Neuro pharm

Question 1

Glaucoma drug:

alpha agonists

Answer 1

Epinephrine: decrease aqueous humor synthesis via vasoconstriction

Brimonidine (alpha2): decrease aqueous humor synthesis.

Side effects: mydriasis so do not use in close-angle glaucoma, blurry vision, ocular hyperemia, foreign body sensation, ocular allergic reaction, ocular pruritis.

Question 2

Glaucoma drugs:

beta blockers

Answer 2

Timolol, betaxolol, carteolol: decrease aqueous humor synthesis.

Side effect: no pupillary or vision changes

Question 3

Glaucoma drug:

diurectics

Answer 3

Acetazolamide: decrease aqueous humor synthesis via inhibition of carbonic anhydrase.

Side effect: no pupillary or vision changes

Question 4

Glaucoma drug:

cholinomimetics

Answer 4

Direct (pilocarpine, carbachol): increase outflow of aqueous humor via contraction of ciliary muscle and opening trabecular meshwork

Indirect (physostigmine, echothiophate): use pilocarpine in emergencies–very effective at opeing meshwork into canal of Schlemm

Side effects: miosis and cyclospasm (contraction of ciliary muscle)

Question 5

Glaucoma drug:

Prostagladin

Answer 5

Latanoprost (PGF2a): increases outflow of aqueous humor

Side effect: darkens color of iris (browning)

Question 6

Opioid analgesics: names

Answer 6

Morphine, fentanyl, codeine, heroin, methadone, meperidine, dextromethorphan, diphenoxylate.

Question 7

Opioid analgesics: mechanism

Answer 7

Act as agonist at opioid receptors (mu = morphin, delta= enkephalin, kappa=dunorphin) to modulate synaptic transmission

Via G-coupled receptor, Open K+ channels, close Ca2+ channels, thus decreases synaptic transmission

Inhibit release of ACh, NE, 5-HT, glutamate, substance P

Question 8

Opioid clinical use

Answer 8

Pain, 
cough suppression (dextromethorphan)
diarrhea (loperamide and diphenoxylate) 
acute pulm edema, 
maintenance for addicts (methadone)

Question 9

Opioid toxicity

Answer 9

Addition, respiratory depression, constipation (vs diarrhea in ACh toxicity), miosis (pinpoint pupils), addictive CNS depression with other drugs.

Tolerance does NOT develop to miosis and constipation.
Toxicity treated with naloxone or naltrexone (vs. butorphanol not easily reversed)

Question 10

Butorphanol

Answer 10

Mu-opioid partial agonist and kappa-opioid agonist, produces analgesia.

Clinical use: severe pain (migraine, labor), causes less respiratory depression than full opioid agonist.

Toxicity: can cause opioid withdrawal symptoms if pt also taking full opioid agonist (competition for opioid receptor).

Overdose NOT easily reversed with naloxone.

Question 11

Traumadol

Answer 11

Very weak opioid agonist, also inhibit serotonin and NE reuptake (works on multiple neurotransmitters)
“Tram it all with traumadaol”

Clinical use: chronic pain

Toxicity: similar to opioid, decreases seizure threshold