Comprehensive Drugs to Know for Final Flashcards
Pilocarpine
Parasympathetic
MOA: cholinergic agonist
Clinical Use: glaucoma, urinary retention problems, dry mouth, reverse neuromuscular blockade from surgical anesthesia, Alzheimer’s
SLUD- salivation, lacrimation, urination, diarrhea
Ocular Side Effects: miosis, accommodation, opening of TM (decreases IOP)
Varenicline
Parasympathetic
MOA: cholinergic agonist
Clinical Use: glaucoma, urinary retention problems, dry mouth, reverse neuromuscular blockade from surgical anesthesia, Alzheimer’s
SLUD- salivation, lacrimation, urination, diarrhea
Ocular Side Effects: miosis, accommodation, opening of TM (decreases IOP)
Edrophonium
Parasympathetic
MOA: short-acting anticholinesterase (indirect-acting cholinomimetic)
Clinical Use: diagnosis of Myasthenia Gravis*, glaucoma, urinary retention problems, dry mouth, reverse neuromuscular blockade from surgical anesthesia, Alzheimer’s;
SLUD- salivation, lacrimation, urination, diarrhea
Ocular Side Effects: miosis, accommodation, opening of TM (decreases IOP)
Atropine
Parasympathetic
MOA: cholinoceptor blocking
Clinical Use: cholinomimetic toxicity*, CNS disorders, ocular disorders (accurate refraction, dilated fundus exam, treatment of uveitis), respiratory disorders, urinary disorders, cardiovascular system, cholinergic poisoning;
opposite of SLUD
Ocular Side Effects: mydriasis (contraindicated in glaucoma patients), cycloplegia
Cyclopentolate
Parasympathetic
MOA: cholinoceptor blocking
Clinical Use: CNS disorders, ocular disorders (accurate refraction, dilated fundus exam, treatment of uveitis), respiratory disorders, urinary disorders, cardiovascular system, cholinergic poisoning;
opposite of SLUD
Ocular Side Effects: mydriasis (contraindicated in glaucoma patients), cycloplegia
Homatropine
Parasympathetic
MOA: cholinoceptor blocking
Clinical Use: cholinomimetic toxicity*, CNS disorders, ocular disorders (accurate refraction, dilated fundus exam, treatment of uveitis), respiratory disorders, urinary disorders, cardiovascular system, cholinergic poisoning;
opposite of SLUD
Ocular Side Effects: mydriasis (contraindicated in glaucoma patients), cycloplegia
Ipratropium
Parasympathetic
MOA: cholinoceptor blocking
Clinical Use: cholinomimetic toxicity*, CNS disorders, ocular disorders (accurate refraction, dilated fundus exam, treatment of uveitis), respiratory disorders, urinary disorders, cardiovascular system, cholinergic poisoning;
opposite of SLUD
Ocular Side Effects: mydriasis (contraindicated in glaucoma patients), cycloplegia
Tiotropium
Parasympathetic
MOA: cholinoceptor blocking
Clinical Use: cholinomimetic toxicity*, CNS disorders, ocular disorders (accurate refraction, dilated fundus exam, treatment of uveitis), respiratory disorders, urinary disorders, cardiovascular system, cholinergic poisoning;
opposite of SLUD
Ocular Side Effects: mydriasis (contraindicated in glaucoma patients), cycloplegia
Tropicamide
Parasympathetic
MOA: cholinoceptor blocking
Clinical Use: cholinomimetic toxicity*, CNS disorders, ocular disorders (accurate refraction, dilated fundus exam, treatment of uveitis), respiratory disorders, urinary disorders, cardiovascular system, cholinergic poisoning;
opposite of SLUD
Ocular Side Effects: mydriasis (contraindicated in glaucoma patients), cycloplegia
Epinephrine
Sympathetic
MOA: non-selective alpha and beta agonist
Clinical Use: cardiac arrest, anaphylaxis
Ocular Side Effects: n/a
Phenylephrine
Sympathetic
MOA: alpha-1 agonist
Clinical Use: acute hypotension, chronic orthostatic hypotension, induce local vasoconstriction
Ocular Side Effects: mydriasis
Apraclonidine
Sympathetic
MOA: alpha-2 agonist
Clinical Use: hypertension, glaucoma, produces dilation of abnormal pupil in Horner syndrome*
Ocular Side Effects: decreased aqueous production, decreased IOP
Brimonidine
Sympathetic
MOA: alpha-2 agonist
Clinical Use: hypertension, glaucoma
Ocular Side Effects: decreased aqueous production, decreased IOP
Albuterol
Sympathetic
MOA: beta-2 agonist
Clinical Use: treatment of asthma
Ocular Side Effects: relaxes ciliary muscle, production of aqueous (increases IOP)
Formoterol
Sympathetic
MOA: beta-2 agonist
Clinical Use: treatment of asthma
Ocular Side Effects: relaxes ciliary muscle, production of aqueous (increases IOP)
Salmeterol
Sympathetic
MOA: beta-2 agonist
Clinical Use: treatment of asthma
Ocular Side Effects: relaxes ciliary muscle, production of aqueous (increases IOP)
Tamsulosin
Sympathetic
MOA: alpha-1 antagonist
Clinical Use: chronic hypertension
Ocular Side Effects: intraoperative floppy iris syndrome
Timolol
Sympathetic
Cardiovascular Agent
MOA: non-selective beta antagonist
Clinical Use: HTN, ischemic heart disease, cardiac arrhythmias, heart failure, glaucoma, hyperthyroidism, neurologic diseases
Ocular Side Effects: lowers IOP
Nebivolol
Sympathetic
Cardiovascular Agent
MOA: beta-1 selective antagonist
Clinical Use: HTN, ischemic heart disease, cardiac arrhythmias, heart failure, glaucoma, hyperthyroidism, neurologic diseases
Ocular Side Effects: lowers IOP
Atenolol
Sympathetic
Cardiovascular Agent
MOA: beta-1 selective antagonist
Clinical Use: HTN, ischemic heart disease, cardiac arrhythmias, heart failure, glaucoma, hyperthyroidism, neurologic diseases
Ocular Side Effects: lowers IOP
Carvedilol
Sympathetic
Cardiovascular Agent
MOA: non-selective beta antagonist
Clinical Use: HTN, ischemic heart disease, cardiac arrhythmias, heart failure, glaucoma, hyperthyroidism, neurologic diseases
Ocular Side Effects: lowers IOP
Metoprolol
Sympathetic
Cardiovascular Agent
MOA: beta-1 selective antagonist
Clinical Use: HTN, ischemic heart disease, cardiac arrhythmias, heart failure, glaucoma, hyperthyroidism, neurologic diseases
Ocular Side Effects: lowers IOP
Amoxicillin
Antimicrobial- antibiotic
MOA: 3rd generation penicillin; targets transpeptidase in cell wall synthesis
Clinical Use: some gram negative coverage
Ocular Side Effects: n/a
Cephalexin
Antimicrobial- antibiotic
MOA: 1st generation cephalosporin; targets transpeptidase in cell wall synthesis
Clinical Use: gram positive coverage; skin infections
Ocular Side Effects: n/a
Cefuroxime
Antimicrobial- antibiotic
MOA: 2nd generation cephalosporin; targets transpeptidase in cell wall synthesis
Clinical Use: gram positive, some gram negative, anaerobic; intra-abdominal infections
Ocular Side Effects: n/a
Cefdinir
Antimicrobial- antibiotic
MOA: 3rd generation cephalosporin; targets transpeptidase in cell wall synthesis
Clinical Use: gram negative; pneumonia
Ocular Side Effects: n/a
Clavulanic acid
Antimicrobial- antibiotic
MOA: beta-lactamase inhibitor, combined with a penicillin to inhibit breakdown of beta-lactamse in penicillin
Clinical Use: combined with penicillin
Ocular Side Effects: n/a
Bacitracin
Antimicrobial- antibiotic
MOA: inhibits bacterial cell wall synthesis by weakening peptidoglycan polymerization
Clinical Use: great gram positive coverage, used topically, blepharitis, bacterial corneal ulcers
Ocular Side Effects: n/a
Vancomycin
Antimicrobial- antibiotic
MOA: inhibits bacterial cell wall synthesis by weakening peptidoglycan polymerization
Clinical Use: MRSA, very effective against gram positive
Ocular Side Effects: n/a
Doxycycline
Antimicrobial- antibiotic
MOA: tetracycline; inhibits protein synthesis by binding to 30s ribosomal subunit
Clinical Use: broad spectrum, 50 mg doxycycline can be used for inflammation
Ocular Side Effects: Pseudotumor Cerebri
Other Side Effects: Teeth
Minocycline
Antimicrobial- antibiotic
MOA: tetracycline; inhibits protein synthesis by binding to 30s ribosomal subunit
Clinical Use: broad spectrum
Ocular Side Effects: Pseudotumor Cerebri
Other Side Effects: Teeth
Tetracycline
Antimicrobial- antibiotic
MOA: inhibits protein synthesis by binding to 30s ribosomal subunit
Clinical Use: broad spectrum, 50 mg doxycycline can be used for inflammation
Ocular Side Effects: Pseudotumor Cerebri
Other Side Effects: Teeth
Tobramycin
Antimicrobial- antibiotic
MOA: aminoglycoside; inhibits protein synthesis by binding to 30s ribosomal subunit
Clinical Use: gram negative and some gram positive
Ocular Side Effects: allergic reactions
Other Side Effects: ototoxicity
Gentamicin
Antimicrobial- antibiotic
MOA: aminoglycoside; inhibits protein synthesis by binding to 30s ribosomal subunit
Clinical Use: gram negative and some gram positive
Ocular Side Effects: allergic reactions
Other Side Effects: ototoxicity
Neomycin
Antimicrobial- antibiotic
MOA: aminoglycoside; inhibits protein synthesis by binding to 30s ribosomal subunit
Clinical Use: gram negative and some gram positive
Ocular Side Effects: allergic reactions
Other Side Effects: ototoxicity
Azithromycin
Antimicrobial- antibiotic
MOA: macrolide; inhibits protein synthesis by binding to 50s ribosomal subunit
Clinical Use: good for respiratory infections and chlamydia
Ocular Side Effects: n/a
Erythromycin
Antimicrobial- antibiotic
MOA: macrolide; inhibits protein synthesis by binding to 50s ribosomal subunit
Clinical Use: good alternative to PCN, good for gram positive
Ocular Side Effects: n/a
Ciprofloxacin
Antimicrobial- antibiotic
MOA: 2nd generation fluoroquinolone; inhibits DNA replication by interfering with DNA gyrase and topoisomerase IV
Clinical Use: Pseudomonas, Anthrax, great gram negative coverage
Ocular Side Effects: n/a
Ofloxacin
Antimicrobial- antibiotic
MOA: 2nd generation fluoroquinolone; inhibits DNA replication by interfering with DNA gyrase and topoisomerase IV
Clinical Use: Pseudomonas, Anthrax, great gram negative coverage
Ocular Side Effects: n/a
Levofloxacin
Antimicrobial- antibiotic
MOA: 3rd generation fluoroquinolone; inhibits DNA replication by interfering with DNA gyrase and topoisomerase IV
Clinical Use: very broad spectrum
Ocular Side Effects: n/a
Moxifloxacin
Antimicrobial- antibiotic
MOA: 4th generation fluoroquinolone; inhibits DNA replication by interfering with DNA gyrase and topoisomerase IV
Clinical Use: gram negative, enhanced gram positive
Ocular Side Effects: n/a
Sulfacetamide
Antimicrobial- antibiotic
MOA: sulfonamide; competes with dihydropteroate synthestase and inhibits folate production
Clinical Use: wide spectrum
Ocular Side Effects: n/a
Trimethoprim
Antimicrobial- antibiotic
MOA: inhibits dihydrofolate reductase and inhibits folate production
Clinical Use: wide spectrum, potent
Ocular Side Effects: n/a
Cotrimoxazole (Bactrim)
Antimicrobial- antibiotic
MOA: trimethoprim + sulfamethoxazole; inhibits folate production
Clinical Use: broad spectrum, UTIs, respiratory tract infections, pneumocystis jiroveci, MRSA
Ocular Side Effects: n/a
Ethambutol
Antimicrobial- antimycobacterial
MOA: interferes with cell wall synthesis
Clinical Use: mycobacteria- TB
Ocular Side Effects: optic neuritis
Rifampin
Antimicrobial- antimycobacterial
MOA: interacts with bacterial RNA polymerase to block transcription
Clinical Use: mycobacteria- leprosy, TB, gram negative and gram positive
Ocular Side Effects: secretions will have an orange-red color, including tears
Oseltamivir
Antimicrobial- antiviral
MOA: selectively inhibits neuraminidase enzyme, which is essential to life cycle of the virus; prevents release of new virions
Clinical Use: influenza A and B
Ocular Side Effects: n/a
Acyclovir
Antimicrobial- antiviral
MOA: converted to active form by viral enzyme; inhibits DNA polymerase and is incorporated into the viral DNA
Clinical Use: herpes virus, herpetic keratitis
Ocular Side Effects: n/a
Valacyclovir
Antimicrobial- antiviral
MOA: converted to active form by viral enzyme; inhibits DNA polymerase and is incorporated into the viral DNA
Clinical Use: herpes virus, herpetic keratitis
Ocular Side Effects: n/a
Trifluridine
Antimicrobial- antiviral
MOA: inhibits DNA synthesis; also able to incorporate into cellular DNA
Clinical Use: herpes virus- restricted to use in the eye,
Ocular Side Effects: irritation
Ganciclovir
Antimicrobial- antiviral
MOA: converted to active form by viral enzyme; inhibits DNA polymerase and is incorporated into the viral DNA
Clinical Use: herpes virus, herpetic keratitis, CMV
Ocular Side Effects: n/a
Tenofovir
Antimicrobial- antiviral
MOA: nucleotide/nucleoside inhibitor; inhibits reverse transcriptase/RNA polymerase, termination of replication
Clinical Use: Hepatitis B/C, HIV
Ocular Side Effects: n/a
Efavirenz
Antimicrobial- antiviral
MOA: non-nucleoside reverse transcriptase inhibitor (NNRTI); highly selective inhibitor of HIV-1 reverse transcriptase, causes conformational change to enzyme
Clinical Use: HIV
Ocular Side Effects: n/a
Ritonavir
Antimicrobial- antiviral
MOA: protease inhibitor; inhibits HIV aspartyl protease, prevents maturation of the viral particles
Clinical Use: HIV, used as an enhancer of other protease inhibitors (not used on its own), can also be given as a pharmacological booster for hepatic viral infections
Ocular Side Effects: n/a
5-Fluorouracil
Anticancer
MOA: antimetabolite; forms a complex that derives the cell of thymidine, stopping DNA synthesis
Clinical Use: topical uses- skin cancer, prevention of scar tissue formation in surgery, some ocular surgeries
Ocular Side Effects: n/a
Methotrexate
Anticancer
MOA: antimetabolite; dihydrofolate reductase antagonist; leads to decreased production of required nucleic compounds; DNA, RNA, and protein synthesis is depressed, leading to cell death
Clinical Use: cancer, severe psoriasis, Rheumatoid arthritis, Crohn’s disease
Ocular Side Effects: n/a
Prednisone
Anticancer
MOA: triggers production of specific proteins that reduce cell growth and proliferation
Clinical Use: treatment of lymphomas
Ocular Side Effects: cataract formation, increased IOP
Tamoxifen
Anticancer
MOA: estrogen antagonist; inhibits RNA synthesis
Clinical Use: breast cancer
Ocular Side Effects: crystalline retinopathy and other vision problems
Bevacizumab
Anticancer
MOA: monoclonal antibody; antiangiogenesis agent; attaches to and stops VEGF from stimulating the formation of new blood vessels; decreases oxygen supply to tumor cells
Clinical Use: cancer, intravitreal for retinal neovascular diseases
Ocular Side Effects: n/a
Hydrochlorothiazide
Cardiovascular Agent
MOA: thiazide diuretic; inhibits Na/Cl co-transporter in distal convoluted tubule; increased excretion of Na and Cl; reduced peripheral vascular resistance
Clinical Use: hypertension, heart failure, hypercalciuria, diabetes insipidus
Ocular Side Effects: n/a
Furosemide
Cardiovascular Agent
MOA: loop diuretic; major action on ascending limb of loop of Henle; inhibits co-transport of Na/K/2Cl; increased Na and K excretion; increased Ca excretion
Clinical Use: drug of choice for reducing acute pulmonary edema of heart failure, useful in emergency situations, useful in treatment of hypercalcemia and hyperkalemia, not as frequently in HTN
Ocular Side Effects: n/a
Acetazolamide
Cardiovascular Agent
MOA: carbonic anhydrase inhibitor; inhibits carbonic anhydrase in proximal tubule; decreases the kidney’s ability to exchange Na for H; Na is excreted at a higher rate
Clinical Use: glaucoma (2-250 mg tablets), treatment of pseudotumor cerebri, mountain sickness
Ocular Side Effects: decreases production of aqueous
Clonidine
Cardiovascular Agent
MOA: centrally acting alpha 2 agonist; acts in vasomotor center within the medulla; decreases sympathetic outflow; decrease in vascular tone and cardiac output
Clinical Use: HTN
Ocular Side Effects: n/a
Amlodipine
Cardiovascular Agent
MOA: vasodilator- calcium channel blocker; block inward movement of calcium; less calcium available to activate contraction in smooth muscle and cardiac muscle; produces reduction in vascular tone; produces dilation of coronary and peripheral arteries; decreases force of contraction and reduces cardiac workload
Clinical Use: HTN, some arrhythmias, angina
Ocular Side Effects: n/a
Benazepril
Cardiovascular Agent
MOA: ACE inhibitor; prevents conversion of angiotensin I to angiotensin II; reduces peripheral vascular resistance; reduce the inactivation of bradykinin (a vasodilator); results in vasodilation as well as decreased sodium and water retention
Clinical Use: HTN, diabetic nephropathy, following a heart attack
Ocular Side Effects: n/a
Lisinopril
Cardiovascular Agent
MOA: ACE inhibitor; prevents conversion of angiotensin I to angiotensin II; reduces peripheral vascular resistance; reduce the inactivation of bradykinin (a vasodilator); results in vasodilation as well as decreased sodium and water retention
Clinical Use: HTN, diabetic nephropathy, following a heart attack
Ocular Side Effects: n/a
Losartan
Cardiovascular Agent
MOA: Angiotensin-Receptor Blocker; antagonist at angiotensin receptor; results in vasodilation, but does not increase bradykinin levels
Clinical Use: HTN, diabetic nephropathy, following a heart attack
Ocular Side Effects: n/a
Nitroglycerin
Cardiovascular Agent
MOA: organic nitrate; enzyme activation of drug causes release of nitric oxide; cause a rapid reduction in myocardial oxygen demand; rapid relief of symptoms; relaxation of smooth muscle in arteries and veins; decreases venous return to the heart; dilate coronary vasculature; increase blood supply to the heart; relieves coronary artery spasm
Clinical Use: acute angina from exercise or emotional stress
Ocular Side Effects: n/a
Ranolazine
Cardiovascular Agent- vasodilator
MOA: sodium channel blocker; inhibits the late phase of the sodium current; reduces intracellular sodium and calcium overload; improves diastolic function and improves oxygen supply
Clinical Use: used mainly to treat chronic angina
Ocular Side Effects: n/a
Procainamide
Cardiovascular Agent
MOA: class IA anti-arrhythmic; binds to sodium channels and potassium channels; slows the rate of rise of action potential; slows conduction (phase 0) and slows repolarization (phase 3); increase duration of action potential and refractory period
Clinical Use: tachycardia-type rhythms
Ocular Side Effects: n/a
Amiodarone
Cardiovascular Agent
MOA: class III anti-arrhythmic; K channel blocker; diminishes the outward potassium current during repolarization of cardiac cells; prolong the duration of the action potential (phase 3); prolong the effective refractory period; shows class I, II, III, and IV actions
Clinical Use: atrial fibrillation, sometimes angina
Ocular Side Effects: whorl keratopathy, non-arteritic ischemic optic neuropathy (NAION)
Sildenafil
Cardiovascular Agent
MOA: type 5 phosphodiesterase inhibitor; potentiates the vasodilative effect of acetylcholine; parasympathetic activation causes release of acetylcholine; acetylcholine activates muscarinic receptors in vascular endothelial cells; increases production and release of NO; type 5 phosphodiesterase breaks down cGMP; these drugs inhibit this step, causing a continuation of vasodilation
Clinical Use: erectile dysfunction
Ocular Side Effects: mild impairment of color vision, blurry vision
Tadalafil
Cardiovascular Agent
MOA: type 5 phosphodiesterase inhibitor; potentiates the vasodilative effect of acetylcholine; parasympathetic activation causes release of acetylcholine; acetylcholine activates muscarinic receptors in vascular endothelial cells; increases production and release of NO; type 5 phosphodiesterase breaks down cGMP; these drugs inhibit this step, causing a continuation of vasodilation
Clinical Use: erectile dysfunction
Ocular Side Effects: mild impairment of color vision, blurry vision (less likely to cause ocular side effects than others)
Vardenafil
Cardiovascular Agent
MOA: type 5 phosphodiesterase inhibitor; potentiates the vasodilative effect of acetylcholine; parasympathetic activation causes release of acetylcholine; acetylcholine activates muscarinic receptors in vascular endothelial cells; increases production and release of NO; type 5 phosphodiesterase breaks down cGMP; these drugs inhibit this step, causing a continuation of vasodilation
Clinical Use: erectile dysfunction
Ocular Side Effects: mild impairment of color vision, blurry vision
Dabigatran
Cardiovascular Agent
MOA: anticoagulant- direct thrombin inhibitor; competitive, reversible inhibitor of thrombin
Clinical Use: prevention of stroke in patients with atrial fibrillation
Ocular Side Effects: subconjunctival and retinal hemes are possible
Apixaban
Cardiovascular Agent
MOA: anticoagulant- factor Xa inhibitor; selectively inhibits only factor Xa
Clinical Use: often used in hip or knee surgery as well as prevention of stroke
Ocular Side Effects: subconjunctival and retinal hemes are possible
Rivaroxaban
Cardiovascular Agent
MOA: anticoagulant- factor Xa inhibitor; selectively inhibits only factor Xa
Clinical Use: often used in hip or knee surgery as well as prevention of stroke
Ocular Side Effects: subconjunctival and retinal hemes are possible
Clopidogrel
Cardiovascular Agent
MOA: platelet inhibitor- ADP receptor blocker; when ADP binds to platelet, GP receptors are expressed; ADP receptor blockers inhibit expression of GP receptors for fibrinogen by binding to ADP; inhibits platelet function for the life of the platelet
Clinical Use: prevention of TIA and strokes in patients with previous event or following heart attack, adjunct with aspirin following coronary stent implantation, decrease thrombotic events in patient with acute coronary syndrome
Ocular Side Effects: subconjunctival and retinal hemes are possible
Prasugrel
Cardiovascular Agent
MOA: platelet inhibitor- ADP receptor blocker; when ADP binds to platelet, GP receptors are expressed; ADP receptor blockers inhibit expression of GP receptors for fibrinogen by binding to ADP; inhibits platelet function for the life of the platelet
Clinical Use: prevention of TIA and strokes in patients with previous event or following heart attack, adjunct with aspirin following coronary stent implantation, decrease thrombotic events in patient with acute coronary syndrome
Ocular Side Effects: subconjunctival and retinal hemes are possible
Ticagrelor
Cardiovascular Agent
MOA: platelet inhibitor- ADP receptor blocker; when ADP binds to platelet, GP receptors are expressed; ADP receptor blockers inhibit expression of GP receptors for fibrinogen by binding to ADP; does not inhibit platelet for the life of the platelet
Clinical Use: prevention of TIA and strokes in patients with previous event or following heart attack, adjunct with aspirin following coronary stent implantation, decrease thrombotic events in patient with acute coronary syndrome
Ocular Side Effects: subconjunctival and retinal hemes are possible
Warfarin
Cardiovascular Agent
MOA: anticoagulant- vitamin K antagonist; several protein coagulation factors require vitamin K as a cofactor for synthesis; warfarin inhibits vitamin K epoxide reductase; results in the production of clotting factors with diminished activity
Clinical Use: blood thinner
Ocular Side Effects: subconjunctival and retinal hemes are possible
Other Side Effects: extensive drug interactions!
Rosuvastatin
Cardiovascular Agent
MOA: HMG CoA reductase inhibitor; inhibit the first committed enzymatic step of cholesterol synthesis; analogs of HMG, a precursor of cholesterol; compete with HMG CoA reductase enzyme; end result- lowers intracellular supply of cholesterol in liver; causes hepatocyte to increase LDL receptors on surface; internalize circulating LDL and prevent release of VLDL
Clinical Use: first line therapy for increased LDL, effective in lowering plasma cholesterol levels in all types of hyperlipidemias
Ocular Side Effects: n/a
Simvastatin
Cardiovascular Agent
MOA: HMG CoA reductase inhibitor; inhibit the first committed enzymatic step of cholesterol synthesis; analogs of HMG, a precursor of cholesterol; compete with HMG CoA reductase enzyme; end result- lowers intracellular supply of cholesterol in liver; causes hepatocyte to increase LDL receptors on surface; internalize circulating LDL and prevent release of VLDL
Clinical Use: first line therapy for increased LDL, effective in lowering plasma cholesterol levels in all types of hyperlipidemias
Ocular Side Effects: n/a
Atorvastatin
Cardiovascular Agent
MOA: HMG CoA reductase inhibitor; inhibit the first committed enzymatic step of cholesterol synthesis; analogs of HMG, a precursor of cholesterol; compete with HMG CoA reductase enzyme; end result- lowers intracellular supply of cholesterol in liver; causes hepatocyte to increase LDL receptors on surface; internalize circulating LDL and prevent release of VLDL
Clinical Use: first line therapy for increased LDL, effective in lowering plasma cholesterol levels in all types of hyperlipidemias
Ocular Side Effects: n/a
Colesevelam
Cardiovascular Agent
MOA: bile acid sequestrant; binds bile acids and bile salts in the small intestine (prevents reabsorption into liver); liver must then increase conversion of cholesterol to bile acids; cell surface LDL receptors increase
Clinical Use: lower LDL levels, hyperlipidemias
Ocular Side Effects: n/a
Ezetimibe
Cardiovascular Agent
MOA: cholesterol absorption inhibitor; inhibits absorption of cholesterol from the small intestine; decreases delivery of intestinal cholesterol to the liver; reduces hepatic cholesterol stores and increases clearance of cholesterol from blood
Clinical Use: hyperlipidemia
Ocular Side Effects: n/a
Fluoxetine
CNS Medication
MOA: SSRI; blocks reuptake of 5HT; leads to increased concentration in the synaptic gap
Clinical Use: depression
Ocular Side Effects: n/a
Sertraline
CNS Medication
MOA: SSRI; blocks reuptake of 5HT; leads to increased concentration in the synaptic gap
Clinical Use: depression
Ocular Side Effects: n/a
Duloxetine
CNS Medication
MOA: SNRI; blocks reuptake of NE and 5HT; non-selective
Clinical Use: depression, may be more effective if pain is experienced along with depression
Ocular Side Effects: n/a
Bupropion
CNS Medication
MOA: atypical antidepressant; weak dopamine and NE reuptake inhibitor
Clinical Use: depression, also assists in decreasing the craving and attenuating the withdrawal symptoms for nicotine
Ocular Side Effects: n/a
Alprazolam
CNS Medication
MOA: benzodiazepine; binding to receptor increases the affinity of GABA for its receptor; enhances the inhibitory effects of GABA; also decreases the release of GABA
Clinical Use: anxiety, sedative and hypnotic, anterograde amnesia, anticonvulsant, muscle relaxant, anesthesia, alcohol or opiate physical dependence/addiction (sedates patient during withdrawal)
Ocular Side Effects: n/a
Diazepam
CNS Medication
MOA: benzodiazepine; binding to receptor increases the affinity of GABA for its receptor; enhances the inhibitory effects of GABA; also decreases the release of GABA
Clinical Use: anxiety, sedative and hypnotic, anterograde amnesia, anticonvulsant, muscle relaxant, anesthesia, alcohol or opiate physical dependence/addiction (sedates patient during withdrawal)
Ocular Side Effects: n/a
Eszopiclone
CNS Medication
MOA: benzo-like; high affinity for the benzodiazepine binding site of GABA receptors; mimic effect of BZDs
Clinical Use: sleep problems
Ocular Side Effects: n/a
Zolpidem
CNS Medication
MOA: benzo-like; high affinity for the benzodiazepine binding site of GABA receptors; mimic effect of BZDs
Clinical Use: sleep problems
Ocular Side Effects: n/a
Aripiprazole
CNS Medication
MOA: second generation antipsychotic; dopamine and 5HT receptor antagonist; have activity at more dopamine receptors than first generation; also called “atypical” antipsychotics; do not produce movement disorders
Clinical Use: effective control of positive and negative signs, antiemetic effects, adjunct treatment of depression or a treatment of bipolar disorder
Ocular Side Effects: n/a
Quetiapine
CNS Medication
MOA: second generation antipsychotic; dopamine and 5HT receptor antagonist; have activity at more dopamine receptors than first generation; also called “atypical” antipsychotics; do not produce movement disorders
Clinical Use: effective control of positive and negative signs, antiemetic effects, adjunct treatment of depression or a treatment of bipolar disorder
Ocular Side Effects: n/a
Levodopa
CNS Medication
MOA: anti-Parkinson drug; boosts DA synthesis; increases content of DA vesicles; increases amount of DA released; increased activation of postsynaptic receptors
Clinical Use: Parkinson’s
Ocular Side Effects: n/a
Carbidopa
CNS Medication
MOA: anti-Parkinson drug; given along with levodopa to inhibit PNS conversion to dopamine; allows therapeutic levels of levodopa to reach the CNS at a lower dose; essentially makes levodopa more bioavailable
Clinical Use: Parkinson’s
Ocular Side Effects: n/a
Amantadine
CNS Medication
MOA: antiviral; also used for Parkinson’s, but MOA is not known; possibly more than usual DA-containing vesicles in the axon terminal are induced to release contents into the synapse
Clinical Use: Parkinson’s, influenza A
Ocular Side Effects: n/a
Memantine
CNS Medication
MOA: NMDA receptor antagonist; binds to glutamine receptors on the post-synaptic neuron; prevents binding of glutamine; theory is that blockage of NMDA receptors reduces cytotoxic effects on neurons caused by Ca influx across the plasma membranes
Clinical Use: Alzheimer’s Disease
Ocular Side Effects: n/a
Rivastigmine
CNS Medication
MOA: cholinesterase inhibitor; binds reversibly to acetylcholinesterase; leads to an increase in acetylcholine in the synapse
Clinical Use: Alzheimer’s Disease, Myasthenia Gravis
Ocular Side Effects: n/a
Dexmethylphenidate
CNS Medication
MOA: amphetamine; is a substrate for the enzyme responsible for reuptake of NE and DA; is not metabolized by MAO and is instead stored in neurotransmitter storage vesicles (leaves NE and DA out); causes release of intracellular stores of neurotransmitter via a reversal of the reuptake enzyme; also inhibits MAO to a certain extent
Clinical Use: ADHD, narcolepsy
Ocular Side Effects: n/a
Lisdexamfetamine
CNS Medication
MOA: amphetamine; is a substrate for the enzyme responsible for reuptake of NE and DA; is not metabolized by MAO and is instead stored in neurotransmitter storage vesicles (leaves NE and DA out); causes release of intracellular stores of neurotransmitter via a reversal of the reuptake enzyme; also inhibits MAO to a certain extent
Clinical Use: ADHD, narcolepsy
Ocular Side Effects: n/a
Fentanyl
Opiate
MOA: opioid agonist
Clinical Use: pain control and in conjunction with general anesthesias; analgesic, sedative, respiratory depressant, antitussive, antidiarrheal, miotic
Ocular Side Effects: pupillary constriction (withdrawal = dilation)
Methadone
Opiate
MOA: opioid agonist
Clinical Use: treatment of opioid addiction- eases cravings, does not produce high; analgesic, sedative, respiratory depression, and antitussive effects
Ocular Side Effects: pupillary constriction (withdrawal = dilation)
Oxycodone
Opiate
MOA: opioid agonist
Clinical Use: pain control, in conjunction with general anesthesia; analgesic, sedative, respiratory depressant, antitussive, antidiarrheal, miotic
Ocular Side Effects: pupillary constriction (withdrawal = dilation)
Codeine
Opiate
MOA: partial opioid agonist
Clinical Use: antitussive action at doses that do not produce analgesia (some OTC preparations), analgesic
Ocular Side Effects: pupil constriction
Hydrocodone
Opiate
MOA: partial opioid agonist
Clinical Use: pain control, in conjunction with general anesthesia; analgesic, sedative, respiratory depressant, antitussive, antidiarrheal, miotic
Ocular Side Effects: pupil constriction
Tramadol
Opiate
MOA: binds to opioid receptor and weakly inhibits reuptake of NE and serotonin
Clinical Use: moderate to moderately severe pain
Ocular Side Effects: pupil constriction
Naloxone
Opiate
MOA: opioid antagonist; reverse all effects of agonist except induction of coma
Clinical Use: opiate overdose; allows stabilization prior to transportation to an emergency center
Ocular Side Effects: n/a
