Blue Pharm 2

Question 2

What is the mechanism of action for tacrolimus and cyclosporine?

Answer 2

Both tacrolimus and cyclosporine inhibit calcineurin, which inactivates NFAT and inhibits IL-2.

Question 3

How much more potent is tacrolimus compared to cyclosporine, and what are its main uses?

Answer 3

Tacrolimus is 50–100 times more potent than cyclosporine and is used mainly after allogenic transplants and for immune-mediated diseases like corneal graft rejection, ocular inflammation, ocular pemphigoid, and uveitis.

Question 4

What is the main enzyme responsible for the metabolism of tacrolimus?

Answer 4

CYP3A5 is the main enzyme responsible for tacrolimus metabolism.

Question 5

What is the indication for topical ciclosporin eye drops (Ikervis)?

Answer 5

Topical ciclosporin eye drops are indicated for severe keratitis in adult patients with dry eye disease unresponsive to tear substitutes.

Question 6

What are the common ocular adverse events with ciclosporin eye drops?

Answer 6

Common adverse events include instillation site pain (6%), instillation site irritation (9%), eye irritation (8.8%), eye pain (3.5%), and instillation site lacrimation.

Question 7

How does vismodegib work in treating BCC?

Answer 7

Vismodegib inhibits the Hedgehog pathway, which is involved in cell growth and differentiation and implicated in BCC pathogenesis.

Question 8

What is the mechanism of action of mitomycin-C in glaucoma surgery?

Answer 8

Mitomycin-C works by alkylating DNA, acting as an immunosuppressant.

Question 9

What is the key difference between tacrolimus/cyclosporine and anti-TNF-alpha treatments like infliximab and adalimumab?

Answer 9

Tacrolimus and cyclosporine inhibit interleukin-2, whereas infliximab and adalimumab target TNF-alpha.

Question 10

What does Macushield contain and what are its reported benefits in the context of age-related macular degeneration?

Answer 10

Macushield contains zeaxanthin and meso-zeaxanthin and has been shown to reduce the risk of visual loss and disease progression in non-advanced age-related macular degeneration.

Question 11

What is meso-zeaxanthin, and why is it important in Macushield?

Answer 11

Meso-zeaxanthin is a carotenoid extracted from marigolds and is essential for maximizing the antioxidant effect, particularly in the macula.

Question 13

What is the main difference between the AREDS1 and AREDS2 formulas regarding beta-carotene?

Answer 13

AREDS1 formula includes beta-carotene, while AREDS2 replaces it with lutein and zeaxanthin.

Question 14

What does the AREDS2 formula include that the AREDS1 formula does not?

Answer 14

The AREDS2 formula includes lutein and zeaxanthin, which were not present in the AREDS1 formula.

Question 15

How does the AREDS2 formula differ in terms of zinc content compared to AREDS1?

Answer 15

The AREDS2 formula reduces the zinc content by 25% compared to the AREDS1 formula, from 80 mg to 25 mg.

Question 17

Why did AREDS2 replace beta-carotene with lutein and zeaxanthin?

Answer 17

AREDS2 replaced beta-carotene with lutein and zeaxanthin to reduce the risk of lung cancer in smokers, as beta-carotene increased this risk, while lutein and zeaxanthin offer targeted antioxidant protection for the eye without this risk.

Question 18

What is the classical triad of presumed ocular histoplasmosis syndrome (POHS)?

Answer 18

The classical triad of POHS includes yellow spots, a macular CNVM, and atrophy/scarring adjacent to the optic disc.

Question 19

What additional finding might be seen in the peripheral fundus of a patient with presumed ocular histoplasmosis syndrome (POHS)?

Answer 19

Linear rows of histo-spots might be visible in the peripheral fundus of a patient with POHS.

Question 20

Where is presumed ocular histoplasmosis syndrome (POHS) endemic?

Answer 20

POHS is endemic in the Ohio and Mississippi river valleys.

Question 21

How is presumed ocular histoplasmosis syndrome (POHS) treated?

Answer 21

POHS is not treated with oral antifungals; treatment options include focal or photodynamic therapy laser, surgical removal of the lesion, antivascular endothelial growth factor (VEGF) treatment, and intravitreal triamcinolone steroids.

Question 22

What are EGFR inhibitors used to treat, and what effect do they have on the cornea?

Answer 22

EGFR inhibitors are used for treating solid tumors like non-small cell bronchial carcinoma, pancreatic carcinoma, colorectal carcinoma, and BCC. EGFR plays a key role in corneal wound healing, and its inhibition can delay healing and cause inflammation of the meibomian glands.

Question 23

How does epidermal growth factor (EGF) influence the meibomian glands in the eyelids?

Answer 23

EGF stimulates the proliferation of epithelial cells in the meibomian glands in the eyelids.

Question 24

What is the main concern when using dapsone in patients with G6PD deficiency?

Answer 24

Dapsone should not be used in patients with G6PD deficiency as it increases the risk of haemolysis.

Question 25

What is dapsone used to treat in ophthalmology, and what are the treatment escalation options if it is not effective?

Answer 25

Dapsone is effective in treating mild ocular cicatricial pemphigoid. If not effective within 3 months, treatment should be escalated to azathioprine, methotrexate, mycophenolate, or cyclophosphamide.

Question 26

What is imiquimod used to treat, and how does it work?

Answer 26

Imiquimod is used to treat superficial basal cell carcinoma (BCC) and works as a toll-like receptor 7 agonist, modifying the immune response through upregulation of cytokines.

Question 27

How does the effectiveness of imiquimod compare to surgery for treating BCC?

Answer 27

While surgery is the gold standard for treating BCC, imiquimod is a relatively effective, less invasive, and cheaper treatment option for superficial BCC.