Cumulative Review Drugs

acetylcholine

• direct acting cholinergic agonist

• indication: injected into eye during surgery

• MoA: binds to M2/M3 receptors on iris

• effects: miosis

• very limited clinical uses b/c it doesn’t pass through membranes easily & is rapidly broken down

B12

vitamin ____ deficiency can lead to pernicious anemia

bethanech

• direct acting cholinergic agonist

• indication: urinary retention

• MoA: binds M3/M2 receptors on bladder

• adverse effects:

  • sweating

  • increased GI motility

  • miosis

  • increased accommodation

  • increased tearing

  • retinal detachment

  • decreases IOP

• contraindications: bradycardia & asthma/COPD

pilocarpine, cevimeline

• direct acting cholinergic agonist

• indication: Sjogren’s syndrome

• MoA: binds & stimulates M2/M2 receptors on lacrimal & salivary gland

• adverse effects:

  • sweating

  • increased urination

  • increased GI motility

  • miosis

  • increased accommodation

  • retinal detachment

  • decreases IOP

• contraindications: bradycardia & asthma/COPD

edrophonium

• reversible, indirect acting cholinergic agonist

• indication: diagnosis of myasthenia gravis

• MoA: binds & inhibits acetylcholinesterase

• adverse effects:

  • sweating

  • increased salivation

  • increased urination

  • increased GI motility

  • miosis

  • increased accommodation

  • retinal detachment

  • decreases IOP

• contraindications: bradycardia, asthma/COPD

• can’t cross BBB

pyridostigmine, neostigmine

• reversible, indirect acting cholinergic agonist

• indication: long-term tx of myasthenia gravis

• MoA: binds & inhibits acetylcholinesterase

• adverse effects:

  • sweating

  • increased salivation

  • increased urination

  • increased GI motility

  • miosis

  • increased accommodation

  • retinal detachment

  • decreases IOP

• contraindications: bradycardia, asthma/COPD

• can’t cross BBB

physostigmine

• reversible, indirect acting cholinergic agonist

• indication: myasthenia gravis tx

• MoA: binds & inhibits acetylcholinesterase

• adverse effects:

  • sweating

  • increased salivation

  • increased urination

  • increased GI motility

  • miosis

  • increased accommodation

  • retinal detachment

  • decreases IOP

• contraindications: bradycardia, asthma/COPD

• can cross BBB

echothiophate

• irreversible, indirect acting cholinergic agonist

• indication: decrease IOP in glaucoma (not really used)

• MoA: covalently binds & inhibits acetylcholinesterase

• adverse effects:

  • sweating

  • increased salivation

  • increased urination

  • increased GI motility

  • miosis

  • increased accommodation

  • retinal detachment

  • decreased IOP

  • skeletal muscle cramps or weakness (if OD)

• contraindications: bradycardia, asthma/COPD

atropine

• cholinergic antagonist

• indication: emergent cardiac or respiratory issues

• MoA: binds & inhibits M1/2/3 receptors on heart & lungs & brain (crosses BBB)

• adverse effects:

  • dry mouth

  • decreased sweating

  • tachycardia

  • urinary retention

  • constipation

  • mydriasis

  • dry eye

  • hallucinations

  • ataxia

  • delirium

  • coma

scopolamine

• cholinergic antagonist

• indication: motion sickness or nausea/vomiting conditions

• MoA: binds & inhibits M1/2/3 receptors in brain (crosses BBB)

• adverse effects:

  • dry mouth

  • decreased sweating

  • tachycardia

  • urinary retention

  • constipation

  • mydriasis

  • dry eye

  • hallucinations

  • ataxia

  • delirium

  • coma

• contraindications:

ipratropium, tiotropium, umeclidinium

• cholinergic antagonist

• indication: asthma/COPD

• MoA: binds & inhibits M2/M3 receptors on lungs

• adverse effects:

  • dry mouth

  • tachycardia

  • mydriasis (M3 inhibition at iris sphincter)

  • dry eye (M2/M3 inhibition at lacrimal gland)

  • increased IOP (M2/M3 inhibition on ciliary muscle)

  • reduced accommodation (M2/M3 inhibition on ciliary muscle

oxybutynin, tolterodine, solifenacin, hyoscyamine

• cholinergic antagonist

• indication: overactive bladder

• MoA: binds & inhibits M2/M3 receptors on bladder

• adverse effects:

  • dry mouth

  • decreased sweating

  • tachycardia

  • urinary retention

  • constipation

  • mydriasis

  • dry eye

  • hallucinations

  • ataxia

  • delirium

  • coma

glycopyrrolate

• cholinergic antagonist

• indication: hyperhidrosis

• MoA: binds & inhibits M2/M3 receptors on sweat glands

• adverse effects:

  • dry mouth

  • tachycardia

  • urinary retention

  • constipation

  • mydriasis

  • dry eye

  • hallucinations

  • ataxia

  • delirium

  • coma

physostigmine

what is the antidote for atropine overdose?

atropine

what is the antidote for a pyridostigmine or neostigmine overdose?

pralidoxime

what is the antidote for an echothiophate overdose?

nicotine

• ganglionic agonist

• indication: smoking cessation

• MoA: binds nicotinic receptors in sympathetic & parasympathetic ganglia

• adverse effects of smoking it:

  • dry eye (smoke irritation)

  • worsens TED

  • worsens AMD

  • progresses cataracts

• affects the dominant system at the time

epinephrine

• adrenergic agonist

• indication: anaphylaxis, cardiac arrest, respiratory emergency

• MoA: binds & stimulates a1, a2, B1, B2

• adverse effects:

  • mydriasis (a1 stimulation on dilator)

  • dry eye (a1 stimulation on lacrimal gland)

  • decreased accommodation (B2 stimulation on ciliary muscle)

  • eyelid raise (a1 stimulation on Mueller’s muscle)

  • decreased eye redness (a1 stimulation on vessels)

  • increased IOP (B1 & B2 stimulation increasing aqueous humor production)

norepinephrine

• adrenergic agonist

• indication: shock, cardiac arrest

• MoA: binds & stimulates a1, a2, B1

• adverse effects:

  • mydriasis (a1 stimulation on dilator)

  • dry eye (a1 stimulation on lacrimal gland)

  • decreased accommodation (B2 stimulation on ciliary muscle)

  • eyelid raise (a1 stimulation on Mueller’s muscle)

  • decreased eye redness (a1 stimulation on vessels)

  • increased IOP (B1 & B2 stimulation increasing aqueous humor production)

isoproterenol

• non-selective beta agonist

• indication: shock, cardiac arrest

• MoA: binds & stimulates B1, B2

• adverse effects:

  • decreased accommodation (B2 stimulation on ciliary muscle)

  • increased IOP (B1 & B2 stimulation increases aqueous humor production)

albuterol, levalbuterol, salmeterol, formoterol, vilanterol

• selective beta agonist

• indication: asthma & COPD

• MoA: binds & stimulates B2

• adverse effects:

  • decreased accommodation (B2 stimulation on ciliary muscle)

  • increased IOP (B2 stimulation increases aqueous production)

phenylephrine, oxymetazoline

• selective alpha agonist

• indication: nasal congestion

• MoA: binds & stimulates a1

• adverse effects:

  • HTN

  • mydriasis (a1 stimulation on dilator)

  • dry eye (a1 stimulation on lacrimal gland)

  • eyelid raise (a1 stimulation on Mueller’s muscle)

  • decreased eye redness (a1 stimulation on conjunctival vessels)

cocaine

• indirect adrenergic agonist

• indication: severe nosebleeds

• MoA: blocks NE reuptake

• adverse effects:

  • HTN

  • mydriasis (a1 stimulation on dilator)

  • dry eye (a1 stimulation on lacrimal gland)

  • decreased accommodation (B2 stimulation on ciliary muscle)

  • eyelid raise (a1 stimulation on Mueller’s muscle)

  • decreased eye redness (a1 stimulation on vessels)

  • increased IOP (B1 & B2 stimulation increasing aqueous humor production)

  • crack cornea (if smoked)

  • corneal ulcers (if smoked)

pseudoephedrine

• mixed acting adrenergic agonist

• indication: nasal decongestion

• MoA: binds & stimulates a1, a2, B1, B2

• adverse effects:

  • HTN

  • tachycardia

  • urinary retention

  • mydriasis (a1 stimulation on dilator)

  • dry eye (a1 stimulation on lacrimal gland)

  • decreased accommodation (B2 stimulation on ciliary muscle)

  • eyelid raise (a1 stimulation on Mueller’s muscle)

  • decreased eye redness (a1 stimulation on vessels)

  • increased IOP (B1 & B2 stimulation increasing aqueous humor production)

tamsulosin, terazosin, doxazosin, prazosin

• alpha blockers

• indication: BPH, HTN tx

• MoA: inhibits a1

• adverse effects:

  • IFIS

propranolol

• non-selective beta blocker

• indications: CV disease-HTN, angina, heart failure

• MoA: binds & blocks B1, B2

• adverse effects:

  • increased accommodation (B2 blocked on ciliary muscle)

  • decreased IOP (B1 & B2 blocked on NPCE which decreases aqueous production)

  • dry eye (lower proteins in lacrimal gland)

• contraindications: bradycardia, bronchoconstriction

labetalol, carvedilol

• non-selective beta & alpha blockers

• indications: CV disease-HTN, angina

• MoA: binds & inhibits B1, B2, a1

• adverse effects:

  • miosis (a1 blocked on dilator)

  • decreased accommodation (B2 blocked on ciliary muscle)

  • decreased IOP (B1 & B2 block on NPCE ciliary body which decreases aqueous production)

  • dry eye (lower proteins in lacrimal gland)

• contraindications: bradycardia, bronchoconstriction

metoprolol, atenolol

• cardio selective beta blockers

• indications: CV disease- HTN, angina, arrythmia

• MoA: binds & inhibits B1

• adverse effects:

  • decreased eye pressure (B1 blocked on NPCE ciliary body which decreases aqueous production

  • dry eye (lower proteins in lacrimal gland)

• contraindications: bradycardia

succinylcholine

• direct acting NMJ desensitizing drug

• indication: muscle relaxation/paralysis during surgery

• MoA: binds nicotinic receptors in NMJ causing an initial twitch then makes receptor stop working

onabotulinumtoxin A, incobotulinumtoxin A

• NMJ indirect antagonist

• indication: blepharospasm, strabismus, sweating, wrinkles, HA

• MoA: blocks pre-synaptic release of ACh at NMJ which inhibits skeletal muscle contractions

decreased sweating, dry mouth, thirst, tachycardia, blurry vision, urinary retention, hot & dry skin, restlessness, fatigue, rapid/weak pulse, hallucinations, ataxia, delirium, coma

what are the signs of atropine OD?

diarrhea, urination, miosis, bradycardia, emesis, lacrimation, lethargy, salivation

what are the signs of indirect cholinergic agonist OD?

clonidine

• centrally acting a2 agonist

• indication: HTN

• MoA: stimulates a2 receptors in the brain → decreased HR/contraction & vasodilation

• adverse effects:

  • decreased IOP (a2 stimulated on ciliary body which constricts vessels & decreases aqueous humor production)

  • miosis (a2 stimulated on pre-synaptic neurons of dilator, less NE release, less NE to bind to a1 receptors)

  • dry eye (anti-cholinergic SE)

stimulation of a2 on ciliary body causes vasoconstriction and decreased aqueous production

describe the MoA of clonidine decreasing IOP

a2 stimulation on presynaptic neurons in iris dilator inhibits NE release & there is less NE available to bind to iris dilator a1 receptors

describe the MoA of clonidine causing miosis

amlodipine, felodipine, nifedipine

• dihydropyridine Ca channel blocker

• indication: HTN, angina

• MoA: inhibit L-type Ca channels → decreases Ca influx into blood vessel smooth muscle → vasodilation

diltiazem, verapamil

• non-dihydropyridine Ca channel blocker

• indication: HTN, angina, arrythmia

• MoA: inhibit L-type Ca channels → decreasing influx of Ca into cardiac cells → decreases HR/contraction

  • less effective on BV (very slight vasodilation)

• watch for pt on these, should not be given further beta blocker drops due to increased risk for bradycardia

hydrochlorothiazide, chlorothiazide, chlorthalidone

• thiazide diuretics

• indication: HTN, heart failure

• MoA: inhibit Na/Cl transporter in DCT → increase Na & H2O excretion → decreased blood volume → decreased BP

• adverse effects: idiosyncratic drug rxn (bilateral acute transient myopia & acute angle closure glaucoma), dry eye

furosemide

• loop diuretic

• indication: HTN, heart failure

• MoA: inhibit Na/K/Cl transporter in TAL of LoH → increase Na & H2O excretion → decreased blood volume → decreased BP

• adverse effects: idiosyncratic drug rxn (bilateral acute transient myopia & acute angle closure glaucoma), dry eye

spironolactone

• potassium sparing diuretic

• indication: HTN, heart failure

• MoA: inhibit aldosterone’s actions on Na/K/H pump in DCT → increases Na & H2O excretion → decreases blood volume → decreases BP

• adverse effects: dry eye

triamterene

• potassium sparing diuretic

• indication: HTN, heart failure

• MoA: directly inhibits Na/K/H pump in DCT → increases Na & H2O excretion → decreases blood volume → decreases BP

• adverse effects: dry eye

hydralazine

• vasodilator

• indication: HTN, angina, heart failure

• MoA: unclear

• adverse effects: Lupus-like syndrome (w/ photosensitivity), conjunctivitis, tearing

quinapril, captopril, benazepril, lisinopril, enalapril

• ACE inhibitors

• indication: HTN, heart failure

• MoA: inhibits ACE → prevents formation of angiotensin II → vasodilation & Na & H2O excretion → decreased BP

losartan, valsartan

• ARBS

• indication: HTN

• MoA: inhibit angiotensin II from binding to AT1 receptors → vasodilation, increased Na & H2O excretion → decreased BP

nitroglycerin, isosorbide

• nitrodilators

• indication: angina, heart failure

• MoA: turns into NO in body → activates cGMP in blood vessels → blocks Ca entry → strong vasodilation in coronary arteries

digoxin

• positive inotrope

• indication: heart failure, arrythmias

• MoA: inhibits Na/K/ATPase on heart → increases intracellular Ca2+ → increased force of contraction & decreases HR

• adverse effects: visual snow, xanthopsia, retrobulbar optic neuritis, flickering lights

amiodarone

• K channel blocker

• indication: arrhythmia

• MoA: blocks K, Na, Ca channels

• adverse effects: whorl keratopathy, anterior subcapsular lens deposits and/or cataracts, NAION, torsades des pointes

lidocaine

• Na channel blocker

• indication: emergency cardiac arrest (arrythmia)

• MoA: blocks Na channels

aspirin

• anti-platelet

• indication: clots

• MoA: inhibits cox-1 → inhibits thromboxane A2 → irreversibly inhibits platelet aggregation

• adverse effects: subconj heme (easy bleeding)

clopidogrel, ticlopidine

• anti-platelet

• indication: clots

• MoA: inhibits ADP P2Y12 receptors → irreversibly inhibits platelet aggregation

• adverse effects: subconj heme (easy bleeding)

dipyridamole, cilostazol

• anti-platelet

• indication: clots

• MoA: inhibits PDE → increases cAMP → inhibits platelet aggregation & adhesion to blood vessel walls & vasodilates coronary arteries

• adverse effects: subconj heme (easy bleeding)

warfarin

• anti-coagulant

• indication: clots

• MoA: inhibits vitamin K → decreases production of vitamin K-dependent clotting factors (7, 10, 2, 9) → reduces clot formation

• must follow a consistent vitamin K diet, so watch in AMD pt

apixaban, rivaroxaban

• direct acting oral anti-coagulants

• indication: clots

• MoA: directly inhibits factor 10

• adverse effects: subconj heme (easy bleeding)

heparin

• anti-coagulant

• indication: clots

• MoA: potentiates anti-thrombin III → inhibits factor 10 & thrombin → inhibits clotting factors

• adverse effects: subconj heme (easy bleeding)

protamine

what is the antidote for heparin toxicity?

tissue plasminogen factor

• thrombolytic

• indication: clots

• MoA: convert plasminogen to plasmin → plasmin breaks down fibrin → breaks up clot

aminocaproic acid

what is the antidote to tPA toxicity?

vitamin K

what is the antidote to warfarin toxicity?

lovastatin, simvastatin, atorvastatin, fluvastatin, rosuvastatin, pravastatin

• HMG CoA reductase inhibitors

• indication: high cholesterol

• MoA: inhibits HMG CoA reductase → reduces LDL in liver & pulls more LDL into liver, increases HDL secretion

• adverse effects: jaundice/icterus (from hepatotoxicity)

fenofibrate, gemfibrozil

• fibric acid derivatives

• indication: high cholesterol

• MoA: binds & activates PPAR-a → increases lipoprotein lipase activity to breakdown triglycerides & VLDL to be used for energy → decreases amount of VLDL & triglycerides in blood

• adverse effects: jaundice/icterus (from hepatotoxicity)

cholestyramine

• bile-acid binding resins

• indication: high cholesterol

• MoA: binds bile acid in gut → prevents chylomicron absorption → chylomicrons excreted in feces

ezetimibe

• indication: high cholesterol

• MoA: blocks transport of dietary cholesterol in small intestines, so don’t get transport in body

omega-3 acid ethyl esters

• indication: high cholesterol

• MoA: unknown

• decrease triglycerides, may increase LDL

niacin

• indication: high cholesterol

• MoA: inhibits VLDL formation & secretion in liver → reduces LDL & triglycerides in blood, also increases HDL

• adverse effects: jaundice/icterus (from hepatotoxicity), cystoid macular edema

alprazolam, clonazepam, diazepam, lorazepam, midazolam

• benzodiazepines

• indication: anxiety, sleep disorders

• MoA: bind & activate GABA receptor → decreases neurotransmission by opening Cl- channel

• adverse effects: anti-cholinergic SE

  • mydriasis (M3 inhibition at sphincter)

  • increased IOP (M3 inhibition on ciliary muscle)

  • reduced accommodation (M3 inhibition on ciliary muscle)

  • dry eye (M2/3 inhibition on lacrimal gland)

• fatal if combined w/ alcohol or opioids

phenobarbital

• barbiturate

• indication: anxiety, sleep disorders, epilepsy

• MoA: binds & activates GABA receptor → decreases neurotransmission by opening Cl- channel

• adverse effects: respiratory depression, anti-cholinergic SE

  • mydriasis (M3 inhibition at sphincter)

  • increased IOP (M3 inhibition on ciliary muscle)

  • reduced accommodation (M3 inhibition on ciliary muscle)

  • dry eye (M2/3 inhibition on lacrimal gland)

• fatal if ODed (no antidote), fatal if combined w/ alcohol or opioids

zolpidem, eszopiclone

• z drugs

• indication: insomnia

• MoA: bind & activate GABA receptor → decreases neurotransmission by opening Cl- channel

• adverse effects: anti-cholinergic SE

  • mydriasis (M3 inhibition at sphincter)

  • increased IOP (M3 inhibition on ciliary muscle)

  • reduced accommodation (M3 inhibition on ciliary muscle)

  • dry eye (M2/3 inhibition on lacrimal gland)

diphenhydramine, hydroxyzine, meclizine, promethazine

• anti-histamines

• indication: mild insomnia, mild anxiety disorders, vomiting, motion sickness, nausea

• MoA: inhibits H1 receptors in brain

• adverse effects: anti-cholinergic SE

  • mydriasis (M3 inhibition at sphincter)

  • increased IOP (M3 inhibition on ciliary muscle)

  • reduced accommodation (M3 inhibition on ciliary muscle)

  • dry eye (M2/3 inhibition on lacrimal gland)

melatonin, tasimelteon

• melatonin receptor agonists

• indication: non-24-hr sleep-wake disorder in total blindness

• MoA: stimulate melatonin receptors involved in control of circadian rhythms to promote sleep

phenytoin

• indication: epilepsy

• MoA: blocks voltage sensitive Na+ channels → decreases firing rate

• adverse effects:

  • nystagmus

  • diplopia

  • EOM palsies

divalproex, valproic acid

• indication: epilepsy

• MoA: inhibits voltage-gated Na channels & T-type Ca2+ channels, enhances GABA by increasing its synthesis & decreasing its breakdown

• adverse effects: subconj heme (low platelets)

topiramate

• indication: epilepsy, migraines, weight loss

• MoA: blocks voltage gated Na channels, GABA agonist, blocks glutamate kainite & AMPA receptors

• adverse effects: idiosyncratic drug rxn (bilateral transient myopic shift & bilateral angle closure), nystagmus, diplopia

gabapentin

• indication: epilepsy, post-herpetic neuralgia, restless leg syndrome, diabetic neuropathy

• MoA: increase GABA release & inhibits L-type Ca2+ channels

pregabalin

• indication: epilepsy, diabetic neuropathy, postherpetic neuralgia, restless-leg syndrome

• MoA: inhibits voltage-gated Ca2+ channels

nitrous oxide gas

• inhaled general anesthetic

• indication: surgery

• MoA: GABA agonist, Na & Ca inhibition

• no respiratory depression

isoflurane

• inhaled general anesthetic

• indication: surgery

• MoA: GABA agonist, Na & Ca inhibition

• adverse effects: respiratory depression

midazolam

• general anesthetic, parenteral

• indication: surgery, cataract surgery

• MoA: GABA agonist

• respiratory depression

propofol

• general anesthetic, parenteral

• indication: surgery

• MoA: GABA agonist

• respiratory depression

haloperidol

• typical antipsychotics

• indication: schizophrenia, depression, BPD, autism, nausea

• MoA: block DA receptor → reduce effects of DA

• adverse effects: oculogyric crisis, anti-cholinergic SE

  • mydriasis (M3 inhibition at sphincter)

  • increased IOP (M3 inhibition on ciliary muscle)

  • reduced accommodation (M3 inhibition on ciliary muscle)

  • dry eye (M2/3 inhibition on lacrimal gland)

thioridazine, chlorpromazine

• typical antipsychotics

• indication: schizophrenia, depression, BPD, autism, nausea

• MoA: block DA receptor → reduce effects of DA

• adverse effects: oculogyric crisis, pigmentation on cornea, anterior stellate cataracts, pigment disruption of RPE, anti-cholinergic SE

  • mydriasis (M3 inhibition at sphincter)

  • increased IOP (M3 inhibition on ciliary muscle)

  • reduced accommodation (M3 inhibition on ciliary muscle)

  • dry eye (M2/3 inhibition on lacrimal gland)

aripiprazole

• atypical antipsychotic

• indication: schizophrenia, depression, BPD

• MoA: block DA receptor → reduce effects of DA

• adverse effects: anti-cholinergic SE

  • mydriasis (M3 inhibition at sphincter)

  • increased IOP (M3 inhibition on ciliary muscle)

  • reduced accommodation (M3 inhibition on ciliary muscle)

  • dry eye (M2/3 inhibition on lacrimal gland)

citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline

• SSRIs

• indication: affective disorders

• MoA: inhibit reuptake of serotonin → increases serotonin in the brain

• adverse effects:

  • serotonin syndrome

  • subconj heme (due to platelet inhibition)

  • anti-cholinergic SE

    • mydriasis (M3 inhibition at sphincter)

    • increased IOP (M3 inhibition on ciliary muscle)

    • reduced accommodation (M3 inhibition on ciliary muscle)

    • dry eye (M2/3 inhibition on lacrimal gland)

mydriasis, mental status changes, increased BP, increased pulse, increase temp, sweating, tremors, hypereflexia

what are the symptoms of serotonin syndrome?

venlafaxine, duloxetine

• SNRIs

• indication: affective disorders

• MoA: inhibit NE & serotonin reuptake → increase NE & serotonin in brain

• adverse effects:

  • serotonin syndrome

  • subconj heme (due to low platelets)

  • anti-cholinergic SE

    • mydriasis (M3 inhibition at sphincter)

    • increased IOP (M3 inhibition on ciliary muscle)

    • reduced accommodation (M3 inhibition on ciliary muscle)

    • dry eye (M2/3 inhibition on lacrimal gland)

amitriptyline, imipramine

• TCAs

• indication: affective disorders

• MoA: inhibit NE & serotonin reuptake → increase NE & serotonin in brain

• adverse effects:

  • OD is fatal

  • serotonin syndrome

  • subconj heme (due to low platelets)

  • STRONG anti-cholinergic SE

    • mydriasis (M3 inhibition at sphincter)

    • increased IOP (M3 inhibition on ciliary muscle)

    • reduced accommodation (M3 inhibition on ciliary muscle)

    • dry eye (M2/3 inhibition on lacrimal gland)

phenelzine

• MAOI

• indication: affective disorders

• MoA: inhibit monoamine oxidase → increases NE, serotonin, & DA in brain

• adverse effects:

  • excessive HTN can be fatal (if taken w/ tyramine containing food/drinks)

  • nystagmus

  • photophobia

  • STRONG anti-cholinergic SE

    • mydriasis (a1 stimulation at iris dilator)

    • increased IOP (M3 inhibition on ciliary muscle)

    • reduced accommodation (M3 inhibition on ciliary muscle)

    • dry eye (M2/3 inhibition on lacrimal gland)

bupropion

• anti-depressant

• indication: affective disorders, smoking cessation

• MoA: inhibit NE & DA reuptake → increases NE & DA levels in brain

• adverse effects: anti-cholinergic SE

  • mydriasis (M3 inhibition at sphincter)

  • increased IOP (M3 inhibition on ciliary muscle)

  • reduced accommodation (M3 inhibition on ciliary muscle)

  • dry eye (M2/3 inhibition on lacrimal gland)

mirtazapine

• anti-depressant

• indication: affective disorders

• MoA: uncertain; increases NE & serotonin release & blocks histamine

• adverse effects: anti-cholinergic SE

  • mydriasis (M3 inhibition at sphincter)

  • increased IOP (M3 inhibition on ciliary muscle)

  • reduced accommodation (M3 inhibition on ciliary muscle)

  • dry eye (M2/3 inhibition on lacrimal gland)

trazodone

• anti-depressant

• indication: affective disorders

• MoA: blocks reuptake of serotonin, blocks serotonin from binding to 5HT receptors, blocks histamine from binding to histamine receptors

• adverse effects: anti-cholinergic SE

  • mydriasis (M3 inhibition at sphincter)

  • increased IOP (M3 inhibition on ciliary muscle)

  • reduced accommodation (M3 inhibition on ciliary muscle)

  • dry eye (M2/3 inhibition on lacrimal gland)

lithium

• mood stabilizer

• indication: mania

• MoA: unknown, reduces NE & DA in brain

• adverse effects: IIHTN → papilledema

amphetamine, dextroamphetamine, lisdexamphetamine

• CNS stimulants, indirect adrenergic agonists

• indication: ADHD, narcolepsy, obesity

• MoA: enters DA & NE neurons → gets packaged into vesicles with DA & NE → enhances effects of NE & DA

• adverse effects:

  • mydriasis (a1 stimulation on dilator)

  • dry eye (a1 stimulation on lacrimal gland)

methylphenidate

• CNS stimulant, indirect adrenergic agonist

• indication: ADHD, narcolepsy, obesity

• MoA: inhibits DA & NE reuptake → increasing DA & NE in brain

• adverse effects:

  • mydriasis (a1 stimulation on dilator)

  • dry eye (a1 stimulation on lacrimal gland)

carbidopa-levodopa

• indication: Parkinson’s disease

• MoA: increase DA synthesis

• adverse effects: mydriasis (a1 stimulation on dilator)

amantadine

• indication: Parkinson’s disease

• MoA: increases DA release

• adverse effects: mydriasis (a1 stimulation on dilator)

bromocriptine

• indication: pituitary adenomas

• MoA: DA agonist

• adverse effects: mydriasis (a1 stimulation on dilator)

donepezil

• indirect, reversible cholinergic agonist

• indication: Alzheimer’s disease

• MoA: inhibits acetylcholinesterase → increases effects of ACh

• adverse effects:

  • miosis (M3 stimulation at sphincter)

  • tearing (M2/3 stimulation at lacrimal gland)

  • increased accommodation (M2/3 stimulation at ciliary muscle)

cyclobenzaprine

• muscle relaxant

• indication: skeletal muscle spasms

• MoA: uncertain, increases NE, serotonin, DA & anti-histamine/anti-cholinergic effects in CNS → causes sedation

• adverse effects: STRONG anti-cholinergic SE

  • mydriasis (M3 inhibition at sphincter)

  • increased IOP (M3 inhibition on ciliary muscle)

  • reduced accommodation (M3 inhibition on ciliary muscle)

  • dry eye (M2/3 inhibition on lacrimal gland)

ergotamine

• serotonin receptor agonist

• indication: migraine

• MoA: serotonin 5-HT1 receptor agonist → vasoconstriction, inhibit release of peptides & other pain mediators, inhibit trigeminal nerves

• adverse effects:

  • NAION

  • retinal artery & vein occlusions

sumatriptan, zolmitriptan

• serotonin receptor agonist

• indication: migraine

• MoA: serotonin 5-HT1 receptor agonist → vasoconstriction, inhibit release of peptides & other pain mediators, inhibit trigeminal nerves

• adverse effects:

  • NAION

  • retinal artery & vein occlusions

  • idiosyncratic drug rxn (bilateral transient myopic shift & angle closure)

morphine, meperidine, oxycodone, hydrocodone, fentanyl, codeine

• opioids

• MoA: full opioid mu receptor agonists

• adverse effects:

  • respiratory depression

  • miosis (direct stimulation of EW nucleus of CN3 → parasympathetic stimulation of sphincter)

• contraindications: alcohol, benzodiazepines, barbiturates, other opioids, muscle relaxants, sleep aids/hypnotics, first gen antihistamines, asthma, COPD, sleep apnea, kidney or liver disease, closed head injury, history of addiction