Blue Pharm 1 Flashcards
(32 cards)
Why is methotrexate contraindicated in pregnancy, and when must it be stopped before conception?
Teratogenic at any dose; must be discontinued ≥ 3 months before conception.
What are the pregnancy risks associated with mycophenolate mofetil?
Teratogenicity and increased risk of spontaneous abortion; unsafe in pregnancy.
Which immunosuppressants are considered safe in pregnancy when dosed appropriately?
Azathioprine, ciclosporin, and tacrolimus.
Is prednisolone compatible with pregnancy?
Yes—safe in all stages of pregnancy.
What is the main CNS concern when using brimonidine in children?
Can cause CNS depression (drowsiness, lethargy); contraindicated < 2 years old.
How should brimonidine be used in children ≥ 2 but < 12 years?
Use with caution, close monitoring, and consider alternative IOP‑lowering therapy.
Are there contraindications to topical β‑blockers in pediatric ophthalmology?
None specific beyond usual systemic: asthma, COPD, bradycardia, and heart block.
Which topical carbonic anhydrase inhibitor is effective and safe in children?
Brinzolamide.
Are prostaglandin analogues safe for use in children?
Yes—they are considered safe.
What is co‑trimoxazole, and what ophthalmic infection is it commonly used to treat?
Trimethoprim + sulfamethoxazole; used for toxoplasma uveitis.
Why is acetazolamide contraindicated in certain patients?
It’s a sulfonamide derivative—contraindicated with confirmed sulfonamide hypersensitivity.
How is azathioprine (AZA) metabolized, and what is the population distribution of TPMT enzyme activity?
AZA is converted to its active metabolite via several steps including TPMT; TPMT activity is high/normal in ~90%, intermediate in ~10%, and low/absent in ~0.3% of individuals.
What do the British Society of Rheumatology DMARD guidelines recommend before initiating azathioprine?
They recommend performing a TPMT assay to assess risk of toxicity, though routine blood monitoring (FBC, U&E, LFTs) remains mandatory regardless of TPMT result.
What should be considered for patients with low or absent TPMT activity starting AZA?
They are at risk of delayed, profound neutropenia—consider reducing AZA dose or using an alternative agent.
What is Mydricaine for subconjunctival injection, and what are the key practical considerations?
An off‑license 0.3mL Moorfields preparation for acute anterior uveitis mydriasis; caution advised in pregnancy (not contraindicated), not UK‑licensed but widely used when no alternatives exist.
How do Mydricaine No.1 and No.2 preparations differ?
No.1 (paediatric/elderly): procaine 3mg + atropine + adrenaline at half strength; No.2 (adult): procaine 6mg + atropine + adrenaline at full (double No.1) strength.
What is the mechanism of action of vigabatrin and how is it absorbed?
Selective irreversible inhibitor of GABA‑transaminase; water‑soluble and rapidly absorbed from the gastrointestinal tract.
What is the typical dosing and main clinical uses of vigabatrin?
Maximal efficacy at 2–3g/day (children 50–100mg/kg/day); used for partial epilepsy (with or without secondary generalization) and as a main treatment for West syndrome (infantile spasms).
What is tocilizumab and what receptor does it target?
A humanized monoclonal antibody immunosuppressant that binds and inhibits the interleukin‑6 receptor (IL‑6R).
For which conditions is tocilizumab approved by NICE, and what is its dosing regimen?
Approved for rheumatoid arthritis and giant cell arteritis; administered as a weekly 162mg subcutaneous injection; key evidence from the multicenter GiACTA trial.
What is aflibercept (Eylea/VEGF Trap) and how does it work?
A soluble decoy receptor fusion protein that binds and inhibits VEGF‑A, VEGF‑B, and placental growth factor (PlGF).
How does aflibercept differ from ranibizumab and bevacizumab?
It has much higher affinity for VEGF‑A and uniquely targets VEGF‑B and PlGF, unlike ranibizumab and bevacizumab.
What are the therapeutic uses of topiramate beyond epilepsy?
Used for migraine prophylaxis, trigeminal neuralgia, and as adjunctive treatment for depression.
