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Brimonidine
Alpha agonist, use for glaucoma
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Timolol, betaxolol,carteolol
Betal blockers, use for glaucoma
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Latanoprost
- Prostaglandin, use for glaucoma
- Causes darkening of iris
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Fentanyl
- Opoid analgesic, opens K+ channels and closes Ca++ channels at mu receptors
- Causes addiction, respiratory depression, contipation, and miosis
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Naloxone
Mu receptor antagonist, use to treat opiate overdose
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Butorphanol
- Partial agonist at mu receptors, use for analgesia
- Causes less respiratory depression than opiates, but can cause withdrawal symptoms if the patient is also on an opiate (e.g. morphine, codeine, heroin)
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Tramadol
- Weak opiate agonist, inhibits serotonin and NE reuptake
- Use to treat chronic pain
- Major side effect is seizures in epileptic patients
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3 first line drugs for tonic clonic seizures
Phenytoin, carbamazepine, valproic acid
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First line anti-epileptic in children and pregnant women
Phenobarbital
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First line drug for trigeminal neuralgia
Carbamazepine
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First line drug for status epilepticus
- Benzos in acute cases
- Phenytoin after patient has been stabilized
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Uses and side effects of carbamazepine
- Tonic clonic seizures, trigeminal neuralgia
- Cause-
- Agranulocytosis
- Aplastic anemia
- Hepatotoxicity
- SIADH
- Steven-Johnson syndrome
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Ethosuximide
- Use for absence seizures
- Causes GI distress, urticaria, and Steven-Johnson syndrome
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Side effects of phenytoin
- Nystagmus
- Sedation
- Gingival hyperplasia
- Megaloblastic anemia
- Fetal hydantoin syndrome
- SLE
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Side effects of valproic acid
- GI distress
- Hepatotoxicity (can be fatal)
- Neural tube defects in fetuses
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Topiramate
- Anti-epileptic, blocks Na channels and upregulates GABA action
- Use for all but absence seizures and status epilepticus
- Side effects include sedation, weight loss, and kidney stones
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What condition contraindicates barbiturate use?
Porphyrias, because they induce ala synthase
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CYP 450 inducers
- Carbamazepine
- Phenobarbital
- Phenytoin
- Griseofulvin
- Rifampin
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CYP 450 inhibitors
- Cimetidine
- Ciprofloxacin
- Azoles
- Ritonavir
- Isoniazid
- Grapefruit juice
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Short acting benzos
- Midazolam
- Triazolam
- Oxazepam
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Decreased solubility in blood for an anesthetic indicates
Rapid induction and recovery
-
Increased solubility in the blood for an anesthetic indicates
Long induction and recovery times, but high potency
-
Inhaled anesthetic with high solubility (so slow onset and high potency)
-what is the toxicity?
Halothane, hepatotoxicity
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Side effect of enflurane
Seizures
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Cause and treatment of malignant hyperthermia
- Caused by a mutation in the ryanodine receptor that allows Ca to flood the muscles in response to inhaled anesthetics.
- Presents with fever, rigidity, and rhabdomyolysis after surgery.
- Treat with dantrolene
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Why does thiopental have a rapid recovery time?
Redistribution of the drug into fat and skeletal muscle
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Mechanism, use, and side effects of ketamine
- Blocks NMDA receptors and stimulates the CV system.
- Good dissociative anesthetic for traumatic field injury.
- Causes disorientation and hallucinations
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Propofol
Rapid anesthetic for short procedures
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Side effect of bupivacaine
CV toxicity
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Why is epinephrine given with local anesthetics?
Causes local vasoconstriction, traps drug in target tissues
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2 uses of dantrolene
- Neuroleptic malignant syndrome
- Malignant hyperthermia
- (blocks release of Ca from SR)
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Entacapone, tolcapone
- COMT inhibitors, prevent dopamine breakdown.
- Use for Parkinson's
-
Selegiline
- Selective MAO B inhibitor, prevents dopamine breakdown.
- Use for Parkinson's.
-
Dopamine agonists (4)
- Bromocriptine
- Pergoide
- Pramipexole
- Ropinirole
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Use of benztropine in Parkinson's
Antimuscarinic drug, can help control tremor and rigidity, but has little effect on bradykinesia
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Vitamin that increases dopamine metabolism
B6 (ask Parkinson's patients if they are taking multivitamins)
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Sumatriptan
- Serotonin agonist, causes vasoconstriction, inhibits activation of the trigeminal nerve
- Short half life
- Use to treat acute migraines and cluster headaches
- Major side effect is coronary vasospasm
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