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53 Cards in this Set
- Front
- Back
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Treatment for Glaucoma
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Treatments:
1. α agonists - ↓ aqueous humor SYNTHESIS 2. β blockers - ↓ aqueous humor SECRETION 3. Carbonic Anhydrase Inhibitor (Acetazolamide) - ↓ aqueous humor SECRETION (2° to ↓ HCO3) 4. Cholinomimetics - ↑ reuptake (outflow) of aqueous humor by contracting ciliary muscle and opening trabecular network to OPEN CANAL of SCHLEMM 5. Prostaglandin - ↑ outflow of aqueous humor |
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α agonists used to treat Glaucoma
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Mech: ↓ SYNTHESIS of aqueous humor due to VASOCONSTICTION
Drugs: Epinephrine and Brimonidine Side Effects of Epinephrine: Mydriasis and Stinging C/I to Epinephrine: CLOSED-ANGLE GLAUCOMA |
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β blockers used to treat Glaucoma
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Mech: ↓ SECRETION of Aqueous humor
Drugs: Timolol, Betaxolol, Carteolol |
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Acetazolamide in treatment of Glaucoma
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Drug Class: Carbonic Anhydrase Inhibitor
Mech: ↓ HCO3 --> ↓ SECRETION of Aqueous Humor |
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Cholinomimetics used to Treat Glaucoma
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Mech: CONTRACTS ciliary muscle and OPENS TRABECULAR NETWORK --> OPENING OF CANAL OF SCHLEMM. VERY effective
Drugs: PILOCARPINE PHYSOSTIGMINE Carbachol Echothiophate Use PILOCARPINE in EMERGENCIES Side Effects: Miosis, Cyclospasm (ciliary muscle used in accomodation to see objects at different distances) |
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Prostaglandin used to treat Glaucmoa
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Mech: ↑ outflow of aqueous humor
Drug: Latanoprost |
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Drug used in emergencies for Glaucoma
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PILOCARPINE
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Opioid Analgesics
Morphine Fentanyl Codeine Heroin Methadone Meperidine Dextromethorphan |
Mech: Act as agonists at opioid receptors
μ (morphine) receptors δ (enkephalin) receptors κ (dynorphin) receptors Open K+ channels and close Ca2+ channels to HYPERPOLARIZE neurons and ↓ excitability Use: Pain, Acute Pulmonary Edema, Cough Suppression (Dextramethorphan), Diarrhea (loperamide and diphenoxylate), and Addiction (Methadone) Toxicities: Addiction Respiratory Depression CNS Depression (additive with other drugs) Miosis (pinpoint pupils) Constipation Reversal with Naloxone/Naltrexone (Narcan) |
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Opioid used to treat cough
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DEXTROMETHORPHAN
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Opioid used to treat heroin addiction
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METHADONE
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Butorphanol
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Mech: Partial agonist at μ receptors, full agonist at κ receptors.
Use: Pain. LESS RESPIRATORY DEPRESSION Toxicity: W/D if on full opioid agonist |
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Tramadol
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Mech: very weak opioid agonist. inhibits SEROTONIN and NE reuptake. Multiple NTs = "Tram-it-all in"
Use: Chronic Pain Toxicity: Similar to opioids |
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1st Line Therapy for Generalized Tonic-Clonic Seizures
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Phenytoin
Carbamazepine Valproic Acid (Valproate) |
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1st Line Therapy for Status Epilepticus PROPHYLAXIS
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Phenytoin
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1st Line Therapy for Abscence Seizures
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Ethosuximide
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1st Line Therapy for Partial or Generalized Seizures in PREGNANT WOMEN and CHILDREN
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Phenobarbital
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1st Line for ACUTE STATUS EPILEPTICUS
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Benzodiazepines (Diazepam or Lorazepam)
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1st Line for Seizures of Eclampsia
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MgSO4
Often used in conjunction with Diazepam or Lorazepam |
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Used for Myoclonic Seizures
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Valproate
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Used for Partial, Generalized Tonic-Clonic, and PERIPHERAL NEUROPATHY
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Gabapentin
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Used for Seizures and TRIGEMINAL NEURALGIA
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Carbamazepine
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Phenytoin
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Mech: Inactivation of Na+ channels
Use: 1st line for Generalized Tonic-Clonic Seizures 1st Line for Status Epilepticus PROPHYLAXIS Partial Seizures TYPE 1B ANTIARRHYTHMIC Toxicities: Nystagmus & Diplopia Ataxia Hirsutism Megaloblastic Anemia SLE-like Syndrome Notes: **INDUCER of Cyt P-450 --> ↓ concentration of drugs metabolized by Cyt P-450** **TERATOGENIC - Minor Face and Limb Defects; MR, Variety of other defects** |
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Carbamazepine
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Mech: Inactivation of Na+ channels
Use: 1st Line for Generalized Tonic-Clonic Seizures 1st Line for TRIGEMINAL NEURALGIA Partial Seizures Toxicity: Diplopia Ataxia AGRANULOCYTOSIS APLASTIC ANEMIA Liver Toxicity Notes: **INDUCER of Cyt P-450 --> ↓ conc. of drugs metabolized by Cyt P-450** **TERATOGENIC** |
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TERATOGENIC Seizure Treatments
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PHENYTOIN
CARBAMAZEPINE |
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Valproic Acid
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Mech: Inactivates Na+ channels AND ↑ GABA Concentration
Use: 1st Line for Generalized Tonic-Clonic Seizures 1st Line for Myoclonic Seizures ABSENCE Seizures (not 1st line) Partial Seizures Toxicity: NEURAL TUBE DEFECTS in Fetus Rare but FATAL HEPTOTOXICITY GI Distress Weight Gain C/I: PREGNANCY |
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Topiramate
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Mech: Inactivation of Na+ channels AND ↑ action of GABA
Use: Generalized Tonic-Clonic Seizures Partial Seizures Toxicity: Kidney Stones (may shift away from this drug) Sedation Mental Dulling Weight Loss |
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Lamotrigine
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Mech: Inactivation of voltage-gated Na+ channels
Use: Generalized Tonic-Clonic Seizures Partial Seizures Toxicity: Stevens-Johnson Syndrome (malaise, fever, purpuric rash that progresses to epidermal necrosis) |
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Gabapentin
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Mech: ↑ release of GABA
Use: Generalized Tonic-Clonic Seizures PERIPHERAL NEUROPATHY Partial Seizures Toxicity: Sedation and Ataxia |
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Ethosuximide
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Mech: Inactivates T-type Ca2+ channels
Use: Absence Seizures Toxicity: *Stevens Johnson Syndrome *GI Distress *Headache Fatigue Urticaria |
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Diazepam or Lorazepam
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Mech: ↑ FREQUENCY of Cl- channels open due to GABA. Overall ↑ GABA action
Use: 1st Line for ACUTE STATUS EPILEPTICUS Use with MgSO4 for Seizures of Eclampsia |
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Phenobarbital
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Mech: ↑ DURATION of Cl- Channel opening due to GABA. Overall, ↑ GABA Action
Use: 1st Line Treatment for Seizures in PREGNANT WOMEN and CHILDREN (both Generalized Tonic Clonic and Partial) Toxicity: INDUCTION of Cyt P-450 Sedation Dependence Tolerance |
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Barbiturates
Phenobarbital Pentobarbital Thiopental Secobarbital |
Mech: ↑ DURATION that Cl- channels are open. ↑ action of GABA. ↓ Nerve firing
Use: Sedative / Tx for Insomnia Seizures Induction of Anesthesia (Thiopental) Toxicity: Additive CNS depressant effects with other drugs (Alcohol) CV or Respiratory Depression INDUCTION of Cyt P-450 Dependence Treatment of OD: Symptom Management (Assist Respiration, ↑ BP) |
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Benzodiazepines
Diazepam Lorazepam Midazolam Triazolam Alprazolam Temazepam Oxazepam CHLORDIAZEPOXIDE |
Mech: ↑ FREQUENCY of Cl- Channel Opening. ↑ Action of GABA and ↓ Neuron Firing.
Use: 1st Line for ACUTE STATUS EPILEPTICUS (diazepam/lorazepam) Use with MgSO4 for Seizures of Eclampsia Anxiety ↓ REM Sleep - Night Terrors, Sleepwalking Detox from ETOH (DTs) Toxicity: Additive CNS Depressant effects with ETOH Dependence OD: FLUMAZENIL (competitive antagonist) Note: LESS risk of RESPIRATORY DEPRESSION than Barbiturates |
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Inhaled Anesthetics
Halothane Isoflurane Desflurane Enflurane Sevoflurane NITROUS OXIDE |
Mech: Unknown
Effects: Myocardial and Respiratory Depression ↑ cerebral blood flow (∴ ↓ cerebral demand) Nausea/Emesis Toxicities Malignant Hyperthermia - Rare, but serious. Tx: Dantrolene Halothane - Hepatotoxicity Enflurane - Proconvulsant Methoxyflurane - Nephrotoxicity Nitrous Oxide - Expansion of Trapped Gas |
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IV Anesthetics (5)
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Barbiturates (Thiopental)
Benzodiazepines (Midazolam) Ketamine Opiates Propofol |
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Thiopental
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Barbiturate IV Anesthetic
Characteristics: ↑ Potency, (↑ Lipid Solubility); Rapid Onset and Recovery (↓ Blood Solubility) Use: Induction of Anesthesia & Short Procedures Toxicity: ↓ Cerebral Blood Flow |
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Midazolam
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Benzodiazepine IV Anesthetic
Characteristics: Used with Gaseous anesthetics and Narcotics Use: Most common drug for endoscopy Toxicity: SEVERE Post Op Respiratory Depression ↓ BP Amnesia (Beneficial) |
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Ketamine
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PCP Analog used as a Dissociative IV Anesthetic
Mech: Blocks NMDA receptors (glutamate). Use: IV anesthesia (kids) Toxicity: Cardiovascular stimulant Disorientation, Hallucinations, Bad Dreams NO RESPIRATORY DEPRESSION |
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Opiates used as IV Anesthetics
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Fentanyl and Morphine
Used in conjunctions with other IV anesthetics |
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Propofol
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IV Anesthetic
Mech: Potentiates GABA Use: Rapid anesthesia induction and short procedures Note: LESS Post Op NAUSEA than with THIOPENTAL |
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Succinylcholine
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Mech: DEPOLARIZING PARALYTIC (Neuromuscular Blocking Drug). Selective for Motor Nicotinic Receptors.
Use: Muscle Paralysis in surgery or Mechanical Ventilation Toxicity: ↑ K, ↑ Ca 2 Phases: Phase I: Prolonged depolarization. No Reversal. WORSE with AChEsterase INHIBITORS Phase II: repolarized but blocked. REVERSAL with Cholinesterase inhibitors (neostigmine, physostigmine). |
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Vecuronium // Pancuronium // Rocuronium // Atracurium // TUBOCURARINE
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Mech: NON-DEPOLARIZING PARALYTICS. Competitive Inhibitors at Acetylcholine (ACh) Receptors
Reversal: AChE Inhibitors (neostigmine, physostigmine, Edrophonium) |
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Dantrolene
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Mech: Prevents Ca2+ release from sarcoplasmic reticulum of sk. muscle.
Use: Malignant Hyperthermia (caused by inhaled anesthetics + Succinylcholine) AND Neuroleptic Malignant Syndrome (similar to Malig. Hyperthermia) |
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Parkinson's Disease Pharm Strategy
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1. Agonize Dopamine Receptors (Bromocriptine)
2. ↑ Dopamine (L-Dopa & Carbidopa // Amantadine) 3. Prevent Dopamine Breakdown (Selegiline // Entacapone or Tolcapone) 4. ↓ Cholinergic Activity (Benztropine / Other Antimuscarinic) BALSA B = Bromocriptine A = Amantadine L = L-dopa / Carbidopa S = Selegiline A = Antimuscarinics (Benztropine) |
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Bromocriptine // Pramipexole // Ropirinole
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Mech: Dopamine Receptor Agonist
Use: Parkinson's to simulate effect of dopamine Side Effects: Compulsive Gambling, Disinhibition |
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Levodopa / Carbidopa
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Mech: Levodopa is L-Dopa (unlike dopamine, it can cross BBB). Dopa Decarboxylase converts to Dopamine in CNS. Carbidopa is a COMT inhibitor that prevents decarboxylation of L-Dopa in the periphery.
Use: ↑ amount of Dopamine in CNS Side Effects: Long Term Use: dyskinesia with administration akinesia in between administrations |
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Treatment of Familial / Essential Tremor
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β-BLOCKERS!
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Amantadine
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Mech: may ↑ Dopamine RELEASE
Use: Parkinson's Antiviral - Influenza A and Rubella Toxicity: Ataxia |
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Selegiline
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Mech: Selectively Inhibits MAO-B (↑ Dopamine availability)
Use: Parkinson's Disease Toxicity: May enhance Adverse Effects of L-Dopa |
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Benztropine
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Mech: Antimuscarinic
Use: Parkinson's for Tremor and Rigidity, but NOT USEFUL FOR BRADYKINESIA **Essentially Peripheral Symptom Management** |
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Sumatriptan
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Mech: Serotonin (5-HT 1B & 1D) Agonist causing vasoconstriction, inhibiting trigeminal activation and vasoactive peptide release.
Use: Acute Migraine and Cluster Headaches Toxicity: Coronary VASOSPASM C/I: CAD or Prinzmetal's Angina |
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Memantine
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Mech: NMDA Receptor Antagonist. Prevents Excitotoxicity (Ca2+ mediated)
Use: Alzheimer's Toxicity: Dizziness, Confusion, Halucinations |
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Donepezil
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Mech: Centrally Acting AChE Inhibitor
Use: Alzheimer's Toxicity: Nausea, Dizziness, Insomnia |
