Professional Documents
Culture Documents
Morphine
Methadone
Etorphine
Buprenorphine
Naloxone
Narcan
Diprenorphine
Nalorphine
analgesic
Pentazocine
analgesic
Oxycodone
roxicodone
Codeine
Oxycontin
Diphenoxylate
Lomotil
antidiarrheal
Percodan
analgesic
Percocet
analgesic
Merperidine
Demerol
L-acetyl-alpha-methadol
LAAM
Subutex
Suboxone
Naltrexone
Fentanyl
Nalbuphine
Endogenous Peptides
Met, Leu-Enkephalin
Beta-endorphin
Dynorphin-A
Dynorphin-B
alpha-Neoendorphin
Mechanism
Binds to mu, K, and delta receptors in spinal cord to block transmission between cfibers and STh neurons. Disinhibits descending pain inhibitors. Decreases substance
P. Modulates affect to make you not care about pain.
Normal opiate effects with less euphoria, mental clouding, and a much longer
duration of action. Withdrawal symptoms less severe, but longer in duration
Especially targets K receptors in spinal cord and best for acute pain
eptides
mu < delta agonist
mu = delta agonist
mu < kappa agonist
mu = delta < kappa agonist
mu = delta < kappa agonist
Side Effects
Constapation and miosis (occor every time with no tolerance).
Nausea, vomitting, sedation, mental clouding, decreased
brainstem response to CO2, thus decreased resp. Smooth
muscle constriction: thus cant use in pregnancy, gall bladder
pain, renal colic pain, and athma.
Name
Clinical Indications
Topiramate
Topamax
Na channel blocker
Carbamazepine
Tegretol
Na channel blocker
Phenytoin
Dilantin
Na channel blocker
Phenobarbital
Luminal
Barbiturate
Primidone
Mysoline
Potentiation of GABA
Diazepam
BZ
Benzodiazepines
BZ
Valproic Acid
Valproate
Ca channel Blockers
Ethosuximide
Zarontin
Ca channel Blockers
Lamotrigine
Lamictal
Felbamate
Felbatol
Partial seizure
Topiramate
Topamax
vigabatrin
Sabril
partial seizures
Tiagabine
Gabitril
partial seizures
Gabapentin
Neurontin
partial seizure
Pregabalin
Lyrica
partial seizure
SEE Topiramate
Above
levetiracetam
Keppra
Mechanism
Side Effects
Na channel Blockers
Drug interactions
Potentiation of GABA
Potentiaties GABA by increasing Cl conduction, at
hight doses and directly activate GABA receptor
Ca channel blockers
enhance GABA synthesis and inhibits break down,
inhibits Na channels similar to carbamazepine,
inhibits T-type Ca channels
Hepatic
Antagonism of Glutamate
Blocks NMDA, Na channel block
anti-folate activity
aplastic anemia
hepatic
alpha2-delta modulation
Binds to GABA B and alph 2 delta Ca channel.
Binds to GABA B and alph 2 delta Ca channel.
Others
Metabolism Notes
hepatic/ active
metabolites
dose-dependent
elimination (starts 1st
order -> 0 order)
No DDIs
No DDIs
No DDIs
No DDIs
Name
Brand Name
Clinical Indications
Sumatriptan
Acute Migraine Headaches
rizatriptan
NSAIDS
administer during early part (aspirin, ibuprofen, naproxen, indomethacin, diclofenac, ketoprofen, ketorolac)
Ergotamine
Dihydroergotamine DHE
Acetaminophen
Migraines
Esgic
Acute Migraine Headaches
Excedrin
Methylprednisone
Medrol
Valproate
Valproic acid
metoclopramide
antiemetic
Topiramate
Migraine Prophylaxis,
Antiepileptic
Propanolol
migraine prophylaxis
Amitriptyline
Gabapentin
Verapamil
cluster headaches
Venlafaxine
Botulinum Toxin
Botox
Migraine Prophylaxis
Mechanism
Side Effects
Drug interactions
Ca channel blocker
dizziness, hypotension,
constipation, cardiac conduction
blocks
Muscle paralysis
CYP3A inhibitioin
Metabolism
no hepatic
metabolism; good for
pts with impaired liver
function
Notes
Believed to bind to brainstem nuclei and the area around the vasculature near trigeminal nerve innervation; block vasoactive peptide release
from trigeminal nerve endings; promote vasocontriction of vasculature; block pain pathways in brainstem; First line of defense
Name
Brand Name
Class/Type
Clinical Indications
Amitriptyline
Elavil
TCA
Desipramine
Norpramin
TCA
Nortriptyline
Pamelor
TCA
Clomipramine
Anafranil
TCA
Imipramine
Tofranil
TCA
Doxepin
Sinequan
TCA
Amoxapine
Asendin
TCA
Phenelzine
Nardil
MAOI
Tranylcypromine
Parnate
MAOI
Selegiline
Eldeprenyl
MAOI
Fluoxetine
Prozac
SSRIs
Sertaline
Zoloft
SSRIs
Paroxetine
Paxil
SSRIs
Fluvoxamine
Luvox
SSRIs
Citalopram
Celexa
SSRIs
Escitalopram
Lexapro
SSRIs
Buproprion
Welbutrin/Zyban
Venlafaxine
Effexor IR XR
Desvenlafaxine
Pristiq
SNRI
SARI (SE antagonist
and RI)
Nefazodone
Mirtazapine
Remeron
Duloxetine
Cymbalta
SNRI
Atamoxetine
Strattera
NRI
ADHD
Mechanism
Side Effects
Block 5HT and NE reuptake, but are also Dangerous in an OD. Sedation (H1, mACh),
antagonists for H1, Alpha1 and mACh. Also Weight Gain (H1), Hypotension (Alpha1), Blurred
good for chronic headaches
vision & constipation (mACh), Sexual Dysfunction
Drug interactions
Avoid giving with drugs that inhibit
2D6 enzyme
Fluvoaxamine, paroxetine,
fluoxetine inhibit CYP450 enzymes
no liver metabolism
Metabolism
Notes
expensive medication
liver toxicity
Name
Ibuprofen
Naproxen
meclofenamate
paroxicam
Sulindac
indomethacin
nabumetone
celecoxib
Celebrex
refecoxib
Aspirin
Acetaminophen
Mechanism
Side Effects
Blocks COX 1 > COX2: in tissues this decreases PG synth and thus
decreases neural sensitization and inflammation cascade. In
hypothalamus, block of PG reduces fever. In blood blocks TXA.
Blocks COX 1 > COX2: in tissues this decreases PG synth and thus
decreases neural sensitization and inflammation cascade. In
hypothalamus, block of PG reduces fever. In blood blocks TXA.
Blocks COX 1 < COX 2: in tissues this decreases PG synth and thus
decreases neural sensitization and inflammation cascade. In
hypothalamus, block of PG reduces fever. In blood blocks TXA.
Blocks COX 1 << COX2: in tissues this decreases PG synth and thus
decreases neural sensitization and inflammation cascade. In
hypothalamus, block of PG reduces fever. In blood blocks TXA.
Drug interactions
Metabolism Notes
Positive effect in
treatment of
Paroxysmal
Hemicrania
Pregnancy
Class B
Name
Brand Name
Class
Clinical Indications
Xanax
BZ
Lorazepam
Ativan
BZ
Chloridazepoxide
Librium
BZ
Diazepam
Valium
BZ
Oxazepam
Serax
BZ
Clonazepam
Klonopin
BZ
Buspirone
Buspar
Propranol
Clonidine
Prazosin
Tiagabine
Neurleptics
Mechanism
Side Effects
Drug interactions
Metabolism Notes
Name
Receptor
Coupling Protein
Effector
2nd messenger
Gq
increases
PLC
Gs
increases
adenyl
cyclase
Gi
decrease Ca
influx, increase
decreases
enzyme
adenyl
decreases camp
activity,
cyclase
increase K
efflux
beta, D1
alpha 2, M2
camp
Result
increase in Ca,
increase
protein kinase
activity
increase Ca
influx, increase
enzyme activity
Notes
Name
Brand Name
Class
Clinical Indications
Lithium
Mood Stabilizer
Chlorpromazine
First Generation
Antipsychotic
(typical
antipsychotic)
Perphenazine
First Generation
Antipsychotic
(typical
antipsychotic)
Fluphenazine
First Generation
Antipsychotic
(typical
antipsychotic)
Thiothixene
First Generation
Antipsychotic
(typical
antipsychotic)
Haloperidol
First Generation
Antipsychotic
(typical
antipsychotic)
Clozapine
Second generation
Schizophrenia, acute mania, agitation associated
Antipsychotic
with demetia, anxiety disorder, and obsessive
(atypical
compulsive disorder
antipsychotic)
Olanzapine
Quetiapine
Second generation
Schizophrenia, acute mania, agitation associated
Antipsychotic
with demetia, anxiety disorder, and obsessive
(atypical
compulsive disorder
antipsychotic)
Asenapine
Second generation
Schizophrenia, acute mania, agitation associated
Antipsychotic
with demetia, anxiety disorder, and obsessive
(atypical
compulsive disorder
antipsychotic)
Risperidone
Second generation
Schizophrenia, acute mania, agitation associated
Antipsychotic
with demetia, anxiety disorder, and obsessive
(atypical
compulsive disorder
antipsychotic)
Ziprasidone
Second generation
Schizophrenia, acute mania, agitation associated
Antipsychotic
with demetia, anxiety disorder, and obsessive
(atypical
compulsive disorder
antipsychotic)
Paliperidone
Second generation
Schizophrenia, acute mania, agitation associated
Antipsychotic
with demetia, anxiety disorder, and obsessive
(atypical
compulsive disorder
antipsychotic)
Iloperidone
Second generation
Schizophrenia, acute mania, agitation associated
Antipsychotic
with demetia, anxiety disorder, and obsessive
(atypical
compulsive disorder
antipsychotic)
Lurasidone
Second generation
Schizophrenia, acute mania, agitation associated
Antipsychotic
with demetia, anxiety disorder, and obsessive
(atypical
compulsive disorder
antipsychotic)
Aripiprazole
Second generation
Schizophrenia, acute mania, agitation associated
Antipsychotic
with demetia, anxiety disorder, and obsessive
(atypical
compulsive disorder
antipsychotic)
Carbamazepine
Lamotrigine
Topiramate
Valproic Acid
fewer Extra Pyramidal Symptoms but more H1, alpha1, and muscarinic bloc
more extrapyramidal side effects and fewer H1, alpha1, and anticholiner
Mechanism
Side Effects
Anticonvulsants
Drug interactions
Metabolism
Notes
Low potency
Medium Potency
High potency
Medium Potency
High potency
Name
Clinical Indications
Methylphenidate
Concerta
Stimulant
ADHD
Amphetamine
Adderall
Stimulant
ADHD
Clonidine
Catapres
Alpha2 agonist
ADHD; PTSD
Guanfacine
Tenex
Alpha2 agonist
ADHD; PTSD
Imipramine
Tofranil
TCA
Burproprion
Welbutrin/Zyban
ADHD
NRI
ADHD
Atomoxetine
Mechanism
Side Effects
Drug interactions
Metabolism
Notes
Pregnancy class C
CI in pregnancy
hepatic
hepatic
No sexual dysfunction;
mood stabilizer; no weight
gain
less abuse potential than
stimulants