Neurology Flashcards
Glaucoma drugs Mechanism
Decrease intraocular pressure via decreased amt of aqueous humor (inhibit synthesis/secretion or increase drainage)
Glaucoma Drugs - alpha-agonists
Alpha- agonists
Epinephrine, Brimonidine (alpha2)
MECHANISM: Decrease aqueous humor synthesis via vasoconstriction, Decrease aqueous humor synthesis
SIDE EFFECTS: Mydriasis; do not use in closed-agle glaucoma
Blurry vision, ocular hyperemia, foreign body sensation, ocular allergic reactions, ocular pruritus
Glaucoma drugs - Beta blockers
Beta blockers Timolol, betaxolol, carteolol
MECHANISM: Decrease aqueous humor synthesis, targets ciliary epithelium (Beta-AR’s)
SE: No pupillary or vision changes
Glaucoma drugs - Diuretics
Diuretics - Acetazolamide
MECH: Dec aqueous humor synthesis via inhibition of carbonic anhydrase
SE: No pupillary or vision changes
Glaucoma drugs - cholinomimetics
Cholinomimetics Direct (pilocarpine, carbachol), Indirect (physostigmine, echothiophate)
MECH: Inc outlfow of aqueous humor via contraction of ciliary muscle (muscarinic receptors) and opening of trabechular meshwork
Use pilocarpine in emergencies, very effective at opening meshwork into canal of schlemm
SE: Miosis and cyclospasm (contraction of ciliary muscle)
Glaucoma drugs: Prostaglandins
Glaucoma drugs: Prostaglandins
Latanoprost (PGF-2alpha)
MECH: Increases outflow of aqueous humor
SE: Darkens color of iris (browning)
Opioid Analgesics
Opioid Analgesics
Levorphanol, oxymorphone, morphine, fentanyl, codeine, heroin, methadone, meperidine, dextromethorphan (also used as antitussive by blocking glutamate NMDA receptor), diphenoxylate (combined with atropine for antidiarrheal)
MECH: Agonists at opioid receptors to modulate synaptic transmission. Inhibit release of ACh, NE, 5-HT, glutamate, substance P
CLINICAL USE: Pain, cough suppresion (dextro), diarrhea (loperamide and diphenoxylate), acute pulmonary edema, maintenance programs for addicts (methadone - long t1/2, potent, dec w/drawal s/s)
TOXICITY: addiction, respiratory depression (dec CO2 sensitivity in brainstem, constipation (dec GI motility), miosis (pinpoint pupils) additive CNS depression with other drugs.
Tolerance does not develop to miosis and constipation. Toxicity treated with naloxone or naltrexone (opioid receptor antagonist)
Butorphanol and Pentazocine
Butorphanol and Pentazocine
MECH: Mu-opioid receptor partial agonist and kappa-opioid receptor agonist; produces analgesia
CLINICL USE: severe pain (migraine, labor, etc), causes less respiratory depression than full opioid agonists.
TOXICITY: Can cause opioid withdrawal s/s if pt is also taking full opioid agonist (competition for opioid receptors). Overdose is not easily reversed with naloxone
Tramadol
Tramadol
MECH: Very weak opioid agonists; also inhibits 5HT and NE reuptake (works on multiple neurotransmitters)
“tram it all” with tramadol
CLINICAL USE: Chronic pain
TOXICITY: similar to opioids. Decreases seizure threshold
