Direct Cholinergic Antagonists Flashcards
(169 cards)
1
Q
What is the 1 direct cholinergic agonists on the drug list?
A
Pilocarpine
2
Q
What is the MOA of pilocarpine as an IOP lowering agent?
A
Interaction with ciliary muscle receptors
Pulls scleral spur posteriorly and opens the TM
3
Q
Pilocarpine can be used to diagnose which pupil dysfunction?
A
Adie’s tonic pupil
4
Q
What are the 5 potential side effects of Pilocarpine?
A
Browaches Headaches Myopic shifts Cataracts Secondary angle-closure
5
Q
What are 4 the indirect cholinergic agonists?
A
Edrophonium
Echothiophate
Pyridostigmine
Neostigmine
6
Q
How do the indirect cholinergic agonists work?
A
Inhibit acetylcholinesterase, making them parasympathomimetics
7
Q
What is the indication for edrophonium?
A
Tensilon test for MG
8
Q
What are the 2 possible indications for echothiophate?
A
Accommodative esotropia
Glaucoma (rarely)
9
Q
What is the indication for pyridostigmine?
A
Tx of MG
-60mg every 4 hours
10
Q
What is the indication for neostigmine?
A
Evaluate limb strength in suspected myasthenics
11
Q
What do cholinergic antagonists do?
A
Mimic the sympathetic system by blocking the parasympathetic system
12
Q
What are the 5 ocular cholinergic antagonists?
A
"STop ACH" Scopolamine Tropicamide Atropine Cyclopentolate Homatropine
13
Q
What is the 1 systemic cholinergic antagonist?
A
Succinylcholine
14
Q
Which med has the higher possibility of CNS toxicity, scopolamine or atropine? Why?
A
Scopolamine
Better penetrance of the blood-brain barrier
15
Q
What is the most potent mydriatic and cycloplegic med?
A
Atropine
16
Q
What is the duration of atropine?
A
Up to 10 days dilation
17
Q
Atropine should not be used in what patient population?
A
Down’s syndrome
18
Q
Which anti-cholinergic is most often used in conjunction with Pred Forte for uveitis?
A
Homatropine 5% BID
19
Q
What is the indication for the systemic cholinergic antagonish succinylcholine?
A
Muscle relaxant prior to surgery
*contraindicated for intraocular Sx
20
Q
What is the general MOA of adrenergic agonists?
A
Promote the sympathetic system
21
Q
Which 3 adrenergic agonists work primarily on alpha-1 receptors?
A
Phenylephrine
Tetrahydrozoline
Naphazoline
22
Q
Which 2 adrenergic agonists work primarily on alpha-2 receptors?
A
Apraclonidine
Brimonidine
23
Q
Which adrenergic agonist works primarily on neorepinephrine activitiy?
A
Hydroxyamphetamine
24
Q
Care should be taken if using phenyl 10% on patients with what conditions?
A
Heart conditions HTN Grave's MAOI use TCA use
25
What is the major drawback to using apraclonidine for glaucoma?
Tachyphylaxis
26
Other than tachyphylaxis, what issue of commonly found with long term use of apraclonidine?
Allergy (50% if used for more than 1 year)
27
Which alpha agonist is more alpha-2 selective, apraclonidine or brimonidine?
Brimonidine
28
Which IOP lowering drop may have neuroprotective properties?
Brimonidine
29
What is the typical dosing schedule for brimonidine?
TID
30
What is the most common systemic side effect to the alpha agonist IOP gtts?
Dry mouth
31
Brimonidine is contraindicated in patients taking what class of drug?
Monoamine oxidase inhibitors
32
What is the clinical use of hydroxyamphetamine?
Lesion location in Horner's
| -if pt doesn't dilate with HA, lesion is postganglionic
33
What are the 6 adrenergic agonists?
```
Phenylephrine
Tetrahydrozoline
Naphazoline
Apraclonidine
Brimonidine
Hydroxyamphetamine
```
34
What is the typical dosage schedule for naphazoline and tetrahydrozoline?
No more than QID
35
What class of drug is metaproterenol, and what is its indication?
Beta-2 agonist
| Bronchodilator for asthma
36
Ritalin and Dexedrine are in which class of drugs, and may cause what side effects?
Adrenergic agonists for ADD, narcolepsy and depression
Mydriasis and dry eyes
(possible angle closure with narrow angles)
37
What is the MOA of clonidine?
Alpha-2 agonist
38
What is the indication for Clonidine?
HTN
| -decreases vascular resistance and heart rate
39
Cocaine blocks which type of channels?
Na
40
Cocaine has what effect on healthy eyes?
Mydriasis
41
What is the MOA of Albuterol, and its indication?
Beta 2 agonist
| Asthma, COPD
42
What are the potential side effects of albuterol?
```
Tachycardia (due to Beta-1 activity)
Heart palpitations
Nervousness
Tremor
Nausea
```
43
What is levalbuterol?
A new derivative of albuterol, with fewer side effects
44
What are the 4 ocular beta blockers?
Timolol
Levobunolol
Betaxolol
Metipranolol
45
What are the 4 systemic beta-blockers?
Labetolol
Propranolol
Atenolol
Metoprolol
46
Which ocular beta blocker is safest for lung conditions, due to primary beta-1 activity?
Betaxolol
47
Timolol should be used cautiously in patients with which 3 systemic conditions? Why?
Diabetes
Hyperthyroidism
MG (worsened by Timolol)
Can mask clinical signs/symptoms
48
What is the typical dosing schedule of timolol for IOP reduction?
BID, but QD is acceptable
49
If dosed QD, when should timolol be administered?
AM - it has better daytime efficacy
50
Ocular beta-blockers can lose efficacy due to what 2 reasons?
Long-term drift
| Short-term escape
51
Cosopt is a combo of what 2 meds?
Timolol
| Dorzolamide (CAI)
52
What is the typical dosing schedule for Cosopt?
BID
53
Combigan is a combo of what 2 meds?
Timolol
| Brimonidine (a-agonist)
54
Which beta-blocker should be most avoided in patients with heart problems?
Betaxolol
55
What class of med is tamsulosin?
Alpha-blocker
56
What class of med and what is the indication for prazosin?
Alpha blocker
| HTN
57
What class of med is dapiprazole, and what is its indication?
Topical alpha blocker (only one)
| Reverses dilation
58
What are the 2 ocular carbonic anhydraze inhibitors?
Brinzolamide (Azopt)
| Dorzolamide (trusopt)
59
What is the typical dosing schedule of dorzolamide?
TID
60
What is the typical dosing schedule of brinzolamide?
BID
61
What are the 3 oral CAIs?
Acetazolamide
Methazolamide
Dichlorphenamide
62
What is the dosing of oral acetazolamide for angle closure?
500mg
63
What are the common adverse effects of oral acetazolamide?
```
Metallic taste
Tingling hands/feet
Metabolic acidosis
Aplastic anemia
Diarrhea
Myopic shifts
```
64
Acetazolamide is contraindicated in what conditions?
COPD
Pregnancy
Sulfa allergy
Renal disease
65
What are the potential side effects of prostaglandin analogs?
Increased pigmentation/growth of lashes
Skin darkening
Iris heterochromia
Conj hyperemia
66
Prostaglandin analogs are contraindicated in patients with what?
CME
Active inflammation
Previous herpes simplex keratits
67
If used during acute angle closure, which med is best for diabetics, glycerine or isosorbide?
Isosorbide
| -Glycerin breaks down into carbs
68
What is the typical dosing of Muro 128 soln?
QID
69
Which 2 meds are cell wall synthesis inhibitor via inhibition of peptidoglycan?
Bacitracin
| Vangomycin
70
Which 2 types of ABx inhibit cell wall synthesis via inhibition of transpeptidase?
Penicillins
| Cephalosporins
71
Bacitracin is selective to which type of bacteria?
Gram +
72
What ABx are in polysporin?
```
Bacitracin (+)
Poymyxin B (-)
```
73
What ABx are in neosporin?
Polysporin
| Neomycin
74
Vancomycin is strong, but has what 3 severe potential side effects?
Ototoxicity
Nephrotoxicity
Red Man Syndrome
75
What are the 2 major indications for IV Vancomycin?
Endophthalmitis
| MRSA
76
Penicillins are good for which gram type?
(+)
| Strep, syphilis, meningitis, pneumococcal
77
Which 2 types of penicillins have more gram (-) coverage than standard penicillin?
Ampicillin
| Amoxicillin
78
Augmentin is a combination of amoxicillin and what?
Clavulonic acid (penicillinase inhibitor)
79
If a patient is allergic to penicillin, they may also be allergic to which class of ABx?
Cephalosporins
80
Which 3 penicillins are penicillinase resistant?
Methicillin
Nafcillin
Dicloxacillin
81
Keflex is commonly prescribed for what 3 ocular conditions?
Dacryoadenitis
Dacryocystitis
Preseptal cellulitis
82
What is the IV treatment of choice for gonococcal conjunctivitis and orbital cellulitis?
Ceftriaxone
83
Which 4 ABx types impact DNA synthesis?
Fluoroquinolones
Sulfonamides
Trimethoprim
Pyrimthamine
84
Fluoroquinolones inhibit bacterial DNA synthesis by acting on what 2 things?
DNA gyrase
| Topoisomerase IV
85
What are the possible side effects of fluoroquinolones?
Tendonitis
| Inhibition of cartilage and bone growth in kids
86
Fluoroquinolones primarily work agains which gram of bacteria?
(-)
| Later generations have increased (+) coverage
87
What are the 4 sulfonamides?
Sulfisoxazole
Sulfacetamide
Sulfamethoxazole
Sulfadiazine
88
How do sulfonamides work?
Inhibit the 1st step of folic acid synthesis
89
Why aren't topical sulfonamides prescribed often?
Resistance
90
Sulfadiazine is used in combination with pyrimethamine to treat what?
Toxooplasmosis
91
Which 2 antibiotics inhibits the second step of folic acid synthesis?
Trimethoprim
| Pyrimethamine
92
What meds make up polytrim?
Trimethoprim
| Polymyxin B
93
What types of ABx impact protein synthesis?
```
Aminoglycosides (30S)
Tetracyclines (30S)
Chloramphenicol (50S_
Lincomycin (50S)
Macrolides (50S)
Clinadmycin (50S)
```
94
What are the 3 macrolide ABx?
Erythromycin
Azithromycin
Clarithromycin
95
What are the 2 aminoglycosides?
Tobramycin
| Gentamycin
96
Why aren't aminoglycosides commonly used?
Corneal toxicity
97
Which gram coverage do aminoglycosides offer?
broad spectrum, but (-) > (+)
98
Which aminoglycoside is available in both topical ophthalmic and ointment forms?
Tobramycin
99
Why aren't oral aminoglycosides common?
Nephrotoxicity
| Ototoxicity
100
What gram coverage to tetracyclines offer?
Broad spectrum
101
What is the typical dosing of doxycycline for MGD?
100mg BID x 4 weeks
| Then QD 3-6 months
102
What is the dosing of doxycycline for chlamydial conjunctivitis?
100mg BID x 10 days
103
What are the important side effects of doxycycline?
```
Pseudotumor cerebrii
Bone growth retardation
Tooth discoloration
Photosensitivity
GI distress
```
104
Which oral ABs should be taken without food?
"PAT"
Penicillin
Azithromycin
Tetracycline
105
What is the major side effects of chloramphenicol that makes it an uncommonly prescribed med?
Aplastic anemia
Optic neuritis
Gray baby syndrome
106
What are the 3 macrolides?
Erythromycin
Azithromycin
Clarithromycin
107
Macrolides act on which bacterial subunit?
50S
108
Which macrolide is commonly used for chlamydial conjunctivitis Tx?
Azithromycin
| Single 1g dose on empty stomach
109
What is the dosing of topical azithromycin soln (AzaSite) for blepharitis?
QD
110
What are the 4 TB drugs?
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
111
Which TB drug can cause orange tears?
Rifampin
112
Which of the TB drugs can cause optin neuritis?
Isoniazid
| Ethambutol
113
What is the common suffix of anti-fungal drugs?
Azole
114
What type of drug is amphotericin B?
Anti-fungal
| -Ung and soln
115
What are the common Tx choices for fungal keratitis?
Natamycin
Amphotericin B
Q1-2H
Possible systemic anti-fungals
116
What is the Tx for acanthamoeba?
Oral ketoconazole 200mg x several weeks
| Topical anti-fungal Q1-2H
117
What is the only FDA approved topical for fungal infections?
Natamycin
118
What topical med is prescribed for HSK?
Trifluridine (viroptic)
119
What is the Tx for HSK?
Trifluridine Q2H until re-epithelialization
| Then 5x/day for 5-7 days
120
What are the 3 oral Tx for HZO?
Acyclovir
Valacyclovir
Famciclovir
121
What is the dosing of the 3 oral antivirals for HZO?
Acyclovir 800mg 5x/day 7 days
Valacyclovir 1000mg TID x 7 days
Famciclovir 500mg TID x 7 days
122
What is the dosing of the 3 oral antivirals for HSK?
Acyclovir 400mg 5x/day 7 days
Valacyclovier 500mg TID x 7 days
Famciclovier 250mg TID x 7 days
123
Which 2 antivirals may be prescribed for CMV?
Ganciclovir IV
| Foscarnet (if ganciclovir fails)
124
What are the 2 important antiparacitic drugs?
Chloroquine
| Kwell
125
What is the dosing of Choroquine that increases risk of bull's eye maculopathy?
3mg/kg
| 5 years
126
What is the Tx for ocular pediculosis?
Removal of lice and eggs
| Topical ABx ung TID 1-2 weeks
127
Which common OTC analgesic has no anti-inflammatory properties?
Acetaminophen (Tylenol)
128
What is the overdose risk of acetaminophen?
Hepatotoxicity - 4000mg/day
129
What are the ocular side effects of opioids?
Miosis
130
What are the typical systemic side effects of opioids?
```
Respiratory depression
Drowsiness
Euphoria
Nausea
Vomiting
GI depression
```
131
What are alprazolam and diazepam used to treat?
Anxiety
| Xanax and Valium
132
What are the side effects of alprazolam and diazepam?
```
Mydriasis
Nystagmus
Drowsiness
Sedation
Confusion
```
133
Anti-anxiety meds should never be taken with what?
Alcohol
134
What are the 2 important antipsychotic meds?
Chlorpromazine (Thorazine)
| Thioridazine (Mellaril)
135
What are the side effects of the antipsychotics?
```
Hyperpigmentation of RPE
Endothelial pigment
Anterior cataracts
Dry eye
Mydriasis
Increased IOP
```
136
What are the 4 anti-parkinson's drugs?
Carbidopa-Levodopa (Sinemet)
Bromocriptine (Parlodel)
Selegeline (Eldepryl
Amantadine (Symmetrel)
137
Anti-parkinson's meds can also be used to treat what ocular condition?
Benign essential blepharospasm
138
What is Donepezil (Aricept) used for?
Dementia
139
What are the ocular side effects of Donepezil?
Cataracts
Blurred vision
Irritation
140
What class of med is phenelzine (Nardil)?
MAOI
141
What common ocular med is contraindicated with phenelzine use?
Phenylephrine 10%
| -HTN crisis
142
What class of med is Amitriptyline (Elavil)?
TCA
143
How to tricyclic antidepressants work?
Inhibit norepinephrine and serotonin reuptake
144
What are the 2 ocular side effects of TCAs?
Dry eye
| Increased IOP
145
What common ocular med is contraindicated with TCA use?
Phenylephrine 10%
| -HTN crisis
146
What are the 2 SSRIs?
Fluoxetine (Prozac)
| Setraline (Zoloft)
147
What is the common ocular side effect of all antidepressant meds (MAOIs, TCAs, SSRIs)?
Dry eye
148
What are the 3 anticonvulsant meds?
Phenytoin (Dilantin)
Topriamate (Topomate)
Phenobarbitol (Luminal Na)
149
What are the potential ocular side effects of phenytoin?
Nystagmus
| Diplopia
150
What is the most common side effect of topiramate?
Blurry vision
| -May have acute secondary angle closure glaucoma
151
What class of med in Metformin?
Biguanide
152
What is the indication for Furosemide (Lasix)?
HTN
| Pulmonary edema
153
What is the indication for hydrochlorothiazide?
HTN
CHF
Hypercalciuria
154
What are the 4 ACE inhibitors?
Lisinopril
Benazepril
Enalapril
Captopril
155
What is the most common side effect of ACE inhibitors?
Cough
156
What class of med is Losartan?
Angiotensin II receptor Antagonist
157
What is the indication for losartan?
HTN
158
What is the indication for oral beta-blockers?
HTN
159
What are calcium channel blockers used for?
Angina
| HTN
160
What are the 3 Ca channel blockers?
Verapamil
Diltiazem
Nifedipine
161
What is the indication for Clonidine?
HTN
162
What are the ocular side effects of Digoxin?
Blue/yellow color defects
Entoptic phenomenon
Retrobulbar optic neuritis
163
What is the indication for amiodarone?
Arrhythmia (K channel blocker)
164
What is the dosing of amiodarone that makes whorl keratopathy inevitable?
400mg/day
165
What are the 4 stand alone mast cell stabilizers?
Cromolyn Na
Lodoxamide
Pemirolast
Nedocromil
166
What are the 2 stand alone topical antihistamines?
Emedastine
| Pheniramine
167
Why might a steroid be used on a corneal ulcer?
Reduce scarring (once defect is almost healed)
168
If using a mild steroid for allergic conjunctivitis, what is the typical dosing regimen?
QID x 7 dyas
| Then BID 4-8 weeks
169
Which NSAID has whorl keratopathy as a potential side effect?
Indomethacin
