Glaucoma and opioid pharm FA Flashcards
how do glaucoma drugs work?
decrease intraoccular pressure via decrease amt of aqueous humor (inhib synth/secretion or increase drainage)
2 alpha-agonist glaucoma drugs
- epinephrine
2. brimonidine (alpha-2)
epinephrine (alpha agonist) for glaucoma uses what mech?
decrease aqueous humor synthesis via vasoconstriction
Brimonidine (alpha-2) for glaucoma uses what mech?
decreased aqueous humor synthesis
Epinephrine, used for glaucoma, has what side effects (1) and what contraindication?
mydriasis (a dilation of the pupil); do not used in closed angle glaucoma!
when should you not used epinephrine for glaucoma?
Do not use in closed angle glaucoma!
side effects of Brimonidine (alpha-2), used for glaucoma (5)?
- Blurry vision
- ocular hyperemia
- foreign body sensation
- ocular allergic reactions
- ocular pruritus
What 3 beta blockers are for glaucoma?
- timolol
- betaxolol
- carteolol
what is the mechanism of the 3 beta blockers used to treat glaucoma (timolol, betaxolol, or carteolol)?
decrease aqueous humor synthesis
what are the side effects of the 3 beta blockers used to treat glaucoma (timolol, betaxolol, or carteolol)?
no pupillary or vision changes
what diuretic is used to treat glaucoma?
acetazolamide
mech of acetazlamide?
decrease aqueous humor synthesis via inhibition of carbonic anhydrase
acetazolamide is what type of drug? what does it treat?
diuretic used to treat glaucoma
timolol is what type of drug? what does it treat?
beta blocker, glaucoma
betaxolol is what type of drug? what does it treat?
beta blocker, glaucoma
carteolol is what type of drug? what does it treat?
beta blocker, glaucoma
cholinomimetics used to treat direct glaucoma? (2)
- pilocarpine
2. carbachol
pilocarpine is what kind of drug? it treats what?
cholinomimetic - treats direct glaucoma
carbachol
cholinomimetic - treats direct glaucoma
mech of pilocarpine in direct glaucoma
increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork
mech of carbachol in direct glaucoma
increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork
2 cholinomimetics used for indirect glaucoma
- physostigmine
2. echothiophate
physostigmine is what kind of drug? it treats what?
cholinomimetics, indirect glaucoma
echothioophate is what kind of drug? it treats what?
cholinomimetics, indirect glaucoma
what is the mech of physostigmine in indirect glaucoma
increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork
what is the mech of echothioophate in indirect glaucoma
increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork
which drug for glaucoma should you use in emergencies?
pilocarpine: very effective at opening meshwork into canal of Schlemm
how does pilocarpine work in emergencies?
very effective at opening meshwork into canal of Schlemm
what prostaglandin drug is used for glaucoma?
Latanoprost (PGF-2alpha)
Latanoprost (PGF-2alpha) is what type of drug for what?
prostaglandin, to txt glaucoma
what is the mech of latanoprost (PGF-2alpha) used for glaucoma?
increase outflow of acqueous humor
side effects of latanoprost, a prostaglandin used to txt glaucoma?
darkens the color of the eye
8 opioid analgesics
- morphine
- fentanyl
- codeine
- heroin
- methadone
- meperidine
- dextromethorphan
- diphenoxylate
morphine is what type of drug?
opioid analgesic
fentanyl is what type of drug?
opioid analgesic
codeine is what type of drug?
opioid analgesic
heroin is what type of drug?
opioid analgesic
methadone is what type of drug?
opioid analgesic
meperidine is what type of drug?
opioid analgesic
dextromethorphan is what type of drug?
opioid analgesic
diphenoxylate is what type of drug?
opioid analgesic
opioid analgesic mech:
agonist at opioid receptors to modulate synaptic transmission– open K+ channels, close Ca2+ channels —-> decrease synaptic transmission —> inhib release of ACh, NE, 5-HT, glutamate, substance P
what are the 5 neurotransmitters are inhibited by opioids?
- ACh
- NE
- 5-HT
- glutamate
- substance P
3 opioid receptors
- mu= morphine
- delta = enkephalin
- kappa = dynorphin
what are opioid analgesics used for (5 things)?
- pain
- cough suppression (dextromethorphan)
- diarrhea (loperamide and diphenoxylate)
- acute pulmonary edema
- maintenance programs for addicts (methadone)
which opioid is particularly helpful for cough suppression?
dextromethorphan
which 2 opioids are particularly helpful for diarrhea?
loperamide and diphenoxylate
which opioid analgesic is particularly helpful for maintenance programs for addicts?
methadone
what are the effects of opioid analgesic toxicity? (5)
- addiction
- respiratory depression
- constipation
- miosis (pinpoint pupils)
- additive CNS depression with other drugs
does tolerance develop to miosis and constipation related to opioid analgesics?
nope
opioid toxicity is treated with (2)
naloxone and naltrexone (opioid receptor antagonists)
naloxone is an
opioid receptor antagonist
naltrexone is an
opioid receptor antagonist
Mech of Butorphanol?
Mu-opioid receptor partial agonist and kappa-opioid receptor agonist —-> produces analgesia
what does butorphanol do?
produces analgesia
what is butophanol used for clinically?
severe pain (migraine, labor, etc)
what is the good thing about using butophanol for severe pain?
causes less respiratory depression than full opioid agonists
toxicity of butorphanol?
can cause opioid withdrawal symptoms if pt is also taking full opioid agonist (competition for opioid receptors).
can naloxone be used for an overdose with Butorphanol?
overdose not easily reversed with naloxone
- butorphanol is a mu-opioid receptor partial agonist and kappa-opioid receptor agonist
tramadol mech?
very weak opioid agonist. Also inhibits serotonin and NE reuptake (works on multiple neurotransmitter).
“tram it all” with tramadol
tramadol is used for…
chronic pain
which opioid specifically decreases the seizure threshold (so seizures are more common)?
tramadol
what are the side effects/toxicities of tramadol (6)?
- decrease seizure threshold (increase seizure risk)
- similar to opioids
(a. addiction
b. respiratory depression
c. constipation
d. miosis (pinpoint pupils)
e. additive CNS depression with other drugs)
