Drug



Benzodiazepines |(sedatives & hypnotics) | |

|Diazepam (Valium) |Long-acting |Muscle injuries, MS & CP |CI—pregnancy & nursing (cleft |10X less potent than Xanax |

| |(IV or IM dose) |Status epilepticus |palates) |1st prescription until 1992 |

| | |EtOH withdrawal | |10s onset (MOST lipophilic) |

|Clorazepate |Long-acting |Partial seizures | |Combo w/ anti-convulsants |

| | |EtOH withdrawal | |Decarboxylated in stomach |

|Clonazepam (Klonopin) |Long-acting |Panic disorder |Tolerance w/in 1-6m | |

| | |Phobic disorders (2nd-line) | | |

| | |Spasticity (w/o sedation) | | |

| | |Absence seizures | | |

|Flurazepam |Long-acting |Insomnia (inpatients, up to 4w) |Daytime sedation |t1/2 > 100h |

| | | |CI—sleep apnea, snorers | |

|Lorazepam (Ativan) |Intermediate-acting |GAD (2nd) |Safe for elderly & liver dz |2-3min onset |

| |(IV or IM dose) |Status epilepticus |(NO active metabolite) | |

|Alprazolam (Xanax) |Intermediate-acting |DOC for GAD | |10th prescription in US |

| | |Panic disorder (higher doses) | | |

| | |Phobic disorder (2nd-line) | | |

|Temazepam |Intermediate-acting |Insomnia (w/ frequent waking) |Safe for elderly & liver dz |Peaks 2-3h after oral dose |

| | | |(NO active metabolite) | |

| | | |CI—sleep apnea, snorers | |

|Oxazepam |Short-acting |Anxiety, EtOH withdrawal |Safe for elderly & liver dz | |

| | | |(NO active metabolite) | |

|Triazolam |Short-acting |Insomnia (falling asleep) |Tolerance (ONLY 7-10d), rebound |MOST potent (4X Xanax) |

| | | |insomnia, REM rebound, amnesia, | |

| | | |disinhibition | |

|Midazolam |Ultra-short-acting |Pre-op anesthesia, |CI—narcotics & COPD |NOT general anesthesia |

| | |oral surgery | | |

|Flumazenil |Benzo antagonist |Benzo overdose | | |

| |(IV dose ONLY) |Rx for sedation | | |

|Buspirone |5-HT1A agonist |Selective anxiolytic |NO dependence or WD |NOT muscle relaxant OR |

| | |(elderly & alcoholics) |NO interaction w/ EtOH |anti-convulsant |

| | | | |Slow 2-4w onset |

|Zolpidem (Ambien) |Benzo receptor agonists |Selective hypnotic |Minimal rebound insomnia | |

|Zaleplon (Sonata) | | |Interacts w/ EtOH | |

| | | |NO WD or REM effects | |

| | | | | |

|Anti-depressants | | | | |

|Nortryptaline |TCAs |Refractory depression (1st-line) |Anti-cholinergic (esp. elderly), | |

| |(block reuptake of 5-HT & NE) | |sedation (anti-histamine), | |

| | | |seizures, hypotension, | |

| | | |arrhythmias, falls | |

|Sertraline (Zoloft) |SSRIs |MDD |N/D, activating, weight gain, |t1/2 = 26h |

| |(block reuptake of 5-HT) | |sexual dysfxn (30-50%), | |

| | | |5-HT syndrome (combo w/ MAOIs) | |

| | | |LEAST inhibits P450 | |

|Paroxitine (Paxil) |SSRIs |MDD |LESS GI upset, anti-cholinergic, | |

| | | |extra-pyramidal effects, | |

| | | |MOST sexual dysfxn | |

|Fluoxetine (Prozac) |SSRIs |MDD |MOST activating |t1/2 = 192h |

| | | |MOST inhibits P450 | |

|Phenelzine |MAOIs |Reserved for atypical depression |Food (tyramine) OR Pseudoephedrine| |

| |(block degradation of 5-HT & NE) | |( HTN crisis, headaches, | |

| | | |arrhythmias | |

|Bupropion (Wellbutrin) |Blocks reuptake of 5-HT, NE, & DA| | | |

|Hypericum |Inhibits MAO & reuptake of 5-HT &|1st-line MDD in Germany | | |

|(St. John’s Wort) |NE | | | |

|Nefazadone |Blocks reuptake of 5-HT | |Liver toxicity | |

|Trazadone |Strongly blocks reuptake of 5-HT | |Sedative in elderly |Short t1/2 |

|Venlafaxine |Strongly blocks reuptake of 5-HT | |LESS SE than TCAs | |

| |& NE (like TCA) | | | |

| | | | | |

|Anti-psychotics | | | | |

|Chlorpromazine |Phenothiazines | |Anti-cholinergic, anti-NE, | |

| |(DAR antagonist & | |anti-histamine, PD-like effects | |

| |(-blocker) | |sedative | |

|Thioridazine |Phenothiazines | |MORE anti-cholinergic | |

| |(anti-cholinergic) | |LESS sedative & PD-like effects | |

|Fluphenazine |Phenothiazines |MOST potent |LESS sedative | |

| |(w/ 3 halogen substituents) | |MORE PD-like effects | |

|Haloperidol |Typical anti-psychotic | |LESS sedative, LESS cholinergic |Eliminated in bile |

| |(NOT phenothiazine) | |MORE PD-like effects | |

|Clozapine |Atypical anti-psychotics |Low potency |Anti-cholinergic, LESS PD-like | |

| |(blocks 5-HT, NOT D2R) | |effects, agranulocytosis (rare) | |

|Risperidone |Atypical anti-psychotics | |LESS PD-like effects, | |

| |(blocks 5-HT & DAR) | |minimal sedation | |

| | | | | |

| | | | | |

| | | | | |

|Parkinson’s Disease | | | | |

|Benztropine |Anti-cholinergics |Moderate PD (esp. in young) |Dry mouth, blurred vision, |Synthetic derivative similar to|

|Trihexyphenidyl |(1st drugs for PD) |NOT for bradykinesia |cognitive impairment, |Atropine |

| | | |hallucinations | |

| | | |CI—glaucoma, heart dz, GI | |

| | | |obstruction | |

|L-DOPA |(bypasses rate-limiting step of |Best in first 2-5y |Orthostatic hypotension, |95% metabolized by COMT or |

| |DA synthesis) |NOT for cognitive decline |arrhythmias, GI upset, accelerated|L-AAD in periphery |

| | | |cell loss?, | |

| | | |abnormal movements & behavior | |

|Carbidopa (Lodosyn) |Inhibits L-AAD in periphery |(L-DOPA dose by 75% |LESS SEs |Combo w/ L-DOPA (Sinemet) |

| |(prevents L-DOPA metabolism) | | |NOT cross BBB |

|Tolcapone |COMT inhibitors |Force conversion of |Diarrhea, hepatitic necrosis |Highly metabolized |

|Entacapone |(prevent L-DOPA metabolism to |L-DOPA to DA | | |

| |O-methylated metabolite) |((on-off phenomenon) | | |

|Bromocryptine |D2-agonist & |L-DOPA adjunct |Hallucinations, confusion, nausea,| |

| |partial D1-agonist | |hypotension | |

| | | |Peritoneal fibrosis | |

|Selegiline |MAOB inhibitor |Early PD (delay L-DOPA use) |Nausea, dry mouth, confusion, |MAOA metabolizes 5-HT & NE |

| |(prevents DA metabolism) | |euphoria, insomnia, psychosis |Metabolized to amphetamine |

|Amantidine |DA-releasing agent |Mild PD (short-term) |Dry mouth, confusion, anxiety, |Weak M-antagonist |

| |(blocks uptake into vesicles) |Influenza |anorexia, hallucinations | |

| | | | | |

|General Anesthetics | | | | |

|Methoxyflurane |Inhalation |OB surgery |Sensitizes heart, |Highly metabolized (produces |

| |MOST potent (MAC 0.16%) |Muscle relaxant (except uterus) |renal toxicity (20% mortality) |F-) |

| | |Low-dose analgesia | | |

|Halothane |Inhalation (halogenated alkane) |Anesthesia in kids & asthma |Hypotension, sensitization to |Liver metabolism |

| |High potency (MAC 1atm) |(release of endorphins) |Diffusional anoxia | |

| | |NOT muscle relaxant | | |

|Thiopental |IV |Rapid sequence induction |Injection site necrosis (>2.5% |Rapid redistribution (LOC in |

| |(ultrashort-acting barbiturate) |NOT analgesia |concentration), laryngospasm, |10-20s, recovery in 20-30min) |

| | | |hyperalgesia |(opening of GABAA channels |

|Etomidate |IV |Very short procedures ONLY |Muscle spasms, (cortisol |Recovery in 5min |

| |(ultrashort-acting, | | | |

| |NON-barbiturate sedative) | | | |

|Propofol |IV |Regional (continuous infusion) |Hypotension, (RR, |“milk of anesthesia” |

| |(rapid-acting, |NOT analgesia |allergies (egg products) |(ICP |

| |NON-barbiturate sedative) | |NOT impair renal or hepatic fxn | |

|Ketamine |IV |Marked anesthesia w/ amnesia |Hallucinations, excitement, |Blocks glutamate receptors in |

| |(dissociative anesthetics) |ER, radiology in kids |delirium; preserves respiratory |cortex & limbic system, blocks |

| | |Good analgesia |responses & (CO |( opioid receptors |

|Midazolam |Benzos |Pre-op anxiety & sedation |CNS depression |NOT analgesic |

| |(anesthetic adjunct) |w/ amnesia | |Reverse w/ Flumazenil |

|Fentanyl |Opioids |Cardiac surgery analgesia |N/V, pruritis, respiratory | |

| |(anesthetic adjunct) | |depression (reverse w/ Naloxone) | |

|Succinylcholine |Muscle relaxants |(MAC of inhalation anesthetics |Hyperkalemia, |Depolarizing |

|d-Turbocurarine |(anesthetic adjuncts) | |malignant hyperthermia |NON-depolarizing |

| | | | | |

|Local Anesthetics | | | | |

|Lidocaine |Amides |Anti-arrhythmic |Ventricular fibrillation |Highly protein bound |

| |(oral, parenteral, topical) |Local, regional, epidural, topical| |Hepatic metabolism |

| | | | |Combo w/ vasoconstrictor |

|Bupivacaine |Amides |Epidural or spinal, NOT regional |Hypotension, (contractility, MORE |MORE potent & long-acting |

| | |(parturition & LE orthopedics) |ventricular fib | |

|Ropivacaine |Amides |Epidural or spinal |LESS cardiotoxic |LESS potent |

|Procaine |Esters |LESS potent |Respiratory depression |Shorter acting |

| |(parenteral, NOT topical) | |Allergies | |

|Chloroprocaine |Esters |MORE potent than Procaine | |Rapid metabolism |

|Tetracaine |Esters |Spinal (10X MORE potent) |10X MORE toxic |Slower onset & longer duration |

|Benzocaine |Esters |Topical ONLY | |ALWAYS unionized (lacks amine |

| | | | |group) |

|Cocaine |Local anesthetic & inhibit | |Euphoria, (HR, (RR ( agitation, |NOT combo w/ vasoconstrictors |

| |catecholamine reuptake | |HTN, dyspnea ( seizure, | |

| | | |arrythmias, respiratory failure | |

| | | | | |

|Anti-convulsants | | | | |

|Phenobarbital |Barbiturates |Unclassified seizures |Sedation, cognitive impairment, |Induce P450 |

| |(long-acting) |Status epilepticus |behavioral changes (40% kids), | |

| | | |addiction, rebound seizures | |

|Phenytoin (Dilantin) |Hydantoins |Partial & grand mal seizures |Muscle necrosis, thickened facial |Rate-limited hepatic metabolism|

| | |Status epilepticus (Fosphenytoin) |features, darkened hair, gum |( p-HPPH |

| | | |hypertrophy (esp. kids), |Induce P450 |

| | | |macrocytosis (folate deficiency) | |

|Carbamazepine |Iminostilbenes |Partial & grand mal seizures |Lethargy, ataxia, diplopia, |Slow absorption |

| |((noradrenergic neuron firing & |Mania |neutropenia, aplastic anemia |Similar to TCAs |

| |(SHRFR) | |(rare), hyponatremia (esp. |Induce P450 |

| | | |elderly) | |

|Lamotrigine |Phenyltriazines |Partial & absence seizures |Rash, dizziness, headache, |Metabolism induced by Phenytoin|

| |(blocks Na2+ & Ca2+-channels, |Lennox-Gastaut syndrome |diplopia, ataxia, somnolence |& Carbamazepine, inhibited by |

| |inhibits Glu & Asp release, | | |Valproic acid |

| |blocks photic stimulation) | | | |

|Levetiracetam |(blocks n-type Ca2+-channels) |Partial seizures (esp. w/ comorbid|Somnolence, dizziness, headache |NOT metabolized |

| | |liver dz) | |NO drug interactions |

|Topiramate |Sulfate-substituted fructose |Adjunct for partial seizures |Somnolence, fatigue, impaired |ONLY 20% metabolized |

| |(blocks Na+ & Ca2+-channels, | |concentration, word-finding |Metabolism inhibited by |

| |(GABA binding, inhibits | |difficulties, renal stones, |Phenytoin & Carbamazepine |

| |kainate/AMPA-activated Glu | |paresthesias, weight loss | |

| |receptor) | | | |

|Valproate (Depakote) |Branched-chain COOH |Myoclonic seizures |N/V, (liver enzymes, liver |Rapid absorption |

| |((SHRFR, (GABA binding & |Refractory absence seizures |necrosis (esp. ................
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