NBEO Drug List

acetaminophen

brand name: Tylenol

category: non-steroidal analgesic/antipyretic

main action: relieve pain and fever (NOT inflammation)

MOA: exact mechanism is unknown but thought to inhibit the synthesis of prostaglandins in the central nervous system (possibly through COX-3 enzyme instead of COX-1/2)

uses: mild to moderate pain

side effects: liver toxicity with chronic overuse

acetaminophen-codeine

brand name: Tylenol #3

category: non-steroidal analgesic + opioid combo

main action: relieve pain and fever (NOT inflammation)

MOA:

--exact mechanism of acetaminophen is unknown but thought to inhibit the synthesis of prostaglandins in the central nervous system (possibly through COX-3 enzyme instead of COX-1/2)

--codeine stimulates opiate mu receptors, which leads to decreased adenylate cyclase activity and results in decreased neuronal excitability and decreased release of Glu, ACh, 5-HT, NE, and substance P

uses: mild to moderate pain

side effects:

--liver toxicity with chronic overuse

--respiratory depression

--nausea & vomiting

--drug dependence

--miosis

--constipation

acetaminophen-hydrocodone

brand name: Lortab, Vicodin

category: non-steroidal analgesic + opioid combo

main action: relieve pain and fever (NOT inflammation)

MOA:

--exact mechanism of acetaminophen is unknown but thought to inhibit the synthesis of prostaglandins in the central nervous system (possibly through COX-3 enzyme instead of COX-1/2)

--hydrocodone stimulates opiate mu receptors, which leads to decreased adenylate cyclase activity and results in decreased neuronal excitability and decreased release of Glu, ACh, 5-HT, NE, and substance P

uses: moderate to severe pain + cough relief

side effects:

--liver toxicity with chronic overuse

--respiratory depression

--nausea & vomiting

--drug dependence

--miosis

--constipation

acetazolamide

brand name: Diamox

category: carbonic anhydrase inhibitor (oral)

main action: decrease aqueous production to lower IOP (20%)

MOA: inhibits carbonic anhydrase in the ciliary body, preventing water and carbon dioxide from getting into the ciliary body from the blood, thus never converted to bicarbonate to get into aqueous and resulting in reduced sodium and fluid transport into aqueous

uses:

--open angle glaucoma

--acute, extreme IOP elevation (>40)

--idiopathic intracranial hypertension (IIH)

--cystoid macular edema (e.g., in retinitis pigmentosa)

side effects:

—bitter, metallic taste

--blurry vision

--kidney stones

--sulfa reaction (SJS)

--aplastic anemia (bone marrow suppression)

--fatigue

contraindications:

--sulfa allergy

--renal dysfunction

--renal calculi

--sickle cell anemia

acetylcysteine

brand name: Mucomyst

main action: break down mucus on ocular surface

MOA: breaks down disulfide bridges in mucus to dissolve it, as well as inhibits MMP secretion and facilitates wound healing in damaged epithelial cells

uses:

--filamentary keratitis (and associated dry eye symptoms)

--may also be used as antidote for acetaminophen overdose

side effects:

—rotten egg odor

acyclovir

brand name: Zovirax

category: antiviral (nucleotide analog)

main action: inhibits viral DNA polymerase to reduce pain, shorten healing time, and reduce viral shedding

MOA: deoxyguanosine derivative that is phosphorylated by viral and host cell kinases so that it can be incorporated into DNA to be taken up by viral DNA polymerase (NOT the human enzyme), thus inhibiting the enzyme from producing viral DNA

uses: herpesviruses

--chicken pox

--shingles

--HSV keratitis

note: mostly used for acute symptom management, not chronic management

side effects:

—nausea

--vomiting

--diarrhea

--liver/kidney issues

--eye irritation & SPK

--follicular conjunctivitis

--contains lactose, so not good for lactose intolerant patients

aflibercept

brand name: Eylea

category: anti-VEGF agent

main action: prevents and controls neovascularization in the retina

MOA: inhibits VEGF-A, VEGF-B, and placental growth factor (PGF) from binding to their receptors, which are normally produced by a hypoxic retina to induce weak, leaky vessels in an attempt to restore oxygen to the retina; therefore, it controls neovascularization

uses:

--wet AMD

--diabetic macular edema

--any kind of retinal or choroidal neovascularization

side effects:

—eye pain

--conjunctival hemorrhage

--floaters

--increasd IOP

--inflammation

--Crunch syndrome: tractional RD following injection in an eye with PDR

albendazole

brand name: Albenza

category: anti-parasitic

main action: inhibits glucose absorption in tapeworms

MOA: inhibits tubulin polymerization, immobilizing the worm and preventing it from absorbing and using glucose

uses: tapeworms

side effects:

—nausea

--stomach pain

--diarrhea

--headache/dizziness

albuterol

brand name: Proventil, Ventolin

category: sympathetic agonist

main action: bronchodilation

MOA: stimulates beta 2 receptors to induce smooth muscle relaxation in the lungs

uses: asthma, COPD

side effects:

--headache

--muscle tremors & shakiness

--sore throat

--tachycardia

alcaftadine

brand name: Lastacaft

category: mast cell stabilizer + antihistamine dual acting agent

main action: prevents release of histamine/pro-inflammatory markers and blocks cells from responding to histamine that has already been released

MOA:

--blocks calcium channels in mast cells to prevent degranulation and histamine release

--blocks H1 receptors to prevent histamine from binding

uses: acute & chronic allergies (e.g., allergic conjunctivitis)

side effects:

—dry eye

--foreign body sensation

--burning

--bad taste

--blurry vision

--hyperemia

--tearing

--rhinitis

alendronate

brand name: Fosamax

category: bisphosphonate

main action: prevents bone breakdown and increases bone density

MOA: binds to hydroxyapatite crystals within bone to downregulate osteoclast-mediated resorption

uses: osteoporosis

side effects:

—nausea

--heartburn

--constipation or diarrhea

--joint, muscle, or bone pain

--headache

--esophageal ulcers

--jaw issues

--blurry vision, diplopia, light sensitivity

alfa-2b interferon

brand name: Intron-A

category: immunomodulator

main action: synthetic protein that helps your immune system fight viral infections and certain cancer growth

MOA: binds to cell surface receptors to initiate the JAK/STAT pathway and activate the host defense system

uses:

--hepatitis B & C

--lymphoma

--malignant melanoma

--Kaposi sarcoma

--hairy cell leukemia

--genital warts

side effects: wide range of toxicities since we're essentially ramping up someone's immune system

allopurinol

brand name: Zyloprim

category: xanthine oxidase inhibitor

main action: decreases uric acid levels in the blood

MOA: inhibits the enzyme xanthine oxidase, which is usually responsible for converting hypoxanthine to uric acid

uses:

--gout

--prevention of excess uric acid caused by cancer medicines or kidney stones

side effects:

—skin rash

--nausea & vomiting

--drowsiness

--diarrhea

--yellowing of eyes

alprazolam

brand name: Xanax

category: benzodiazepine

main action: inhibit neural activity to provide a calming and sedative effect

MOA: binds to the GABA-A chloride channel receptor to facilitate the binding of GABA, resulting in increased Cl influx and thus more hyperpolarization and less depolarization, propagating the inhibitory effect of GABA

uses: anxiety & insomnia

side effects:

—sedation & hypnotic effect

--nystagmus

--diplopia

--ataxia

--drowsiness

--amnesia

--increased hostility and irritability

--confusion in elderly

--vivid, disturbing dreams

amantadine

brand name: Symmetrel

category: antiviral & treatment of extrapyramidal signs

main action:

--prevents uncoating of the flu virus

--manages extrapyramidal side effects seen with antipsychotics

MOA:

--blocks viral M2 proton channels that are normally needed to acidify the virus so it can be uncoated

--Parkinson's effect not well understood, but likely increases dopamine release in basal ganglia and also possibly inhibits dopamine reuptake

uses:

--influenza

--Parkinson's disease

side effects:

—high incidence of viral resistance due to mutation of M2 channel

amikacin

brand name: Amikin

category: aminoglycoside (antibiotic)

main action: inhibits protein synthesis

MOA: irreversibly inhibits the 30S subunit of the ribosome to inhibit bacterial protein synthesis

spectrum: bactericidal against aerobic gram (-) bacteria and only acts against gram (+) synergistically

uses:

--meningitis

--infections of blood, abdomen, lungs, skin, bones, urinary tract

side effects:

—ototoxicity: hair cell damage, tinnitus, nystagmus, dizziness, vertigo

--nephrotoxicity

--GI upset

aminocaproic acid

brand name: Amicar

category: hemostatic agent (anti-fibrinolytic)

main action: prevents clot breakdown

MOA: competitively inhibits lysine binding sites on plasmin so that it cannot degrade fibrin, thus preventing excessive bleeding

uses: used when blood clots are broken down too quickly in patients after surgery or with bleeding disorders

other key info: possibly used as a reversal agent for alteplase (tissue plasminogen activator - breaks down fibrin clots)

amiodarone

brand name: Cordarone, Pacerone

category: anti-arrhythmic

main action: slows nerve impulses in the heart to regulate heart rhythm

MOA:

--blocks potassium currents that cause repolarization of the heart muscle during the third phase of the cardiac action potential, thus increasing duration of action potential and refractory period, reducing muscle cell excitability and preventing/treating abnormal heart rhythms

--also acts on beta 1 receptors and Na/Ca channels, as well as decreases firing of SA node

uses: ventricular tachycardia & fibrillation

side effects:

—vortex keratopathy

--NAION

--anterior lens subcapsular opacities

--hypotension

--bradycardia

--hypothyroidism (since it can also bind to thyroid receptors)

--pulmonary fibrosis

--worsening of arrhythmia

amitriptyline

brand name: Elavil

category: tricyclic antidepressant

MOA:

--blocks reuptake of serotonin & norepinephrine via transporter to keep them more available in the synaptic cleft

--increases release of serotonin and NE over the following 2-4 weeks

--also blocks adrenergic, cholinergic, and histamine receptors

uses:

--depression

--headaches/migraines

--nerve pain

--anxiety disorders

--OCD

side effects:

--CV effects from alpha antagonism: orthostatic hypotension, reflex tachycardia

--anti-SLUDGE from anti-cholinergic effect

--blurry vision

--headaches

--narrow angles

--antihistamine effects: sedation, weakness, fatigue

--serotonin syndrome: anxiety, agitation, sweating, confusion, tremors, high BP, high heart rate

amlodipine

brand name: Norvasc

category: calcium channel blocker (w/o cardiac effects)

main action: decrease blood pressure

MOA: selectively blocks calcium channels in blood vessels (not the heart) so they can't constrict; instead, vascular smooth muscle relaxes (vasodilation)

uses: hypertension

side effects:

—reflex tachycardia

--dizziness

amoxicillin

brand name: Amoxil, Dispermox

category: β lactam/penicillin (antibiotic)

main action: inhibits cell wall synthesis

MOA: inhibits active site on penicillin binding proteins (transpeptidases) in bacteria to prevent cross-linking of peptidoglycan to form the bacterial cell wall

spectrum: bactericidal against gram (+) cocci; narrow spectrum but slightly more extended than regular penicillin

uses: wide variety of infections including ENT, sinuses, skin, lower respiratory tract, GI tract, urinary system

side effects:

—susceptible to β lactamase and thus resistance

--allergic reaction

--GI upset

amoxicillin-clavulanate

brand name: Augmentin

category: β lactam + β lactamase inhibitor (antibiotic)

main action: inhibits cell wall synthesis

MOA:

--amoxicillin inhibits active site on penicillin binding proteins (transpeptidases) in bacteria to prevent cross-linking of peptidoglycan to form the bacterial cell wall

--clavulanate inhibits the β lactamase enzyme produced by bacteria to destroy amoxicillin

spectrum: bactericidal against gram (+) cocci; narrow spectrum but slightly more extended than regular penicillin

uses: wide variety of infections including ENT, sinuses, skin, lower respiratory tract, GI tract, urinary system

side effects:

--allergic reaction

--has more GI effects than just amoxicillin

amphotericin B

brand name: Amphocin

category: polyene (anti-fungal)

main action: disrupts fungal cell membrane stability

MOA: binds to ergosterol in the cell membrane and removes it to create pores, causing leakage of K ions and osmotic imbalance, resulting in fungal cell lysis and death

uses:

--fungal keratitis and endophthalmitis

--systemic life-threatening fungal infections

side effects:

—reversible renal damage

--hypotension

--vomiting

--heart issues

--liver issues

apixaban

brand name: Eliquis

category: anticoagulant (blood thinner)

main action: prevents fibrin clotting

MOA: directly binds to and inhibits Factor Xa to prevent it from activating prothrombin to convert it into thrombin (therefore fibrin can never be activated)

uses:

--those with DVT

--prevention of clotting in patients with atrial fibrillation

side effects:

—bleeding & bruising

--subconjunctival hemorrhages

--valsalva retinopathy

--contraindicated in pregnancy

apraclonidine

brand name: Iopidine

category: sympathetic agonist

main action: decrease aqueous production & increase uveoscleral outflow to lower IOP (up to 40%)

MOA: non-selectively stimulates alpha 1 (weak) and alpha 2 (strong) receptors in ciliary body vessels to activate an inhibitory G protein, downregulate cAMP and protein kinase A, and slow down Na/K ATPase in NPCE, as well as possibly increase prostaglandin release to increase outflow

uses:

--glaucoma

--diagnosis of Horner's pupil

--in-office IOP lowering

--prevent post-laser IOP spikes

side effects:

--tachyphylaxis after a few weeks

--follicular conjunctivitis

--hypotension

--dizziness & drowsiness

--dry mouth

--CNS depression

--anterior uveitis (rare)

contraindications:

--concurrent use of MAO inhibitors

--children

aripiprazole

brand name: Abilify

category: atypical antipsychotic

main action: alleviates negative symptoms of psychosis (e.g., delusions, hallucinations) with fewer extrapyramidal side effects than typical antipsychotics

MOA:

--acts as a full antagonist against serotonin receptors in the mesocortical pathway, and since serotonin usually blocks dopamine release, this leads to increased dopamine

--acts as a partial agonist for dopamine receptors in the mesolimbic and mesocortical pathways, acting like a functional antagonist in the mesolimbic (to decrease DA) and functional agonist in the mesocortical (to increase DA)

uses:

--schizophrenia

--bipolar disorder

--other psychoses

--Tourette's syndrome

side effects: fewer side effects than typical antipsychotics

articaine

brand name: Zorcaine

category: amide-type anesthetic

MOA: reversible blockage of sodium channel from within the cell, preventing Na influx and thus depolarization

uses: local dental anesthesia

side effects:

--restlessness & tremor

--euphoria

--drowsiness & sedation

--vasodilation

--hypotension

--cardiac depression

--loss of muscle tone

ascorbic acid**

also known as: vitamin C

category: water soluble vitamin

main action: accelerates epithelial wound healing and minimizes scarring, such as in erosions, abrasions, and ulcers

MOA:

--suppresses VEGF and MMPs

--acts as a cofactor in synthesis of extracellular matrix

--acts as an antioxidant

aspirin

also known as: acetylsalicylic acid (ASA)

category: NSAID + anti-platelet (blood thinner)

main action: reduces inflammation & platelet aggregation

MOA:

--if low dose ("baby" aspirin), selectively irreversibly inhibits COX-1 to prevent production of thromboxane A2, which normally promotes vasoconstriction and platelet aggregation (thus vasodilation and anti-aggregation)

--if higher dose, also irreversibly inhibits COX-2 to prevent production of prostaglandins that promote inflammation

uses:

--headache/general inflammation

--prevention of second stroke/MI

--acute MI symptoms

side effects:

—prolonged bleeding

--subconjunctival hemorrhages

--valsalva retinopathy

--kidney/liver failure

--Reye's syndrome in kids

--exacerbation of ulcers since COX-1 helps to protect gastric mucosal lining (so NSAIDs are contraindicated for ulcers)

aspirin-dipyridamole

brand name: Aggrenox

category: anti-platelet combo (blood thinner)

main action: reduces platelet aggregation

MOA:

--aspirin inhibits COX-1 to prevent production of thromboxane A2, which normally promotes vasoconstriction and platelet aggregation (thus vasodilation and anti-aggregation)

--dipyridamole inhibits phosphodiesterase, leading to increased cAMP and reduced calcium, thus promoting vasodilation and reducing platelet activation

uses: stroke prevention in patients who have had TIAs

side effects:

—bleeding & bruising

--exacerbation of ulcers since COX-1 helps to protect gastric mucosal lining (so NSAIDs are contraindicated for ulcers)

atenolol

brand name: Tenormin

category: beta blocker (B1 selective)

main action: decrease heart rate to decrease BP

MOA: blocks beta 1 receptors in the heart and kidney to decrease heart rate and renin secretion

uses: hypertension

side effects:

--masks hypoglycemia (careful w/ diabetics)

--bradycardia (can mask symptoms of hyperthyroidism)

--arrythmia

--hypotension

--cardiac arrest

--confusion, depression, headache

--can lead to tachyphylaxis

--respiratory failure

--nausea, vomiting, diarrhea

--erectile dysfunction

--fatigue (can exacerbate MG)

atenolol-chlorthalidone

brand name: Tenoretic

category: beta blocker + diuretic (thiazide-like)

main action:

--decrease heart rate to decrease BP (atenolol)

--increase fluid excretion to reduce blood volume & BP (chlorthalidone)

MOA:

--atenolol blocks beta 1 receptors in the heart and kidney to decrease heart rate and renin secretion

--chlorthalidone inhibits Na/Cl symporter in the distal tubule to decrease reabsorption of Na

uses: hypertension

side effects:

--depression

--fatigue

--vivid dreams

--masks hypoglycemia

--hypokalemia

atorvastatin

brand name: Lipitor

category: HMG CoA reductase inhibitors (statins)

main action: inhibits cholesterol synthesis

MOA: blocks HMG CoA reductase in the liver, which results in less cholesterol being made and incorporated into VLDLs, so the liver now takes up the LDLs from plasma

uses: high cholesterol

other important info: one of the only two high intensity statins

side effects:

—muscle and liver damage

--contraindicated in pregnancy since fetus needs lots of cholesterol

--possible cataract progression

atropine**

category: parasympathetic antagonist

MOA: non-selectively blocks muscarinic receptors on the iris sphincter and ciliary body muscle, preventing iris constriction and accommodation

uses:

--myopia management

--amblyopia treatment

--dilation/cycloplegia for 7-10 days

--uveitis

--oral route: can work with pralidoxime to cure organophosphate poisoning

side effects:

--light sensitivity

--blurry vision at near

--increased IOP

--SPK

--anti-SLUDGE

--tachycardia

contraindications:

--narrow angles

--Down syndrome

--infants

autologous serum**

main action: mimic natural tears for dry eye treatment

MOA: mimic salinity and pH of tears without preservatives to 1) lubricate the ocular surface and 2) provide necessary growth factors, anti-inflammatory cytokines, chemokines, and hyaluronic acid to promote a healthy ocular surface

uses: severe dry eye syndrome

side effects: minimal since no preservatives and is very similar to tears

azathioprine

brand name: Azasan, Imuran

category: DMARD (immunosuppressant)

main action: suppress inflammation

MOA: purine analog that converts to its active metabolites, mercaptopurine (6-MP) and thioguanine (6-TGN), to inhibit purine synthesis and incorporate into DNA to halt replication and cell division

uses:

--rheumatoid arthritis

--prevent kidney transplant rejection

--off-label for inflammatory bowel disease

side effects:

—nausea, fever, fatigue

--bone marrow suppression

--rash

--kidney damage

--hepatotoxicity

azelastine

brand name: Optivar

category: mast cell stabilizer + antihistamine dual acting agent

main action: prevents release of histamine/pro-inflammatory markers and blocks cells from responding to histamine that has already been released

MOA:

--blocks calcium channels in mast cells to prevent degranulation and histamine release

--blocks H1 receptors to prevent histamine from binding

uses: acute & chronic allergies (e.g., allergic conjunctivitis)

side effects:

—dry eye

--foreign body sensation

--burning

--bad taste

--blurry vision

--hyperemia

--tearing

--rhinitis

azithromycin

brand name: AzaSite, Z-Pak, Zithromax

category: macrolide (antibiotic)

main action: inhibits bacterial protein synthesis

MOA: reversibly inhibit the 50S ribosomal subunit to inhibit bacterial protein synthesis

spectrum: bacteriostatic against some gram (+), some gram (-), and some atypical bacteria

uses:

--URTI

--pneumonia

--chlamydia

--gonorrhea

--dry eye

--internal hordeolum

side effects:

—GI upset

--eye irritation

--contact dermatitis

--keratitis

--dry eye

--nasal congestion

--sinusitis

beclomethasone

brand name: Beconase AQ, QVAR

category: nasal and inhaled steroid

main action: prevents synthesis of pro-inflammatory markers

MOA: inhibits phospholipase A2 via production of annexin A1 from cytoplasmic or nuclear receptors, resulting in decreased arachidonic acid available to make prostaglandins and other pro-inflammatory mediators

uses: asthma

side effects:

—Addisonian crisis if not tapered (decreased BP & blood sugar, increased blood K)

--increased blood sugar

--insomnia

--increased appetite/weight

--nausea & GI issues

--posterior subcapsular cataract

--higher risk of infection

--decreased wound healing

--dry nose/mouth

benazepril

brand name: Lotensin

category: ACE inhibitor

main action: decrease blood pressure

MOA: blocks ACE enzyme in the lungs, preventing conversion of inactive angiotensin I into active angiotensin II, which keeps aldosterone from being released (resulting in vasodilation)

uses: hypertension

other important info: good BP drug for patients with diabetes and kidney issues

side effects:

—dry cough

--fetal/neonatal problems (contraindicated for pregnant patients!)

benoxinate**

brand name: Fluress (w/ fluorescein)

category: ester-type anesthetic

MOA: reversible blockage of sodium channel from within the cell, preventing Na influx and thus depolarization

uses:

--Goldmann tonometry

side effects:

--mild SPK

--conjunctival hyperemia

--decreased TBUT

--burning/stinging

--reduced epithelial healing

--photophobia & pain

--ulcers with long term use

--vasovagal syncope

benzalkonium chloride**

also known as: BAK

category: chemical preservative (quaternary ammonium)

MOA: increases permeability of bacterial cell membrane in order to lyse its contents

uses: #1 preservative in eye drops (also used to make Polyquad)

side effects:

--SPK ("BAK causes SPK")

--decreased TBUT

--tearing, burning, itching

bepotastine

brand name: Bepreve

category: mast cell stabilizer + antihistamine dual acting agent

main action: prevents release of histamine/pro-inflammatory markers and blocks cells from responding to histamine that has already been released

MOA:

--blocks calcium channels in mast cells to prevent degranulation and histamine release

--blocks H1 receptors to prevent histamine from binding

uses: acute & chronic allergies (e.g., allergic conjunctivitis)

side effects:

—dry eye

--foreign body sensation

--burning

--bad taste

--blurry vision

--hyperemia

--tearing

--rhinitis

besifloxacin

brand name: Besivance

category: 4th gen. fluoroquinolone (antibiotic)

main action: inhibits bacterial nucleic acid synthesis

MOA: inhibits DNA gyrase in gram (-) bacteria and DNA topoisomerase in gram (+) bacteria, which both normally prevent supercoiling of DNA, thus these inhibit DNA synthesis altogether

spectrum: bactericidal against most gram (-) with extensive action against gram (+) and atypical bacteria

note: newer generation FLQs are less resistant than earlier generation drugs, especially with gram (+) bacteria

uses: various bacterial eye infections (Pseudomonas) + prophylaxis after LASIK

side effects:

—GI upset

--CNS symptoms: headache, dizziness, depression, insomnia

--black box warning: tendinitis/tendon rupture

--exacerbates muscle weakness in myasthenia gravis

betaxolol

brand name: Betoptic S

category: beta blocker (B1 selective)

main action: decrease aqueous humor production to lower IOP (20-25%)

MOA: inhibits norepinephrine from binding to beta 1 receptors ONLY (selective), which normally upregulates cAMP and protein kinase to activate the Na/K pump in NPCE

uses: POAG & angle closure attacks

side effects: less likely than other beta blockers to induce respiratory complications, but more likely to worsen CHF

bevacizumab

brand name: Avastin

category: anti-VEGF agent

main action: prevents and controls neovascularization in the retina

MOA: inhibits all VEGF isomers from binding to their receptors, which are normally produced by a hypoxic retina to induce weak, leaky vessels in an attempt to restore oxygen to the retina; therefore, it controls neovascularization

uses:

--wet AMD

--diabetic macular edema

--any kind of retinal or choroidal neovascularization

--all ocular use is off-label: actually intended for colorectal cancer

side effects:

—eye pain

--conjunctival hemorrhage

--floaters

--increasd IOP

--inflammation

--Crunch syndrome: tractional RD following injection in an eye with PDR

bimatoprost

brand name: Lumigan, Durysta, Latisse

category: prostaglandin analog

main action: increase uveoscleral outflow to decrease IOP (30%)

MOA: binds to prostanoid receptors for PGF2-alpha, which are located directly on aqueous outflow structures, causing...

--substantial remodeling of extracellular matrix

--decreased collagen in ciliary muscle and sclera

--decreased hydraulic resistance to outflow

--increased MMP production, causing a breakdown in collagen

uses:

--glaucoma or ocular HTN

--eyelash growth

side effects:

--hyperemia (most common)

—eyelash growth (Latisse)

--periocular pigmentation (due to phospholipase C activation on skin receptors)

--periorbitopathy

--iris darkening (due to phospholipase C activation on skin receptors)

--conjunctival hyperemia

--cystoid macular edema

--corneal pseudo-dendrites

--blurry vision

--burning, stinging, SPK

--ocular inflammation

brimonidine

brand name: Alphagan P, Lumify

category: alpha agonist (sympathetic agonist)

main action:

--lower IOP (25%) by decreasing aqueous production and increasing uveoscleral outflow

--vasoconstriction for eye whitening

MOA: selectively stimulates alpha 2 receptors in ciliary body vessels to activate an inhibitory G protein, downregulate cAMP and protein kinase A, and slow down Na/K ATPase in NPCE, as well as possibly increase prostaglandin release to increase outflow

uses:

--open angle glaucoma, mostly as adjunct therapy with BBs or PGAs

--red eyes

side effects:

--tachyphylaxis after a few weeks

--follicular conjunctivitis

--miosis

--hypotension

--dizziness & drowsiness

--dry mouth

--CNS depression

--anterior uveitis (rare)

contraindications:

--concurrent use of MAO inhibitors

--children

brimonidine-timolol

brand name: Combigan

category: alpha agonist + beta blocker (non-selective)

main action:

--decrease aqueous humor production (both)

--increase uveoscleral outflow (brimon.)

MOA:

--brimonidine stimulates alpha 2 receptors in ciliary body vessels to slow down Na/K ATPase in NPCE, as well as possibly increase prostaglandin release to increase outflow

--timolol inhibits norepinephrine from binding to beta 1 and beta 2 receptors, which normally activate the Na/K pump in NPCE

uses: glaucoma

side effects:

--masks hypoglycemia

--bradycardia

--arrythmia

--hypotension

--can lead to tachyphylaxis

--follicular conjunctivitis

--dry mouth

contraindications: DO NOT give to patients with COPD, asthma, CHF, low pulse, or hypotension

brinzolamide

brand name: Azopt

category: carbonic anhydrase inhibitor (topical)

main action: decrease aqueous production to lower IOP (20%)

MOA: inhibits carbonic anhydrase in the ciliary body, preventing water and carbon dioxide from getting into the ciliary body from the blood, thus never converted to bicarbonate to get into aqueous and resulting in reduced sodium and fluid transport into aqueous

uses:

--open angle glaucoma

--acute, extreme IOP elevation (>40)

side effects:

—bitter, metallic taste

--blurry vision

--irritation & burning

--FBS

--keratitis

--corneal edema

--kidney stones

--sulfa reaction (SJS)

--aplastic anemia (bone marrow suppression)

--fatigue

contraindications:

--sulfa allergy

--renal dysfunction

--renal calculi

--sickle cell anemia

brinzolamide-brimonidine

brand name: Simbrinza

category: carbonic anhydrase inhibitor + alpha agonist

main action:

--decrease aqueous production to lower IOP (both)

--increase uveoscleral outflow (brimonidine only)

MOA:

--brinzolamide inhibits carbonic anhydrase in the ciliary body, preventing water and carbon dioxide from getting into the ciliary body from the blood, thus never converted to bicarbonate to get into aqueous

--brimonidine stimulates alpha 2 receptors to slow down Na/K ATPase in NPCE, as well as possibly increase prostaglandin release to increase outflow

uses: glaucoma

side effects:

--follicular conjunctivitis

--hypotension

--dry mouth

--bitter metallic taste

--mild irritation & keratitis

--corneal edema

--renal issues

brolucizumab**

brand name: Beovu

category: anti-VEGF agent

main action: prevents and controls neovascularization in the retina

MOA: inhibits VEGF-A from binding to its receptors, which is normally produced by a hypoxic retina to induce weak, leaky vessels in an attempt to restore oxygen to the retina; therefore, it controls neovascularization

uses: wet AMD

side effects:

--retinal vasculitis

--retinal artery occlusion

--severe vision loss

—eye pain

--conjunctival hemorrhage

--floaters

--increasd IOP

--inflammation

--Crunch syndrome: tractional RD following injection in an eye with PDR

bromfenac

brand name: Bromday, Prolensa, Xibrom

category: NSAID

main action: inhibits inflammation

MOA: inhibits cyclooxygenase (COX-1 and COX-2 equally) enzymes, thus preventing the formation of pro-inflammatory prostaglandins

uses: post-cataract surgery to prevent Irvine-Gass syndrome (not really used as much for ocular allergies anymore)

side effects:

--blurry vision

--stinging upon instillation

--conjunctival hyperemia

--corneal SPK, thinning, melting

bromocriptine

brand name: Parlodel

category: dopamine receptor agonist

MOA:

--selectively binds and stimulates D2 dopamine receptors in the striatum and anterior pituitary (while acting as a partial agonist for D1 receptors)

--dopaminergic effect can counteract growth hormone release

--acts on the circadian neuronal activities in the hypothalamus to reset an abnormally elevated hypothalamic drive for increased plasma glucose, free fatty acids, and triglycerides in insulin-resistant patients

uses:

--hyperprolactinemia (helps with amenorrhea, infertility, abnormal milk production)

--acromegaly

--Parkinson's disease

--type II diabetes

side effects:

—drowsiness

--low blood pressure

--heart attack, stroke, seizure

--compulsive behaviors

brompheniramine

brand name: Dimetane

category: 1st generation antihistamine

main action: block the effect of pro-inflammatory markers like histamine

MOA:

--blocks H1 (and some H2) receptors (including those in the brain after crossing the blood brain barrier) to block inflammation mediated by histamine

--also has a partial anti-muscarinic effect

uses:

--allergies

--common cold

--sleep agent

--motion sickness

side effects:

—sedation

--mydriasis

--dry eye

--acute poisoning: paradoxical excitement, hallucinations, ataxia, incoordination, convulsions, coma, mixed pupils, cardiorespiratory collapse

budesonide

brand name: Uceris

category: glucocorticoid

main action: treats respiratory and digestive conditions by preventing synthesis of pro-inflammatory markers

MOA: inhibits phospholipase A2 via production of annexin A1 from cytoplasmic or nuclear receptors, resulting in decreased arachidonic acid available to make prostaglandins and other pro-inflammatory mediators

uses:

--asthma

--COPD

--Crohn's disease

--ulcerative colitis

side effects:

—Addisonian crisis if not tapered (decreased BP & blood sugar, increased blood K)

--increased blood sugar

--insomnia

--increased appetite/weight

--nausea & GI issues

--posterior subcapsular cataract

--higher risk of infection

--decreased wound healing

--dry nose/mouth

budesonide-formoterol

brand name: Symbicort

category: steroid + beta agonist

main action:

--budesonide prevents synthesis of pro-inflammatory markers in the airway

--formoterol promotes bronchodilation

MOA:

--budesonide inhibits phospholipase A2, resulting in decreased arachidonic acid available to make prostaglandins and other pro-inflammatory mediators

--formoterol stimulates beta 2 receptors to induce smooth muscle relaxation in the lungs

uses: COPD, bronchitis, emphysema

side effects:

--headache

--muscle tremors

--sore throat

--tachycardia

—Addisonian crisis if not tapered (decreased BP & blood sugar, increased blood K)

--increased blood sugar

--insomnia

--increased appetite/weight

--nausea & GI issues

--posterior subcapsular cataract

--higher risk of infection

--decreased wound healing

--dry nose/mouth

bupivacaine

brand name: Marcaine, Sensorcaine

category: amide-type anesthetic

MOA: reversible blockage of sodium channel from within the cell, preventing Na influx and thus depolarization

uses: epidural injection during childbirth or surgery, also used in dentistry

side effects:

--restlessness & tremor

--euphoria

--drowsiness & sedation

--vasodilation

--hypotension

--cardiac depression

--loss of muscle tone

bupivacaine-epinephrine

brand name: Marcaine Epi

category: amide-type anesthetic + direct sympathetic agonist

MOA: reversible blockage of sodium channel from within the cell, preventing Na influx and thus depolarization (bupivacaine) + vasoconstriction (epi)

uses: local anesthesia with bleeding control

side effects:

--restlessness & tremor

--euphoria

--drowsiness & sedation

--vasodilation

--hypotension

--cardiac depression

--loss of muscle tone

bupropion

brand name: Wellbutrin, Zyban

category: NDRI

MOA: blocks the reuptake of norepinephrine and dopamine, increasing synaptic concentrations of both

uses:

--depression

--anxiety

--nicotine addiction (smoking cessation)

side effects:

—headache

--agitation

--insomnia

--dry mouth

--seizures

calcium carbonate

brand name: Os-Cal, Tums

category: dietary supplement + antacid

main action: raises blood calcium level and neutralizes stomach acid

MOA:

--as an antacid, it acts as a buffer and neutralizes H+ ions to raise gastric pH levels, minimizing acidic damage

--as a supplement, it is absorbed by the small intestine with the help of vitamin D and circulates in the blood

uses:

--heartburn

--indigestion

--osteoporosis

--osteomalacia

--hypoparathyroidism

side effects:

—constipation

--upset stomach

--hypercalcemia

canagliflozin

brand name: Invokana

category: renal glucose reabsorption inhibitor

main action: decrease glucose reabsorption from renal tubules and thus increase glucose excretion

MOA: inhibit sodium glucose type 2 (SGLT2) transporters to inhibit glucose reabsorption

uses: type II diabetes

side effects:

--UTI

--genital yeast infection

captopril

brand name: Capoten

category: ACE inhibitor

main action: decrease blood pressure

MOA: blocks ACE enzyme in the lungs, preventing conversion of inactive angiotensin I into active angiotensin II, which keeps aldosterone from being released (resulting in vasodilation)

uses: hypertension

other important info: good BP drug for patients with diabetes and kidney issues

side effects:

—dry cough

--fetal/neonatal problems (contraindicated for pregnant patients!)

carbidopa-levodopa

brand name: Sinemet

category: decarboxylase inhibitor + dopamine agonist combo

main action: increase dopamine and reduce its breakdown to control movement

MOA:

--levodopa crosses the blood-brain barrier and is decarboxylated to form dopamine in the brain

--carbidopa irreversibly inhibits PLP, thus inhibiting the PLP-dependent decarboxylase enzyme AADC (but cannot cross the BBB, so acts peripherally to prevent L-dopa metabolism)

uses: Parkinson's disease

side effects: unusual or uncontrolled movements of the mouth, tongue, face, head, neck, arms, and legs

carboxymethylcellulose

brand name: Celluvisc, Refresh Plus

category: demulcents

main action: serve as the lubricant in artificial tears

MOA: increases viscosity to increase contact time of artificial tears on the cornea

uses: dry eye

carteolol

brand name: Ocupress

category: beta blocker (non-selective)

main action: decrease aqueous humor production to lower IOP (20-25%)

MOA: inhibits norepinephrine from binding to beta 1 and beta 2 receptors, which normally activate a stimulatory G protein to upregulate cAMP and protein kinase to increase the speed of the Na/K pump in NPCE

uses:

--POAG

--angle closure attacks

--hypertension

side effects:

--may have less side effects than other BBs! (but still the same in general)

--can also potentially reduce cholesterol

--reduced nocturnal bradycardia ("CART keeps your HEART beating at night")

--masks hypoglycemia

--bradycardia, arrythmia, hypotension

--cardiac arrest

--confusion, depression, headache

--can lead to tachyphylaxis

--respiratory failure

--cough

contraindications: DO NOT give to patients with COPD, asthma, hypotension, low pulse, or CHF

carvedilol**

brand name: Coreg

category: mixed alpha/beta antagonist

main action: decrease blood pressure

MOA:

--inhibits alpha 1 receptors to inhibit vasoconstriction, causing vasodilation

--inhibits beta 1 receptors in heart and kidney (and beta 2 in lungs), decreasing heart rate and renin secretion

uses: hypertension

side effects:

—labored breathing

--depression

--fatigue

--vivid dreams

--orthostatic hypotension

caspofungin**

brand name: Cancidas

category: echinocandin (anti-fungal)

main action: fungal cell wall synthesis inhibitor

MOA: non-competitively inhibits beta 1,3-glucan synthase, preventing synthesis of glucans for the fungal cell wall and causing an osmotic balance resulting in fungal cell lysis and death

uses:

--good for widespread or resistant fungal infections

--fungal keratitis, endophthalmitis, retinitis, choroiditis, optic neuritis (used if infection is resistant to other anti-fungals)

side effects:

—nausea & stomach pain

--liver problems (jaundice)

--dark urine

--clay colored stool

cefepime

brand name: Maxipime

category: β lactam/4th generation cephalosporin (antibiotic)

main action: inhibits cell wall synthesis

MOA: inhibits active site on transpeptidases (PBPs) in bacteria to prevent cross-linking of peptidoglycan to form the bacterial cell wall

spectrum: bactericidal against almost exclusively gram (-)

uses:

--pseudomonas infections

--pneumonia

--UTI

--skin infections

side effects:

—susceptible to β lactamase and thus resistance

--allergic reaction (1% cross allergy with penicillin)

--GI upset

ceftazidime

brand name: Fortaz

category: β lactam/3rd generation cephalosporin (antibiotic)

main action: inhibits cell wall synthesis

MOA: inhibits active site on transpeptidases (PBPs) in bacteria to prevent cross-linking of peptidoglycan to form the bacterial cell wall

spectrum: bactericidal against mostly gram (-) cocci and a little bit of gram (+)

uses:

--pneumonia

--gynecological infections

--bone/joint infections

--septicemia

side effects:

—susceptible to β lactamase and thus resistance

--allergic reaction (1% cross allergy with penicillin)

--GI upset

ceftriaxone

brand name: Rocephin

category: β lactam/3rd generation cephalosporin (antibiotic)

main action: inhibits cell wall synthesis

MOA: inhibits active site on transpeptidases (PBPs) in bacteria to prevent cross-linking of peptidoglycan to form the bacterial cell wall

spectrum: bactericidal against mostly gram (-) cocci and a little bit of gram (+)

uses:

--various infections including respiratory, skin, soft tissue, UTI, ENT

--gonorrhea

--orbital cellulitis

side effects:

—susceptible to β lactamase and thus resistance

--allergic reaction (possible cross allergy with penicillin)

--GI upset

cefuroxime

brand name: Ceftin

category: β lactam/2nd generation cephalosporin (antibiotic)

main action: inhibits cell wall synthesis

MOA: inhibits active site on transpeptidases (PBPs) in bacteria to prevent cross-linking of peptidoglycan to form the bacterial cell wall

spectrum: bactericidal against some gram (+) cocci and some gram (-)

uses:

--bronchitis

--sinusitis

--tonsilitis

--ear/skin infections

--gonorrhea

--UTI

side effects:

—susceptible to β lactamase and thus resistance

--allergic reaction (1% cross allergy with penicillin)

--GI upset

celecoxib

brand name: Celebrex

category: NSAID

main action: reduces inflammation

MOA: selectively inhibits COX-2 enzyme to inhibit production of pro-inflammatory prostaglandins

uses: headaches and general inflammation/pain

side effects:

—prolonged bleeding

--kidney/liver failure

--less likely to cause/exacerbate ulcers since it doesn't affect COX-1

cenegermin**

brand name: Oxervate

category: recombinant human nerve growth factor

main action: stimulates regeneration of sensory nerve and proliferation/growth of corneal epithelial cells, as well as promotes reflex tearing from the lacrimal gland

MOA: provides a recombinant form of human nerve growth factor (NGF) to act through specific receptors in the anterior segment of the eye to promote corneal innervation, cell proliferation, and tear secretion

uses: neurotrophic keratitis

cephalexin

brand name: Keflex

category: β lactam/1st generation cephalosporin

main action: inhibits cell wall synthesis

MOA: inhibits active site on transpeptidases (PBPs) in bacteria to prevent cross-linking of peptidoglycan to form the bacterial cell wall

spectrum: bactericidal against mostly gram (+) cocci and a little bit of gram (-)

uses:

--respiratory infections

--otitis media

--internal hordeolum

--preseptal cellulitis

--dacryoadenitis

side effects:

—susceptible to β lactamase and thus resistance

--allergic reaction (1% cross allergy with penicillin)

--GI upset

cetirizine

brand name: Zyrtec

category: 2nd generation antihistamine

MOA: competitively blocks H1 receptors to block inflammation mediated by histamine

uses: acute allergies & common cold

side effects:

--dry eye

--possible oculogyric crisis

--no anti-muscarinic side effects like with 1st gen

chloramphenicol**

category: antibiotic

main action: inhibits bacterial protein synstheis

MOA: reversibly inhibits the 50S ribosomal subunit to prevent bacterial protein synthesis

spectrum: bactericidal against meningitis causes; bacteriostatic against everything else

uses:

--bacterial conjunctivitis

--ear infections

side effects:

—aplastic anemia

--optic neuritis

--these are BAD, so not really used in the U.S. anymore!

chlorhexidine (topical)

brand name: Betasept, Biopatch, Calgon Vesta, ChloraPrep, Dyna-Hex, Hibiclens, Hibistat Towelette, Scrub Care Exidine, Spectrum-4

category: anti-protozoal (biguanide) + chemical preservative (amide)

MOA: positively charged cation binds to bacterial cell surface to disrupt cell membrane and destroy bacteria

uses:

--antiseptic hand sanitizer

--treatment for Acanthamoeba keratitis

--contact lens solution

side effects:

--can cause allergic reaction

chlorhexidine gluconate 1% + ethyl alcohol 61%

brand name: Avagard

category: chemical preservative (amide + alcohol)

MOA: positively charged cation binds to bacterial cell surface (chlorhexidine) and alcohol disrupts lipids to overall disrupt cell membrane and destroy bacteria

uses:

--antiseptic hand sanitizer

side effects:

--can cause allergic reaction

chloroquine

brand name: Aralen

category: anti-parasitic

MOA:

--inhibits lysosomal function and thus prevents breakdown of toxic heme byproducts in bacteria, eventually causing it to lyse and die

--inhibits phospholipase A2 (like steroids) to alter signaling and transcriptional pathways to inhibit immune activation

--binds to melanin with RPE cells, causing localized RPE damage and subsequent migration of RPE cells to the ONL and OPL

uses:

--malaria

--rheumatoid arthritis

--lupus

risks for ocular toxicity:

--dosing more than 2.3 mg/kg body weight

--treatment duration >5 years

--kidney/liver issues

--age >60

--high body fat

--concomitant retinal disease

side effects:

—toxic retinopathy (bull's eye maculopathy)

--vortex keratopathy

--blurry vision

--photophobia

--paracentral or central scotoma

--muscle problems

--loss of appetite

--diarrhea

--skin rash

chlorothiazide

brand name: Diuril

category: diuretic (thiazide)

main action: increase fluid excretion to reduce blood volume & BP

MOA: inhibits Na/Cl symporter in the distal tubule to decrease reabsorption of Na, resulting in more ions and water being excreted in urine

uses: hypertension

side effects:

—hypokalemia

--increased blood sugar

--increased blood lipids

--decreased insulin sensitivity

chlorpheniramine

brand name: Chlor-Trimeton

category: 1st generation antihistamine

main action: block the effect of pro-inflammatory markers like histamine

MOA:

--blocks H1 (and some H2) receptors (including those in the brain after crossing the blood brain barrier) to block inflammation mediated by histamine

--also has a partial anti-muscarinic effect

uses:

--allergies

--common cold

--sleep agent

--motion sickness

side effects:

—sedation

--mydriasis

--dry eye

--acute poisoning: paradoxical excitement, hallucinations, ataxia, incoordination, convulsions, coma, mixed pupils, cardiorespiratory collapse

chlorpromazine

brand name: Thorazine

category: typical antipsychotic

main action: alleviates positive symptoms of psychosis (e.g., delusions, hallucinations)

MOA: blocks dopamine (mostly, much less action against serotonin) from binding to its receptors in the mesolimbic and nigrostriatal pathways, preventing depolarization and leading to remodeling of the neurons which changes how they respond to dopamine

uses:

--schizophrenia

--bipolar disorder

--other psychoses

--nausea/vomiting

--hiccups

side effects:

—miosis

--photosensitivity

--pigmentation of skin, cornea, and lens

--cataracts

--extrapyramidal side effects (due to blockage of dopamine in nigrostriatal pathway): akathisia, acute dystonia, Parkinsonism, arrive dyskinesia

--FDA black box warning for increased mortality in elderly patients

--reduced emotions & social withdrawal

--cognitive deficits

--low energy/motivation

chlorpropamide

brand name: Diabinese

category: insulin secretagogue

main action: decrease blood sugar

MOA: binds to pancreatic beta cell receptors to inhibit K+ efflux, inducing depolarization which stimulates calcium influx through voltage-gated channels, inducing insulin release

uses: type II diabetes

side effects:

—this is a sulfonylurea, so contraindicated for sulfa allergy

--hypoglycemia

cholestyramine

brand name: Questran

category: bile acid sequestrants

main action: increase excretion of bile acids

MOA: binds to bile acids in the gut to prevent reabsorption and promote excretion, causing the liver to convert more cholesterol into bile acids

uses: high cholesterol

side effects:

—nausea

--constipation

--GI upset

--reduced drug/nutrient absorption (e.g., messes with fat soluble vitamins)

chymotrypsin

brand name: Catarase

category: dietary supplement

main action: protein digestion

MOA: supplements the normal protease enzyme that acts in the duodenum to break down proteins and polypeptides from the diet

uses: reduce redness and swelling associated with pockets of infection (abscesses), ulcers, surgery, or traumatic injuries

side effects:

—GI discomfort: gas, diarrhea, constipation, nausea

--allergy

cidofovir

brand name: Vistide

category: antiviral (nucleotide analog)

main action: inhibits viral DNA polymerase to reduce pain, shorten healing time, and reduce viral shedding

MOA: deoxycytosine derivative that is phosphorylated by viral and host cell kinases so that it can be incorporated into DNA to be taken up by viral DNA polymerase, thus inhibiting the enzyme from producing viral DNA

uses:

--ocular herpesvirus infections

--CMV retinitis

side effects:

—myelosuppression

--retinal toxicities

--nephrotoxicity (monitor BUN and creatinine

--nausea/vomiting

--fever

--abdominal pain/diarrhea

--hair loss

--rash

--anemia

--seizures

--these side effects are worse than acyclovir because human DNA polymerase can pick up these

cilostazol

brand name: Pletal

category: anti-platelet (blood thinner)

main action: prevent platelet aggregation

MOA: inhibits phosphodiesterase, which normally breaks down cAMP, therefore this leads to increased cAMP levels, which reduces calcium release and thus platelet activation

uses: decrease leg pain due to blood flow problem (since it promotes vasodilation and prevents clotting)

side effects: bleeding & bruising

cimetidine

brand name: Tagamet

category: H2 receptor blocker

main action: prevent gastric acid secretion

MOA: block H2 receptors located on gastric parietal cells, preventing histamine from stimulating HCl secretion (however, this does not prevent ACh or gastrin-stimulated acid secretion...just histamine-stimulated secretion)

uses:

--gastric ulcers

--GERD

--Zollinger-Ellison syndrome

--indigestion

--heartburn

side effects:

—diarrhea

--stomachache

--difficulty in absorbing minerals (e.g., iron deficiency, hypocalcemia)

ciprofloxacin

brand name: Ciloxan, Cipro

category: 2nd gen. fluoroquinolone (antibiotic)

main action: inhibits bacterial nucleic acid synthesis

MOA: inhibits DNA gyrase in gram (-) bacteria and DNA topoisomerase in gram (+) bacteria, which both normally prevent supercoiling of DNA, thus these inhibit DNA synthesis altogether

spectrum: bactericidal against most gram (-) with limited action against gram (+) and atypical bacteria

side effects:

—GI upset

--CNS symptoms: headache, dizziness, depression, insomnia

--black box warning: tendinitis/tendon rupture

--exacerbates muscle weakness in myasthenia gravis

citalopram

brand name: Celexa

category: SSRI

MOA: selectively blocks reuptake of serotonin (only) to keep more serotonin available in the synaptic cleft

uses: anxiety disorders, depression, bipolar disorder, OCD, bulimia, PTSD, phobias

side effects:

--takes 2-4 weeks to see therapeutic effect, so may experience increased anxiety in the meantime

--suicidal thoughts and behaviors

--headache

--blurry vision

--serotonin syndrome (high BP, tremor, fever, hyperthermia, CV collapse)

clindamycin

brand name: Cleocin

category: antibiotic

main action: inhibits bacterial protein synthesis

MOA: reversibly inhibits the 50S ribosomal subunit to inhibit bacterial protein synthesis

spectrum: bactericidal against gram (+) and most anaerobic bacteria, which are usually gram (-)

uses: respiratory infections

side effects: GI upset

clonazepam

brand name: Klonopin

category: benzodiazepine (anxiolytic & anti-convulsant)

main action: inhibit neural activity to provide a calming and sedative effect

MOA: binds to the GABA-A chloride channel receptor to facilitate the binding of GABA, resulting in increased Cl influx and thus more hyperpolarization and less depolarization, propagating the inhibitory effect of GABA

uses:

--anxiety & insomnia

--seizures

side effects:

—sedation & hypnotic effect

--nystagmus

--diplopia

--ataxia

--drowsiness

--amnesia

--increased hostility and irritability

--confusion in elderly

--vivid, disturbing dreams

clonidine

brand name: Catapres

category: sympathetic agonist

main action: inhibit vasoconstriction to lower blood pressure

MOA: stimulates alpha 2 receptors to stimulate inhibitory G proteins that inhibit norepinephrine release and thus inhibit vasoconstriction

uses: hypertension, ADHD

side effects:

--sedation

--dry mouth

--rebound HTN if discontinued abruptly

--dizziness/fainting

clopidogrel

brand name: Plavix

category: anti-platelet (blood thinner)

main action: prevents platelet aggregation

MOA: irreversibly inhibits platelet ADP receptor, which inhibits activation of glycoprotein IIb/IIIa receptors, which prevents platelet aggregation (platelets can't recognize the "SOS" signal sent by ADP)

uses: prevention of secondary stroke/MI if patient is high risk (since this is a very strong drug)

side effects:

--bleeding & bruising

--subconjunctival hemorrhages

--valsalva retinopathy

clotrimazole

brand name: Mycelex

category: imidazole (anti-fungal)

main action: disrupts fungal cell membrane stability

MOA: inhibits the conversion of lanosterol to ergosterol, which is the main component of fungal cell membranes, thus altering the stability of the membrane

uses:

--ringworm

--athlete's foot

--jock itch

--vaginal yeast infections

--yeast infections of mouth/throat

--ocular fungal infections

side effects:

--superficial punctate keratitis

—nausea

--diarrhea

--fever

--anorexia

--anemia

--possible liver injury

--interacts with statins and warfarin

cocaine**

category: sympathetic agonist & ester-type anesthetic (PABA derivative)

MOA:

--binds transporters to prevent reuptake of norepinephrine, dopamine, and serotonin

--reversible blockage of sodium channel from within the cell, preventing Na influx and thus depolarization

uses:

--local anesthetic for ENT surgeries

--diagnose Horner's pupil

side effects:

--anger/irritability

--paranoia

--decreased appetite

--euphoria

--extreme sensitivity

--headaches & seizures

cromolyn sodium

brand name: Crolom, Opticrom

category: mast cell stabilizer

main action: prevents release of histamine and pro-inflammatory markers

MOA: blocks calcium channels in mast cells, causing a decrease in Ca influx and thus preventing degranulation of mast cells so they can't release histamine

uses: chronic allergies & asthma management

side effects:

—headache

--nasal congestion

--stinging upon instillation

--acute swelling

cyanocobalamin

also known as: vitamin B12

MOA: absorbed by vitamin B12 specific plasma proteins (transcobalamin I & II) to enter cells, where it serves as a cofactor for two vital enzymes in the body: methylmalonyl-CoA mutase and methionine synthase (helps with DNA synthesis)

uses: vitamin B12 deficiency (e.g., pernicious anemia)

side effects:

—allergic reaction (esp. if cobalt allergy)

--acne, rosacea, rash

--shortness of breath

--pulmonary edema

--hypokalemia

--polycythemia

cyclobenzaprine

brand name: Flexeril

category: muscle relaxant

main action: relaxes muscles to relieve pain and discomfort

MOA: acts centrally (not on skeletal muscle or neuromuscular junction) to block 5-HT2 receptors, responsible for its anti-spasmodic effect

uses:

--strains, sprains, and other muscle injuries

--fibromyalgia & myofascial pain (off label)

--also antagonizes muscarinic receptors, similar to tricyclic antidepressants

side effects:

—drowsiness

--dizziness

--confusion

--tachycardia

--some anti-SLUDGE effects