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30 Cards in this Set
- Front
- Back
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Which drug should be used in emergent glaucomic tx? Why? SE?
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pilocarpine (cholinomimetic); very effective at opening meshwork into canal of Schlemm.
- Miosis, cyclospasm |
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Which types of drug \\aq humor production in Glaucoma?
- Which has pupillary/viz changes associated with it? - which should NOT be given in acute/closed angle? Which ^^outflow? SE of these classes? |
a-agonists:
- Epi (Mydriasis, stinging, do NOT use in closed angle) - Brimonidine B-blockers: - timolol, betaxolol, carteolol Diuretics: - Acetazolamide -------------------------------------------- Cholinomimetics (either primary or secondary): miosis, cyclospasm Prostaglandins - Latanoprost : darkens color or iris ("browning") |
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mu-opioid receptors are for...
- delta? - kappa? How do the opioid analgesics work? - mechanistically speaking? |
- morphine
- enkephalin - dynorphin Work at one or more of these receptor types. - open K channels, close Ca channels --> halts synaptic transmission --> inhibits release of ACh, NE, 5HT, glutamate, substance P. |
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Use of dextromethorphan?
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cough suppression (mu-agonist).
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What are the main toxicities of opioid analgesics?
What are the two that tolerance does NOT develop to? |
respiratory depression, constipation, miosis, additive CNS depression.
Can cause painful gallbladder contractions (biliary colic). Miosis and constipation. |
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Butorphanol
- mechanism? - uses? why? - can cause what if they were on morphine or somesuch before switching to this? |
partial agonist at mu receptors, agonist at Kappa receptors.
- pain; causes less respiratory depression than full agonists - withdrawal. |
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Tramadol
- mechanism? (saying to help remember?) - unique toxicity? - other tox? |
very weak opioid agonist, also inhibits 5HT and NE reuptake.
- "Tram it all in" - chronic pain - DECREASES seizure threshold - shares other opioid toxicities. |
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Mech, tox, and seizure uses of benzo's.
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Increase FREQUENCY of GABA Cl- channel opening
sedation, tolerance, and dependence. |
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Mech, tox, and seizure uses of carbamazepine.
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Na+ channel inactivation
diplopia, ataxia, blood dyscrasia (agranulocytosis, aplastic anemia), liver tox, teratogenesis, and induction of P450. SIADH. Steven'johnsons syndrome. Both type of partial seizures, 1st line for tonic-clonic and trigeminal neuralgia. |
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Mech, tox, and seizure uses of Phenobarbital.
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Increase DURATION of GABA chloride channel opening.
sedation, tolerance, dependence. P450 induction. Can be used for both type of partials; and is 1st line for tonic-clonic in pregnancy and children. |
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Mech, tox, and seizure uses of Ethosuximide.
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Blocks thalamic T-type Ca channels.
GI distress, fatigue, HA, urticaria, Stevens-Johnson syndrome. 1st line for absence seizures. |
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Mech, tox, and seizure uses of Phenytoin.
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Increases Na channel inactivation (also an antiarrhythmic: 1B)
nystagmus, diplopia, ataxia, sedation, GINGIVAL HYPERPLASIA, hirsuitism, megaloblastic anemia, teratogenesis (fetal hydantoin syndrome), SLE-like syndomre. P450 inducer. Both partials, 1 of 3 first lines for tonic-clonic. 1st line for status epilepticus PROPHYLAXIS. |
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What is Fosphenytoin?
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used for parenteral admin.
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Mech, tox, and seizure uses of Valproic acid?
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Increase Na channel activation, ^^ GABA concentration.
GI distress, rare but FATAL hepatotox (monitor LFTs), NT defects in fetus, tremor, WG. Both partials. 1 of 3 first line for tonic-clonic. 1st line for myoclonic seizures. 2nd line for absence seizures. |
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Mech, tox, and seizure uses of Lamotrigine.
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Blocks VOLTAGE gated Na channels.
Steven's-Johnson syndrome Can be used for Partials and for Tonic/clonic. Not 1st line for anything. |
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Mech, tox, and seizure uses of Gabapentin.
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inhibits HVA Calcium channels (was designed as GABA analog, but not the main mech of action)
sedation, ataxia Peripheral neuropathy, bipolar disorder; partial and tonic-clonic. |
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Mech, tox, and seizure uses of topiramate.
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Blocks Na channels and increases GABA action.
Kidney stones, Sedation, mental dulling, weight LOSS. Partials and Tonic-clonic. |
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Tiagabine use and mech.
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partials; inhibits GABA reuptake
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Vigabatrin use and mech.
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Partials
IRREVERSIBLY inhibis GABA transaminate --> ^^GABA concentration |
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Levetiracetam use and mech.
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Partials and tonic-clonic
unknown. |
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What are the 3 first line drugs for tonic-clonic seizures?
Drug for absence seizures? Myoclonic seizures? Trigeminal neuralgia? peripheral neropathy? acute Status-epilepticus? - chronic prophylaxis? |
phenytoin, carbamazepine, valproic acid.
ethosuximide valproic acid Carbamazepine Gabapentin Benzodiazepines - Phenytoin. |
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Drug used for induction of anesthesia?
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thiopental (barbiturate)
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Which antiepileptic increases the inactivation of Na channels with a use-dependent blockade, and *also* decreases glutamate release from presynaptic neurons?
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Phenytoin.
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Which benzo's have the highest addictive potential? why?
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TOM thumb is short
- Triazolam, Oxazepam, Midazolam. - they're the shortest acting. |
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what do benzo's do to REM sleep?
Do most benzo's have active metabolites? How do you tx a benzo OD? |
decrease it.
yes. Flumazenil (competive antagonist at GABA benzo receptor) |
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Flumazenil use and mechanism?
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Flumazenil (competive antagonist at GABA benzo receptor)
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What determines MAC?
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degree of lipid solubility. High = low MAC = HIGH potency.
MAC is INVERSELY relatd to potency. |
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Halothane has a ___lipid solubility and a ____ blood solubility.
NO? |
high = high potency
high = slow onset/induction. low = low potency; low = FAST induction. |
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Inhaled anesthetics do what do cerebral BF?
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increase it
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which inhaled anesthetic is known for it's hepatotox?
Nephrotox? proconvulsanst SE? Expansion of trapped gas? Which can cause malignant hyperthermia? |
Halothane
Methoxyflurane Enflurane NO. All can, but it's rare. |
