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Flashcards in Glaucoma and opioid pharm FA Deck (63):
1

how do glaucoma drugs work?

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

2

2 alpha-agonist glaucoma drugs

1. epinephrine
2. brimonidine (alpha-2)

3

epinephrine (alpha agonist) for glaucoma uses what mech?

decrease aqueous humor synthesis via vasoconstriction

4

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

decreased aqueous humor synthesis

5

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

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

6

when should you not used epinephrine for glaucoma?

Do not use in closed angle glaucoma!

7

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

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

8

What 3 beta blockers are for glaucoma?

1. timolol
2. betaxolol
3. carteolol

9

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

decrease aqueous humor synthesis

10

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

no pupillary or vision changes

11

what diuretic is used to treat glaucoma?

acetazolamide

12

mech of acetazlamide?

decrease aqueous humor synthesis via inhibition of carbonic anhydrase

13

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

diuretic used to treat glaucoma

14

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

beta blocker, glaucoma

15

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

beta blocker, glaucoma

16

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

beta blocker, glaucoma

17

cholinomimetics used to treat direct glaucoma? (2)

1. pilocarpine
2. carbachol

18

pilocarpine is what kind of drug? it treats what?

cholinomimetic - treats direct glaucoma

19

carbachol

cholinomimetic - treats direct glaucoma

20

mech of pilocarpine in direct glaucoma

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

21

mech of carbachol in direct glaucoma

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

22

2 cholinomimetics used for indirect glaucoma

1. physostigmine
2. echothiophate

23

physostigmine is what kind of drug? it treats what?

cholinomimetics, indirect glaucoma

24

echothioophate is what kind of drug? it treats what?

cholinomimetics, indirect glaucoma

25

what is the mech of physostigmine in indirect glaucoma

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

26

what is the mech of echothioophate in indirect glaucoma

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

27

which drug for glaucoma should you use in emergencies?

pilocarpine: very effective at opening meshwork into canal of Schlemm

28

how does pilocarpine work in emergencies?

very effective at opening meshwork into canal of Schlemm

29

what prostaglandin drug is used for glaucoma?

Latanoprost (PGF-2alpha)

30

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

prostaglandin, to txt glaucoma

31

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

increase outflow of acqueous humor

32

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

darkens the color of the eye

33

8 opioid analgesics

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

34

morphine is what type of drug?

opioid analgesic

35

fentanyl is what type of drug?

opioid analgesic

36

codeine is what type of drug?

opioid analgesic

37

heroin is what type of drug?

opioid analgesic

38

methadone is what type of drug?

opioid analgesic

39

meperidine is what type of drug?

opioid analgesic

40

dextromethorphan is what type of drug?

opioid analgesic

41

diphenoxylate is what type of drug?

opioid analgesic

42

opioid analgesic mech:

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

43

what are the 5 neurotransmitters are inhibited by opioids?

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

44

3 opioid receptors

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

45

what are opioid analgesics used for (5 things)?

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

46

which opioid is particularly helpful for cough suppression?

dextromethorphan

47

which 2 opioids are particularly helpful for diarrhea?

loperamide and diphenoxylate

48

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

methadone

49

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

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

50

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

nope

51

opioid toxicity is treated with (2)

naloxone and naltrexone (opioid receptor antagonists)

52

naloxone is an

opioid receptor antagonist

53

naltrexone is an

opioid receptor antagonist

54

Mech of Butorphanol?

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

55

what does butorphanol do?

produces analgesia

56

what is butophanol used for clinically?

severe pain (migraine, labor, etc)

57

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

causes less respiratory depression than full opioid agonists

58

toxicity of butorphanol?

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

59

can naloxone be used for an overdose with Butorphanol?

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

60

tramadol mech?

very weak opioid agonist. Also inhibits serotonin and NE reuptake (works on multiple neurotransmitter).

"tram it all" with tramadol

61

tramadol is used for...

chronic pain

62

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

tramadol

63

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

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)