Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
137 Cards in this Set
- Front
- Back
|
5 categories of drugs used for glaucoma
|
Alpha-agonists
Beta-blockers Diuretics Cholinomimetics Prostaglandin |
|
|
Glaucoma drug to avoid in closed-angle glaucoma
|
Alpha-agonists
|
|
|
Two alpha agonists used in glaucoma
|
Epi
Brimonidine |
|
|
Mechanism of alpha-agonists for glaucoma
|
Decrease AH synthesis
|
|
|
3 beta blockers used in glaucoma
|
Timolol, betaxolol, carteolol
|
|
|
Mechanism of beta blockers for glaucoma
|
Decrease AH secretion
|
|
|
Diuretic used in glaucoma
|
Acetazolamide
|
|
|
Mechanism of acetazolamide in glaucoma
|
Decrease AH secretion due to decreased HCO3- (via inhibition of carbonic anhydrase)
|
|
|
Examples of direct and indirect cholinomimetics used for glaucoma
|
Direct: pilocarpine, carbachol
Indirect: physostigmine, echothiophate |
|
|
Mechanism of cholinomimetics for glaucoma
|
Increase outflow of AH (contract ciliary muscle and open trabecular meshwork into canal of Schlemm)
|
|
|
When is pilocarpine used in glaucoma?
|
Emergenices
|
|
|
Side effects of cholinomimetics for glaucoma
|
Miosis
Cyclospasm |
|
|
Prostaglandin used in glaucoma
|
Latanoprost (PGF-2alpha)
|
|
|
Mechanism of latanoprost for glaucoma
|
Increase outflow of AH
|
|
|
Side effect of latanoprost
|
Darkens color of iris (browning)
|
|
|
7 opioid analgesics
|
Morphine, fentanyl, codeine, heroin, methadone, meperidine, dextromethorphan
|
|
|
3 intrinsic opioid receptors
|
Mu = morphine
Delta = enkephalin Kappa = dynorphin |
|
|
Opioids are agonists at opioid receptors, causing
|
K+ channels to open (efflux)
Ca channels to close Both --> decreased synaptic transmission |
|
|
Opioids decrease release of these 5 neurotransmitters
|
ACh, NE, 5HT, glutamate, substance P
|
|
|
Other than pain and methadone addiction programs, 3 clinical uses for opioids
|
Cough suppression (dextromethorphan)
Diarrhea (loperamide and diphenoxylate) Acute pulmonary edema |
|
|
7 side effects of opioids
|
Addiction
Respiratory depression Constipation Miosis Addictive CNS depression with other drugs Biliary colic from smooth muscle cell contraction in the sphincter of Oddi Histamine-released --> vasodilation |
|
|
Tolerance does not develop to these 2 opioid side effects
|
Miosis
Constipation |
|
|
Tolerance is mediated by ____ (neurotransmitter) activating ____ (its receptor), leading to ______ of the opioid receptors
|
Glutamate ---> NMDA activation --> phosphorylation of opioid receptors
|
|
|
Tolerance can be decreased with _____ antagonists
|
NMDA (e.g. ketamine, dextromethorphan)
|
|
|
Partial agonist at opioid mu receptors, agonist at kappa receptors
|
Butorphanol
|
|
|
Advantage of butorphanol over other opioids
|
Less respiratory depression than full agonists
|
|
|
Toxicity of butorphanol
|
Causes withdrawal if on full agonist
|
|
|
Tramadol is a ____ opioid agonist that also inhibits ____ and ____ reuptake
|
Weak
Serotonin and NE |
|
|
Additional side effect of tramadol
|
Decreased seizure threshold
|
|
|
12 epilepsy drugs
|
Phenytoin
Carbamazepine Lamotrigine Gabapentin Topiramate Phenobarbital Valproic acid Ethosuximide Benzos Tiagabine Vigabatrin Levetiracetam |
|
|
All epilepsy drugs can be used for partial seizures except
|
Ethosuximide
Benzos |
|
|
First line for tonic-clonic seizures (3)
|
Phenytoin
Carbamazepine Valproic acid |
|
|
First line Rx for absence seizures
|
Ethosuximide (valproic acid also possibly)
|
|
|
1st line of acute treatment of status epilepticus
|
Benzos
|
|
|
1st line for prophylaxis of status epilepticus
|
Phenytoin
|
|
|
Unique mechanism of ethosuximide
|
Blocks thalamic T-type Ca2+ channels
|
|
|
Epilepsy drugs that block/ inactivate Na channels (5)
|
Phenytoin
Carbamazepine Lamotrigine Topiramate Valproic acid |
|
|
Epilepsy drugs that increase GABA (7)
|
Topiramate
Phenobarbital Valproic acid Benzos Tiagabine Vigabatrin Levetiracetam |
|
|
Epilepsy drugs that work on both Na channels and GABA
|
Topiramate
Valproic acid |
|
|
Epilepsy drug that was designed as a GABA analog, but primarily inhibits HVA Ca channels
|
Gabapentin
|
|
|
Epilepsy drug to use in pregnant women or children
|
Pehnobarbital
|
|
|
Best drug for myoclonic seizures
|
Valproic acid
|
|
|
2 drugs to use in seizures of eclampsia
|
Benzos
MgSO4 (1st line) |
|
|
1st line drug for trigeminal neuralgia
|
Carbamazepine
|
|
|
Other uses of gabapentin besides epilepsy (3)
|
Peripheral neuropathy
Bipolar disorder Fibromyalgia |
|
|
Prodrome of malaise and fever followed by apid onset of erythematous/ purpuric macules (oral, ocular, genital); skin lesions may progress to epidermal necrosis and sloughing
|
Stevens-Johnson Syndrome (and TEN)
|
|
|
Anti-epileptic drugs (AED) that cause SJS (3)
|
Carbamazepine
Ethosuximide Lamotrigine |
|
|
Side effects of carbamazepine
|
Diplopia
Ataxia Blood dyscrasias (agranulocytosis, aplastic anemia) Liver toxicity Teratogenesis Induction of P-450 SIADH SJS |
|
|
AED that can cause urticaria
|
Ethosuximide
|
|
|
AED that can cause NTDs in fetus
|
Valproic acid
|
|
|
AED that can cause fatal hepatotoxicity (follow with LFTs)
|
Valproic acid
|
|
|
AED that can cause agranulocytosis
|
Carbamazepine
|
|
|
AED that can cause aplastic anemia
|
Carbamazepine
|
|
|
AED that can cause fetal hydantoin syndrome
|
Phenytoin
|
|
|
AED known for weight gain
|
Valproic acid
|
|
|
Side effects of phenytoin (10)
|
Nystagmus
Diplopia Ataxia Sedation Gingival hyperplasia Hirsutism Megaloblastic anemia Teratogenesis (fetal hydantoin syndrome) SLE-like syndrome Induction of P450 |
|
|
AED known for weight loss
|
Topiramate
|
|
|
AED known for mental dulling
|
Topiramate
|
|
|
AED associated w/ kidney stones
|
Topiramate
|
|
|
AED associated with megaloblastic anemia
|
Phenytoin
|
|
|
2 AEDs associated with diplopia and ataxia
|
Carbamazepine and phenytoin
|
|
|
Phenytoin is a class ___ antiarrhythmic
|
1B
|
|
|
AED associated with SLE-like syndrome
|
Phenytoin
|
|
|
Why does phenytoin cause a megaloblastic anemia?
|
Decreased folate absorption
|
|
|
Compare the mechanism of barbiturates to benzodiazepines
|
Both facilitate GABA A action by acting on the Cl- channel
Barbiturates increase the duration of opening Benzos increase the frequency of opening |
|
|
Rx for barbiturate overdose?
|
Symptom management (assist respiration, increase BP)
|
|
|
Effect of benzos on REM sleep
|
Decrease it
|
|
|
Benzos are used in treatment of withdrawal from?
|
Alcohol (DTs)
|
|
|
3 sleep problem indications for benzos
|
Insomnia
Night terrors Sleepwalking |
|
|
Short-acting benzos
|
Triazolam
Oxazepam Midazolam Alprazolam |
|
|
Which benzos should be used for acute anxiety?
|
Short-acting
|
|
|
Highest addictive potential with these benzos
|
Short-acting
|
|
|
Rx for benzo overdose
|
Flumazenil (competitive antagonist at GABA benzo receptor)
|
|
|
Best drugs for insomnia
|
ZaZolEs
Zaleplon Zolpidem Eszopiclone |
|
|
Action of ZaZolEs is reversed by
|
Flumazenil
|
|
|
3 toxicities of zazoles
|
Ataxia, headaches, confusion
|
|
|
Anesthetic principle: increased blood solubility causes ____ onset of action
|
lower
|
|
|
Inhaled anesthetics caused _____ cerebral blood flow
|
Increased (and deceased cerebral metabolic demand)
|
|
|
Toxicity of halothane
|
Hepatotoxicity
|
|
|
Toxicity of methoxyflurane
|
Nephrotoxicity
|
|
|
Inhaled anesthetic that is a proconvulsant
|
Enflurane
|
|
|
5 categories of IV anesthetics
|
Barbiturates
Benzos Arylcyclohexylamines (ketamine) Opiates Propofol |
|
|
Best for induction of anesthesia/ short procedures
|
Barbiturates (also propofol, which has less postop nauseua than thiopental)
|
|
|
Barbiturates ____ cerebral blood flow
|
Decrease
|
|
|
Ketamine ____ cerebral blood flow
|
Increases
|
|
|
2 groups of local anesthetics
|
Esters
Amides (have 2 Is in name) |
|
|
3 esters
|
Procaine
Cocaine Tetracaine |
|
|
3 amides
|
Lidocaine
Mepivacaine Bupivacaine |
|
|
Mechanism of local anesthetics
|
Bind Na channels (receptors on inner portion)
Preferentially bind activated channels, so most effective in rapidly firing neurons |
|
|
Local anesthetics penetrate membrane in _____ form, then bind to ion channels in ____ form
|
Uncharged
Charged |
|
|
In infected (acidic) tissue, is more or less anesthetic needed?
|
More (alkaline anesthetics are charged and cannot penetrate)
|
|
|
Order of pain blockade based on size and myelination
|
Small myelinated
Small unmyelinated Large myelinated Large unmyelinated |
|
|
Order of loss of neurons based on sensation transmitted
|
Pain first > temp > touch > pressure (last)
|
|
|
Local anesthetics should be given with what other drug class
|
Vasoconstrictors (epinephrine)
|
|
|
Why are local anesthetics given with EPI?
|
To enhance local action and decrease bleeding
|
|
|
Which local anesthetic is not given with EPI?
|
Cocaine
|
|
|
If a patient is allergic to esters, should give?
|
Amides
|
|
|
Toxicity of cocaine
|
Arrhythmias
|
|
|
Toxicity of bupivacaine
|
Severe CV toxicity
|
|
|
3 toxicities of local anesthetics
|
CNS excitation
HTN Hypotension |
|
|
Depolarizing NM blockade provided by
|
Succinyl choline
|
|
|
Nondepolarizing NM blockade provide by
|
Tubocurarine and the curiums (e.g. atracurium, rocuronium)
|
|
|
NM blockade drugs are selective for the ____ receptor
|
Motor nicotinic (vs. autonomic nicotinic)
|
|
|
3 complications of succinyl choline
|
Hypercalcemia
Hyperkalemia Malignant HTN |
|
|
2 phases of succinylcholine blockade (prolonged depolarization and repolarized but blocked): antidote for each?
|
No antidote for Phase I (potentiated by cholinesterase inhibitors)
Phase II: cholinesterase inhibitors |
|
|
Reversal of nondepolarizing NM blockade
|
Cholinesterase inhibitors (neostigmine, edrophonium, etc.)
|
|
|
Treatment of malignant HTN
|
Dantrolene
|
|
|
Another use of dantrolene
|
Neuroleptic malignant syndrome (toxicity of antipsychotics)
|
|
|
Mechanism of dantrolene
|
Prevents release of Ca from sarcoplasmic reticulum
|
|
|
4 strategies in PD treatment
|
Agonize dopamine receptors
Increase dopamine Prevent dopamine breakdown Curb excess cholinergic activity |
|
|
3 drugs that agonize dopamine receptors
|
Bromocriptine
Pramipexole Ropinirole |
|
|
Two drugs that increase dopamine
|
Amantadine
L-dopa |
|
|
Mechanism and toxicity of amantadine
|
May increase dopamine release (also an antiviral)
Causes ataxia |
|
|
Why is L-Dopa given instead of dopamine?
|
Dopamine cannot cross BBB
|
|
|
What drug is always given with L-Dopa?
|
Carbidopa
|
|
|
Mechanism of carbidopa
|
Peripheral decarboxylase inhibitor (icnreases bioavailability of L-dopa in brain and limits peripheral side effects)
|
|
|
Two drugs that prevent dopamine breakdown
|
MAOB inhibitor (selegiline)
COMT inhibitors (entacapone, tolcapone) |
|
|
Best antimuscarinic for PD?
|
Benztropine
|
|
|
Benzotropine improves ____ and _____ but has little effect on ____
|
Tremor and rigidity
Bradykinesia |
|
|
Best drugs for essential or familial tremors
|
Beta-blockers
|
|
|
L-dopa is converted to dopamine in the CNS by ______
|
Dopa decarboxylase
|
|
|
3 toxicities of L-dopa
|
Arrhythmias (from peripheral conversion to dopamine)
Dyskinesia (from long-term use) Akinesia (btwn doses) |
|
|
MAO-B selectivity metabolizes ____ over ____ and ____
|
Dopamine
NE and 5HT |
|
|
2 classes of drugs in Alzheimer's treatment
|
NMDA receptor antagonists
Acetylcholinesterase inhibitors |
|
|
NMDA receptor antagonist
|
Memantine
|
|
|
Memantine helps prevent _____, mediated by _____
|
Excitotoxicity
Ca |
|
|
3 toxicities of memantine
|
Dizzines
Confusion Hallucinations |
|
|
3 acetylcholinesterase inhibitors used in Alzheimer's
|
Donepezil
Galantamine Rivastigmine |
|
|
3 toxicities of cholinesterase inhibitors
|
Nausea
Dizziness Insomnia |
|
|
In Huntington's disease, ____ is increased while ___ and ___ are decreased
|
Dopamine
GABA and ACh |
|
|
Dopamine antagonist used in Huntington's
|
Haloperidol
|
|
|
Two amine depleting drugs used in Huntington's
|
Reserpine
Tetrabenazine |
|
|
Sumatriptan is a ______ agonist
|
5HT-1B/1D agonist
|
|
|
Sumatriptan has these 2 clinical uses
|
Acute migraine
Cluster headaches |
|
|
3 effects of sumatriptan
|
Vasoconstriction
Inhibition of trigeminal activation Vasoactive peptide release |
|
|
2 toxicities of sumatriptan
|
Coronary vasospasm
Mild tingling |
|
|
Sumatriptan is contraindicated in pts with ___ or _____
|
CAD
Prinzmetal's angina |
