Neurology Flashcards
Glaucoma drugs
Decrease IOP and amount of aqueous humor
a-agonists (epinephrine, brimonidine/a2) B-blockers (timolol, betaxol, carteolol) Diuretics (acetazolamide) Cholinomimetics (direct = pilocarpine, carbachol; indirect = physostigmine, echothiophate) Prostaglandin = latanoprost (PGF2a)
Epinephrine and Brimonidine (a2)
Use/MOA/SE
Glaucoma
Decrease aqueous humor synthesis via vasoconstriction
SE = mydriasis (don’t use in closed angle glaucoma); blurry vision, ocular hyperemia, foreign body sensation, ocular allergic reactions, ocular pruritus
Timolol, betaxolol, carteolol
Use/MOA/SE
Glaucoma
Decrease aqueous humor synthesis
SE = no pupillary or vision changes
Acetazolamide
Glaucoma
Decrease aqueous humor synthesis via inhibition of carbonic anhydrase
SE = no pupillary or vision changes
Direct and indirect cholinomimetics for glaucoma
D = Pilocarpine, Carbachol
I = Physostigmine, Echothiophate
Increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork
SE = miosis and cyclospasm (contraction of ciliary muscle)
Drug used in glaucoma emergencies
Pilocarpine
Very effective at opening meshwork into canal of Schlemm
Latanoprost
PGF2a for glaucoma
Increase outflow of aqueous humor
SE = darkens color of iris (browning)
Opioid analgesics
Morphine, fentanyl, codeine, loperamide, methadone, meperidine, dextromethorphan, diphenoxylate
Agonists at opioid receptors (mu = morphine, delta = enkephalin, kappa = dynorphin)
Modulate synaptic transmission = open K, close Ca channels = decrease transmission
Inhibit release of ACh, NE, 5HT, glutamate, substance P
Opioid analgesic - pain and cough suppression
Dextromethorphan
Opioid analgesic - diarrhea
Loperamide
Diphenoxylate
Acute pulmonary edema and maintenance programs for heroin addicts
Methadone
Opioid analgesic toxicity
Addiction Respiratory depression CONSTIPATION MIOSIS (PINPOINT PUPILS) Additive CNS depression with other drugs Tolerance does not develop to miosis and constipation
Treatment for opioid toxicity
Naloxone
Naltrexone (opioid receptor antagonist)
Butorphanol
Mu opioid receptor partial agonist and kappa-opioid receptor agonist
Produces analgesia
Use = severe pain (migraine, labor)
Less respiratory depression
Butorphanol toxicity
Opioid withdrawal symptoms if also taking full opioid agonist
Overdose NOT easily reversed with naloxone
Tramadol
Weak opioid agonist Also inhibits 5HT and NE reuptake "Tram it all with Tramadol" Use = chronic pain Toxicity = decreases seizure threshold, serotonin syndrome
Ethosuximide
Absence
Blocks thalamic T-type Ca channels
SE = fatigue, GI distress, headache, itching (urticaria), Stevens-Johnson syndrome
Benzodiazepines
Status epilepticus
Increase GABAa action
SE = sedation, tolerance, dependence, respiratory depression
Eclampsia seizures
MgSO4
Phenytoin
All seizures
Prophylaxis status epilepticus, first line tonic-clonic
Increase Na channel inactivation; zero-order kinetics
SE = gingival hyperplasia, megaloblastic anemia, teratogenic (fetal hydantoin syndrome), SLE like syn, induction P450, Stevens Johnson, osteopenia, nystagmus/diplopia, ataxia, sedation
Carbamazepine
First line simple, complex, tonic-clonic
Increase Na channel inactivation
SE = blood dyscrasias (agranulocytosis, aplastic anemia), induction P450, SIADH, Stevens-Johnson syn
Trigeminal neuralgia
Carbamazepine
Valproic acid
All, first line tonic clonic
Increase Na channel inactivation
Increase GABA concentration by inhibiting GABA transaminase
SE = fatal hepatotoxicity (measure LFTs!!!), NTD, tremor, WG
Myoclonic seizures, bipolar disorder
Valproic acid
Gabapentin
Simple, complex, tonic-clonic
Inhibits high-voltage-activated Ca channels
Designed as GABA analog
SE = sedation, ataxia
Peripheral neuropathy, postherpetic neuralgia, migraine prophylaxis, bipolar disorder
Gabapentin
Phenobarbital
Simple, complex, tonic-clonic
Increase GABAa action
SE = sedation, induction P450, cardiorespiratory depression
First line in neonates
Topiramate
Simple, complex, tonic-clonic
Blocks Na channels, increase GABA action
SE = sedation, MENTAL DULLING, kidney stones, WL
Migraine prevention
Topiramate
Lamotrigine
All
Blocks voltage-gated Na channels
SE = Stevens-Johnson syn (titrate slowly)