Thrombolytic | alteplase (tPA) | Binds to fibrin in the thrombus and converts entrapped plasminogen to plasmin | Acute ischemic stroke with last seen normal within 4.5 hours | Hemorrhage (intracranial and otherwise) |
Antiplatelet | aspirin | Irreversible inhibition of COX-1 and -2 enzymes → inhibited formation of prostaglandin derivative (thromboxane A2) → inhibition of platelet aggregation | Stroke, TIA | Bleeding, GI ulcer, gastritis, hepatitis, allergic reaction, tinnitus, hearing loss |
| clopidogrel (Plavix) | Irreversible inhibition of P2Y12 component of ADP receptors on platelet surface → prevents activation of GPIIb/IIIa receptor complex → reduced platelet aggregation | Stroke, TIA | Hemorrhage |
Antilipidemic | atorvastatin | Inhibition of HMG-CoA reductase enzyme → increased expression of LDL receptors → stimulation of LDL catabolism; additionally, reduces inflammation at the plaque site and improves endothelial function | Stroke, TIA | Increased transaminases, myalgia, myopathy |
Anticonvulsants | phenytoin (Dilantin) | Na+ channel blocker → neuronal membrane stabilization | Seizures, trigeminal neuralgia | Dizziness, ataxia, cardiac arrhythmia, sedation, slurred speech, rash, gingival hyperplasia; teratogenic |
| valproic Acid (Depakote) | Enhances action of GABA on neurons, blocks voltage-dependent Na+ channels | Seizures, migraine prophylaxis | Thrombocytopenia, increased transaminases, tremor, rash, hirsutism, weight gain; teratogenic |
| levetiracetam (Keppra) | Modulation of synaptic neurotransmitter release through binding to the synaptic vesicle protein SV2A | Seizures | Aggression, agitation, anxiety, irritability, headache, sedation |
| carbamazepine (Tegretol) | Na+ channel blocker | Seizure, neuropathic pain (including trigeminal neuralgia) | Rash (including SJS/TEN), dizziness, ataxia, sedation |
Anti-parkinson agent | carbidopa-levodopa | Levodopa converted to dopamine; carbidopa inhibits peripheral conversion and increases available levodopa at the blood-brain barrier | Parkinsonism | Orthostatic hypotension, dizziness, nausea, depression, dyskinesia, hallucinations, insomnia |
Acetylcholine-sterase inhibitor | donepezil | Reversible and noncompetitive inhibition of centrally active acetylcholinesterase → increased concentrations of acetylcholine available for synaptic transmission in the CNS | Alzheimer disease, Parkinson-related dementia, Lewy body dementia, vascular dementia | Diarrhea, insomnia, anorexia, abnormal dreams |
Antidepressants | amitriptyline | Increases synaptic concentration of serotonin/norepinephrine in the CNS by inhibiting reuptake by the presynaptic neuron | Migraine, neuropathic pain | Orthostatic hypotension, sedation, dizziness, confusion, cardiac conduction disturbance |
| venlafaxine | Inhibitor of serotonin and norepinephrine reuptake | Migraine, neuropathic pain | Anorexia, sexual dysfunction, tremor |
Antihypertensive | propranolol | Non-selective beta-adrenergic blocker | Migraine, essential tremor | Bradycardia, orthostatic hypertension, depression, bronchospasm; can mask symptoms of hypoglycemia in insulin-dependent diabetics |
Serotonin receptor antagonist | sumatriptan | Serotonin receptor agonist on intracranial blood vessels → vasoconstriction | Migraine, cluster headache | Paresthesia, dizziness, flushing, chest discomfort; contraindicated in patients with CAD/CVD/PVD, cardiac conduction disorders |
Vitamins | thiamine | Essential enzyme in carbohydrate metabolism, combines with ATP to form thiamine pyrophosphate | Thiamine deficiency, alcohol withdrawal syndrome, Wernicke encephalopathy | Flushing, hypersensitivity reaction (IV) |
| cyanocobalamin | Coenzyme for numerous metabolic functions | Vitamin B12 deficiency | Headache (IM) |
Neuromuscular blocking agent | botox | Prevents Ca2+-dependent release of acetylcholine | Migraine, spasticity due to stroke, multiple sclerosis, dystonia | Weakness, ptosis, strabismus, URI |