Glaucoma and opioid pharm FA

Question 1

how do glaucoma drugs work?

Answer 1

decrease intraoccular pressure via decrease amt of aqueous humor (inhib synth/secretion or increase drainage)

Question 2

2 alpha-agonist glaucoma drugs

Answer 2

1. epinephrine

2. brimonidine (alpha-2)

Question 3

epinephrine (alpha agonist) for glaucoma uses what mech?

Answer 3

decrease aqueous humor synthesis via vasoconstriction

Question 4

Brimonidine (alpha-2) for glaucoma uses what mech?

Answer 4

decreased aqueous humor synthesis

Question 5

Epinephrine, used for glaucoma, has what side effects (1) and what contraindication?

Answer 5

mydriasis (a dilation of the pupil); do not used in closed angle glaucoma!

Question 6

when should you not used epinephrine for glaucoma?

Answer 6

Do not use in closed angle glaucoma!

Question 7

side effects of Brimonidine (alpha-2), used for glaucoma (5)?

Answer 7

1. Blurry vision
2. ocular hyperemia
3. foreign body sensation
4. ocular allergic reactions
5. ocular pruritus

Question 8

What 3 beta blockers are for glaucoma?

Answer 8

1. timolol
2. betaxolol
3. carteolol

Question 9

what is the mechanism of the 3 beta blockers used to treat glaucoma (timolol, betaxolol, or carteolol)?

Answer 9

decrease aqueous humor synthesis

Question 10

what are the side effects of the 3 beta blockers used to treat glaucoma (timolol, betaxolol, or carteolol)?

Answer 10

no pupillary or vision changes

Question 11

what diuretic is used to treat glaucoma?

Answer 11

acetazolamide

Question 12

mech of acetazlamide?

Answer 12

decrease aqueous humor synthesis via inhibition of carbonic anhydrase

Question 13

acetazolamide is what type of drug? what does it treat?

Answer 13

diuretic used to treat glaucoma

Question 14

timolol is what type of drug? what does it treat?

Answer 14

beta blocker, glaucoma

Question 15

betaxolol is what type of drug? what does it treat?

Answer 15

beta blocker, glaucoma

Question 16

carteolol is what type of drug? what does it treat?

Answer 16

beta blocker, glaucoma

Question 17

cholinomimetics used to treat direct glaucoma? (2)

Answer 17

1. pilocarpine

2. carbachol

Question 18

pilocarpine is what kind of drug? it treats what?

Answer 18

cholinomimetic - treats direct glaucoma

Question 19

carbachol

Answer 19

cholinomimetic - treats direct glaucoma

Question 20

mech of pilocarpine in direct glaucoma

Answer 20

increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork

Question 21

mech of carbachol in direct glaucoma

Answer 21

increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork

Question 22

2 cholinomimetics used for indirect glaucoma

Answer 22

1. physostigmine

2. echothiophate

Question 23

physostigmine is what kind of drug? it treats what?

Answer 23

cholinomimetics, indirect glaucoma

Question 24

echothioophate is what kind of drug? it treats what?

Answer 24

cholinomimetics, indirect glaucoma

Question 25

what is the mech of physostigmine in indirect glaucoma

Answer 25

increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork

Question 26

what is the mech of echothioophate in indirect glaucoma

Answer 26

increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork

Question 27

which drug for glaucoma should you use in emergencies?

Answer 27

pilocarpine: very effective at opening meshwork into canal of Schlemm

Question 28

how does pilocarpine work in emergencies?

Answer 28

very effective at opening meshwork into canal of Schlemm

Question 29

what prostaglandin drug is used for glaucoma?

Answer 29

Latanoprost (PGF-2alpha)

Question 30

Latanoprost (PGF-2alpha) is what type of drug for what?

Answer 30

prostaglandin, to txt glaucoma

Question 31

what is the mech of latanoprost (PGF-2alpha) used for glaucoma?

Answer 31

increase outflow of acqueous humor

Question 32

side effects of latanoprost, a prostaglandin used to txt glaucoma?

Answer 32

darkens the color of the eye

Question 33

8 opioid analgesics

Answer 33

1. morphine 2. fentanyl 3. codeine 4. heroin 5. methadone 6. meperidine 7. dextromethorphan 8. diphenoxylate

Question 34

morphine is what type of drug?

Answer 34

opioid analgesic

Question 35

fentanyl is what type of drug?

Answer 35

opioid analgesic

Question 36

codeine is what type of drug?

Answer 36

opioid analgesic

Question 37

heroin is what type of drug?

Answer 37

opioid analgesic

Question 38

methadone is what type of drug?

Answer 38

opioid analgesic

Question 39

meperidine is what type of drug?

Answer 39

opioid analgesic

Question 40

dextromethorphan is what type of drug?

Answer 40

opioid analgesic

Question 41

diphenoxylate is what type of drug?

Answer 41

opioid analgesic

Question 42

opioid analgesic mech:

Answer 42

agonist at opioid receptors to modulate synaptic transmission-- open K+ channels, close Ca2+ channels ----> decrease synaptic transmission ---> inhib release of ACh, NE, 5-HT, glutamate, substance P

Question 43

what are the 5 neurotransmitters are inhibited by opioids?

Answer 43

1. ACh 2. NE 3. 5-HT 4. glutamate 5. substance P

Question 44

3 opioid receptors

Answer 44

1. mu= morphine 2. delta = enkephalin 3. kappa = dynorphin

Question 45

what are opioid analgesics used for (5 things)?

Answer 45

1. pain 2. cough suppression (dextromethorphan) 3. diarrhea (loperamide and diphenoxylate) 4. acute pulmonary edema 5. maintenance programs for addicts (methadone)

Question 46

which opioid is particularly helpful for cough suppression?

Answer 46

dextromethorphan

Question 47

which 2 opioids are particularly helpful for diarrhea?

Answer 47

loperamide and diphenoxylate

Question 48

which opioid analgesic is particularly helpful for maintenance programs for addicts?

Answer 48

methadone

Question 49

what are the effects of opioid analgesic toxicity? (5)

Answer 49

1. addiction 2. respiratory depression 3. constipation 4. miosis (pinpoint pupils) 5. additive CNS depression with other drugs

Question 50

does tolerance develop to miosis and constipation related to opioid analgesics?

Answer 50

nope

Question 51

opioid toxicity is treated with (2)

Answer 51

naloxone and naltrexone (opioid receptor antagonists)

Question 52

naloxone is an

Answer 52

opioid receptor antagonist

Question 53

naltrexone is an

Answer 53

opioid receptor antagonist

Question 54

Mech of Butorphanol?

Answer 54

Mu-opioid receptor partial agonist and kappa-opioid receptor agonist ----> produces analgesia

Question 55

what does butorphanol do?

Answer 55

produces analgesia

Question 56

what is butophanol used for clinically?

Answer 56

severe pain (migraine, labor, etc)

Question 57

what is the good thing about using butophanol for severe pain?

Answer 57

causes less respiratory depression than full opioid agonists

Question 58

toxicity of butorphanol?

Answer 58

can cause opioid withdrawal symptoms if pt is also taking full opioid agonist (competition for opioid receptors).

Question 59

can naloxone be used for an overdose with Butorphanol?

Answer 59

overdose not easily reversed with naloxone | - butorphanol is a mu-opioid receptor partial agonist and kappa-opioid receptor agonist

Question 60

tramadol mech?

Answer 60

very weak opioid agonist. Also inhibits serotonin and NE reuptake (works on multiple neurotransmitter). "tram it all" with tramadol

Question 61

tramadol is used for...

Answer 61

chronic pain

Question 62

which opioid specifically decreases the seizure threshold (so seizures are more common)?

Answer 62

tramadol

Question 63

what are the side effects/toxicities of tramadol (6)?

Answer 63

1. decrease seizure threshold (increase seizure risk) 2. similar to opioids (a. addiction b. respiratory depression c. constipation d. miosis (pinpoint pupils) e. additive CNS depression with other drugs)