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SX, OPHTH, DENT > Ocular Pharmacology > Flashcards

Ocular Pharmacology Flashcards

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1
Q

What are the different topical ocular antibiotics

A

1) Neomycin, Polymyxin B, Bacitracin
2) Neomycin, Polymyxin B, Gramicidin
3) Ofloxacin or Ciprofloxacin
4) Moxifloxacin 0.5%
5) Tobramycin
6) Gentamicin
7) Erythromycin
8) Terramycin (Oxytetracycline, Polymyxin B)
9) Chloramphenicol
10) Cefazolin

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2
Q

Neomycin, Polymyxin B, Bacitracin has what spectrum

A

broad spectrum (gram positive and gram negative)

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3
Q

What is a downside of Neomycin, Polymyxin B, Bacitracin

A

1) Does not penetrate an intact corneal epithelium
-used for uncomplicated ulcers
-not recommended for active infections
2) Caution in cats (polymyxin anaphylaxis)

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4
Q

T/F: Neomycin, Polymyxin B, Bacitracin is for active infections

A

False - used for uncomplicated ulcers

DOES NOT penetrate an intact corneal epithelium

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5
Q

Neomycin, Polymyxin B, Bacitracin cannot penetrate what structure

A

an intact corneal epithelium

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6
Q

What species should you use Neomycin, Polymyxin B, Bacitracin cautiously in

A

cats - polymyxin anaphylaxis
you can still use it, just be careful
administer dose in clinic and wait 30 minutes to see if it is their first dose

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7
Q

How does Neomycin, Polymyxin B, gramicidin differ from Neomycin, Polymyxin B, Bacitracin

A

Gramicidin is a solution (instead of an ointment)

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8
Q

Neomycin, Polymyxin B, Bacitracin is for uncomplicated ulcers, what is recommended for actively infected corneal ulcerations

A

Ofloxacin or Ciprofloxacin
they are fluoroquinolones with gram postive and gram negative (good penetration through intact epithelium)

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9
Q

Ofloxacin, Ciprofloxacin, and Moxifloxacin are optic solutions for what

A

actively infected corneal ulcerations (not for simple ulcers)

good penetration through intact epithelium

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10
Q

T/F: tobramycin penetrates an intact epithelium

A

True - it does

it is good for simple ulcers in higher risk patients (brachycephalics)
not epithelial toxic

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11
Q

Aminoglycosides that are used as topic ocular antibiotic

A

Tobramycin and Gentamicin
good activity against gram negative

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12
Q

What ocular antbiotic is a middle road medication between the fluoroquinolines (Ofloxacin or Ciprofloxacin) and NeoPolyBac

A

Tobramycin

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13
Q

an aminoglycoside (gram negative)
does penetrate an intact epithelium (good for simple ulcers in high risk patients (brachycephalics)
not epithelial toxic

A

Tobramycin

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14
Q

Is Tobramycin or Gentamicin epithelial toxic

A

Gentamicin is epithelial toxic over long periods of use

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15
Q

why should you only use gentamicin if culture indicates

A

because it is epithelial toxic over long periods of use

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16
Q

Erythromycin is effective against what bugs

A

Macrolide - mainly effective against gram positive

effective against Chlamydophilia and Mycoplasma (causative agents for conjunctivitis in cats)

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17
Q

What topical antibiotic would you use for conjunctivitis in cats

A

Erythromycin

Macrolide - mainly effective against gram positive
effective against Chlamydophilia and Mycoplasma (causative agents for conjunctivitis in cats)

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18
Q

What is Erythromycin commonly used for

A

Cats with
1) Conjunctivitis (active against Chlmaydophilia and Mycoplasma)
2) Uncomplicated corneal ulcerations

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19
Q

What two drugs are in Terramycin ointment

A

1) Oxytetracycline
2) Polymyxin B
gram negative and positive coverage

beware cats - polymixin anaphylaxis

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20
Q

What are the used of Terramycin

A

1) Effective against chlamydophilia and mycoplasma
2) Shown to reduce healing time in dogs with SCCED (indolent ulcers)

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21
Q

T/F: Chloramphenicol penetrates an intact corneal epithelium

A

True

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22
Q

What is chloramphenicol solution or ointment effective against?

A

gram postivie and negative
penetrates an intact corneal epithelium

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23
Q

What is a major concern with giving Chloramphenicol ophthalmic solution / ointment

A

Can cause APLASTIC ANEMIA - dose independent and fatal
*only use if culture indicates and you will loose the eye without treatment
Have owners sign a waiver, must wear gloves

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24
Q

Only use Chloramphenicol if ___________ due to _________

A

only use it if culture indicates and you will loose the eye without treatment

have owners sign a waiver, must wear gloves

causes aplastic anemia (owner risk) dose independent and fatal

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25
a first generation cephalosporin (gram + coverage) use with gram negative coverage antibiotic does not penetrate intact epithelium injection used as ophthalmic solution compounded, check local laws
Cefazolin
26
T/F: Cefazolin penetrates an intact epithelium
False
27
T/F: Tobramycin penetrates an intact epithelium
True
28
Fluoroqinolines (Ofloxacin, Ciprofloxacin, and Moxifloxacin) penetrates the intact epithelium
True
29
Morris labrador squinting OS 2 days ago -Belpharospasm -Epiphora -Faint Fluorescein stain uptake OS 2mm superficial corneal ulcer just ventral to the central cornea What is the diagnosis and treatment
Simple Corneal Ulceration heals within 5-7 days not infected superficial treat with NeoPolyBac
30
You have a dog with a complicated infected and melting corneal ulceration. What medication do you give
Ofloxacin - big gun antibiotic with good penetration you could also add Cefazolin but dont use alone
31
used to stabilize the cornea with keratomalacia (bacteria and WBCs produce collagenases which melt corneal collagen)
Anti-Collagenase medications 1) Serum 2) Acetylcysteine 3) EDTA 4) Doxycycline
32
What are the different Anti-Collagenase medications
1) Serum 2) Acetylcysteine 3) EDTA 4) Doxycycline
33
How is serum used as anti-collagenase medications
Collected from patient (can cross species) must be refrigerated (good for 1 week) or frozen for longer storage
34
What is a downside of using serum for anti-collagenase medications
1) Irritating and pro-inflammatory 2) takes a lot of time
35
What is the preferred anti-collagenase medication
Acetylcysteine
36
How is acetylcysteine used as anti-collagenase medication
compounded into 4-5% solution from the 20% oral / injectable form can be added directly to Ofloxacin (check local compounding laws)
37
What antibiotic can be used as anti-collagenase
Doxycycline - concentrates in. the tear film and gets some anti-collagenase activity (not preferred)
38
3yo FS DSH with -Belpharospasm and epiphora -Severe Blepharoedema/ Blepharitis -Severe chemosis (swollen conjunctiva) and moderate conjunctival hyperemia What antibiotic would you start morris on
Erythromycin - bilateral (tells it might be chlamydia or mycoplasma) need a macrolide to target these bugs
39
Cat with blepharospasm, epiphora, multifocal superficial dendritic corneal ulcerations What is cause and how do you treat
FHV-1 (dendritic corneal ulcerations - unilateral) cant use antibiotic for virus do anti-viral medications
40
T/F: FHV-1 causes dendritic ulcers bilaterally
False - it is a unilateral disease
41
causes chemosis in cats often bilateral
Chlamydophilia
42
causes hyperemia and typically unilateral in cats
FHV-1
43
What are the different anti-viral medications you can do
1) Cidofovir (compounded solution BID) 2) Idoxuridine (compounded solution or ointment 5x) 3) Famciclovir (oral BID to TID)
44
What is a downside of using Idoxuridine
it needs to be applied >5 times a day (Cidofovir is only twice a day)
45
Is cidofovir or idoxuridine more practical for owners
Cidofovir (2 times and day instead of 5)
46
an oral anti-viral medication
Famciclovir - oral works because it is latent at the nerve stops it at the place the virus is living
47
Not an anti-viral (supplement) stops viral replication due to a competitive imbalance between L-lysine and arginine reduces the severity and frequency of FHV-1 flareups
L-lysine
48
T/F: L-lysine helps acute flareups of FHV-1
False - it reduces severity and frequency of flareups some cats, might make flareups worse
49
What do you do if L-lysine makes FHV-1 flareups worse
Stop it
50
What is dose of L-lysine
500mg PO BID - needs to be given frequently because you need more L-lysine than arginine to reduce the severity and frequency of flareups
51
What are different topical anti-inflammatories
1) Prednisolone acetate 2) Dexamethasone sodium phosphate 3) Flurbiprofen (NSAID) 4) Diclofenac (NSAID) 5) Ketorolac (NSAID)
52
T/F: Prednisolone acetate penetrates the cornea
True - can be used for intraocular inflammation
53
Do not use prednisolone acetate if
there is a corneal ulcer
54
Why might you use prednisolone acetate
1) Intraocular inflammation 2) Immune mediated keratitis
55
T/F: Dexamethasone sodium phosphate penetrates the cornea well
False - use prednisolone acetate instead Dex is best used for conjuctivitis
56
Do not use dexamethasone sodium phosphate if there is
a corneal ulcer
57
Equine patients receiving dexamethasone sodium phosphate, you need to watch for
fungal keratitis and stromal abscesses
58
What are the different NSAID ophthalmic solutions
1) Flurbiprofen (NSAID) 2) Diclofenac (NSAID) 3) Ketorolac (NSAID)
59
T/F: NSAIDs are not as strong as topical steroids
False
60
Why do you typically not want to use topic anti-inflammatories on cats *
because cats commonly get infectious disease, inflammation might go away but as soon as you take it away they are toast dogs also can get immune mediated diseases where youll want to use NSAIDs and steroids
61
T/F: Dexamethasone is more potent, so it should be used for aggressive topical anti-inflammatory targeting over prednisolone acetate
False - even though Dex is 7-10x more potent than Pred. Pred is still used because it comes in the 1% solution while Dex comes in the 0.1% solution plus pred can penetrate the corneal wall (better for uveitis)
62
Does Prednisolone or Dex penetrate the corneal wall
Prednisolone acetate
63
T/F: NSAIDS like Flurbiprofen, Diclofenac, and Ketorolac penetrate the cornea
True- NSAIDs are useful for long term uveitis prevention (eg. lens induced uveitis)
64
You should avoid or reduce the use of NSAIDS like Flurbiprofen, Diclofenac, and Ketorolac when
a corneal ulcer is present can delay healing, but not as bad as steroids can become epithelial toxic when used more than QID if uveitis if bad enough that QID is required then you should use a steroid
65
When giving NSAIDS like Flurbiprofen, Diclofenac, and Ketorolac, what can occur if given QID
epithelial toxic when used more than QID go on steroid if uveitis is bad enough where QID is needed
66
What are different topic antibiotic / anti-inflammatory combinations
1) Neomycin-Polymyxin-Dexamethasone 2) Neomycin-Polymyxin B- Bacitracin - Hydrocortisone 3) Tobramycin-Dexamethasone
67
What is classic clinical use for NSAIDS like Flurbiprofen, Diclofenac, and Ketorolac
mature cataract - autoimmune attack against lens protein (lens uveitis)
68
Neomycin-Polymyxin-Dexamethasone is most effective against
allergic conjunctivitis in dogs (inflammatory)
69
Dont use Neomycin-Polymyxin-Dexamethasone if there is a
corneal ulcer
70
What is the risk of giving Neomycin-Polymyxin-Dexamethasone to cats
Cats can get infectious conjunctivits (eg. FHV-1) from the immunosuppression Dex
71
What is the risk of giving Neomycin-Polymyxin-Dexamethasone to horses
Horses can get stromal abscesses and fungal keratitis
72
Why is Neomycin-Polymyxin B- Bacitracin - Hydrocortisone useless
because it does not penetrate the cornea and is not a strong steroid (not very useful)
73
T/F: Neomycin-Polymyxin B- Bacitracin - Hydrocortisone can penetrate the cornea
False - this is useless cant penetrate the cornea and not a strong steroid
74
What is a downside of using Tobramycin-Dexamethasone
historically expensive but more affordable option will happen soon like $100 more for same result
75
How do you avoid mix up of ophthalmic medications with and without steroids
they all look the same so keep on different shelves
76
10 yo poodle. both eyes have cloudy and vision is deteriorating intact PLR but negative menace Diffuse lens opacity Diagnosis? Medication?
Cataracts - loss of menace Start them on topical Diclofenac to prevent lens induced uveitis flareups not severe enough where you dont need to go to pred or Dex
77
2yo MC german shorthaired pointer just returned from camping trip to North Dakota OU blepharospasm and epiphora episcleral injection mild diffuse corneal edema Miotic pupil Negative Fluorescein stain What is your diagnosis? What is your treatment?
Active anterior uveitis need to get aggressive with treatment Prednisolone acetate - active uveitis needs a stronger medication need to run diagnostics and treat with systemic medications
78
What breeds commonly get primary glaucoma
1) Cockerspaniel 2) Basset Hound
79
Do patients with glaucoma have miotic or mydriasis pupils
Mydriatic (dilated) pupil
80
What are the 4 physical exam findings of glaucoma
1) Mydriatic (dilated) pupil 2) Episcleral injection 3) Diffuse corneal edema 4) Elevated IOP
81
What are the different glaucoma medications?
1) Timolol (b blocker) 2) Dorzolamide (topical carbonic anhydrase inhibitor) 3) Methazolamide (oral carbonic anhydrase inhibitor) 4) Latanoprost (Prostaglandin analog)
82
How does timolol help patients with glaucoma
it is a Beta-blocker solution decreases the aqeuous humor production through the blockage of beta-receptors in ciliary body only a mild decrease in IOP
83
What are the side effects of timolol solution for glaucoma
mild bradycardia
84
What top is the timolol ophthalmic solution
Yellow top
85
What type of animals is timolol not permitted
racehorses due to anti-doping rules
86
What is the mechanism of action of carbonic anhydrase inhibitors like Dorzolamide and Methazolamide
inhibits carbonic anhydrate enzyme which is found in the ciliary body epithelium that helps produce aqueous hyumor
87
topical carbonic anhydrase inhibitor for glaucoma treatment
Dorzolamide
88
What color top is the topical carbonic anhydrase inhibitor Dorzolamide
orange (trusopt)
89
oral carbonic anhydrase inhibitor for management of glaucoma
Methazolamide - higher risk of systemic side-effects (metabolic acidosis)
90
Methazolamide is an oral carbonic anhydrase inhibitor, that has more systemic side effects than the topical Dorzolamide. What is the side effect
Metabolic acidosis
91
Cosopt is what two medications
Dorzolamide and Timolol (dark blue top)
92
What color top is Dorzolamide and Timolol (Cosopt)
Dark blue top
93
What is the mechanism of action of Prostaglandin Analogs like Latanoprost (Xalatan)
increases aqueous outflow and may also decrease aqeuous production to some degree
94
increases aqueous outflow and may also decrease aqeuous production to some degree
Prostaglandin Analogs like Latanoprost (Xalatan)
95
Prostaglandin Analogs like Latanoprost (Xalatan) cause what side effect
Decreased IOP Miosis
96
What drug is very helpful in emergency situations of glaucoma
Prostaglandin Analogs like Latanoprost (Xalatan) causes significant decrease in IOP works in 15-20 min
97
How do Prostaglandin Analogs like Latanoprost (Xalatan) affect cats
Cats dont have the receptors ... minimal IOP decrease but will cause miosis
98
What species is Prostaglandin Analogs like Latanoprost (Xalatan) not helpful in decrease IOP
Cats and horses
99
Dont use Prostaglandin Analogs like Latanoprost (Xalatan) if
1) Significant uveitis is present 2) Anterior lens luxation (good if posterior lens luxation)
100
T/F: Prostaglandin Analogs like Latanoprost (Xalatan) is good for anterior lens luxation
False - it is contraindicated excellent for POSTERIOR lens luxation
101
What color top is Prostaglandin Analogs like Latanoprost (Xalatan)
Light blue
102
What is an example of a Prostaglandin Analog for glaucoma
Latanoprost (Xalatan) increases aqueous outflow and may also decrease production
103
Latanoprost (Xalatan) causes
-Miosis -Decreased IOP (uveitis)
104
Rank the glaucoma medications by strength of glaucoma treatment in dogs
Mild: Timolol Moderate: Dorzolamide, Dorzolamide / Timolol Strong: Latanoprost
105
What are the 3 mydriatic agents
1) Tropicamide 2) Phenylephrine 3) Atropine
106
What is the mechanism of Tropicamide
Parasympatholytic - Anticholinergic causes temporary dilation (best for fundic exams) onset 15-20 min duration: 305 hours
107
Tropicamide is indicated for
causes temporary dilation (best for fundic exams) onset 15-20 min duration: 3-5 hours
108
What is the mechanism of phenylephrine
sympathomimetic - alpha adrenergic can also induce tachycardia and elevate systemic blood pressure
109
What are the side effects of Phenylephrine
can also induce tachycardia and elevate systemic blood pressure (sympathomimetic - alpha adrenergic )
110
What are the indications of phenylephrine
1) Reduce conjunctival hemorrhage during ocular surgery (blanch gums) 2) Confirm 3rd order Horner's syndrome after denervation
111
What should you tell the anesthesiologist when giving phenylephrine
that the mouth and gums might be blanched
112
What is the mechanism of topical atropine
parasympatholytic - anticholingeric
113
What is the strongest mydriatic agent
Atropine (onset is 30 min but duration is 7-10 days)
114
What are the side effects of topical atropine
1) Decrease tear production (caution KCS) 2) Decrease gut motility in horses
115
What are the indications of Atropine
1) Excellent cycloplegic (effective for uveitis pain control associated with ciliary body spasm)
116
Red top tubes are contraindicated if
the patient has IOP all dilating drops can increase IOP
117
What should you remember when administering red topped tubes (mydriatic agents)
1) Will dilate pupils (wash hands) 2) Check IOP before administering
118
What tube color are the mydriatic agents such as Tropicamide, Atropine, and Phenylephrine
Red
119
What are the different types of calcineurin inhibitors
1) Cyclosporine 2) Tacrolimus
120
Calcineurin inhibitors like cyclosporine and tacrolimus are primarily used to treat
KCS, however can also be used for some immune mediated diseases (eg Pannus)
121
What two drugs can be combined for bad KCS
Cyclosporine and Tacrolimus
122
What is a good medication if the patient is sensitive to Cyclosporine
Tacrolimus
123
What are the different versions of Cyclosprine
1) Optimmune: 0.2%- ideal for mild KCS (ointment) 2) Compounded in 1 and 2% for worse KCS (solution that last longer)
124
What are the side effects of calcineurin inhibitors like Cyclosporine and Tacrolimus
1) Increases risk of corneal SCC in cases of chronic use and active keratitis 2) Immune suppressive- use gloves or handwashing after use

SX, OPHTH, DENT (15 decks)

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