Medications

Question 1

What are two classes of mydriatics?

Answer 1

anticholinergics
direct-acting sympathomimetics

Question 2

what drugs are anaesthetics?

Answer 2

proparacaine (duration- 20 min)
tetracaine (duration 30 min)
* tetracaine may sting when instilled

Question 3

what are the clinical uses for anesthetics?

Answer 3

provide pain relief
anesthesia for intraocular pressure checks
anesthesia for surgical procedures (FB removal)
chronic use is toxic to cornea

Question 4

what are the clinical uses of fluorescein?

Answer 4

corneal abrasion/ ulcers
IOP pressure check

Question 5

What three medications are anticholinergic mydriatic drops?

Answer 5

atropine (7-14 days)
cyclopentolate (12 hours)
tropicamide (4-6 hours)

Question 6

what is the mechanism of action of anticholinergic mydriatics?

Answer 6

paralysis of the iris sphincter by inhibition of parasympathetic innervation
cycloplegia by paralyzing the ciliary muscle (loss accommodation = blurred vision)

Question 7

what are the clinical uses of anti-cholinergic mydriatics?

Answer 7

fundoscopic examination
treatment of uveitis for photophobia
cycloplegic refraction (peds)

Question 8

complications of anti-cholinergic mydriatics?

Answer 8

complications are rare but
neurological problems (ataxia, confusion, psychosis)
anti-cholinergic effects (tachycardia, dry mouth, urinary retention, constipation)
can precipitate angle-closure glaucoma (rare)

Question 9

which medication is a mydriatics- sympathomimetics?

Answer 9

phenylephrine

Question 10

what is the mechanism of action of mydriatics- sympathomimetics?

Answer 10

stimulates iris dilator muscle (alpha -1 adrenergic)
NO cycloplegia (no paralysis of ciliary muscles)

Question 11

what are clinical uses of sympathomimetics?

Answer 11

dilation

Question 12

what are some complication of of sympathomimetics?

Answer 12

may elevate BP
use lower concentration in infants

Question 13

for routine dilated exams which medication should be used? what about for kids?

Answer 13

phenylephrine (2.5%) and tropicamide (0.5% or 1%)
for kids use cyclopentolate (1%)

Question 14

what are the two mechanisms to decrease IOP?

Answer 14

decrease aqueous prodcution
increase aqueous outflow

Question 15

what beta blocker medications are used for glaucoma?

Answer 15

timolol (nonselective beta 1 and beta 2)
betaxolol (mainly blocks beta 1)

Question 16

what is the mechanism of action of beta blocker medications for glaucoma?

Answer 16

reduce aqueous production

Question 17

what are some complications of beta blocker medications for glaucoma?

Answer 17

arrhythmia, bradycardia, hypotension
asthma, bronchospasm
mask diabetic hypoglycemic response!

Question 18

which medication is Alpha- 2 agonists? and what is the mechanism of action?

Answer 18

brimonidine (alphagan)
reduce aqueous production

Question 19

complications alpha 2- agonist?

Answer 19

AVOID in children <4 years- apnea
headache
fatigue, muscle pains
dry nose and dry mouth
follicular conjunctivitis

Question 20

What medication is a carbonic anhydrase inhibitors (CAI)

Answer 20

Dorzolamide
brinzolamide

Question 21

what is the mechanism of action of carbonic anhydrase inhibitors?

Answer 21

reduce aqueous production

Question 22

what are complications of carbonic anhydrase inhibitors?

Answer 22

ocular burning
bitter taste
consider sulfa allergies

Question 23

what medications for glaucoma are prostaglandins?

Answer 23

latanoprost
bimatoprost
travoprost

Question 24

what is the mechanism of action of medications for glaucoma that are prostaglandins?

Answer 24

increase aqueous outflow

Question 25

what are some complications to be aware of for prostaglandins?

Answer 25

ocular burning/redness darkening of the iris hypertrichosis- eyelash growth orbital fat atrophy

Question 26

which medications are cholinergics for glaucoma?

Answer 26

pilocarpine

Question 27

what is the mechanism of action of pilocarpine (cholinergic medication of glaucoma)

Answer 27

increase aqueous outflow induce miosis (stretches trabecular meshwork)

Question 28

What are some complications to be aware of for pilocarpine

Answer 28

brow ache neurologic problems: confusion; tremor parasympathetic effects: diarrhea, bradycardia, hypotension, bronchospasm associated with higher rate of retinal detachment

Question 29

which medications are steroids?

Answer 29

prednisolone acetate durezol dexmethasone

Question 30

what is the mechanism of action of steroids?

Answer 30

decrease inflammation

Question 31

what are complications of steroid eye drops?

Answer 31

increased intraocular pressure cataracts acceleration exacerbation of viral (HSV) and/or bacterial infections slows down healing DON'T use if patient has corneal abrasion

Question 32

what medications are antibiotic eye drops?

Answer 32

bacitracin, bacitracin/polymixin erythromycin, tobramycin, gentamicin ciprofloxacin, moxifloxacin, ofloxacin, gatifloxacin

Question 33

what are clinical uses of antibiotic eyedrops?

Answer 33

corneal/ conjuctival/ eyelid infections postoperative prophylaxis

Question 34

what are some clinical considerations to consider with antibiotics?

Answer 34

choice of ointment vs drops * if contact lens wearer, NEED fluroquinolone for pseudomonas coverage

Question 35

what is the dosage of antibiotic eyedrops?

Answer 35

dosage is usually 4x/ day- but can be used up to hourly combination antibiotic/steroids should be prescribed by an opthalmologist

Question 36

what medications are NSAIDs?

Answer 36

Diclofenac ketorolac nipafenac bromfenac

Question 37

what are the clinical use of NSAIDS for eyedrops?

Answer 37

pain inflammation macular edema pre/post operatively

Question 38

what are some clinical considerations for NSAIDs?

Answer 38

epithelial toxicity

Question 39

what can be used to treat MRSA?

Answer 39

Vancomycin, Daptomycin, ceftaroline

Question 40

What antibiotics can be used in community acquired MRSA?

Answer 40

TMP-Sulfa, doxycycline, clindamycin

Question 41

What antibiotics can be used to treat pseudomonas?

Answer 41

Ciprofloxacin, levofloxacin, gentamycin, tobramycin ceftazidime, cefepine, Aztreonam, zosyn (pip/tazo)

Question 42

what antibiotics are used for C-diff?

Answer 42

vancomycin metronidazole

Question 43

What is the best antibiotic for a non-pregnant patient with an uncomplicated UTI

Answer 43

TMP- Sulfa

Question 44

Barrier to antibiotics that want to treat gram negative organisms

Answer 44

down-regulated porins efflux pumps and beta lactamase