CNS Drugs

This Mind-map is created for students in the Doctoral Program of Physical Therapy at Marshall University

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CNS Drugs by Mind Map: CNS Drugs

1. CNS Parts & Neurotransmitters

1.1. CNS

1.1.1. Brain Cerebrum Sensory, motor, intellectual & cognitive abilities Basal Ganglia Control of motor activities Diencephalon Thalmus Hypothalamus Mesencephalon Midbrain Brainstem Reticular formation Cerebellum Plans & coordination of motor activity Efference copy Vestibular mechanisms for maintaining balance & posture Limic system Control of emotional & behavioral activity

1.1.2. Spinal cord Gray matter Synaptic connection between neurons White matter Myelinated axons of neurons

1.2. CNS Neurotransmitters

1.2.1. Acetylcholine Both central & peripheral Plays critical role in cognition & memory Generally excitatory

1.2.2. Monoamines Catecholamines Dopamine Norepinephrine 5-hydroxytryptamine Release by cells at the midline pons Strong inhibitor of painful stimuli

1.2.3. Amino Acids Excitatory Aspartate Glutamate Inhibitory Glycine GABA

1.2.4. Peptides Substance P Excitatory Transmits pain in spinal cord pathways Opioids Excitatory Inhibit painful sensation & decrease central perception of pain

2. I. CNS Depressants


2.1.1. Class of drugs that cause a dose-dependent depression of the CNS functions - Induces Sleep Progresses to Unconsciousness with increasing dose Relieves Anxiety

2.1.2. Drug Categories Barbiturates Largely Superseded in Use by Benzodiazepines. Some limited usage is in extreme Insomnia, Seizures not responsive to other agents, Induction of Anesthesia (see anesthetics mind-map), and in tension headaches (added w/Caffeine) Drug Examples Benzodiazepines Drug Examples Adverse Effects Other Benzodiazepine-Like Substances (Z-Drugs) Zolpidem (Ambien) Zaleplon Azapirones (Buspirone) Selective Serotonin Reuptake Inhibitors (SSRIs) - Prototype Drug Venlafaxine (Expand to read Important info >>>) Paraldehyde (Cyclic Ether) - Not common & Not Important for details for now Alcohols Behaves like Barbiturates in Dose-dependent Effects Drugs that don't fit into above Categories Methaqualone (Quaalude) Ethchlorvynol (Placidyl) Chloralhydrate (Noctec) Mebrobamate (Miltown)


2.2.1. Pain

2.2.2. Cough Suppressant

2.2.3. Seizures


2.3.1. Anesthesia

2.3.2. Pain Management


2.4.1. Schizoaffective Disorders

3. V. Side-Effects

3.1. Tolerance & Dependence

3.1.1. See PowerPoint for details (Drugs of Dependence & Abuse)

4. VI. Relevance to Physical Therapy


4.1.1. No Driving

4.1.2. No Operating Heavy Machivery


4.2.1. Addictive & Habit-forming Needs strong education to break dependence

4.2.2. Signs of Drug-Interactions (Additive Effects) When taken inadvertently with other CNS Depressants

4.2.3. Signs of Drug Withdrawal Seizure-like Symptoms Ataxic Gait May not be treated by Gait Aids - patient will still be at high risk for falls Falls


4.3.1. e.g.:: Anti-psychotics can cause extra-pyramidal side-effects

5. How to Navigate this Mind Map

5.1. Numbered Progression

5.2. This is placeholder Mind-Map. Begin reviewing this Map under CNS Pharmacology First, then use the Links to navigate to the individual Drug Therapeutic Classes

5.3. Note PT Relevance and how it is connected to Side-effects considerations

6. CNS Stimulants

6.1. Drugs to treat Affective (Mood) Disorders

6.1.1. Anti-Depressants (Depression) SSRI's Citalopram Sertraline Fluoxetine SNRI's Duloxetine Cymbalta Venlafaxine Duloxetine Tricyclics Block reuptake of amines at presynaptic terminal Amitriptyline Nortriptyline MAOI's Increase activity at amine synapses Higher incidence of side effects Phenelzine A-typical antidepressants Trazadone Bupropion

6.1.2. Bipolar Disorder Lithium Primary drug to treat bipolar disorder Narrow therapeutic index/not metabolized by the body Prevents neuronal degeneration & sustain neuronal function Side-effects:

6.2. Antipsychotic Drugs

6.2.1. Traditional antipsychotics Associated w/ more side effects Strong affinity for CNS dopamine Examples: Haloperiodol Chlorpromazine Fluphenazine

6.2.2. Atypical antipsychotics Decreased risk of producing movement disorders & motor side effects Do not block dopamine receptors as strong as traditional antipsychotic Block 5-HT serotonin receptors in the limit system Less effective than traditional drugs, but decreased chance for relapse Examples: Chlozapine Quetiapine Olazapine Risperidone

6.2.3. Therapeutic concerns Extra-pyramidial effects Sedation Cardiovascular complications Obesity Diabetes High Cholesterol Heat Intolerance Sexual Dysfunction

6.3. Drug management of Parkinson's Disease

6.3.1. Levodopa Converted to dopamine after crossing blood brain barrier Best drug for resolving Parkinsonian s/s Side Effects: GI: nausea/vomiting Cardiovascular: arrhythmias, postural hypotension Dyskinesias Behavioral: psychotic symptoms Diminishing response over 3-4 years of continued use Fluctuation in response - end-of-dose akinesia

6.3.2. Carbidopa Given w/ Levodopa Prevents premature conversion of levodopa to dopamine

6.3.3. Dopamine agonists Stimulates dopamine receptors in the basal ganglia May produce fewer side effects than levodopa Early use may delay progression of Parkinson's disease

6.3.4. Anti-cholinergics inhibits excessive acetylcholine influence Use in Parkinson's disease limited by frequent side effects

6.3.5. Amantadine Inhibits the effect of glutamate in the basal ganglia Used in early/mild stage or added when levodopa loses effectiveness

6.3.6. MAO-B inhibitors Inhibits the enzyme that breaks down dopamine in the basal ganglia May improve s/s in early stages; long term may be neuroprotective

6.3.7. COMT inhibitors Prevents breakdown of dopamine & allows more levodopa to reach the brain Adjunct to levodopa/carbidopa; prolongs & improves effect of levodopa

6.3.8. Non-prescription Vitamin E Co-enzyme Q-10