PTCB

CNS medications treat depression, anxiety, insomnia, pain, seizures, ADHD, psychosis, and Parkinson's disease. Many are controlled substances, and several carry boxed warnings or serious interaction risks such as serotonin syndrome and respiratory depression.

Class	Examples(Brand)	Uses	KeySideEffectsandNotes
SSRIs	Fluoxetine(Prozac) sertraline(Zoloft) , ,	Depression ,	First-line Sexual dysfunction insomnia . , ,
	paroxetine(Paxil) citalopram(Celexa) , ,	anxiety	weightchange;serotoninsyndromewithother
	escitalopram(Lexapro)		serotonergicdrugs;boxedwarningfor
			suicidalityinchildrenandyoungadults
SNRIs	Venlafaxine(EffexorXR) duloxetine ,	Depression ,	SimilartoSSRIs pluspossiblebloodpressure ,
Tricyclic antidepressants	(Cymbalta) desvenlafaxine(Pristiq) , Amitriptyline nortriptyline(Pamelor) , , doxepin	anxiety , neuropathicpain Depression , chronicpain	elevation 1 Anticholinergiceffects sedation cardiac , , effects;dangerousinoverdose

Centralnervoussystemdrugclasses(Continued)

Class	Examples(Brand)	Uses	KeySideEffectsandNotes
Benzodiazepines	Alprazolam(Xanax) lorazepam ,	Anxiety seizures , ,	Dependence sedation respiratorydepression , ,
(C-IV)	(Ativan) diazepam(Valium) , ,	insomnia	(especiallywithopioids);flumazenilisthe
	clonazepam(Klonopin)		reversalagent
Nonbenzodiazepine	Zolpidem(Ambien) eszopiclone ,	Insomnia	Complexsleepbehaviorssuchas
hypnotics(C-IV)	(Lunesta) zaleplon ,		sleepwalking and sleep-driving
Opioidanalgesics	Morphine oxycodone(OxyContin;with ,	Moderateto	ScheduleII excepttramadol(ScheduleIV) , .
	acetaminophen Percocet) , ,	severepain	Constipation respiratorydepression , ,
	hydrocodone/acetaminophen fentanyl ,		dependence;naloxonereversesoverdose
	(Duragesic) hydromorphone(Dilaudid); ,
	tramadol
Anticonvulsants	Phenytoin(Dilantin) carbamazepine ,	Seizures;also	Many significant interactions and blood -level
	(Tegretol) valproicacid(Depakote) , ,	bipolardisorder	monitoring(phenytoin carbamazepine , ,
	levetiracetam(Keppra) lamotrigine ,	andneuropathic	valproicacid);lamotriginecarriesaboxed
	(Lamictal) gabapentin(Neurontin) , ,	pain	warningforseriousrash
	pregabalin (Lyrica C-V) ,
ADHDmedications	Methylphenidate(Ritalin Concerta) , ,	ADHD	StimulantsareScheduleIIwithabusepotential
	amphetaminesalts(Adderall) ,		andcardiovasculareffects;atomoxetineisnot
	lisdexamfetamine(Vyvanse);		controlled
	atomoxetine(Strattera)
Antipsychotics	Firstgeneration:haloperidol ,	Schizophrenia ,	Extrapyramidalsymptoms metaboliceffects ,
	chlorpromazine Secondgeneration: .	bipolardisorder	(weightgain glucose lipids) QTprolongation , , ,
	quetiapine(Seroquel) risperidone ,
	(Risperdal) olanzapine(Zyprexa) , ,
	aripiprazole(Abilify)
Parkinson's	Carbidopa/levodopa(Sinemet) ,	Parkinson's	Carbidopapreventsperipheralconversionof
diseasedrugs	pramipexole(Mirapex) ropinirole ,	disease	levodopa; protein-rich meals near a dose
	(Requip) selegiline ,		reducelevodopa'seffect

Respiratory and Gastrointestinal Medications

Respiratory drugs are divided into rescue medications that relieve acute symptoms and maintenance medications that control chronic disease. Correct device use matters as much as the drug itself, so inhaler technique is a frequent counseling point for the pharmacist.

Class	Examples(Brand)	UsesandKeyNotes
Short-acting beta	Albuterol(ProAir Ventolin) levalbuterol , ,	Rescueinhalersforacutebronchospasm;tachycardiaandtremor
agonists(SABAs)
Long-acting beta	Salmeterol formoterol ,	MaintenanceinasthmaandCOPD combinedwithaninhaled ,
agonists(LABAs) Inhaled corticosteroids(ICS)	Fluticasone(Flovent) budesonide , (Pulmicort) beclomethasone(Qvar) ,	corticosteroid;neverusedaloneforasthma 1 Maintenancetherapy;rinsethemouthafterusetopreventoral thrush

Respiratoryandallergydrugclasses(Continued)

ICS/LABA

Fluticasone/salmeterol (Advair),

Convenient maintenance therapy in one device

combinations

budesonide/formoterol (Symbicort), fluticasone/vilanterol (Breo Ellipta)

Anticholinergic

Ipratropium (Atrovent, short-acting),

COPD; dry mouth, urinary retention

bronchodilators

tiotropium (Spiriva, long-acting)

Leukotriene modifiers

Montelukast (Singulair), zafirlukast

Asthma and allergic rhinitis; montelukast has a boxed warning for neuropsychiatric events

Antihistamines

First generation: diphenhydramine

Allergies. First generation causes sedation and anticholinergic

(Benadryl), chlorpheniramine. Second

effects; second generation causes less sedation

generation: loratadine (Claritin), cetirizine (Zyrtec), fexofenadine (Allegra)

Decongestants

Pseudoephedrine (Sudafed),

Nasal congestion. Pseudoephedrine is sold behind the counter

phenylephrine

under federal limits; avoid in uncontrolled hypertension

Proton pump

Omeprazole (Prilosec), esomeprazole

GERD, ulcers, H. pylori. Taken before meals; long-term use is

inhibitors (PPIs)

(Nexium), pantoprazole (Protonix),

linked to fractures and low magnesium

lansoprazole (Prevacid)

H2 receptor

Famotidine (Pepcid), cimetidine

GERD, heartburn, ulcers; less acid suppression than PPIs.

antagonists

(Tagamet)

Ranitidine has been withdrawn from the U.S. market

Antacids

Calcium carbonate, aluminum

Rapid heartburn relief; bind many drugs in the gut and reduce

hydroxide, magnesium hydroxide

their absorption

Antiemetics

Ondansetron (Zofran), promethazine,

Nausea and vomiting. Ondansetron can prolong the QT interval;

metoclopramide (Reglan),

metoclopramide has a boxed warning for tardive dyskinesia

prochlorperazine

Laxatives

Bulk-forming (psyllium), osmotic

Constipation; polyethylene glycol is first-line for chronic

(polyethylene glycol, lactulose),

constipation

stimulant (bisacodyl, senna), stool softener (docusate)

Antidiarrheals

Loperamide (Imodium), bismuth

Diarrhea; loperamide is an opioid agonist without CNS effects at

subsalicylate (Pepto-Bismol)

normal doses

Endocrine Medications

Endocrine drugs treat diabetes, thyroid disorders, and inflammatory conditions. Insulin is a high-alert medication, and insulin products differ in onset and duration, so product selection and storage must be exact.

Type	Examples(Brand)	Notes
Rapid -acting	Insulinlispro(Humalog) insulinaspart(NovoLog) , ,	Givenwithmeals
	insulinglulisine(Apidra)
Short-acting	Regularinsulin(HumulinR NovolinR) ,	Clear;maybemixedwithNPH
Intermediate-acting	NPH(HumulinN NovolinN) ,	Cloudy;rollgentlytomix
Long-acting	Insulinglargine(Lantus Basaglar Toujeo) insulin , , ,	Basalinsulin;glarginemustnotbemixedwith
	degludec(Tresiba)	otherinsulins

Unopened insulin is stored in the refrigerator; an opened vial or pen is typically stable at room temperature for 28 to 42 days, depending on the product.

Class	Examples(Brand)	UsesandKeyNotes
Biguanide	Metformin(Glucophage)	First-line for type 2 diabetes; GI upset; rare lactic acidosis
		(boxedwarning);heldbeforeiodinatedcontrast;doesnot
		causehypoglycemiaalone
Sulfonylureas	Glipizide(Glucotrol) glyburide , ,	Stimulateinsulinrelease;hypoglycemiaandweightgain
	glimepiride(Amaryl)
GLP-1receptor	Liraglutide(Victoza) semaglutide ,	Type2diabetes andsomeproductsforweightmanagement; ,
agonists	(Ozempic;oraltabletRybelsus) ,	mostlyinjectable;nausea pancreatitisrisk ,
	dulaglutide(Trulicity)
SGLT2inhibitors	Empagliflozin(Jardiance) dapagliflozin ,	Increaseurinaryglucoseexcretion;heartandkidneybenefits;
	(Farxiga) canagliflozin(Invokana) ,	genitalinfections diabeticketoacidosis ,
DPP-4inhibitors	Sitagliptin(Januvia) saxagliptin linagliptin , ,	Type2diabeteswithlowhypoglycemiarisk
	(Tradjenta)
Thyroiddrugs	Levothyroxine(Synthroid)for	Levothyroxineistakenonanemptystomachandseparated
	hypothyroidism;methimazolefor	fromcalciumandironby4hours
	hyperthyroidism
Corticosteroids	Prednisone methylprednisolone(Medrol) , ,	Inflammation and autoimmune conditions; long-term use
	dexamethasone	causesadrenalsuppression osteoporosis hyperglycemia and , , ,
		immunosuppression;notstoppedabruptly