Pharm Exam 1 - MOA, ADRS, & Interventions

Pancuronium

MOA: block ACh at neuromuscular junction --> causes complete paralysis

Echothiophate

MOA: inhibits breakdown of Ach --> pupil constriction --> opens trabecular meshwork --> increase aqueous humor outlfow --> lower IOP

Lorazepam (Ativan)

Flumazenil is the reversal agent

Memantine

MOA: blocks NMDA receptors --> decreases calcium influx --> protects against neural damage

Betaxolol/Timolol

MOA: beta blocker --> decreases aqueous humor production --> lowers IOP

Interferon beta

MOA: decreased leukocyte migration across BBB --> protects myelin from autoimmune damage

Modafinil

MOA: unclear, thought to block norepinephrine reuptake --> prolonged action promotes wakefulness

Levodopa/Carbidopa

MOA: levodopa crosses BBB --> converted to dopamine --> restores neurotransmission

Valproic acid

MOA: blocks Na+ and Ca+

Pilocarpine

MOA: muscanaric agonist (inc ACh at receptors) --> pupil constriction --> opens trabecular meshwork --> increase aqueous humor outflow --> lower IOP

Baclofen

MOA: enhance GABA in spinal cord, decrease hyperactive reflexes --> muscle relaxation

Lidocaine

MOA: blocks na+ channels --> prevents depolarization & action potentials --> loss of sensation

Donepezil

MOA: inhibits acetylcholinesterase --> increase ACh

Phenytoin

MOA: decrease neural excitability by blocking Na+

Latanoprost

MOA: binds to prostaglandin receptors --> relaxation --> increases aqueous humor outflow --> lower IOP

Amphetamine/Dextroamphetamine

MOA: increase norepinephrine and dopamine release --> increases alertness, energy, mood, HR, BP, decrease appetite

Methohexital Sulfate

MOA: potent CNS depression --> enhances GABA inhibitory effects

Selegiline

MOA: inhibits MAO-B (enzyme that activates dopamine) --> prolongs affects of dopamine and levodopa

Oxcarbazepine

MOA: blocks Na+ channels

Sumatriptan

MOA: activates 5-HT receptors --> vasoconstriction --> decreases CGRP release --> decreasing inflammation & pain

Dantrolene

MOA: direct action on skeletal muscle --> inhibits calcium release --> prevents contraction --> relaxation

Carbamazepine

MOA: decreases neural excitability by blocking Na+

Pancuronium (ADRs)

Respiratory paralysis — does NOT sedate (give with a sedative) have reversal agent READY

Echothiophate (ADRs)

decrease visual acuity (poor night vision) Cataract risk w/ long term use (opacity behind pupil) urinary urgency, bradycardia, bronchospasm (if absorbed) punctal occlusion x 60 sec (5 mins between drops) AVOID EXPOSURE TO INSECTICIDES

Memantine (ADRs)

Dizziness + headache + increased confusion + constipation (stool softners & fiber) moderate to severe alzheimers AVOID OTC ANTACIDS

Betaxolol/Timolol (ADRs)

stinging, burning, itching (tolerable) bradycardia, hypotension, bronchospasm (if absorbed) monitor vitals before & after punctal occlusion x 60 sec DO NOT RUB EYES

Interferon beta (ADRs)

Flu-like symptoms myelosuppression hepatotoxicity pre-medicate with acetaminophen for site pain AVOID TAKING WITH STEROIDS

Modafinil (ADRs)

Headache,tachycardia, hypertension rare- SJS (rash & blistering) TERATOGENIC

Levodopa/Carbidopa (ADRs)

orthostatic hypertension (fall risk) dyskineasis psychosis (toxicity) start with low dose, titrate slowly, can take up to 6 months in adjustment period ( on & off episodes/ wearing off effect) AVOID HIGH PROTEIN MEALS DO NOT TAKE WITH MAOIS- hypertensive crisis

Valproic acid (ADRs)

Hepatotoxicity (jaundice) Pancreatitis (amylase) Hyperammonemia (confusion) Bone Marrow Supression (fever & sore throat) Teratogenic CAUSES SPINA BIFIDA

Pilocarpine (ADRs)

decrease visual acuity (dont drive at night) urinary urgency, bradycardia, bronchospasm ( if absorbed) Risk for retinal detachment (flashers& floaters) punctal occulsion x 60sec

Baclofen (ADRs)

Drowsiness (avoid driving & move slowly), weakness; dangerous withdrawal → seizures/hallucinations, DRY MOUTH TAPER SLOWLY, AVOID MAOIS USE CAUTION with elderly, children, and siezure disorders

Lidocaine (ADRs)

CNS toxicity/seizures + respiratory/cardiac effects RARE Epinephrine combo ( % and w/ or w/o) porolongs effects but can cause ischemia in fingers, toes, and nose

Donepezil (ADRs)

Insomnia (take at bedtime) Bradycardia (syncope) - hold if

Phenytoin (ADRs)

Gingival hyperplasia, SJS, teratogenic, stop slowly

Latanoprost (ADRs)

iris/eyelid pigmentation and growth changes one drop daily in evening punctal occlusion x 60 sec do not use >1 prostaglandin analog remove contacts and seperate drops 5 mins benzalkonium chloride

Amphetamine/Dextroamphetamine (ADRs)

insomnia (give early in day) growth suppression and weight loss (monitor height & weight) hypertension, tachycardia, palpitations TAPER SLOWLY AVOID CAFFEINE AVOID MAOIs - HYPERTENSIVE CRISIS HIGH MISUSE RISK

Methohexital Sulfate (ADRs)

Respiratory depression/apnea + hypotension HIGH RISK OF DEATH & SUICIDE (OVERDOSE) IV ONLY, slowly keep resuscitation equip at bedside, monitor vitals at ALL time

Selegiline (ADRs)

Insomnia (last dose by noon) oral mucosa irritation hypertensive crisis with interactions/tyramine (inhibits MAO-A)

Oxcarbazepine (ADRs)

Hyponatremia (confusion & seizures) SJS (rash) Hypothyroidism Teratogenic

Sumatriptan (ADRs)

Coronary vasospasm/angina, chest heaviness, tingling & vertigo NOT PREVENTATIVE AVOID MAOIS

Dantrolene (ADRs)

Liver toxicity + muscle weakness to treat malignant hyperthermia (IV) and muscle spasticity (oral) IV, LIVER, NO CALCIUM CHANNEL BLOCKERS (arythmias)

Carbamazepine (ADRs)

Bone marrow suppression (fever & sore throat) SJS (rash) visual disturbances (largest dose at night) photosensitivity (sunscreen) fluid retention (edema & SOB) Teratogenic