Reverse pharm-CNS Flashcards
alpha 1 agonist
Decr. aqueous humor secretion by vasoconstriction
Mydriasis; don’t use in closed angle glaucoma
Blurry vision, ocular hyperemia, foreign body sensation, ocular allergic reactions, cular pruritus
epinephrine
alpha 2 agonist
Decr. aq. humor synth
lurry vision, ocular hyperemia, foreign body sensation, ocular allergic reactions, cular pruritus
brimonidine
Beta blockers
decr. aque humor synth
No pupillary or vision changes
timolol, betaxolol, carteolol
Diuretic
Decr. aq humor synth via inhibition of carb. anhydrase
No pupillary or vision changes
acetazolamide
Direct cholinomimetics (2)
Incr. outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular mesh
Miosis and cyclospasm
Use 1 in emergencies-very effective at opening meshwork into canal of schlemm
Pilocarpine (1) and carbachol
InDirect cholinomimetics (2)
Incr. outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular mesh
Miosis and cyclospasm
Physostigmine and echothiophate
Prostaglandin (PGF2alpha)
Incr. outflow of aq humr
Darkens color of iris (browning)
latanoprost
Opioid analgesics (11)
Agonists at opioid receptors (mu=morphine, delta=enkephalin, kappa=dynorphin) to modulate synaptic transmission (open k+ channels, close Ca channels) leading to decr. synaptic transmission. Inhibit release of ACh, NE, 5-HT, glutamate, and substance P
1=cough suppresion (1)
2=diarrhea (2)
3=maintenance programs for heroin addicts (3)
pain, acute PE
Addiction, resp. depression, constipation, miosis, additive CNS depression w/ other drugs.
Tolerance does not develop to constipation and miosis
Naloxone or naltrexone (opiod receptor antag)
What kind of drugs are dextromethorpan (1), loperamide/diphenoxylate (2), methadone/buprenorphine + naloxone (3), morphine, fentanyl, codein, meperidine, pentazocine? What is their mechanism? What is their clinical use overall? Of 1? 2? 3? What is their toxicity? How is toxicity treated? Mech? Which sx does tolerance develop to?
Kappa opioid receptor agonist and mu opioid receptor partial agonist; produces analgesia
Severe pain (migraine/labor).
Causes less resp. depression than full agonist
Can cause opioid withdrawal symptoms if pt. is also taking full agonist
Overdose not easily reversed w/ naloxone
butorphanol
Very weak opioid agonist; also inhibits 5-HT and NE reuptake
Chronic pain
Similar to opioids. Decreases seizure threshhold. Serotonin syndrome.
tramadol
Blocks thalamic T type Ca channels
Absence (first line)
Fatigue GI Distress Headache Itching (urticaria) Stevens-Johnson syndrome
Ethosuximide
Status epilepticus (acute 1st line) Eclampsia
Incr. GABA-A action
Sedation, tolerance, dependence, resp. depression
Benzos
Simple, complex, tonic clonic (first line), status epilepticus (prophylaxis first line)
Incr. Na channel inactivation; zero order kinetics
Nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, periph neuro, megaloblastic anemia, teratogenesis, SLE like syndrome, induction of cytochrome p450, SIADH, SJS
Phenytoin
Simple, complex, tonic clonic (all first line)
1st line for trigeminal neuralgia
Incr. Na channel inactivation
Diplopia, ataxia, blood dyscrasias, liver toxicity, teratogenesis, induction of p450, SIADH, SJS
Carbamazepine
Simple, complex, tonic clonic (first line), absence, myoclonic seizures, BPD
Incr. na channel inactivation
Incr. GABA conc. by inhibiting GABA transaminase
GI, distress, rare but fatal hepatotoxicity, neural tube defects, tremor, weight gain, CI in pregnancy
valproic acid
Simple, complex
periph neuro
postherpetic neuralgia
Primarily inhibits high voltage gated Ca channels: GABA analog
Sedation, ataxia
Gabapentin
Simple, complex, tonic clonic
1st line in neonates
Incr. GABA-A action
Sedation, tolerance, dependence, induction of P450, cardioresp depress
Phenobarbital
simple, complex, tonic clonic
Migraine prevention
Blocks Na channels
Incr. GABA action
Sedation, mental dulling, kidney stones, weight loss
topiramate
Simple, complex, tonic clonic, absence
Blocks voltage gated Na channels
SJS
Lamotrigine
simple, complex, tonic clonic
unknown; may modulate GABA and glutamate release
Levetiracetam
simple, complex
Iincr. GABA by inhibit uptake
Tiagabine