Drugs Flashcards
Lidocaine
- local anaesthetic
- amide
- blockade of voltage gated sodium channels, use dependent, medium acting
- systemic doses can result in death due to the blockade of respiration, cardiovascular problems and depress smooth muscle contraction, seizures
Bupivacaine
- local anaesthetic
- blockade of voltage gated sodium channels, use dependent, long acting
- systemic doses can result in death due to the blockade of respiration, cardiovascular problems and depress smooth muscle contraction, seizures
Procaine
- local anaesthetic
- ester - can cause a local allergic reaction via a para-aminobenzoic acid (PABA) formation
- blockade of voltage gated sodium channels, use dependent, short acting
- systemic doses can result in death due to the blockade of respiration, cardiovascular problems and depress smooth muscle contraction, seizures.
Benzocaine
- local anasthetic
- ester - can cause a local allergic reaction via a para-aminobenzoic acid (PABA) formation
- blockade of voltage gated sodium channels, surface use only and lacks efficacy, short acting
- systemic doses can result in death due to the blockade of respiration, cardiovascular problems and depress smooth muscle contraction, seizures.
Cocaine
- local anaesthetic
- ester - can cause a local allergic reaction via a para-aminobenzoic acid (PABA) formation
- blockade of voltage gated sodium channels, in addition, due to cocaine’s ability to block reputable of NE, an also result in local vasoconstriction, medium acting.
- systemic doses can result in death due to the blockade of respiration, cardiovascular problems and depress smooth muscle contraction, seizures, also can lead to addiction due to its ability to block reuptake of dopamine
Pancuronium
- neuromuscular blocker
- competitive agent
- skeletal muscle nicotinic channel antagonist, long duration of action (ie 60 minutes)
- ganglionic blockade causing decrease in blood pressure and tachycardia, release of histamine, respiratory paralysis
Atracurium
- neuromuscular blocker
- competitive agents
- skeletal muscle nicotinic channel antagonist, intermediate duration of action
- ganglionic blockade causing decrease in blood reassure and tachycardia, release of histamine, respiratory paralysis
Vecuronium
- neuromuscular blocker
- competitive agents
- skeletal muscle nicotinic channel antagonist, intermediate duration of action
- ganglionic blockade causing decrease in blood reassure and tachycardia, release of histamine, respiratory paralysis
Succinylcholine
- neuromuscular blocker
- depolarising agent
- skeletal muscle nicotinic channel agonist, metabolised by butyrylcholinesterase, not metabolised by acetylcholinesterase so the channels cannot “reset” and myocyte cannot depolarise
- can cause MALIGNANT HYPERTHERMIA, high body temperature, tachycardia, bradycardia, release of histamine, rigid muscles, muscle breakdown and respiratory paralysis
Dantrolene
- spasmolytic
- used for malignant hypothermia and ALS
- blocks calcium release from the sarcoplastic reticulum by blocking the ryanodine receptor
- dizziness, drowsiness, weakness, fatigue, GI disturbances, respiratory depression
Diazepam
- spasmolytic and anti-anxiety
- long acting benzodiazepine
- potentiate GABAs ability to open GABA A chloride channel (increase channel opening frequency
- sedation, ataxia, dependence
Baclofen
- spasmolytics
- GABA B agonist (GPCR inhibitory coupling)
- dizziness, drowsiness, weakness, fatigue, seizures, hallucinations
- ALS
Botulinum Toxin
- spasmolytic
- inhibits release of acetylcholine at the NMJ
- anxiety, dizziness, drowsiness, dry eyes and mouth, back and neck pain
Carisoprodol
- spasmolytic
- potentiate GABAs ability to open the GABA A chloride channel (increase channel opening frequency
- sedation, ataxia, somnolence, dependence, withdrawal
Morphine
- opioid
- acts at my GPCR to cause opening K+ channels and blocks VGCC
- constipation, respiratory depression, abuse potential
Codeine
- opioid
- acts at my GPCR to cause opening K+ channels and blocks VGCC, less potent than morphine, better bioavailability
- constipation, respiratory depression, abuse potential
Oxycodone
•opioid
•acts at my GPCR to cause opening K+ channels and blocks VGCC
-percocet contains acetaminophen
-percodan contains aspirin
•constipation, respiratory depression, abuse potential
Fentanyl
- opioid
- acts at my GPCR to cause opening K+ channels and blocks VGCC, my anatgonist, 100 times more potent than morphine
- constipation, respiratory depression, abuse potential
Methadone
- opioid
- acts at my GPCR to cause opening K+ channels and blocks VGCC, orally available mu opioid agonist
- constipation, respiratory depression, abuse potential
Loperamide
- opioid
- acts at my GPCR to cause opening K+ channels and blocks VGCC, weak (less potent) mu agonist that does not cross the blood brain barrier, used for diarrhea
- severe constipation
Buprenorphine
- opioid
- partial mu agonist and Kappa opioid agonist/antagonist
- acts at my GPCR to cause opening K+ channels and blocks VGCC
- constipation, respiratory depression, abuse potential, dysphoria and opioid withdrawal
- +naloxone - used to order to reduce opioid use and abuse, an opioid receptor agonist
Tramadol
- opioids
- partial mu agonist and Kappa opioid agonist/antagonist
- acts at my GPCR to cause opening K+ channels and blocks VGCC, weak mu agonist, also inhibits uptake of NE and 5HT
- severe constipation, some dysphoria and opioid withdrawal, less abuse potential
Naloxone
- not for pain but used for opioid overdose, opioid antagonist
- blocks opioid receptors, short acting (30-90 minutes)
- will cause immediate withdrawal symptoms in opioid addiction
Naltrexone
- not for pain but used for opioid overdose, opioid antagonist
- blocks opioid receptors, longer acting (4-14 hrs)
- will cause immediate withdrawal symptoms in opioid addiction
Aspirin
- NSAID
- many acetyl and non acetyl salicylates available
- irreversible COX inhibition
- GI irritation, GERD and GI ulcers, Reye Syndrome in children (aspirin only)
Ibuprofen
- NSAID
- reversible COX inhibition
- GI irritation, GERD and GI ulcers
Indomethacin
- NSAID
- ductus arteriosus
- reversible COX inhibition
- GI irritation, GERD and GI ulcers
- contraindicated with Lithium
Ketoprofen
- NSAID
- ductus arteriosus
- reversible COX inhibition
- GI irritation, GERD and GI ulcers
Naproxen
- NSAID
- ductus arteriosus
- reversible COX inhibition
- GI irritation, GERD and GI ulcers
Celecoxib
- NSAID
- considered irreversible COX2 inhibition, reversible COX1 inhibition
- lacks GI effects, can cause cardiovascular problems, including stroke and myocardial infarction, can decrease kidney function
Acetaminophen
- pain medication
- paracetamol
- thought to inhibit some COX enzyme, other mechanism unknown
- can be hepatotoxic, skin rash, contraindicated in alcoholism
Dexamethasone
- glucocorticoid
- increase levels of lipocortin (also known as Annexin), that inhibits phospholipids A2, decreasing inflammatory mediators, nuclear receptor-altering gene expression (oral)
- immunosuppression
Prednisone
- glucocorticoid
- increase levels of lipocortin (also known as Annexin), that inhibits phospholipids A2, decreasing inflammatory mediators, nuclear receptor-altering gene expression (oral)
- immunosuppression
- myasthenia gravis for immunosupression and cushingoid
Hydrocortisone
- glucocorticoid
- increase levels of lipocortin (also known as Annexin), that inhibits phospholipids A2, decreasing inflammatory mediators, nuclear receptor-altering gene expression (topical)
- immunosuppression
Gabapentin
- chronic pain
- A2∂ ligand
- decrease the number of voltage sensitive calcium channels on membrane surface
- sedation, somnolence, dizziness, ataxia, peripheral edema
Pregabalin
- chronic pain
- A2∂ ligand
- decrease the number of voltage sensitive calcium channels on membrane surface
- sedation, somnolence, dizziness, ataxia, peripheral edema, visual disturbances
Amitriptyline
Nortriptyline
Desipramine
- chronic pain
- tricyclic antidepressants (TCAs), increase levels of NE and 5HT
- norepinephrine and serotonin reuptake inhibitors
- antimuscarinic action
Duloxetine
- chronic pain
- serotonin and norepinephrine reuptake inhibitors (SNRIs)
- norepinephrine and serotonin reuptake inhibitors
- hypertension, sexual and GI disturbances, somnolence, dizziness
Lidocaine
- chronic pain
- blocks voltage gated sodium channels
- patch
- if high systemic doses are reached can cause cardiovascular arrythmia, seizures
Carbamazepine
- chronic pain, mood stabilizer
- inactivation of VGNa+ channels
- prolong fast inactivation of voltage gated sodium channels
- teratogenic, SJS, TEN, motor coordination
Lamotrigine
- chronic pain, mood stabilizer
- inactivation of VGNa+ channels
- prolong fast inactivation of voltage gated sodium channels in addition may block some glutamate release and calcium channels
- insomnia, SJS, TENs
Clonidine
- chronic pain
- inactivation of VGNa+ channels
- agonist at NE-alpha2, inhibits release of pain neurotransmitters
- hypotension
Sumatriptan
- migraine
- triptans “serotonin agonists”
- 5HTIB and 5HTID agonist
- cardiovascular, coronary artery vasospasm, contraindicated in individuals with previous MI
Rizatripan
- migraine
- triptans “serotonin agonists”
- 5HTIB and 5HTID agonist
- cardiovascular, coronary artery vasospasm, contraindicated in individuals with previous MI
Naratriptan
- migraine
- triptans “serotonin agonists”
- 5HTIB and 5HTID agonist, longest acting of the triptans (1/2 life 6 hours)
- cardiovascular, coronary artery vasospasm, contraindicated in individuals with previous MI
Galcanezumab
- migraine
- CGRP antagonist
- human monoclonal antibody that binds up CGRP (calcitonin gene related peptide)
- injection site hypersensitivity reaction, allergic reaction
Fremanezumab
- migraine
- CGRP antagonist
- human monoclonal antibody that binds up CGRP (calcitonin gene related peptide)
- injection site hypersensitivity reaction, allergic reaction
Erenumab
- migraine
- CGRP antagonist
- human monoclonal antibody that binds up CGRPR (calcitonin gene related peptide receptor)
- injection site hypersensitivity reaction, GI issues
Timolol
- ocular hypertension
- decrease synthesis
- beta 2 receptor antagonist (inhibit aqueous humour secretion)
- bronchospasm, bradycardia
Apraclonidine
- ocular hypertension
- decrease synthesis
- alpha 2 receptor agonist (inhibit aqueous humour secretion)
- ocular allergy
Acetazolamide
- ocular hypertension
- decrease synthesis
- carbonic anhydrase inhibitor (inhibit aqueous humour secretion)
- malaise, fatigue, weight loss, anorexia, depression
Pilocarpine
- ocular hypertension
- increase outflow
- cholinergic agonist
- accommodation, miosis
Latanoprost
- ocular hypertension
- increase outflow
- prostaglandin FP receptor agonist inhibitor (promotes contraction of ciliary muscle which stretches open trabecular outflow pathway)
- eyelash growth, iridium pigmentation, conjunctival hyperemia
Atropine
Scopolamine
- mydriasis
- muscarinic antagonist (inhibit contraction of circular muscle, iris sphincter)
- photosensitivity, blurred vision
Proparacaine
- corneal anaesthesia
- sodium channel blocker (decrease excitability of sensory nerves in corneal)
- corneal irritation
Opioids
- act at GPCRs through G alpha —> decrease in cAMP and protein kinase A
- G beta gamma —> blocking VGCC and opening K+ channels = hyperpolarization
- activate a descending pain inhibitory pathway in areas of the brainstem (disinhibition)
NSAIDs
•COX1 and COX2 inhibitors
Steroidal antiinflammatory medications (glucocorticoid-steroids)
•bind to cytosolic steroid receptors which translocations into the cell nuclei to exter its effects on glucocorticoid-responsive genes resulting in the increase ina peptide called lipocortin which inhibits phospholipase A2, an enzyme responsible for mobilising arachidonic acid from cell membranes after injury
Norepinephrine and/or dual reuptake inhibitors
- block reuptake of serotonin or NE
- thought to work via an increase in descending inhibition, increasing NE and 5HT in the dorsal horn of the SC to inhibit pain
VGSC blockers
- block VGSC on all neurons
* given locally
Triptans
•agonists at 5HT receptors - found on both blood vessels and on neurons with an ability to cause vasoconstriction, reducing inflammatory and pain mediator release as well as though to decrease peripheral neuronal activity —> decrease in headache severity
Beta blockers
- prophylactic use for migraines
- block beta adregenic receptors reducing the ability of endogenous NE and epinephrine to act at the beta receptors resulting in a decrease in hypertension and wide spread decrease in sympathetic activity
- full mechanism as migraine prophylactic unknown