TY - CHAP M1 - Book, Section TI - Key Medications & Interventions in Neurology A1 - Huppert, Laura A. A1 - Dyster, Timothy G. Y1 - 2021 N1 - T2 - Huppert’s Notes: Pathophysiology and Clinical Pearls for Internal Medicine AB - Table Graphic Jump LocationTABLE 12.6Key Medications Used in NeurologyView Table||Download (.pdf)TABLE 12.6Key Medications Used in NeurologyClassMedicationMechanism of ActionUsesAdverse ReactionsThrombolyticalteplase (tPA)Binds to fibrin in the thrombus and converts entrapped plasminogen to plasminAcute ischemic stroke with last seen normal within 4.5 hoursHemorrhage (intracranial and otherwise)AntiplateletaspirinIrreversible inhibition of COX-1 and -2 enzymes → inhibited formation of prostaglandin derivative (thromboxane A2) → inhibition of platelet aggregationStroke, TIABleeding, 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 aggregationStroke, TIAHemorrhageAntilipidemicatorvastatinInhibition of HMG-CoA reductase enzyme → increased expression of LDL receptors → stimulation of LDL catabolism; additionally, reduces inflammation at the plaque site and improves endothelial functionStroke, TIAIncreased transaminases, myalgia, myopathyAnticonvulsantsphenytoin (Dilantin)Na+ channel blocker → neuronal membrane stabilizationSeizures, trigeminal neuralgiaDizziness, ataxia, cardiac arrhythmia, sedation, slurred speech, rash, gingival hyperplasia; teratogenic valproic Acid (Depakote)Enhances action of GABA on neurons, blocks voltage-dependent Na+ channelsSeizures, migraine prophylaxisThrombocytopenia, increased transaminases, tremor, rash, hirsutism, weight gain; teratogenic levetiracetam (Keppra)Modulation of synaptic neurotransmitter release through binding to the synaptic vesicle protein SV2ASeizuresAggression, agitation, anxiety, irritability, headache, sedation carbamazepine (Tegretol)Na+ channel blockerSeizure, neuropathic pain (including trigeminal neuralgia)Rash (including SJS/TEN), dizziness, ataxia, sedationAnti-parkinson agentcarbidopa-levodopaLevodopa converted to dopamine; carbidopa inhibits peripheral conversion and increases available levodopa at the blood-brain barrierParkinsonismOrthostatic hypotension, dizziness, nausea, depression, dyskinesia, hallucinations, insomniaAcetylcholine-sterase inhibitordonepezilReversible and noncompetitive inhibition of centrally active acetylcholinesterase → increased concentrations of acetylcholine available for synaptic transmission in the CNSAlzheimer disease, Parkinson-related dementia, Lewy body dementia, vascular dementiaDiarrhea, insomnia, anorexia, abnormal dreamsAntidepressantsamitriptylineIncreases synaptic concentration of serotonin/norepinephrine in the CNS by inhibiting reuptake by the presynaptic neuronMigraine, neuropathic painOrthostatic hypotension, sedation, dizziness, confusion, cardiac conduction disturbance venlafaxineInhibitor of serotonin and norepinephrine reuptakeMigraine, neuropathic painAnorexia, sexual dysfunction, tremorAntihypertensivepropranololNon-selective beta-adrenergic blockerMigraine, essential tremorBradycardia, orthostatic hypertension, depression, bronchospasm; can mask symptoms of hypoglycemia in insulin-dependent diabeticsSerotonin receptor antagonistsumatriptanSerotonin receptor agonist on intracranial blood vessels → vasoconstrictionMigraine, cluster headacheParesthesia, dizziness, flushing, chest discomfort; contraindicated in patients with CAD/CVD/PVD, cardiac conduction disordersVitaminsthiamineEssential enzyme in carbohydrate metabolism, combines with ATP to form thiamine pyrophosphateThiamine deficiency, alcohol withdrawal syndrome, Wernicke encephalopathyFlushing, hypersensitivity reaction (IV) cyanocobalaminCoenzyme for numerous metabolic functionsVitamin B12 deficiencyHeadache (IM)Neuromuscular blocking agentbotoxPrevents Ca2+-dependent release of acetylcholineMigraine, spasticity due to stroke, multiple sclerosis, dystoniaWeakness, ptosis, strabismus, URI SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1189914469 ER -