Common Name

Sub Category

Mechanism of Action Increased presynaptic NE vesicular release

Clinical Use/Indications ADHD Meds 1st line for ADHD - good for attentional symptoms

Adverse Effects 1. Can be abused and cause psychological and physical dependence

Methylphenidate (Ritalin) Amphetaminetype stimulants Dexmethylphenidate (Focalin) Mixed amphetamine salts (Adderall) Atomoxetine Nonamphetamine stimulant Clonidine Alpha-2 Adrenergic Guanfacine Agonist

2nd line for ADHD = helps with inattention, overactivity Increase noradrenergic tone in inhibitory synapses 3rd line for ADHD - helps with hyperactivity, motor symptoms (tics)

Buproprion Venlafaxine TCAs

Antidepressants Dopamine reuptake inhibitors and dual-reuptake inhibitors (NE/5-HT)

3rd line for ADHD Not used in kids because of cardio

Typical Antipsychotic Agents Chlorpromazine* Thioridazine* Mezoridazine Prochlorperazine Fluphenazine* Trifluoperazine* Haloperidol (Haldol)* Droperidol Thithixene Butyrophenone derivatives Thioxanthene derivative Phenothiazine derivatives 1. Competitively blocking dopamine receptors (D2/D3 ratio = 10-50) 2. Inhibit activation of adenyl cyclase and shuts down the mesolimbic system 3. D2 receptors located in limbic, extrapyramidal, endocrine structures 1. Treatment of psychosis - Schizo -> positive symptoms - Bipolar - Delirium - Depression w/ psychosis 2. Off-label uses - Depression - Aggression - Personality disorders - Eating disorders - Impulse control disorders 1. Anticholinergic - dryness 2. Extrapyramidal (EPS) - Parkinsonian syndrome - Acute dystornia - spasm of nexk muscles - tx w/ benztropine - Tardive dyskinesia - involuntary movement 3. Neuroleptic malignant syndrome (NMS) - blockage of D2 in hypothalamus - hyperthermia, hypertension, dyskinesia - tx w/ dantrolene/bromocriptine 4. Sedation 5. Cardiovascular - prolonged QT, ECG change 6. Endocrine --> galactorrhea, amenorrhea Atypicals have better side effect profiles

Atypical Antipsychotic Agents Serotonin/dopa 1. Competitively block serotonin receptors (5mine HT2), which inhibits dopamine release in frontal lobes Risperidone (Risperdal)* antagonists 2. Higher degree of binding/blocking D4/D3 3. Improves negative symptoms of schizo, reduces Olanzapine* EPS side effect, improves positive symptoms Quetiapine* Clozapine* Ziptrasidone* 1. Dop antag in high (mesolimbic) and agonist in Apripiprazole (Abilify)* Dopamine agonist/antagoni low dopamine (frontal lobes) st See above, except can also treat negative symptoms - Olanzapine for OCD, anxiety, depression, mania, Tourrette's

Common Name

Sub Category

Mechanism of Action

Clinical Use/Indications ADHD Meds Mood Stabilizers

Adverse Effects

Lithium*

Classic

1. Possibly inhibits phosphoinositol cascade

1. 1st line for acute bipolar depression prophylaxes depression 2. Blocks relapse and acute manic events

Lamotrigine

Anticonvulsants Interferes w. Na channels and reduces excitation

1. Prophylax depression - Bipolar depression (treatment and maintenance) 1. Acute mania and in rapid cycling bipolar/mixed episodes

Valproic Acid (Depakote)

Interferes w/ Ca/Na channels, enhances GABA, inhibits glutamate

Carbamazepine

Acts on Na/K channels to enhance GABA

Only use if Lithium or Valproic acid fail

1. LMNOP - Lithium - Movement (tremor) - Nephrogenic DI - hypOthyroidism - Pregnancy problems 2. Need to monitor closely - toxicity seen at 1.5-2 mEq/L 1. Dizziness, sedation, diplopia, ataxia 2. Pregnancy issue 3. Severe rash/Steven Johnson syndrom 1. Pregnancy Issue (D) 2. Sedation, dizziness 3. Can induce Hepatitis/hepatic fail, pancreatitis, abnormal bleeding 1. Pregnancy Issue (D) - spina bifida 2. GI, dizziness, Agranulocytosis 4. Hepatitis/cholestatic jaundice 5. Steven Johnson

Oxcarbazepine Gabapentin Symbyax Antipsychotics Benzodiazepines Other mood stabilizers

Similar to Carbamazepine, with better side effects

Antitussives and Mucokinetic Agents (Coughing) Codeine Hydrocodone Dextromethorphan Centrally acting 1. Non-specifically reduce excitability of cough antitussives center (anodynes) 1. Non-productive cough 1. Resp depression - caution in < 2 - when cough results in sleep loss 2. Constipation, miosis, sedate, addict - to prevent herniation, spread of infection Fewer side effects - Confusion, excitation, nervous, resp depression in high dose - high abusive potential

Promethazine/phenerga Diphenhydramine (Benadryl) Benzonatate

Guaifenesin Robitussin/Humibid N-Acetylcysteine

Peripheral acting antitussive Mucokinetic Expectorants Mucokinetic Mucolytics

Reduce afferent inputs to the cough center - on stretch receptors in the respiratory passage Stimulate/modify mucous production in bronchi stomach irritant that causes bronchial secretion Break down sputum aggregates to smaller parts splits disulfide bonds - Nebulize 1. Productive coughs - Expectorants - thick/tenacious cough secretions - Mucolytics - cystic fibrosis, antidote to acetaminophen poisoning

1. Can cause hypersensitivity rxn procain/tetracaine 2. DON'T CHEW - anesthesia GI tract issues

Common Name Demulcents

Sub Category Mucokinetic Demulcents

Mechanism of Action Sticky substances that protect lining of resp tract

secretions - Mucolytics - cystic fibrosis, antidote to Clinical Use/Indications acetaminophen poisoning ADHD Meds

Adverse Effects

Common Name

Sub Category

Mechanism of Action

Clinical Use/Indications ADHD (vomiting) Anti-EmeticsMeds

Adverse Effects

Chlorpromazine Prochlorperzine Promethazine Thiethylperazine Droperidol Scopolamine Diphenhydramine Dimenhydrinate Hydroxyzine Meclizine Promethazine (phenergan) Ondansetron Granisetron Dolasetron Polonosetron Trimethobenzamide Metoclopramide

Antipsych

1. Depresses excitability of the CTZ by blocking D2 receptors and transmission 2. Also peripherally blocks D2 in GI

1. Radiation/drug induced vomiting 2. Thiethylperazine used for post-op 3. Doperidol has tranquilizing effects

1. Sedation 2. EPS 3. Allergic

Anticholinergic Blocks Ach receptors in CTZ, vest nuclei and GI tract Antihistamines - Blocks Ach receptors in vest nuclei and CTZ Ethanolamine Antihistamine1st gen pipera Antihistamine phenothiazine Serotonin Selectively blocks serotonin receptors (5-HT3) in blockers GI and CTZ

Motion sickness Motion sickness Vertigo, motion sickness

Sedation, blurred vision, reduced GI/bladder tone Sedation, blurred vision, dry mouth 1. Pregnancy issue 1. Contraindicate in children

1. Post-op n/v following highly emetogenic surgery 2. drug-induced n/v (antineoplastics) 3. Radiation therapy n/v 4. NO motion sickness 1. Post-op n/v and coughing 1. GE reflux 2. Daibetic gastric stasis 3. N/v assoc w/ cisplatin, radiation N/v due to antineoplastics Anorexia w/ weight loss in AIDS

1. No EPS 2. Headache, diarrhea, constipation, phlebitis

Benzamide derivatives

Antiemetic - depresses CTZ (D2) Antitussive - suppresses laryngeal reflex 1. Prokinetic 2. Anti-emetic - antagonism of dopamine Vestibular Potent CYP3A4 inhibitor

1. CNS depression 2. EPS, Reye's syndrome 1. CNS depression 2. EPS Impairs cognitive and motor fx

Dronabinol Aprepitant Aplprazolam Triazolam* Lorazepam* Oxazepam Flurazepam Prazepam Diazepam* Pehnobarbital Mephobarbital Pentobarbital Secobarbital

Other - nausea vomiting

Sedative-Hypnotic Drugs Benzodiazepein 1. Binds to site on GABA A receptor, which es (short acting) enhances GABA's effect 2. Mediates both sedation and memory effects 3. Benzo + GABA = increased freq of channelopening events (Cl-) Benzodiazepein es (long acting) 1. Anxiety 2. Spasticity 3. Status epilepticus (lorazepam, diazepam) 4. Detox 5. Night terrors, sleepwalking 6. Insomnia (estazolam, fluraz, quaz, tema, triazolem) - bind 3 alpha-1 sybtype 1. Anticonvulsant - seizures 2. Basal anesthesia 3. Narco-analysis 4. Decreases respiration neurogenic/chemical/hypoxic drives 1. Potential abuse - lethal:effective dose = 200:1 2. Withdrawal 3. Daytime drowsiness 4. Respiratory impairment

Barbiturate Sedativehypnotics

1. Barbiturates + GABA = increased duration of channel-opening events (Cl-) -> decreased neuron firing

1. Contraindicate in porphyria 2. Dependence 3. Lethal, especially with alcohol

hypnotics Common Name Thiopental Chloral hydrate Diphenhydramine (Benadryl) Trazodone Ramelteon Zolpidem (Ambien) Zaleplon (Sonata) Eszopiclone (Lunesta) Historical Antihistamines Antidepressan Sub Category

firing Mechanism of Action

3. Narco-analysis 4. Decreases respiration Clinical Use/Indications neurogenic/chemical/hypoxic drives ADHD Meds

3. Lethal, especially with alcohol Adverse Effects

Hepatic injury Sedating antihistamine

Melatonin agonist Imidazopyridine Act on alpha subunit of GABA A - selectively bind Insomnia derivative to receptor to produce hypnotic effects Pyrazolopyrimid ine class Antidepressants

Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (Paxil) Citalopram (Celexa) Escitalopram (Lexapro) Fluvoxamine Imipramine Desipramine Amitripltyline Nortriptyline Venlafaxine (Effexor)

Selective Serotonin Reuptake Inhibitors (SSRIs)

1. Selectively block uptake of serotonin 2. Advantages - more benign than TCAs, no quinidine action on heart, no significant weight gain 3. High safety margin

1. Depression 2. OCD, panic disorders, PRSD 3. Eating disorders, GAD 4. PMS

1. Transient - nervousness, insomnia, nausea, diarrhea 2. Persistent - sexual dysfx 3. Serotonin syndrome - confusion, fever, altered consciousness, myoclonus 4. Inhibits p450

Tricyclic 1. Block active reuptake of norep and serotonin antidepressants higher levels in synaptic cleft (TCA) 2. Original gold standard

1. Resistant depression 2. Enuresis in childhood (Imipramine) 3. Chronic pain, neuralgias, miagraine, diabetic neuropathy 1. Depression, GAD, Panic 2. PTSD, PMS

1. Sedation, anticholinergic 2. ECG change 3. Weight gain, impotence 4. Can precipitate mania Similar to SSRIs

Duloxetine

Serotonin + Reuptake inhibitor of serotonin, norep, and some Norep reuptake dopamine inhibitors (SNRI)

Phenelzine

MAO inhibitors Inhibits MAO A and B non-selectively, which result in higher norep and serotonin release

Tranylcypromine Buproprion (Wellbutrin, Zyban) Norep + Blocks reuptake of norep and dop dopamine reuptake inhib (NDRI) Noradrenaline + serotonin (NaSSA) Serotonin antag reuptake inhibitors (SARI)

1. Better for bipolar/atypical depression 2. Phobias 3. Migraines 4. Neurodermatitis 1. Depression (fewer sex side effects) 2. Smoking cessation - Zyban 3. ADHD

1. Weight gain, sexual dysfx 2. Hepatotoxic 3. Slower onset Sexual dysfunction Faster onset 1. Agitation, insomnia, seizures 2. Inhibits 2D6

Mirtazapine Nefazodone

Common Name Trazodone

Sub Category reuptake inhibitors (SARI) Serotonin antag Mechanism of Action

Clinical Use/Indications ADHD Meds

Adverse Effects

Common Name

Sub Category

Mechanism of Action

Clinical Use/Indications ADHD Meds General Anesthetics

Adverse Effects

Nitrous Oxide (N2O) Halothane Enflurane Isoflurane Desflurane Sevoflurane Ketamine Propofol Etomidate

Gases

CNS depressants - blood soluble = rapid induction/recovery - lipid soluble = potency = 1/MAC - ventilation + concentration = more rapid uptake

Must combine w. IV narcotics, barbiturate 1. Bone marrow suppression in high conc and relaxants 2. Neuropathy 1. Massive hepatic necrosis (halothane hepatitis) in 1/35,000, less in children 2. slows HR, decreases MAP/CO 1. Free F- released = renal fail (preexist) 2. Increases HR, decreases MAP/CO 1. No renal dysfx, minimal metab 2. Increases HR, decreases MAP/CO + SVR 1. Minimal liver biotransform 2. Increases HR, decreases MAP 1. Same as enflurane - disolve in soda lime 2. Little heart effect

IV agents

Muscarinic receptor antagonist Opiate receptor agonist Produces dissociated anethesia

1. Myocardial depressant 2. Depresses respiration

Local Anesthetics Bupivacaine Ropivacaine Lidocaine Tetracaine Cocaine Procaine Benzocaine Intraocular Pressure (IOP) Lowering Agents - Ocular Hypertensives Brimonidine Timolol Dorzolamide hydrochloride Acetazolamide Mannitol Glycerin Isosorbide Pilocarpine Echothiophate iodide Latanoprost Prostaglandins Miotics Direct - stimulate muscarinic receptors to cause constriction and increase flow Indirect - blocks Ach-esterase F2 - increase matrix turnover = increased flow Alpha agonists Beta blockers Carbonic Anhydrase Inhibitors Hyperosmolar agents Activates alpha 2 - inhibits aqueous secretion Blocks beta receptors - decrease aqueous secre Inhibits CA, which decreases aqueous production 1. Open angle glaucoma 2. Ocular hypertension dry mouth, hypotension, lethargy Bradycardia, bronchospasms, fatigue, worse myasthenia gravis Drops - bitter taste, diuresis, fatigue, StevensJohnson Oral/IV - hypokalemia, renal stones, aplastic anemia, Stevens-Johnson CHF, urinary retention, back acne, MI vomiting, less CHF, similar to mannitol same as glycerin, but safer in DM Angle closure, breakdown of barrier, retinal tears - don't use in young patients Retinal detachment, myopia, angle closure Increase melanin, blurred vision, URI symptoms, myalgia Esters Amides 1. Blocks voltage dependent Na channels - block AP 2. Absorption - short = limited, need vasoconstrictor 3. Vasodilate except for cocaine 4. Esters metab by pseudocholinesterases, Amides by hepatic microsomal enzymes 1. Minor surgery 2. Spinal anesthesia 3. Regional anesthesia 4. Infiltration anesthesia 5. Post-op analgesia 1. CNS - lightheaded, restless, tonic-clonic 2. CV - cocaine = htn, mi, cerebral hemorrhage 3. Allergy - esters 4. Treat convulsions w/ diazepam or barbiturates

Dehydrates vitreous and draw fluid into intravascular space

Common Name Dipivefrin

Sub Category

Mechanism of Action

Clinical Use/Indications ADHD Meds

Adverse Effects Cystoid macular edema, mydriasis, blurred vision, tachycardia, htn, headache

Sympathomimet Beta stimulation in trabecular network = increased ic flow

Common Name

Sub Category

Mechanism of Action

Clinical Use/Indications ADHD Meds Other Eye Drugs

Adverse Effects

Penicillin, etc Non-steroidals/ Corticosteroids Tropicamide Atropine sulfate Phenylephrine Macugen Lucentis Avastin Acetaminophen Aspirin Naproxen Isometheptene (Midrin) Metoclopramide Sumatriptan Zolmitriptan Naratriptan Rizatriptan Almotriptan Frovatriptan Eletriptan Ergaotamine Dihydroergatamine Chlorpromazine Propranolol Timolol Divalproex Topiramate Verapamil Flunarizine TCAs

Antibacterials

Self-explanatory

Antiinflammator y Dilating drops Parasympatholytic - block Ach receptors in iris ciliary body - mydriasis and cycloplegia Sympathomimetic - stimular dilator muscle Anti-VEGF

Eye drops

Mydriasis and cycloplegia (paralysis)

Pegylated oligonucleotide binds to VEGF 165 and Stops angiogenesis/neovascular in: prevents ability to bind to receptor 1. macular degen (wet), DM retino 2. Neovascular glaucoma, retinal vein Recombinant fragment that ragets VEGF-A occlusion Parent of Lucentis Migraine Drugs Mild-moderate migraines Just helps with the pain

1. Blurred vision, pain, redness of eye, increased IOP, retinal detachment 2. Dizziness, headache, nausea, diarrhea 3. Beware hypersensitivity rxn

Analgesic NSAIDs

Ideal for pregnant - contra in severe kidney/liver disease, G6PD

Combine to prevent migraine Good for nausea and vomiting Triptans 1. 5-HT1B/D agonists, some 1F (1B = bv, 1D/F = neurons) 2. Selectively constrict cranial vessels and reduce inflammation 3. Block pain transmission from CN V to trigeminal nucleus caudalis 4. All except sumatriptan are more centrally penetrant Abort Moderate-Severe migraines If doesn't abort in 2-4 then medication won't help 1. Contraindications - Heart disease/MI - Angina, HTN - basilar migraine 2. Triptans can't be used w/ other triptans or ergot or MAOIs 3. Too much ergot = poisoning

Ergot alkaloids 1. 5-HT1B/D agonists 2. Additional receptor affinities Neuroleptics Opioids Beta blockers Anti-epileptic Ca blockers Antidepressants Without sympathomimetic activity GABA agonists Prolonged migraine + signif n/v Don't respond to normal tx Migraine prevention Safe for pregnant when limited 1. Decreased sexual activity, bradycardia, lethargy Pregnancy group D, liver issues Significant cardiac (Class 4 antiarrhy) Severe cardiac effects, orthostatic hypotension

Common Name

Sub Category

Mechanism of Action

Clinical Use/Indications Parkinson's ADHD-Meds Drugs Dopamine agents

Adverse Effects

Levodopa

Levodopa

Trihexyphenidyl Benztropine Bromocriptine Pergolide Pramipexole Ropinirole Apomorphine Entacapone Tolcapone Selegiline Rasagiline Amantadine Antipsychotics Reserpine Tetrabenazine Botulinum toxin

Dopamine replacement - absorbed in SB through LNAA - converted to dopamine + O-methyl dopa by DDC Anticholinergic Blocks central muscarinic receptors Dopamine agonist Stimulate dopamine receptor directly

Most effective for treating Parkinson's tremor, rigidity, bradykinesia

Nausea, hypotension, hallucinations - Must be administered w/ carbidopa, a DDC inhibitor Mild tx for Parkinson's - tremor + rigidity dry mouth, sedation, blurry vision, urinary retention Moderate tx for Parkinson's - tremor, rigidity, bradykinesia PUD, vasoconstrictive, pulm fibrosis, hallucination, valve disease (pergolide) Somnolence, leg edema, compulsive behavior

COMT inhibitors MAO-B Inhibitors Other Dopamine Receptor Blockers and Depleters Poison

Inhibit breakdown of dopamine by COMT Inhibit breakdown of dopamine by MAO Dopaminergic, anticholinergic, NMDA antag

Adjunct w/ L-dopa - increases ON time Mild tx - tremor, rigid, bradykinesia, potentially neuroprotective Mild tx - tremor, rigid, bradykinesia

Orange discoloration of urine, diarrhea Fatal hepatitis Serotonin syndrome w/ SSRIs Peripheral edema, hallucinations

Inhibits release of Ach at the NMJ

Focal dystonia - cervical dystonia, blepharospasm, hemifacial spasm Antiepileptic drugs Tx of choice for acute seizures Refractory status epilepticus Partial seizures

Lasts 3-6 months - could overweaken muscles Sedation, resp depression bad side effects- only use in infant, poor Can cause absence epilepticus, sedation Thrombophlebitis, sedation, dizziness, diplopia, hepatotoxicity, myelosuppression

Benzodiazepines Barbiturates Tiagabine Phenytoin Carbamazepine Oxcarbazepine Lamotrigine Lacosamide Ethosuximide Valproate Topiramate Zonisamide Levetiracetam Gabapentin/Pregabalin

GABA affecting GABA-A - Cl channel opens more GABA-A - Cl channel opens longer Selective GABA reuptake inhibitor Na channel effecting

Voltage/Frequency dependent block of Na channel Partial and GTC seizures

Enhances the slow inactivated state of channel Enhances slow inactivation of the channel Ca channel Blocks T-type Ca channels in thalamus - stops affecting abnormal thalamic excitability Multiple MOAs 1. synaptic GABA, 2. NMDA excite 1. Cl events, 2. glutamate, Ca channels 1. Na channels, 2. Ca channels, 3. CA inhib Unique MOAs Binds vesicle protein SV2A - unknown a2 subunit of Ca channels

Good for all seizures Only absence seizures Good for all seizures All except absence seizures Good for all seizures Good for all seizures Partial seizures - pain

Headache, insomnia, rash Sedation, dizziness, headache, behavioral, myelosuppression Cog impairment, weight gain, hair loss, tremor, bad for pregnant Very safe - paresthesias, cog impair, weight loss Typical side effects, decreased appetite Safe - sedation, irritability Mild - sedation, weight gain

Common Name

Sub Category

Mechanism of Action

Clinical Use/Indications Drugs ofADHD and Addiction Abuse Meds

Adverse Effects

Alcohol

Metabolized via dehydrogenase system

Binds GABA, dilates bvs, decreases glutamate, reduces ADH secretion CNS/resp depression, miosis 1. CNS/resp depression, lethargy, coma 2. GHB - agitation, seizure, brady, amnesia 3. Chloral - dysrthmias 4. Withdrawal - insomnia, n/v, sweat, tachy 1. HR/BP, euphoria, strokes, rhabdomyolysis, seizures, renal fail Euphoria, hallucin, tense jaw, bruxism Euphoria, panic attacks, paranoia Tachy, htn, ataxia, seizure, coma drowsiness, euphora, paranoia Euphoria, dysrythmias, met acid transient euphoria, CNS depress Treats diarrhea/intestinal colic Neonatal opioid dependency Analgesic, dyspnea due to PE Mild/moderate pain, antitussive Schedule 1, 3x more than morphine Parkinsons oral analgesic moderate/severe pain

Heroin/Morphine Barbiturates Benzodiazepines Chloral hydrate GHB Cocaine Ecstasy LSD Phencyclidine (PCP) Marijuana Hydrocarbons Nitrous Oxide (N2O) Paregoric Morphine Codeine Heroin Apomorphine Oxycodone Hydromorphone Meperidine Fentanyl Diphenoxylate Loperamide Methadone Darvocet Pentazocine Nalbuphine Naloxone Naltrexone Buprenorphine

Opioids Sedativehypnotics

Binds to mu receptors 1. Enhance GABA 2. GHB - odorless, colorless 3. Chloral hydrate - pear-like odor

Wenicke, Korsakoff, cirrhosis, PUD, fetal alcohol syndrome, pancreatitis - BAD w/ acetaminophen Tx: ABCs, Narcan for acute, supportive Treatment: 1. Supportive care 2. Phenobarb - urine alkalinization 3. Chloral - beta blokcers 4. Benz - Flumazenil Treatment: supportive Hyperthermia - ice, Seizures - Benzo, phenobarb HTN - sodium nitroprusside, phentolamine Treatment - supportive

Stimulants

1. Block presynaptic reuptake of dopa, norep, serotonin 2. Produces vasoconstrict and local anesthetic Interacts with serotonin receptors Related to ketamine - CNS depressant

Hallucinogens

Inhalants

CNS depressants

Chronic: met acidosis, hypokal Chronic: polyneuro, mega anemia 1. Seizures (Meperidine) 2. Depress resp 3. Emetic effect - n/v 4. Miosis (morphine) 5. Antitussive - lower dose than analgesic 6. Bowel dysfx/constipation 7. CV - hypotension/brady 8. Euphoria, sedation 9. Dependence

Naturally 1. Inhibit firing of neurons in dorsal horn, limbic occuring opioid structures and cerebral cortex agonist 2. adenylyl cyclase -> cAMP -> Ca influx or K efflux -> neurotransmitter release 3. Targets mu receptors Semi-synthetic agonist

Synthetic agonists

Not antitussive, local anesthetic Post-op/chronic pain, anesthesia Diarrhea acute, non-specific diarrhea mod/severe pain, opioid dependency No clinical usefulness

agonist/antagoni Agonists at kappa receptor, antagonists at mu st receptor

Moderate pain due to kappa receptor

Potential abuse, psychotomimetic, hallucinatory and dysphoric effects Need to assist resp depression w/ vent Liver toxicity Reduction in bowel dysfunction, constipation

Pure antagonists Binds all opioid receptors with higher affinity than Antagonize opioid effects agonist and reverse effects of agonists Treat opioid dep, alcohol, detox Partial agonist Mu Agonist to a ceiling, submaximal response PAMOR antagonists Analgesic effect

Prevent opioid withdrawal, so good for opioid dependence

Alvimopan/Methynaltrexo Restricted ne antagonists

Other

Low potency - low incidence of EPS, high sedating/CV effects

High potency - low sedating/CV effects, higher incidence of EPS

May cause agranulocytosis

Metabolic syndrome No weight gain

Other

Drug interact: - DAMN (Dehydrate, AceI, Metro, NSAID) - COAST (CA inhib, Osmotic, Antacid, Salt, Caffeine)

Drug interact - aspirin, felbamate - Rifampin Induces own metabolism watch hepatic enzyme Be careful of asians

Opioids - doses < for cough vs analgesia Non-opioid - d-isomer of codeine - don't use with MAOIs

NOT 1st line antitussive

Smells bad, tastes horrible

Other

Other

Pentothiazine derivatives

Butyro derivative Derm patch aka Benadryl aka Dramamine

Also binds H1 histamine receptors

1. Antacids decrease absorp 2. Antihist/barbit/ETOH increase depression 3. CYP450 except loraz, oxaze, temaz

Lots of interactions because of P450

Other

25-50 mg hs

Rapid acting, short halflife Useful for middle of night insomnia

Takes a long time to reach steady state Shorter half life, better More sedating, better for anxiety

If overdosed (cardiac monitoring) use gastric lavage, NaHCO3, Lidocaine or Phenytoin 1. Liver metabolized 2. Dose dependent HTN Less risk of liver issue, can treat Diabetic neuropathy 1. Tyramine food, amphetamines -> HTN crisis

Other

Other

Nonvolatile 1. Depressed heart contractility 2. Decreased smooth muscle tone, PVR, TV 3. Blocks vent response to hypoxia

More rapid recovery than barbiturates Minimal CV effects Long acting Medium Acting Long duration Medium + surface Short duration Surface Don't use in kids Don't use w/ sulfa allergy, hyponatremia/kalemia, thiazides or digitalis

worse myasthenia gravis

tinal tears - don't use in young

ure

ymptoms, myalgia

Other

red vision, tachycardia, htn,

Other

ney/liver disease, G6PD

Oral, subQ, nasal liver/renal Oral, nasal - liver Oral - renal Oral- no renal/liver Oral - liver Oral - renal Oral - liver Oral - only 2x/wk IV/nasal - avoid preg

High efficacy, mild/moderate adverse effects

Not in US

Other

Ergot derivatives Nonergot derivative w/ specificity for the D3 receptor

Non-selective MAO I's = tyrosine effect

Lorazepam/Diazepam Phenobarbitol (IV) Nonlinear pharmaco SJ syndrome, asians Not as bad Good for Preg women New drug

Hepatic failure, polycystic ovary ight loss Works fast Short half-life

Other

Tx: supply thiamine, benzos, disulfiram

henobarb mine

Tx: supportive, betablockers for dysryth

Dilaudid - good renal

Schedule IV drugs