Neuro: Pharm - Glaucoma and Opioids

Question 1

Glaucoma drugs MOA:

Answer 1

decrease IOP via decreasing amount of aqueous humor (inhibit synthesis/secretion or increase drainage)

Question 2

Epinephrine: MOA

Answer 2

Glaucoma drug - alpha agonist
decreases aqueous humor synthesis via vasoconstriction
SE: mydriasis; do NOT use in closed-angle glaucoma

Question 3

Brimonidine: MOA

Answer 3

alpha 2 agonist - for glaucoma

decreases aqueous humor synthesis

Question 4

Brimonidine: SE

Answer 4

blurry vision, ocular hyperemia, foreign body sensation, ocular allergic reactions, ocular pruritis

Question 5

Timolol: MOA

Answer 5

beta blocker - for glaucoma
decreases aqueous humor synthesis
SE: no pupillary or vision changes

Question 6

Betataxolol: MOA

Answer 6

beta blocker - for glaucoma
decreases aqueous humor synthesis
SE: no pupillary or vision changes

Question 7

Carteolol: MOA

Answer 7

beta blocker - for glaucoma
decreases aqueous humor synthesis
SE: no pupillary or vision changes

Question 8

Acetazolamide: MOA

Answer 8

diuretic - for glaucoma
decreases aqueous humor synthesis via inhibition of carbonic anhydrase
SE: no pupillary or vision changes

Question 9

Direct cholinomimetics:

Answer 9

Pilocarpine, Carbachol

Tx glaucoma

Question 10

Pilocarpine: MOA

Answer 10

Direct cholinomimetic - for glaucoma

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

Question 11

Pilocarpine: SE

Answer 11

Miosis and cyclospasm (contraction of ciliary muscle)

Question 12

Carbachol: MOA

Answer 12

Direct cholinomimetic - for glaucoma

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

Question 13

Carbachol: SE

Answer 13

Miosis and cyclospasm (contraction of ciliary muscle)

Question 14

Indirect cholinomimetics:

Answer 14

Physostigmine, Echothiophate

Tx glaucoma

Question 15

Physostigmine: MOA

Answer 15

Anticholinesterase –> indirect cholinomimetic

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

Question 16

Physostigmine: SE

Answer 16

miosis and cyclospasm (contraction of ciliary muscle)

Question 17

Echothiophate: MOA

Answer 17

AChE inhibitor –> indirect cholinomimetic

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

Question 18

Echothiophate: SE

Answer 18

Miosis and cyclospasm (contraction of ciliary muscle)

Question 19

Glaucoma emergencies: what drug?

Answer 19

Pilocarpine - very effective at opening meshwork into canal of Schlemm

Question 20

Latanoprost: MOA?

Answer 20

PGF2alpha analogue

Increases outflow of aqueous humor

Question 21

Latanoprost: SE

Answer 21

darkens color of iris (browning)

Question 22

Prostaglandin analogue used to treat glaucoma?

Answer 22

Lotanoprost (PGF2alpha)

Question 23

Opioid analgesics:

Answer 23

morphine, fentanyl, codeine, loperamide, methadone, meperidine, dextromethorphan, diphenoxylate

Question 24

Opioid analgesic MOA:

Answer 24

Agonist at opioid receptors to modulate synaptic transmission: open K+ channels, close Ca2+ channels –> decreased synaptic transmission; inhibit release of ACh, NE, 5-HT, gluatamate, and substance P.

Question 25

Opioid analgesic Uses:

Answer 25

pain, cough suppression (dextromethorphan), diarrhea (loperamide and diphenoxylate), acute pulmonary edema, maintenance programs for heroin addicts (methadone, buprenorphine + naloxone).

Question 26

Opioid toxicity:

Answer 26

addiction, respiratory depression, constipation, miosis (pinpoint pupils), additive CNS depression with other drugs.

Question 27

Opioid tolerance does not develop to what SE?

Answer 27

miosis and constipation

Question 28

Opioid toxicity is treated with what?

Answer 28

Naloxone or Naltrexone (opioid receptor antagonist)

Question 29

Drug used to decrease post-op shivering?

Answer 29

Meperidine | K receptor agonist

Question 30

Buprenorphine: MOA

Answer 30

partial agonist at mu receptors

Question 31

Naloxone: MOA

Answer 31

opioid antagonist. Not orally bioavailable, so withdrawal symptoms occur only if injected (decreases abuse potential))

Question 32

Naltrexone: MOA

Answer 32

long-acting opioid antagonist used for relapse prevention once detoxified

Question 33

Methadone: MOA

Answer 33

long-acting oral opiate for heroin detoxification and long term maintenance

Question 34

Butorphanol: MOA

Answer 34

mu-opioid receptor partial agonist and kappa-opioid receptor agonist; produces analgesia

Question 35

Butorphanol: Uses

Answer 35

severe pain: migraine, labor | Less respiratory depression than full opioid agonists

Question 36

Butorphanol: Toxicity

Answer 36

Can cause opioid withdrawal symptoms if pt is also taking full opioid agonist (competition for opioid receptors). Overdose NOT easily reversed with naloxone

Question 37

Tramadol: MOA

Answer 37

Very weak opioid agonist | inhibits serotonin and NE reuptake (works on multiple neurotransmitters - "tram it all" in with tramadol)

Question 38

Tramadol: Uses

Answer 38

chronic pain

Question 39

Tramadol Toxicity

Answer 39

Similar to opioids. Decreases seizure threshold. Serotonin syndrome

Question 40

Sertonin syndrome:

Answer 40

Hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures. Tx: cyproheptatine (5-HT2 antag)