2. Agents for the Central Nervous System

3.  Many CNS medications are used to treat multiple disorders  Neurontin (gabapentin)  Topamax (topiramate)

4.  Brand nameGeneric name Abilifyaripiprazole Invegapaliperidone Risperdal*risperidone Seroquelquetiapine Zyprexaolanzapine *available generically

5.  Extreme, inappropriate behavior  Hallucinations, delusions, violent outbursts  Common side effects:  Sleepiness  Weight gain  Change in blood sugar levels

6.  Aka “manic depression”  Broad spectrum of symptoms & severity  Highs are high  Lows are low  Antidepressants  Antipsychotics  Anticonvulsants  Anti-anxiety medications

7.  Brand nameGeneric name Depakote*divalproex Dilantin*phenytoin Keppra*levetiracetam Neurontin*gabapentin Lamictal*lamotrigine Tegretol*carbamazepine Topamax*topiramate *available generically

8.  Abnormal electrical activity in the brain  “dazed and confused”  Violent convulsions (physical expression of seizure)  Periodic blood tests (Dilantin, Depakote)  Error Alert –  Depakote available as DR (delayed release) and ER (extended release)

9.  Brand nameGeneric name Adderall*,Adderall XR *(CII) dextroamphetamine/amphetamine Concerta (CII) methylphenidate, ext. rel. Focalin* (CII)dexmethylphenidate Ritalin* (CII)methylphenidate Vyvanse (CII)lisdexamfetamine *available generically

10.  Attention Deficit-Hyperactivity Disorder  Chronic – affecting 50% of those diagnosed into adulthood  Boys >>> girls  Symptoms for at least 6 months AND interfere w/ normal living (classroom, home, play)  Hyperactive-impulsive  Predominantly inattentive  Combination hyperactive-impulsive & inattentive

11.  Causes – genetic, social, diet, environmental (?)  Dopamine, glucose metabolism (?)  Hyperactive-impulsive  Excessive talking, fidgeting, squirming in seat, blurts out inappropriate comments, act w/o regard for consequences  Inattentive  Inability to focus or complete tasks, easily distracted, doesn’t listen when spoken to directly, often loses things

12.  Controversial  Higher rates of schizophrenia & bipolar disorder in those treated with stimulants during childhood  Stimulants increase the dopamine and norepinephrine levels  “black box” warnings – heart attack, stroke, sudden death  Strattera – only non stimulant approved for ADHD treatment  Off label – clonidine, guanfacine, certain antidepressants

13.  Brand nameGeneric name Ariceptdonepezil Namendamemantine

14.  Alzheimer’s versus aging  Symptoms  Confusion, lack of judgement, personality changes, inability to perform basic tasks  Aricept – early stage to late stage  Namenda – late stage

15.  Brand nameGeneric name Cogentin*benztropine Sinemet*, Sinemet CR*carbidopa/levodopa & Parcopa *available generically

16.  Progressive disease  Low levels of dopamine; high levels of acetylcholine  Resting tremor, rigid movements, difficulty chewing & swallowing, emotionless facial expression  “Gold standard” = carbidopa/levodopa

17.  Brand nameGeneric name Amergenaratriptan Imitrex*sumatriptan Maxalt, Maxalt MLTrizatriptan Treximetsumatriptan/naproxen Zomig, Zomig ZMTzolmitriptan *available generically

18.  Brand nameGeneric name Fioricet, Esgic Plusbutalbital/APAP/caffeine Fiorinal (CIII)butalbital/ASA/caffeine *all available generically

19.  Fluctuations in serotonin levels  Pain, sensitivity to light/sound/odor, nausea & vomiting  Women >> men  “aura” – flashing lights, burning sensation, numbness, tingling

20.  Prevention  Beta blockers  Tricyclic antidepressants  anticonvulsants  Treatment  Triptans - taken at first sign of migraine ▪ Can cause Serotonin Syndrome  Combination products ▪ caffeine