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Agents for the Central Nervous System

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Many CNS medications are used to treat multiple disorders Neurontin (gabapentin) Topamax (topiramate)

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

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

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

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

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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)

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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

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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

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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, doesnt listen when spoken to directly, often loses things

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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

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Brand nameGeneric name Ariceptdonepezil Namendamemantine

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Alzheimers versus aging Symptoms Confusion, lack of judgement, personality changes, inability to perform basic tasks Aricept early stage to late stage Namenda late stage

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

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

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

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

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

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