Pharm 3 Flashcards by Pallavi Nair

Mydriasis

SNS - alpha 1

from sup cervical gang

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Ciliary relaxation

distance vision
SNS - beta 2
(from sup cervical gang)

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Secretion at ciliary body (aqueous humor)

SNS - alpha 2, beta 2

from sup cervical gang

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Miosis

PSNS - M3

travels w. CN 3 from edinger westphal nuc

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Lacrimal secretion

PSNS M3, M3

CN 7

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What do opiates cause in the eye?

Pinpoint pupils

- block inhibitory interneurons of E-W nut so it’s always constricting

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Muscarinic antagonists and the eye

for optic neuritis and uveitis
cause mydriasis and loss of accommodation
not for glaucoma
AE: inc. intraocular P, systemic antichol effects

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Atropine

muscarinic antag for iritis/uveitis in the eye,

causes mydriasis and loss of accommadation

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Muscarinic antags for the eye

Atropine
Homotripine
Tropicamide
Cyclopentolate
Scopolamine

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Glaucoma treatments

PG analogs
Beta blockers
Diuretics
Cholinomimetics
Alpha Agonists

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Dipivefrin, Phenylephrine, Apraclonidine, Brimonidine, Naphazoline, Tetrahydrozoline

alpha agonists for glaucoma
dec. aqueous humor synthesis via vasoconstriction
AE: mydriasis, blurry vision, hyperemia, foreign body sensation, hypersensitivity
## Caution in hyperthyroid, HTN, DM, CAD, asthma

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Timolol, Levobunolol, Metipranolol, Carteolol

beta blockers for glaucoma
## blocks ciliary body production of aqueous humor by dec. cAMP and pKA or dec. ocular blood flow

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Dorzolamide, Brinzolamide

carbonic anhydrase inhibitors for glaucoma
blocks production of H20 and CO2 from Carbonic acid
less water = less aqueous humor
Dorzolamide, Brinzolamide

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Latanoprost, Travoprost, Bimatoprose

PG analogs for glaucoma treatment
inc. outflow of aqueous humor
darkens color of iris, causes hypertrichosis

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Afliberecept, Pegaptanib, Ranibizumab, Bevacizumab

anti VEGF for macular degeneration

- AE: bleeding, thrombosis, stroke, MI

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Verteporfin

for macular degeneration
systematized and when hit with a laser causes free radicals and destroys new blood vessels
AE: HA, photosensitivity, visual disturbanceq

Rx that cause ototoxicity

Aminoglycosides (apoptosis by caspase/non)
Cisplatin (caspase apop)
Loop diuretics (block Na/K/2Cl channels)

Meclizine

antihistamine/antichol antiemetic
H1 and M1
vestibular and vagal blocker
CYP2D6 metab
AE: drowsiness/dizziness
caution in elderly

Promethazine

antihistamine/antichol antiemetic
H1 and M1
vestibular and vagal blocker
CYP2D6 metab
AE: drowsiness/dizziness
caution in elderly
BBW for IV use

Diphenhydramine

antihistamine/antichol antiemetic
H1 and M1
vestibular and vagal blocker
CYP2D6 metab
AE: drowsiness/dizziness
caution in elderly

Scopolamine

anticholin antiemetic
prophylaxis for motion sickness
blocks M1 activation and stimulation of CN8 that fires cholinergic to VC
patch behind the ear
AE: sedation, dry mouth, drowsiness

Chlorpromazine

antidopaminergic (+antihis and antichol) antiemetic
not for CINV
hepatic metab
AE: blood dyscrasias, QT prolongation

Prochlorperazine

antidopaminergic (+antihis and antichol) antiemetic
not for CINV
hepatic metab
AE: blood dyscrasias, QT prolongation

Ondansetron

strongest antiemetics!!
5HT3 antagonist in SI, stomach, CTZ
sometimes with dexamethasone to increase potency
hepatic metab via CYPs
AE: QT prolongation, constipation
*dose adjustment with hepatic dysfunction**

Granisetron

- strongest antiemetics!! - 5HT3 antagonist in SI, stomach, CTZ - sometimes given with dex to inc potency - hepatic metab via CYPs - AE: QT prolongation, constipation

Dolasetron

- strongest antiemetics!! - 5HT3 antag in SI, stomach, CTZ - sometimes given with dex to inc potency - heptaic metab via CYPs - AE: QT prolongation, constipation

Palonesetron

- strongest antiemetics!! - 5HT3 antag in SI, stomach, CTZ - sometimes given with dex to inc potency - hepatic metab via CYPs - AE: QT prolongation, constipation

Dromabinol or delta 9 tetrahydrocannabinol

- major active substance of marijuana that stimulates CB1 receptor - last resort, usually for chemo pts

Corticosteroids

their own antiemetic effect is though to be due to dec. PG's | - but usually given with other anti emetics to inc their effects

aprepitant/fosaprepitant

- antiemetic - Substance P/NK1 receptor antag - used adjunct for chemo N/V - crosses BBB so acts centrally - CYP3A4

Benzos as antiemetics

Diazepam - adjunctive with other anti emetics - useful in pts with anticipatory vomiting b/c they cause somnolence/amnesia lasting hours - given prior to chemo

AG mechanism of ototoxicity

enters outer hair cells --> AG-Fe --> reacts with electron donors to produce ROS --> ROS activates JNK --> JNK translocates to nucleus and activates apop genes --> mito --> CytC --> a pop

CP mechanism of ototoxicity

enters outer hair cells --> aquated to form MHC --> MHC and CP activate NOX-3 producing ROS --> ROS may activate JNK --> nucleus --> mito --> CytC --> a pop

Where is the central emesis center?

- lateral reticular formation of mid brainstem adjacent to CTZ and AP at the bottom of the 4th ventricle and STN * *no BBB**