CNS 29 - 39

8/7/2019 CNS 29 - 39

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PAIN MANAGEMENT IN PATIENTS WITH CANCERMNEMONICS:

Classifications:

CLASSIFICATIONCATEGORY

MECHANISM OF ACTION DRUGS DrugMNEMO

NICS

1.) Nonopioidanalgesics

Relieves moderate to severe pain byinhibiting COX in the CNS but not in theperiphery.Beneficial effects are painrelief, suppression of inflammation, andreduction of fever.

NSAIDsAcetaminophen

2.) Opioidanalgesics

Relieves pain by mimicking the actionsof endogenous opioid peptides,

primarily at mu receptors and partly atkappa receptors.

MILD TO MODERATEPAIN

CodeineHydrocodoneOxycodoneTramadol

MODERATE TO SEVEREMorphineFentanylHydromorphoneLevorphanolMethadoneOxymorphone

3.) Adjuvantanalagesics

Used to compliment the effects of opioids.

It is employed in combination with opioids-

not as substitutes.

y Tricyclic

antidepressants

Amitriptyline

Desipramine

Doxepin

Imipramine

Nortriptyline

y Other anti

depressantsBupropion

Duloxetine

Venlafaxine

y Antiseizure drugs

Carbamazepine

Gabapentin

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Lamotrigine

Phenytoin

Pregabalin

y Antidysrythmics

LidocaineMexiletine

y CNS stimulants

Dextroamphetamine

Methylphenidate

y Antihistamines

Hydroxyxine

y

GlucocorticoidsDexamethasone

Predinisone

y Bisphosphonates

Etidronate

Pamidronate

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DRUGS FOR HEADACHE

MNEMONICS:

Classifications:



NICS

1.) Abortivetherapy

Relieves moderate to severe migraineattacks. Alters transmission atserotonergic, dopaminergic, and alpha-adrenergic junctions.

Serotonin

AnalgesicsErgot alkaloidsHaloperidolRecepetor AgonistNaproxen

Telcagepant

2.) PreventiveTherapy

Prophylactic therapy can reduce thefrequency and intensity of migraineattacks. Inhibits reuptake of serotonin,making more transmitter available for action.

y Beta AdrenergicBlocking agents

PropanololTimolol

y Tricyclicantidepressant

Amitriptyline

y Antiepileptic DrugsDivalproexTopiramate

y Estrogens

y Calcium channelblockers

VerapamilFlunarizine

Other drugs for prophylaxis

Modulation of neurotransmitter release,a calcium-dependent process thatCCBs are known to effect

y Calcium channelblockers

verpamil

y Neurostabilizer DivalproexTopiramateLithium

y NSAID

IndomethacinNaproxen

y Ergot alkaloids

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Ergotamine

y Glucocorticoids

prednisone

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Antipsychotic Agents and Their Use in SchizophreniaMNEMONICS:

Classifications:



NICS

1.) First-generationantipsychotics:individualagents

FGAs are equally effective at alleviatingsymptoms of schizophrenia. Differencesamong these agents relate primarily toside effects because the high-potencyagents produce fewer side effects thanthe low-potency agents, high potencyagents are generally preferred.

y Low potency agentsChlorpromazineThioridazine

y Medium potencyagents

LoxapineMolindonePerphenazine

y High potency agentsTrifluoperazineThiothixeneFluphenazineHaloperidolPimozide

2.) Second-generationantipsychotics

SGAs and FGAs are equally effective.Major side effects, the SGAs are lesslikely to cause EPS, including TD.However, the SGAs carry an evengreater risk of their own, namely,potentially fatal metabolic effects-weightgain, diabetes, and dyslipidemia-thatcan lead to cardiovascular events andpremature death.

ClozapineOlanzapineRisperidonePaliperidoneQuetiapineZiprasidoneAripiprazole

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AntidepressantsMNEMONICS:

Classifications:



NICS

1.) SelectiveSerotoninReuptakeInhibitors

Fluoxetine - Selective inhibition of 5-HTreuptake, and thereby intensifiestransmission of serotonergic synapsesThese drugs are as effective as theTCAs, but do not cause hypotension,sedation, or anti-cholinergic effects arenausea, agitation/insomnia, and sexual

dysfunction.

SertralineFluoxetineCitalopramEscitalopramFluvoxamineParoxetine

2.) Serotonin/NorepinephrineReuptakeInhibitors

Block neuronal reuptake of serotoninand norepinephrine, with minimaleffects on other transmitters or receptors. Pharmacologic effects aresimilar to those of the SSRIs, althoughthe SSRIs may be better tolerated.

DesvenlafaxineVenlafaxineDuloxetine

3.) MonoamineOxidase

Inhibitors

It is an enzyme found in the liver, theintestinal wall, and terminals of

monoamine-containing neurons. Thefunction of MOA in neurons is to convertmonoamine neurotransmitter- NE, 5-HT,and dopamine- into inactive products.

SelegilineIsocarboxazid

PhenelzineTranylcypromine

4.) AtypicalAntidepressants

The mechanism by which depression isrelieved is unclear, but may be relatedto blockade of dopamine uptake. It doesnot affect serotonergic, cholinergic, or histaminergic transmission.

MirtazapineAmoxapineBupropionNefazodoneTrazodone

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Drugs for Bipolar Disorder

MNEMONICS:

Classifications:



NICS

1.) Mood-StabilizingDrugs

Mood stabilizers are drugs that canrelieve an acute manic or depressiveepisodes, prevent recurrence of manicand depression, or accelerate the rateof cycling.

Lithium

y Antiepileptic DrugsValproic AcidCarbamazepineLamotigrine

2.) Antipsychoticdrugs

Control symptoms during manicepisodes, and long term to help stabilizemood.

OlanzapineQuetiapineRisperidoneAripiprazoleZiprasidoneclozapine

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Sedative-Hypnotic Drugs

MNEMONICS:

Classifications:



NICS

1.) Benzodiazepines

Enhances actions of GABA by bindingto specific receptors in asupramolecular structure known as theGABA receptor-chloride channelcomplex.

TriazolamFlurazepamQuazepamEstazolamTemazepam

2.) Benzodiazepine-Like Drugs

They all act as agonist at thebenzodiazepine receptor site on GABAreceptor-chloride channel complex.

EszopicloneZolpidemZaleplon

3.) MelatoninAgonist

Activates receptors for melatonin-specifically the MT1 and MT2 subtypes,which are key mediators of the normalsleep-wakefulness cycle.

Ramelteon

4.) Barbiturates Bind to GABA receptor-chloride channelcomplex. These drugs can enhance the

inhibitory actions of GABA and directlymimic the actions of GABA.

Other Hypnotics Decrease sleep latency and prolongsleep duration and does not causetolerance or physical dependence.

TrazodoneAntihistaminesAlternative medicines

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Management of Anxiety DisordersMNEMONICS:

Classifications:



NICS

1.) GeneralizedAnxietyDisorder

Enhancing responses to GABA. Onseteffects are immediate, and the marginof safety is high. Principal side effectsare sedation and psychomotor slowing.

AntidperessantsBenzodiazepinesBuspirone

2.) Panic Disorder Decreases frequency and intensity of attacks, anticipatory anxiety, and

avoidance behaviour.

SertralineFluoxetine

Paroxetine

3.) Obsessive-CompulsiveDisorder

All enhances serotonergic transmission. ParoxetineCitalopramEscitalopramFluoxetineFluvoxamineSertraline

4.) Social Anxiety

Disorder

Inhibits CNS neuronal uptake of

serotonin; blocks uptake of serotoninwith weak effect on norepinephrine.

Fluvoxamine

ParoxetineSertraline

5.) Post-TraumaticStressDisorder

Potentiates serotonergic activity in theCNS, resulting antidepressant effect.

ParoxetineSertraline

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DRUGS ABUSE II: ALCOHOLMNEMONICS:

Classifications:



NICS

1.) To FacilitateWithdrawal

Benzodiazepines- Stabilizes vital signs, reduce symptomintensity, and decrease risk of seizuresand delirium tremens.

Beta-Adrenergic Blockers-Improve vital signs; decrease craving,decrease autonomic component of

withdrawal symptoms.

Alpha-Adrenergic Blocker -Decrease autonomic component of withdrawal symptoms.

Antiepileptic Drug- Decreases withdrawal symptoms;prevent seizures.

ChlordiazepoxideDiazepamOxazepamLorazepam

AtenololPropranolol

Clonidine

Carbamazepine

2.) To Maintain

Abstinence

It blocks the pleasurable effects of

alcohol and decreases craving.

Disulfiram Aversion

TherapyNaltrexoneAcamprosateTopiramateOndansetron

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DRUGS ABUSE: MAJOR DRUGS OF ABUSEMNEMONICS:

Classifications:



NICS

1.) Opioids high lipid solubility, which allows thedrug to cross the blood brain barrier with ease. Thereby producing effectsthat are both immediate and intense,

HeroinMorphineMeperidineHydromorphone

2.) Psychostimulants Amphetamines and cocaine canstimulate theheart, blood vessels, and

other structures under sympatheticcontrols. Because of these peripheralactions, these agents are also referredto as sympathomimetics.

CocaineDextroamphetamine

MethamphetamineMethylphenidate

3.) Depressants Produce substantial physicaldependence. Cross-dependence existsbetween barbiturates and other CNSdepressants but not with opioids. Incontrast, the opioid abstinencesyndrome is rarely life threatening.

y BarbituratesAmobarbitalSecobarbitalPentobarbitalPhenobarbital

y BenzodiazepinesDiazepam

FlunitrazepamLorazepam

y MiscellaneousAlcoholMethaqualoneGamma-hydroxybutyrateMeprobamate

4.) Psychedelics Acts multiple sites in the brain andspinal cord. However, effects are most

prominent in the cerebral cortex and thelocus ceruleus.

LSDMescaline

PsilocybinDimethyltryptamine

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5.) DissociativeDrugs

Distort perception of sight and sound,and produce feelings of dissociationfrom the environment. High dosesproduce sedation, immobility, analgesia,and amnesia.

PhencyclidineKetamine

6.) Anabolic steroids Enhances athletic performance. Theprincipal benefit is increased musclemass and strength.

NandroloneOxandroloneTestosterone

7.) Miscellaneous Nicotine can activate nicotinic receptorsat several locations. Most effects resultfrom activating nicotinic receptors inautonomic ganglia and the adrenalmedulla.Marijuana - Activation of specificcannabinoid receptors found in variousparts of the brain.

DextromethorphanMarijuanaNicotineNitrous oxideAmyl nitrite

CNS 29 - 39

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