Alpha-agonists: vasoconstrict and decrease aqueous humor synthesis

B-Blockers: decrease aqueous humor secretion

Diuretics

Cholinomimetics

Prostaglandins

Alpha-agonist

Use: open angle glaucoma (DO NOT use with closed angle)

Mechanism: vasoconstriction -- dec aqueous humor synth

Side Effects: Mydriasis, stinging

Alpha-agonist

Use: glaucoma

Mechanism: vasoconstriction -- dec aqueous humor synth

Side Effects:

B-blockers

Use: glaucoma

Mechanism: Dec aqueous humor secretion

Side Effects:

Diuretic

Use: glaucoma

Mechanism: inhibits carbonic anhydrase -- dec HCO3- -- dec aqueous humor secretion

Side Effects:

Muscarinic agonist

Use: glaucoma (drug of choice!), glaucoma emergencies

Mechanism: contracts ciliary muscle and open trabecular meshwork to increase outflow of aqueous humor

Side Effects: miosis, cyclospasm

Cholinergic agonists

Use: glaucoma

Mechanism: contracts ciliary muscle and open trabecular meshwork to increase outflow of aqueous humor

Side Effects: miosis, cyclospasm

Prostaglandin (PGF2alpha)

Use: glaucoma

Mechanism: facilitates outflow of aqueous humor

Side Effects: darkens color of iris

Morphine

Opiod Analgesics

Use: Pain, acute pulmonary edema

Mechanism: Agonists at opiod receptors to decrease synaptic transmission by opening K+ channels and closing Ca2++ channels

Side Effects: Addiction, resp depresssion, pinpoint pupils, additive CNS depression, constipation.

Tx toxicity with naloxone or naltrexone (opioid receptor antagonist)

Opiod Analgesics

Use: Pain, acute pulmonary edema

Mechanism: Agonists at opiod receptors to decrease synaptic transmission by opening K+ channels and closing Ca2++ channels

Side Effects: Addiction, resp depresssion, pinpoint pupils, additive CNS depression, constipation.

Tx toxicity with naloxone or naltrexone (opioid receptor antagonist)

Opiod Analgesics

Use: Pain, acute pulmonary edema

Mechanism: Agonists at opiod receptors to decrease synaptic transmission by opening K+ channels and closing Ca2++ channels

Side Effects: Addiction, resp depresssion, pinpoint pupils, additive CNS depression, constipation.

Tx toxicity with naloxone or naltrexone (opioid receptor antagonist)

Opiod Analgesics

Use: Pain, acute pulmonary edema

Mechanism: Agonists at opiod receptors to decrease synaptic transmission by opening K+ channels and closing Ca2++ channels

Side Effects: Addiction, resp depresssion, pinpoint pupils, additive CNS depression, constipation.

Tx toxicity with naloxone or naltrexone (opioid receptor antagonist)

Opiod Analgesics

Use: Pain, acute pulmonary edema, maintenence program for addicts

Mechanism: Agonists at opiod receptors to decrease synaptic transmission by opening K+ channels and closing Ca2++ channels

Side Effects: Addiction, resp depresssion, pinpoint pupils, additive CNS depression, constipation.

Tx toxicity with naloxone or naltrexone (opioid receptor antagonist)

Opiod Analgesics

Use: Pain, acute pulmonary edema

Mechanism: Agonists at opiod receptors to decrease synaptic transmission by opening K+ channels and closing Ca2++ channels

Side Effects: Addiction, resp depresssion, pinpoint pupils, additive CNS depression, constipation.

Tx toxicity with naloxone or naltrexone (opioid receptor antagonist)

Opiod Analgesics

Use: Pain, acute pulmonary edema, cough suppressant

Mechanism: Agonists at opiod receptors to decrease synaptic transmission by opening K+ channels and closing Ca2++ channels

Side Effects: Addiction, resp depresssion, pinpoint pupils, additive CNS depression, constipation.

Tx toxicity with naloxone or naltrexone (opioid receptor antagonist)

Partial opiod agonist - kappa receptors

Use: Pain (less resp depression that fulll agonists)

Tox: withdrawal if were on full agonist

weak opioid agonist and inhibits serotonin and NE reuptake

Tram it all in

Use: Chronic Pain

Tox: decreases seizure threshold

Phenytoin

Carbamazepine

Valproic Acid

Carbamazepine

Phenobarbital

Phenytoin

Carbamazepine

Phenytoin (fetal hydantoin syndrome)

Valproic Acid (neural tube defects - spina bifida)

Use: Tonic-clonic seizures, prophylaxis of status epilepticus, Class IB anti-arrhythmic

Mech: Use dependent block of Na channels, inhibition of glutamate release

Tox: Nystagmus, ataxia, diplopia, sedation, SLE-like syndrome, induction of cytochrome P450.  Chronic: Gingival hyperplasia, peripheral neuropathy, hirsutism, megaloblastic anemia. Teratogenic

Use: Tonic-clonic seizures, trigeminal neuralgia

Mech: Na channel inactivation

Tox: Teratogenic, diplopia, ataxia, blood dyscrasias, liver tox, p450

Use: Seizures, peripheral neuropathy

Mech: Inc GABA release

Tox: Sedation, ataxia

Use: Seizures

Mech: Blocks NA channels and inc GABA action

Tox: Sedation, mental dulling, kidney stones, weight loss

Use: Seizures (1st line in pregnant women and kids)

Mech: Inc GABA action

Tox: Sedation, tolerance, dependence, P450

Use: Seizures (1st line tonic clonic), myoclonic seizures

Mech: Inc Na channel inactivation and inc GABA conc

Tox: GI distress, hepatotox (measure LFTs), neural tube defects, tremor, weight gain

Use: Seizures

Mech: Blocks voltage gated Na channels

Tox: Stevens-Johnson syndrome

Use: seizures (absence)

Mech:Blocks thalamic type Ca2+ channels

Tox: GI distress, Stevens-Johnson, fatigue, HA, uticaria

barbiturates

(Phenobarbital, pentobarbital, thiopental, secobarbital)

Use: sedative for anxiety, seizures, insomnia, induction of anesthesia

Mech: Facilitate GABA action by increasing duration of Cl- channel opening and therefore dec neuron firing

Tox: Dependence, CNS depression, resp or card depresssion, P450

Benzodiazepines

(Diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam)

Use: Anxiety, spasticity, status epilepticus, detox, night terrors, sleep walking

Mech: Facilitate GABA by increasing freq of CL- channel opening

Tox: Dependence, CNS depression with alcohol

Tx overdose with flumazenil

Haloethane

Enflurane

Isoflurane

Sevoflurane

Methoxyflurane

NO

Effects: myocardial depression, resp depression, nausea/emesis, inc cerebral blood flow

Barbiturate

Use: IV anesthetic for induction of anesthesia and short procedures

Mech:

Tox:

IV anesthetic

Most common drug used for endoscopy

Tox: post op resp depression, dec BP, amnesia

PCP analog

Use: IV anesthetic

Mech: Block NMDA receptors

Tox: disorientation, hallucination, bad dreams

dec cerebral blood flow

Use: rapid anesthesia induction and short procedures

Mech: Potentiates GABA

Tox:

Depolarizing neuromuscular blockign drug

Use: muscle paralysis in srugery or mechanical ventilation

Mech: Selective for motor nicotinic receptor

Tox: hypercalcemia and hyperkalemia

Nondepolarizing neuromuscular blocking drugs

Use: muscle paralysis in surgery or mechanical ventilation

Mech: competes with ACh for receptors

Reverse with neostigmine, edrophonium, and other cholinesterase inhibitors

Use: treatment of malignant hyperthermia and neuroleptic malignant syndrome

Mech: prevents release of Ca2+ from the SR of skeletal muscle

Tox:

Use: Parkinson's (agonizes dopamine receptors)

Mech: ergot alkaloid and partial dopamine agonist

Tox:

Use: Parkinson's

Mech: Increases dopamine relase (also antiviral used for influenza A and rubella)

Tox: Ataxia

Use: Parkinsons

Mech: Converted to dopamine in CNS

Tox: Arrythmias from peripheral conversion to dopamine;  Long term use can lead to dyskinesia after admin and akinesia between doses

Carbidopa: peripheral decarboxylase inhibitor given with L-dopa to inprove bioavailability in brain and limit side effects

Use: Parkinsons (used as adjunct to L-dopa)

Mech: Selective MAO-B type inhibitor -- prevents dopamine breakdown

Tox: Can enhance adverse effects of L-dopa

Use: Parkinsons

Mech: COMT inhibitors -- prevent dopamine breakdown

Tox:

Use: Parkinsons

Mech: Antimuscarinic so curbs excess cholinergic activity -- improves tremor and rigidity with little effect on bradykinesia

Tox:

Use: Acute migraine, cluster HA attacks

Mech: 5-HT 1B/1D agonist -- vasoconstriction, inhibition of trigeminal activation adn vasoactive peptide release.

Tox:

Use: Alzheimer's

Mech:NMDA receptor antagonist -- helps prevent excitotoxicity

Tox: Dizziness, confusion, hallucinations

Use: Alzheimers

Mech: Acetylcholinesterase inhibitor

Tox: Nausea, dizziness, insomnia