** Inhibits norepinephrine and serotonin reuptake; also inhibits dopamine reuptake but with less efficacy. **Side effects:** anxiety; arrhythmias; tinnitus; tremor; palpitations; nausea and vomiting; weight changes; constipation; depersonalization; diarrhea; sexual dysfunction; sedation; paresthesia **Contraindications:** Uncontrolled hypertension; within 7 days or concurrent use of an MAO inhibitor **Considerations:** * Higher risk of withdrawal symptoms than most other antidepressants; do not stop medication abruptly. * Avoid in pregnancy (toxicity) and breastfeeding (present in milk) unless essential. * Reduce dose by 50% in hepatic impairment; ideally avoid if severe, or reduce dose further. * Increased risk of hemorrhage when administered with anticoagulants such as apixaban. * Avoid amiodarone due to increased risk of QT-prolongation.

Answer 52

Viibryd | Class: Selective serotonin reuptake inhibitor (SSRI)/ 5-HT1A Receptor Partial Agonist ## Footnote **Indication:** Depression **MOA:** Selectively inhibits the neuronal reuptake of serotonin and acts as a partial agonist at the 5-HT1A receptor. **Side effects:** headache; diarrhea; nausea and vomiting; insomnia; dry mouth; serotonin syndrome; akathisia; fatigue; arthralgia; increased appetite; tremor; abnormal dreams; seizures **Contraindications:** Within 14 days or concurrent use of an MAO inhibitor **Considerations:** * Avoid in pregnancy unless essential due to increased risk of low birth weight and preterm delivery. * Originally developed for anxiety; however, doesn't provide justifiable benefit when treating this disorder due to its high risk of side effects. * Avoid anticoagulants due to increased risk of hemorrhage.

Answer 53

Qelbree | Class: Selective norepinephrine‑reuptake inhibitor (NRI) ## Footnote **Indication:** ADHD **MOA:** Reversibly inhibits the norepinephrine transporter (NET), increasing extracellular norepinephrine in the prefrontal cortex. **Side effects:** decreased appetite; nausea; vomiting; irritability; insomnia; constipation; suicidal thoughts and behaviors (boxed warning); heart rate and diastolic BP increase; activation of mania/hypomania in bipolar disorder **Contraindications:** Concomitant use of MAOIs; use within 14 days of MAOI discontinuation; concomitant administration of sensitive or narrow-therapeutic-index CYP1A2 substrates **Considerations:** * Caution in renal impairment. * Strong CYP1A2 inhibitor. * Screen for bipolar disorder before initiation; discontinue if mania/hypomania emerges. * Low abuse potential (not a control).

Answer 54

Sonata | Class: Hypnotic ## Footnote **Indication:** Insomnia **MOA:** Facilitates the activity of g-aminobutyric acid (GABA), GABAa receptor-Cl ion channels, binding on the alpha subunit and increasing the frequency of channel opening, causing hyperpolarization. **Side effects:** dizziness; drowsiness; headache; abdominal pain; vivid dreams; bizarre sleep-related behaviors; diplopia **Contraindications:** Patients who have experienced complex sleep behaviors after taking zaleplon **Considerations:** * Schedule IV controlled substance. * Monitor for bizarre sleep-related behaviors and stop medication if they occur. * Use for short-term use only due to risk of dependence. * Take on an empty stomach or after only a light snack. * Allow at least 4 hours of bedtime after administration.

Answer 55

Geodon | Class: Second‑generation (atypical) antipsychotic ## Footnote **Indication:** Schizophrenia; acute manic or mixed episodes of bipolar I disorder; agitation/aggression associated with psychiatric disorders, substance intoxication, or other organic causes **MOA:** Antagonist at dopamine-D₂ and serotonin-5-HT₂A/5-HT₂C/5-HT₁D receptors; partial agonist at 5-HT₁A; moderate α₁-adrenergic and H₁-histamine blockade; weak serotonin and norepinephrine reuptake inhibition **Side effects:** somnolence; dizziness; nausea; constipation; dyspepsia; rash; mild weight gain; extrapyramidal symptoms (akathisia; tremor); orthostatic light-headedness; QT prolongation; torsade de pointes **Contraindications:** QT-interval prolongation; history of torsade; recent MI; uncompensated heart failure; use with potent QT-prolonging drugs; within 14 days or concurrent use of an MAO inhibitor **Considerations:** * Take with food. * Obtain baseline ECG and electrolytes.

Answer 56

Ambien | Class: Hypnotic ## Footnote **Indication:** Insomnia **MOA:** Facilitate the activity of gamma-aminobutyric acid (GABA), GABAa receptor-Cl ion channels. They bind on the alpha subunit and increase the frequency at which the channel opens, causing hyperpolarization. **Side effects:** dizziness; drowsiness; headache; abdominal pain; vivid dreams; bizarre sleep-related behaviors; diplopia **Contraindications:** Patients who have experienced complex sleep behaviors after taking zolpidem **Considerations:** * Monitor for bizarre sleep-related behaviors and stop medication if they occur. * Use for short-term use only due to risk of dependence.

Answer 57

Zonegran | Class: Anticonvulsant ## Footnote **Indication:** Focal (partial) seizures; infantile spasms; binge eating disorder (off-label) **MOA:** Precise mechanism remains unknown. Hypothesis: binds VGSCs and voltage-dependent Ca2+ channels, decreasing neuronal firing rates. Also inhibits carbonic anhydrase; however, this action has not proven to be significant to its use as an antiepileptic. **Side effects:** anxiety; confusion; constipation; bradyphrenia; nausea and vomiting; urolithiasis; fever; insomnia; memory loss; psychosis; rash; rare: agranulocytosis; metabolic acidosis; coma; renal tubular acidosis; rhabdomyolysis **Contraindications:** Hypersensitivity to drug or any of its components **Considerations:** * Those hypersensitive to sulfonamide will also be hypersensitive to zonisamide. * Avoid in pregnancy unless essential. * Avoid breastfeeding for at least 4 weeks after the final dose of zonisamide. * Avoid in severe hepatic or renal impairment.

Neurologic Agents Flashcards

Master drugs used for neurologic and psychiatric conditions, including antidepressants, antiepileptics, and antipsychotics. (81 cards)