Term
| Carbidopa/Levodopa (Sinemet) |
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Definition
MOA: Carbidopa inhibits the decarboxylation of peripheral levodopa (which normally does not cross the blood-brain barrier). When levels are elevated, enough Levodopa crosses the blood-brain barrier and is decarboxylated into dopamine.
Side effects: drug-induced dyskinesias, nausea, vomiting, orthostatic hypertension
DOC in older pts, often withheld early on for younger pts |
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Term
| Drugs that increase dopamine levels: |
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Definition
Carbidopa/Levodopa (Sinemet) = dopamine precursor
Amantadine releases as much L-dopa from intact SN cells as possible.
Dopamine receptor agonists
COMT inhibitors |
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Term
| Dopamine receptor agonists |
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Definition
fewer dyskinesias but less efficacy than L-dopa
(may be used as early monotherapy in young patients):
Pramipexole (Mirapex): use of this agent is expected to increase as it may have neuroprotective properties
Ropinirole (Requip).
Side effects: postural hypotension, hallucinations, drowsiness |
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Term
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Definition
MOA: inhibit the metabolism of dopamine, thereby increasing levels of this neurotransmitter- see details in Clinical Resource Sheet.
Entacapone (Comtan) is the most important agent here. A related agent,
tolcopone (Tasmar)…may cause elevations of liver enzymes so serial LFTs must be monitored; consequently this agent is seldom used now. |
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Term
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Definition
MOA: Act as agonists at the mu, delta and kappa opioid receptors; work primarily through Gi/Go proteins to hyperpolarize neurons and inhibit neurotransmitter release.
IND: Relief of moderate to severe pain, preoperative medication, and as adjuncts during anesthesia. Some agents are used for their antitussive (eg codeine) and antidiarrheal effects (see below). |
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Term
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Definition
| coma with marked respiratory depression and pinpoint pupils (miosis). Hypotension and decreased bowel sounds are also commonly observed. The Dx can be confirmed by giving IV naloxone (Narcan), a general opioid antagonist. |
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Term
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Definition
| Constipation is very common & occurs through decreased intestinal peristalsis. |
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Term
| Agonists related to morphine/codeine |
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Definition
Morphine (MS Contin, MSIR)
Codeine/APAP (Tylenol #3)
Hydrocodone/APAP (Vicodin)
Oxycodone, Oxycodone/APAP (Oxycontin, Percocet)
Heroin |
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Term
| Synthetic opioid agonists |
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Definition
Fentanyl (Duragesic)
Meperidine (Demerol)
Propoxyphene/APAP (Darvocet)
Tramadol (Ultram)
Methadone (Dolophine)
Remifentanil (Ultiva) |
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Term
| Partial Agonists and Mixed Agonists/Antagonists |
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Definition
Buprenorphine (Buprenex)
Nalbuphine (Nubain) |
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Term
| Synthetic Opioid antagonists |
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Definition
Naloxone (Narcan) MOA: Displaces opioid narcotics from receptor sites.
IND: Reverses the CNS and respiratory depression in suspected overdose
Naltrexone (Revia): longer acting orally bioavailable opioid antagonist used for the treatment of opioid addiction and alcoholism. This agent is also covered in the Psych System- in the Rx of alcoholism |
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Term
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Definition
MOA: Block sodium channels preventing generation and conduction of nerve impulses
IND: Are used for local anesthesia (e.g. dental extraction, suturing)
Examples of drugs in this class include:
Lidocaine (Xylocaine)
Procaine (Novocaine)
Bupivacaine (Marcaine)
Cocaine (Used still as a local anesthetic in some ENT procedures) |
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Term
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Definition
| delay in initiating movement, or slowness it its execution |
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Term
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Definition
| slowness and "poverty" of movement |
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Term
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Definition
| involuntary limb or trunk movements |
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Term
| "freezing" (Parkinson's symptom) |
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Definition
| temporary inability to move, usually with gait |
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Term
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Definition
| rapid, unpredictable change in Parkinson's symptoms |
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Term
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Definition
| waning of the effect of the last dose of levodopa, maybe associated with abrupt changes in performance |
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Term
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Definition
| Amantadine (Symmetrel) MOA: Releases dopamine from intact dopaminergic terminals that remain in the substantia nigra. ( May see used for early mild Parkinson’s disease and L-dopa dyskinesias.) |
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Term
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Definition
MOA: antimuscarinic (inhibits cholinergic CNS receptors) and thus decreases over-firing of key neurons.
Use: effective for treating tremor, but only in young pts w/ mild dx (see side effects)
Side effects: cognitive changes, and many others |
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Term
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Definition
Used in Tonic-Clonic and Partial seizures
MOA: decreases Na and Ca conductance, blocks reuptake of adenosine, enhances GABA (inhibitory)
Pharmacokinetics: slow GI (2-6 HRS) absorption, maybe used IV for status epilepticus. bound to plasma proteins.
SideEffects: hyperplasia of gingiva, hypertrichosis, |
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Definition
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