DOCSLIB.ORG

Autonomic, Autacoid, and Neuromuscular Drugs

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Autonomic, Autacoid, and Neuromuscular Drugs 1-1 Section I Autonomic, Autacoid, and Neuromuscular Drugs Atropine Epoprostenol Phenylephrine Pyridostigmine Tamsulosin Bosentan Metoprolol Pilocarpine Rocuronium Terazosin Dobutamine Metyrosine Pralidoxime Sildenafil Edrophonium Phenoxybenzamine Propranolol Solifenacin Epinephrine Phentolamine Pseudoephedrine Succinylcholine Cholinergic and adrenergic neurotransmission and sites of drug action. See figure on back of card. In skeletal muscle, acetylcholine (Ach) activates nicotinic (N) receptors causing muscle contraction. Neuromuscular blockers (rocuronium) compete with Ach for N receptors and cause muscle relaxation. In smooth muscle and glands, Ach and pilocarpine activate muscarinic (M) receptors, causing muscle contraction and gland secretion. M receptor antagonists (atropine) cause muscle relaxation and inhibit secretions. Norepinephrine (NE) and epinephrine (E) activate α and β adrenoceptors and cause smooth muscle contraction or relaxation, respectively. Activation of cardiac β-receptors leads to increased heart rate, contractility, and conduction velocity. α-Blockers (terazosin) relax vascular and bladder smooth muscle, whereas β-blockers (propranolol) slow heart rate and decrease cardiac output and blood pressure. (α = alpha, β = beta.) 1-2 Autonomic, Autacoid, and Neuromuscular Drugs Ach N Ach M3 Parasympathetic nerves Heart M3 β2 M2 β1 α1 Exocrine glands Smooth muscle Ach N NE Sympathetic nerves Ach N Adrenal N Ach medulla Somatic nerves Skeletal E and NE muscle in the blood Cholinergic and adrenergic neurotransmission and sites of drug action. See back of card for description. 1-3 Autonomic, Autacoid, and Neuromuscular Drugs Sites of action of drugs used in treating glaucoma. See figure on back of card. Aqueous humor is secreted by the ciliary process and flows through the pupillary aperture of the iris into the anterior chamber. It then drains through the trabecular meshwork into the venous sinus of sclera (Schlemm canal). In persons with open-angle glaucoma, elevated intraocular pressure, often resulting from decreased aqueous humor outflow, may lead to the gradual loss of peripheral vision. Drugs can be used to reduce intraocular pressure before irreversible optic nerve damage occurs. Muscarinic receptor agonists (pilocarpine) cause contraction of ciliary muscle fibers that insert near the trabecular meshwork, which opens the trabecular spaces so that aqueous humor drains more easily. Prostaglandins (latanoprost) increase aqueous drainage through the uveoscleral route in which aqueous humor flows through the ciliary muscles into the suprachoroidal space. The β-adrenoceptor blockers (timolol) and the α2-adrenoceptor agonists (apraclonidine) reduce the formation of cyclic adenosine monophosphate (cAMP), a substance that stimulates aqueous humor production. Carbonic anhydrase inhibitors (dorzolamide) reduce formation of bicarbonate, a substance required for aqueous humor secretion. (α = alpha, β = beta.) 1-4 Autonomic, Autacoid, and Neuromuscular Drugs Site of action Cornea of muscarinic Trabecular receptor agonists meshwork Anterior chamber Iris Site of action of Schlemm canal prostaglandins Episcleral vein Lens Ciliary Meridional Site of action of β-adrenoceptor processes ciliary muscle blockers, carbonic anhydrase inhibitors, α2-adrenoceptor Circular agonists, and epinephrine ciliary muscle Sites of action of drugs used in treating glaucoma. See other side for description. 1-5 Autonomic, Autacoid, and Neuromuscular Drugs Atropine (at-roe-peen) ATROPEN See Pharmacology, 5th ed., Chapter 7, pp. 73-75 Heart, smooth muscle, glands Acetylcholine Muscarinic receptors Atropine 1-6 Atropine Autonomic, Autacoid, and Neuromuscular Drugs Therapeutic Class Anticholinergic agent Pharmacologic Class Muscarinic acetylcholine receptor antagonist MOA Competitively blocks all muscarinic receptors, increases heart rate and conduction velocity, causes smooth muscle relaxation, and decreases exocrine gland secretion Clinical Use Treatment (Tx) of bradycardia and atrioventricular block; Tx of irritable bowel symptoms; Tx of anticholinesterase poisoning; antisecretory agent (glycopyrrolate often used for this purpose in surgery); Tx of ocular inflammation (relaxes iris and ciliary muscles) Special Can slow heart rate when first administered, a result of central Considerations vagal stimulation Adverse Effects Tachycardia; mydriasis and cycloplegia; warm, dry, flushed skin; delirium; and hallucinations Interactions Additive anticholinergic effects with antihistamines (diphenhydramine) and tricyclic antidepressants (amitriptyline); slows absorption of other drugs by delaying gastric emptying Similar drugs: Darifenacin, dicyclomine, glycopyrrolate, hyoscyamine, ipratropium, oxybutynin, solifenacin, scopolamine, tolterodine, trospium 1-7 Autonomic, Autacoid, and Neuromuscular Drugs Bosentan (boe-sen-tan) TRACLEER See Pharmacology, 5th ed., Chapter 26, p. 309 Vascular smooth muscle Endothelin-1 Endothelin-1 ETA & ETB receptors Bosentan 1-8 Bosentan Autonomic, Autacoid, and Neuromuscular Drugs Therapeutic Class Vasodilator drug Pharmacologic Class Endothelin-1 receptor antagonist MOA Blocks endothelinA (ETA) and endothelinB (ETB) receptors in vascular smooth muscle, causing vasodilation Clinical Use Treatment of pulmonary arterial hypertension: decreases pulmonary vascular resistance and dyspnea; improves walking distance Special Considerations Likely to cause birth defects; contraindicated in pregnancy Adverse Effects Elevated serum aminotransferase levels Interactions Inhibitors of cytochrome P450 2C9 (CYP2C9) or CYP3A4 (e.g., cyclosporine) elevate bosentan levels; bosentan induces CYP2C9 and CYP3A4 and decreases levels of affected drugs Similar drugs: Ambrisentan, macitentan 1-9 Autonomic, Autacoid, and Neuromuscular Drugs Dobutamine (doe-bue-ta-meen) DOBUTREX See Pharmacology, 5th ed., Chapter 8, pp. 86-87 Cardiac muscle Ca2ϩ Dobutamine b1, adrenoceptors Gs, cAMP, PKA Gs ϭ G protein-s, cAMP ϭ cyclic adenosine monophosphate, PKA ϭ protein kinase A 1-10 Dobutamine Autonomic, Autacoid, and Neuromuscular Drugs Therapeutic Class Sympathomimetic; cardiac stimulant Pharmacologic Class Selective β1-adrenoceptor agonist MOA Activates β1-receptors > β2-receptors ≫ α1-receptors; increases phosphorylation of calcium channels and calcium Influx; increases cardiac contractility and cardiac output > heart rate Clinical Use Treatment of acute heart failure and cardiogenic shock Special Considerations Administered by intravenous infusion; must correct hypovolemia before giving dobutamine Adverse Effects Tachycardia and arrhythmia Interactions Synergistic effect on cardiac output with nitroprusside (a vasodilator that decreases cardiac afterload) Similar drugs: None 1-11 Autonomic, Autacoid, and Neuromuscular Drugs Edrophonium (ed-roe-foe-nee-um) TENSILON See Pharmacology, 5th ed., Chapter 6, p. 66 Cholinesterase Acetylcholine Acetate ϩ Choline Edrophonium 1-12 Edrophonium Autonomic, Autacoid, and Neuromuscular Drugs Therapeutic Class Diagnostic agent Pharmacologic Class Cholinesterase inhibitor MOA Reversibly inhibits cholinesterase; increases acetylcholine levels at neuroeffector junctions Clinical Use Diagnosis of myasthenia gravis (MG); increases muscle strength in persons with MG but increases weakness in MG patients treated with excessive doses of a cholinesterase inhibitor; used to reverse effects of curariform-type neuromuscular blocking agents such as rocuronium Special Considerations Very short-acting after intravenous administration Adverse Effects Muscarinic effects (e.g., miosis, salivation) can be treated with atropine Interactions None usually significant Similar drugs: Neostigmine, physostigmine, pyridostigmine 1-13 Autonomic, Autacoid, and Neuromuscular Drugs Epinephrine (e-pi-nef-rin) ADRENALIN See Pharmacology, 5th ed., Chapter 8, p. 86-88 Vascular smooth muscle a1- & b2- adrenoceptors Epinephrine b1-adrenoceptors Cardiac tissue 1-14 Epinephrine Autonomic, Autacoid, and Neuromuscular Drugs Therapeutic Class Vasopressor; bronchodilator Pharmacologic Class Nonselective adrenoceptor agonist MOA Activates α- and β-receptors, increasing inositol triphosphate and cyclic adenosine monophosphate, respectively α1: vasoconstriction and increased blood pressure β1: increased heart rate, conduction, and contractility β2: vasodilation and decreased diastolic blood pressure; bronchodilation Clinical Use Treatment (Tx) of cardiac arrest; ventricular fibrillation; anaphylactic shock; Tx of asthma and chronic obstructive pulmonary disease; prolongs duration of local anesthetics Adverse Effects Hypertension; tachycardia; ischemia; hyperglycemia Interactions None usually significant Similar drugs: Norepinephrine (does not activate β2-receptors significantly) 1-15 Autonomic, Autacoid, and Neuromuscular Drugs Epoprostenol (e-poe-pros-te-nole) FLOLAN See Pharmacology, 5th ed., Chapter 26, pp. 308-309 1-16 Epoprostenol Autonomic, Autacoid, and Neuromuscular Drugs Therapeutic Class Vasodilator Pharmacologic Class Naturally occurring prostacyclin (PGI2) MOA Activates prostaglandin IP receptors, causing vascular smooth muscle relaxation and vasodilation; increases pulmonary blood flow and reduces dyspnea Clinical Use Treatment of pulmonary arterial hypertension (PAH); administered via central venous catheter Special Considerations Treprostinil is a stable prostacyclin analogue administered by subcutaneous infusion pump that reduces dyspnea and improves physical activity in PAH patients; selexipag is an orally administered prostacyclin IP receptor agonist
Load more

Recommended publications
  • Brimonidine Tartrate; Brinzolamide
    Contains Nonbinding Recommendations Draft Guidance on Brimonidine Tartrate ; Brinzolamide This draft guidance, when finalized, will represent the current thinking of the Food and Drug Administration (FDA, or the Agency) on this topic. It does not establish any rights for any person and is not binding on FDA or the public. You can use an alternative approach if it satisfies the requirements of the applicable statutes and regulations. To discuss an alternative approach, contact the Office of Generic Drugs. Active Ingredient: Brimonidine tartrate; Brinzolamide Dosage Form; Route: Suspension/drops; ophthalmic Strength: 0.2%; 1% Recommended Studies: One study Type of study: Bioequivalence (BE) study with clinical endpoint Design: Randomized (1:1), double-masked, parallel, two-arm, in vivo Strength: 0.2%; 1% Subjects: Males and females with chronic open angle glaucoma or ocular hypertension in both eyes. Additional comments: Specific recommendations are provided below. ______________________________________________________________________________ Analytes to measure (in appropriate biological fluid): Not applicable Bioequivalence based on (95% CI): Clinical endpoint Additional comments regarding the BE study with clinical endpoint: 1. The Office of Generic Drugs (OGD) recommends conducting a BE study with a clinical endpoint in the treatment of open angle glaucoma and ocular hypertension comparing the test product to the reference listed drug (RLD), each applied as one drop in both eyes three times daily at approximately 8:00 a.m., 4:00 p.m., and 10:00 p.m. for 42 days (6 weeks). 2. Inclusion criteria (the sponsor may add additional criteria): a. Male or nonpregnant females aged at least 18 years with chronic open angle glaucoma or ocular hypertension in both eyes b.
    [Show full text]
  • Table 1. Glaucoma Medications: Mechanisms, Dosing and Precautions Brand Generic Mechanism of Action Dosage/Avg
    OPTOMETRIC STUDY CENTER Table 1. Glaucoma Medications: Mechanisms, Dosing and Precautions Brand Generic Mechanism of Action Dosage/Avg. % Product Sizes Side Effects Warnings Reduction CHOLINERGIC AGENTS Direct Pilocarpine (generic) Pilocarpine 1%, 2%, 4% Increases trabecular outflow BID-QID/15-25% 15ml Headache, blurred vision, myopia, retinal detachment, bronchiole constriction, Angle closure, shortness of breath, retinal narrowing of angle detachment Indirect Phospholine Iodide (Pfizer) Echothiophate iodide 0.125% Increases trabecular outflow QD-BID/15-25% 5ml Same as above plus cataractogenic iris cysts in children, pupillary block, Same as above, plus avoid prior to any increased paralysis with succinylcholine general anesthetic procedure ALPHA-2 AGONISTS Alphagan P (Allergan) Brimonidine tartrate 0.1%, 0.15% with Purite Decreases aqueous production, increases BID-TID/up to 26% 5ml, 10ml, 15ml Dry mouth, hypotension, bradycardia, follicular conjunctivitis, ocular irritation, Monitor for shortness of breath, dizziness, preservative uveoscleral outflow pruritus, dermatitis, conjunctival blanching, eyelid retraction, mydriasis, drug ocular redness and itching, fatigue allergy Brimonidine tartrate Brimonidine tartrate 0.15%, 0.2% Same as above Same as above 5ml, 10ml Same as above Same as above (generic) Iopidine (Novartis) Apraclonidine 0.5% Decreases aqueous production BID-TID/up to 25% 5ml, 10ml Same as above but higher drug allergy (40%) Same as above BETA-BLOCKERS Non-selective Betagan (Allergan) Levobunolol 0.25%, 0.5% Decreases
    [Show full text]
  • Tachykinins in the Gut. Part II. Roles in Neural Excitation, Secretion and Inflammation
    Pfxnma~ol.Ther. Vol. 73, No. 3, pp. 219-263, 1997 ISSN 0163-7258197$32.00 CopyrIght0 1997 ElsevierScience Inc. PI1 SO163-7258(96)00196-9 ELSEVIER A.wciate Editor: 1. We&r Tachykinins in the Gut. Part II. Roles in Neural Excitation, Secretion and Inflammation Peter Holzer” and Ulrike Holw-er-Pets&e DEPARTMENT0FEXPERIMENTALANDCLINlCALPHARMACOLOGY,UNIVERSlTYOFGRAZ,UNlVERSITiiTSPLATZ4,A-8010GRAZ,AUSTRIA ABSTRACT. The preprotachykinin-A gene-derived peptides substance (substance P; SP) and neurokinin (NK) A are expressed in intrinsic enteric neurons, which supply all layers of the gut, and extrinsic primary afferent nerve fibers, which innervate primarily the arterial vascular system. The actions of tachykinins on the digestive effector systems are mediated by three different types of tachykinin receptor, termed NK,, NKr and NK, receptors. Within the enteric nervous system, SP and NKA are likely to mediate, or comediate, slow synaptic transmission and to modulate neuronal excitability via stimulation of NK, and NK, receptors. In the intestinal mucosa, tachykinins cause net secretion of fluid and electrolytes, and it appears as if SP and NKA play a messenger role in intramural secretory reflex pathways. Secretory processes in the salivary glands and pancreas are likewise influenced by tachykinins. The gastrointestinal arterial system may be dilated or constricted by tachykinins, whereas constriction and an increase in the vascular permeability are the only effects seen in the venous system. Various gastrointestinal disorders are associated with distinct changes in the tachykinin system, and there is increasing evidence that tachykinins participate in the hypersecretory, vascular and immunological disturbances associated with infection and inflammatory bowel disease. In a therapeutic perspective, it would seem conceivable that tachykinin antagonists could be exploited as antidiarrheal, anti- inflammatory and antinociceptive drugs.
    [Show full text]
  • Eicosanoids & Platelet Activating Factor
    Eicosanoids & Platelet Activating Factor Prof. Sanjay Khattri Dept. of Pharmacology & Therapeutics King George’s Medical University, Lucknow 1 Autacoid These are the substances produced by wide variety of cells that act locally at the site of production. (local hormones) 2 Mediators of Inflammation and Immune reaction 1. Vasoactive amines (Histamine and Serotonin) 2.Eicosanoids 3.Platlet Activating Factor 4.Bradykinins 4.Nitric Oxide 5.Neuropeptides 6.Cytokinines 3 EICOSANOIDS PGs, TXs and LTs are all derived from eicosa (referring to 20 C atoms) tri/tetra/ penta enoic acids. Therefore, they can be collectively called eicosanoids. Major source: 5,8,11,14 eicosa tetraenoic acid (arachidonic acid). Other eicosanoids of increasing interest are: lipoxins and resolvins. The term prostanoid encompasses both prostaglandins and thromboxanes. 4 EICOSANOIDS Contd…. In most instances, the initial and rate-limiting step in eicosanoid synthesis is the liberation of intracellular arachidonate, usually in a one-step process catalyzed by the enzyme phospholipase A2 (PLA2). PLA2 generates not only arachidonic acid but also lysoglyceryl - phosphorylcholine (lyso-PAF), the precursor of platelet activating factor (PAF). 5 EICOSANOIDS Contd…. Corticosteroids inhibit the enzyme PLA2 by inducing the production of lipocortins (annexins). The free arachidonic acid is metabolised separately (or sometimes jointly) by several pathways, including the following: Cyclo-oxygenase (COX)- Two main isoforms exist, COX-1 and COX-2 Lipoxygenases- Several subtypes, which
    [Show full text]
  • Geisinger Lewistown Hospital Published: March 25, 2019
    Geisinger Lewistown Hospital Published: March 25, 2019 DESCRIPTION CHARGE Fine needle aspiration; without imaging guidance $ 607.00 Fine needle aspiration; without imaging guidance $ 286.00 Fine needle aspiration; with imaging guidance $ 2,218.00 Fine needle aspiration; with imaging guidance $ 1,691.00 Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion $ 1,979.00 Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; each $ 1,385.00 additional lesion (List separately in addition to code for primary procedure) Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single $ 657.00 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or $ 986.00 multiple Incision and drainage of pilonidal cyst; simple $ 657.00 Incision and drainage of pilonidal cyst; complicated $ 3,726.00 Incision and removal of foreign body, subcutaneous tissues; simple $ 1,694.00 Incision and removal of foreign body, subcutaneous tissues; complicated $ 4,710.00 Incision and drainage of hematoma, seroma or fluid collection $ 3,470.00 Puncture aspiration of abscess, hematoma, bulla, or cyst $ 1,272.00 Puncture aspiration of abscess, hematoma, bulla, or cyst $ 657.00 Incision
    [Show full text]
  • Title 16. Crimes and Offenses Chapter 13. Controlled Substances Article 1
    TITLE 16. CRIMES AND OFFENSES CHAPTER 13. CONTROLLED SUBSTANCES ARTICLE 1. GENERAL PROVISIONS § 16-13-1. Drug related objects (a) As used in this Code section, the term: (1) "Controlled substance" shall have the same meaning as defined in Article 2 of this chapter, relating to controlled substances. For the purposes of this Code section, the term "controlled substance" shall include marijuana as defined by paragraph (16) of Code Section 16-13-21. (2) "Dangerous drug" shall have the same meaning as defined in Article 3 of this chapter, relating to dangerous drugs. (3) "Drug related object" means any machine, instrument, tool, equipment, contrivance, or device which an average person would reasonably conclude is intended to be used for one or more of the following purposes: (A) To introduce into the human body any dangerous drug or controlled substance under circumstances in violation of the laws of this state; (B) To enhance the effect on the human body of any dangerous drug or controlled substance under circumstances in violation of the laws of this state; (C) To conceal any quantity of any dangerous drug or controlled substance under circumstances in violation of the laws of this state; or (D) To test the strength, effectiveness, or purity of any dangerous drug or controlled substance under circumstances in violation of the laws of this state. (4) "Knowingly" means having general knowledge that a machine, instrument, tool, item of equipment, contrivance, or device is a drug related object or having reasonable grounds to believe that any such object is or may, to an average person, appear to be a drug related object.
    [Show full text]
  • NEW ZEALAND DATA SHEET 1. PRODUCT NAME IOPIDINE® (Apraclonidine Hydrochloride) Eye Drops 0.5%
    NEW ZEALAND DATA SHEET 1. PRODUCT NAME IOPIDINE® (apraclonidine hydrochloride) Eye Drops 0.5%. 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each mL of Iopidine Eye Drops 0.5% contains apraclonidine hydrochloride 5.75 mg, equivalent to apraclonidine base 5 mg. Excipient with known effect Benzalkonium chloride 0.1 mg per 1 mL as a preservative. For the full list of excipients, see section 6.1. 2. PHARMACEUTICAL FORM Eye drops, solution, sterile, isotonic. 4. CLINICAL PARTICULARS 4.1. Therapeutic indications Iopidine Eye Drops 0.5% are indicated for short-term adjunctive therapy in patients on maximally tolerated medical therapy who require additional IOP reduction. Patients on maximally tolerated medical therapy who are treated with Iopidine Eye Drops 0.5% to delay surgery should have frequent follow up examinations and treatment should be discontinued if the intraocular pressure rises significantly. The addition of Iopidine Eye Drops 0.5% to patients already using two aqueous suppressing drugs (i.e. beta-blocker plus carbonic anhydrase inhibitor) as part of their maximally tolerated medical therapy may not provide additional benefit. This is because apraclonidine is an aqueous-suppressing drug and the addition of a third aqueous suppressant may not significantly reduce IOP. The IOP-lowering efficacy of Iopidine Eye Drops 0.5% diminishes over time in some patients. This loss of effect, or tachyphylaxis, appears to be an individual occurrence with a variable time of onset and should be closely monitored. The benefit for most patients is less than one month. 4.2. Dose and method of administration Dose One drop of Iopidine Eye Drops 0.5% should be instilled into the affected eye(s) three times per day.
    [Show full text]
  • Drug List (SORTED by TRADE with GENERIC EQUIVALENT)
    NBEO Drug List (SORTED BY TRADE WITH GENERIC EQUIVALENT) Trade Generic Trade Generic Abilify aripiprazole Avandia rosiglitazone Accolate zafirlukast Avastin bevacizumab Accupril quinapril Azasan azathioprine Achromycin tetracycline AzaSite azithromycin Aciphex rabeprazole Avodart dutasteride Actos pioglitazone Azopt brinzolamide Acular ketorolac Bactrim trimethoprim-sulfamethoxazole Acuvail ketorolac Bactrim DS trimethoprim-sulfamethoxazole Advair fluticasone propionate Baquacil polyhexamethylene biguanide Advil ibuprofen Beconase AQ beclomethasone AeroBid flunisolide Benadryl diphenhydramine Afrin oxymetazoline Bepreve Bepotastine besilate Aggrenox aspirin and dipyridamole Besivance besifloxacin Alamast pemirolast Betadine povidone-iodine Alaway ketotifen Betagan levobunolol Aldactone spironolactone Betasept chlorhexidine topical Aleve naproxen sodium Betaseron interferon beta-1b Allegra fexofenadine Betimol timolol Allegra-D fexofenadine-pseudoephedrine Betoptic S betaxolol Alluvia lopinavir Biopatch chlorhexidine topical Alocril nedocromil Blephamide sulfacetamide-prednisolone Alomide lodoxamide Botox onabotulinum toxinA Alphagan P brimonidine Brolene propamidine isethionate Alrex loteprednol 0.2% Bromday bromfenac Ambien zolpidem Calamine zinc oxide and iron oxide Amicar aminocaproic acid Calan verapamil Amoxil amoxicillin Calgon Vesta chlorhexidine topical Amphocin amphotericin B Capoten captopril Anectine succinylcholine Carafate sucralfate Ansaid flurbiprofen Carbocaine mepivacaine HCl injection Antivert meclizine Cardizem diltiazem
    [Show full text]
  • IOPIDINE® 0.5% (Apraclonidine Ophthalmic Solution) 0.5% As Base
    IOPIDINE® 0.5% (apraclonidine ophthalmic solution) 0.5% As Base DESCRIPTION: IOPIDINE® 0.5% Ophthalmic Solution contains apraclonidine hydrochloride, an alpha adrenergic agonist, in a sterile isotonic solution for topical application to the eye. Apraclonidine hydrochloride is a white to off-white powder and is highly soluble in water. Its chemical name is 2-[(4-amino-2,6 dichlorophenyl) imino]imidazolidine monohydrochloride with an empirical formula of C9H11Cl3N4 and a molecular weight of 281.57. The chemical structure of apraclonidine hydrochloride is: Each mL of IOPIDINE 0.5% Ophthalmic Solution contains: Active: apraclonidine hydrochloride 5.75 mg equivalent to apraclonidine base 5 mg; . Inactives: sodium chloride, sodium acetate, sodium hydroxide and/or hydrochloric acid (pH 4.4-7.8), purified water and benzalkonium chloride 0.01% (preservative) CLINICAL PHARMACOLOGY: Apraclonidine hydrochloride is a relatively selective alpha- 2-adrenergic agonist. When instilled in the eye, IOPIDINE 0.5% Ophthalmic Solution, has the action of reducing elevated, as well as normal, intraocular pressure (IOP), whether or not accompanied by glaucoma. Ophthalmic apraclonidine has minimal effect on cardiovascular parameters. Elevated IOP presents a major risk factor in glaucomatous field loss. The higher the level of IOP, the greater the likelihood of optic nerve damage and visual field loss. IOPIDINE 0.5% Ophthalmic Solution has the action of reducing IOP. The onset of action of apraclonidine can usually be noted within one hour, and maximum IOP reduction occurs about three hours after instillation. Aqueous fluorophotometry studies demonstrate that apraclonidine's predominant mechanism of action is reduction of aqueous flow via stimulation of the alpha-adrenergic system.
    [Show full text]
  • Anesthetic Considerations for the Parturient with Idiopathic Intracranial Hypertension Levi G
    University of North Dakota UND Scholarly Commons Nursing Capstones Department of Nursing 7-12-2018 Anesthetic Considerations for the Parturient with Idiopathic Intracranial Hypertension Levi G. La Porte Follow this and additional works at: https://commons.und.edu/nurs-capstones Recommended Citation La Porte, Levi G., "Anesthetic Considerations for the Parturient with Idiopathic Intracranial Hypertension" (2018). Nursing Capstones. 187. https://commons.und.edu/nurs-capstones/187 This Independent Study is brought to you for free and open access by the Department of Nursing at UND Scholarly Commons. It has been accepted for inclusion in Nursing Capstones by an authorized administrator of UND Scholarly Commons. For more information, please contact [email protected]. Running head: SAFETY OF SUGAMMADEX AND NEOSTIGMINE 1 The Safety and Efficacy in Reversal of Neuromuscular Blockades with Sugammadex versus Neostigmine by Nicole L. Landen Bachelor of Science in Nursing, University of Minnesota, 2014 An Independent Study Submitted to the Graduate Faculty of the University of North Dakota in partial fulfillment of the requirements for the degree of Master of Science Grand Forks, North Dakota December 2019 SAFETY OF SUGAMMADEX AND NEOSTIGMINE 2 PERMISSION Title The Safety and Efficacy in Reversal of Neuromuscular Blockades with Sugammadex versus Neostigmine Department Nursing Degree Master of Science In presenting this independent study in partial fulfillment of the requirements for a graduate degree from the University of North Dakota, I agree that the College of Nursing and Professional Disciplines of this University shall make it freely available for inspection. I further agree that permission for extensive copying or electronic access for scholarly purposes may be granted by the professor who supervised my independent study work or, in her absence, by the chairperson of the department or the dean of the School of Graduate Studies.
    [Show full text]
  • Estonian Statistics on Medicines 2016 1/41
    Estonian Statistics on Medicines 2016 ATC code ATC group / Active substance (rout of admin.) Quantity sold Unit DDD Unit DDD/1000/ day A ALIMENTARY TRACT AND METABOLISM 167,8985 A01 STOMATOLOGICAL PREPARATIONS 0,0738 A01A STOMATOLOGICAL PREPARATIONS 0,0738 A01AB Antiinfectives and antiseptics for local oral treatment 0,0738 A01AB09 Miconazole (O) 7088 g 0,2 g 0,0738 A01AB12 Hexetidine (O) 1951200 ml A01AB81 Neomycin+ Benzocaine (dental) 30200 pieces A01AB82 Demeclocycline+ Triamcinolone (dental) 680 g A01AC Corticosteroids for local oral treatment A01AC81 Dexamethasone+ Thymol (dental) 3094 ml A01AD Other agents for local oral treatment A01AD80 Lidocaine+ Cetylpyridinium chloride (gingival) 227150 g A01AD81 Lidocaine+ Cetrimide (O) 30900 g A01AD82 Choline salicylate (O) 864720 pieces A01AD83 Lidocaine+ Chamomille extract (O) 370080 g A01AD90 Lidocaine+ Paraformaldehyde (dental) 405 g A02 DRUGS FOR ACID RELATED DISORDERS 47,1312 A02A ANTACIDS 1,0133 Combinations and complexes of aluminium, calcium and A02AD 1,0133 magnesium compounds A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 811120 pieces 10 pieces 0,1689 A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 3101974 ml 50 ml 0,1292 A02AD83 Calcium carbonate+ Magnesium carbonate (O) 3434232 pieces 10 pieces 0,7152 DRUGS FOR PEPTIC ULCER AND GASTRO- A02B 46,1179 OESOPHAGEAL REFLUX DISEASE (GORD) A02BA H2-receptor antagonists 2,3855 A02BA02 Ranitidine (O) 340327,5 g 0,3 g 2,3624 A02BA02 Ranitidine (P) 3318,25 g 0,3 g 0,0230 A02BC Proton pump inhibitors 43,7324 A02BC01 Omeprazole
    [Show full text]
  • Glaucoma Medical Treatment: Philosophy, Principles and Practice
    Glaucoma medical CLIVE MIGDAL treatment: philosophy, principles and practice Abstract assessment of these parameters. Indeed There have been numerous recent advances in compounds are under evaluation that affect the the management of glaucoma, not least the function of the optic nerve (via improved blood development of new drugs to help manage supply or improved neuronal cell physiology) raised intraocular pressure. In addition, the but may or may not lower lOP. It may even be concepts of improving blood flow to the optic possible in the future to therapeutically alter the nerve head and neuroprotection are currently human genome, genetically deliver provoking considerable interest. This article neuroprotective substances or aid regeneration considers the aims and philosophy of of the optic nerve axons. glaucoma drug therapy, summarises some of The main aim of glaucoma therapy must still the basic facts and principles of modem be the preservation of visual function. At the glaucoma medications, and suggests a same time, the therapy should not have adverse practical approach to the choice of therapy. side effects and should not affect the quality of life of the patient (by causing either side effects Key words Blood flow, Intraocular pressure, or inconvenience and disruption of daily Neuroprotection, Primary open angle glaucoma, Topical medications lifestyle). The cost of the therapy, both direct and indirect, must also be taken into consideration.s Currently, typical glaucoma management Philosophy consists of lowering the lOP to a satisfactory Primary open-angle glaucoma is a complex and safe target leve1.6 To determine the success disease for which a number of risk factors have of this treatment, the patient must be followed been identified, including intraocular pressure, long-term with routine assessment of lOP, discs age, race and family history.l,2 Due to our and fields to exclude progressive damage.
    [Show full text]