Pharm

Question 1

Glaucoma drugs:

Answer 1

First-Line:
Prostaglandin analogues: Contra. Herpatic keratitis
○ Latanoprost (xalatan)
○ Bimatoprost
Beta-Blockers: Contra. COPD, Brachycardia
○ Timolol
○ Betaxolol
Second-Line:
A-2 Adrenergic Agonists: Contra. Children
○ Aprachlonidine
CAI: Contra. Sulfra allergy, renal faliure, metabolic acidosis
○ Acetazolamide (Diamox)
○ Brinzolamide
New agents:
Rho Kinase inhibitors

Question 2

Medical management of AACG:

Answer 2

Acetazolamide 500mg IV
Timolol 0.5%
Aprachlonidine
Mannitol
Pilocarpine (late)

Prostaglandin analogues contra. > too slow as they work via uveoscleral

Question 3

Pharmacology of nexium

Answer 3

Esomeprazole irreversibly inhibits H/K ATPase proton pump in gastric parietal cells, inhibiting acid production
Indicated for GERD

Question 4

Pharmacology of tropicamide

Answer 4

Anticholinergic (muscarinic antagonist)
Binds M3 receptors > prevents Ach stimulation from sympathetic drive > Mydriasis (iris sphincter) and Cycloplegia (Ciliary muscle)
* Onset 30min, lasts 6h
* Increases IOP
Contra. ACG

Question 4

Somac Pharmacology

Answer 4

Pantoprazole: Proton pump inhibitor (PPI)
○ Inhibits H/K ATPase proton pump in gastric parietal cells, inhibiting acid production
Indicated for GERD

Question 5

Lipitor Pharmacology

Answer 5

Atorvastatin: HMG-CoA reductase inhibitor
Inhibition > decreased HMG-CoA conversion to mevalonate > decreased cholesterol synthesis > upregulation of LDL receptors > decreased LDL level

Question 5

Pharmacology of Zocor and Olmetec

Answer 5

Zorcor (simvastatin): HMG-CoA reductase inhibitor, Decreases cholesterol
○ Inhibition > decreased HMG-CoA conversion to mevalonate > decreased cholesterol synthesis > upregulation of LDL receptors > decreased LDL levels
○ Contra. Ketoconazole
Olmesartan: Angiotensin 2 receptor blocker:
○ Selectivley blocks AT1 receptor for AT-2 > inhibited vasoconstriction, aldosterone secretion > Vasodilation and decreased BP
Contra. Renal faliure

Question 6

Sumatriptan Pharmacology

Answer 6

5-HT1 receptor agonist
○ Activation > BV constriction
Inhibition of pro-inflammatory peptides

Question 7

Lexapro Pharmacology

Answer 7

Escitalopram: Selective Serotonin Reuptake Inhibitor (SSRI)
Inhibits 5-HT reuptake > ^ serotonin

Question 8

Cartia Pharmacology

Answer 8

Diltiazem: Calcium Channel blocker
○ Inhibition on cardiac muscle > Dilated coronary vessels
○ Slows AV node conduction > reduced heart rate
Indicated for hypertension
Contra. Beta blockers

Question 9

Diamox Pharmacology

Answer 9

Acetazolamide: Carbonic anhydrase inhibitor
○ Inhibition > reduced aqueous Humor
○ Renal inhibition > decreased Na+ and Bicarb reabsorbtion > diuresis > metabolic acidosis
○ Acidosis > decreased CSF
Dosage for glaucoma:
○ 250mg twice a day
500mg for AGC

Question 10

Neurofen Pharmacology

Answer 10

Ibuprofen: Nonsteroidal Anti-Inflammatory Drug
COX-1/2 inhibition > reduced conversion of arachidonic acid to prostaglandins > decreased inflammation/fever/pain

Question 11

Prednisolone acetate Pharmacology

Answer 11

Glucocorticoid
○ Cortisol mimicry > glucocorticoid receptor binding > inhibition of phospholipase A2 enzyme > reduced arachidonic acid > decreased inflammatory cytokines, prostaglandins
○ Stabilised vascular endothelium > reduced edema
Dosage: 1% drops
○ Uveitis: 6/d > Tapered 2 per week
○ Allergic: BID
Side effects:
○ ^IOP
○ Cataracts
○ Delayed wound healing
○ Immunosuppression
Contra. Active infection

Question 12

Metformin Pharmacology

Answer 12

Biguanide
○ Insulin sensitization (primary) > increased glucose uptake
○ Inhibits glucogenesis > decreased blood glucose
Indicated T2DM

Question 13

Atozet Pharmacology

Answer 13

Atorvastatin and Ezetimibe: Statin and Cholesterol absorbtion inhibitor
○ Inhibition > decreased HMG-CoA conversion to mevalonate > decreased cholesterol synthesis > upregulation of LDL receptors > decreased LDL level
○ Inhibits NPC1L1 transporter > decreased cholesterol absorbtion
Indicated hyperlipidemia

Question 14

Micardis Pharmacology

Answer 14

Telmisartan: andiotensin 2 receptor blockers
○ Angiotensin 2 inhibition > Vasodilation
○ Decreased aldosterone > decreased BP
Indicated HT

Question 15

Fenofibrate Pharmacology (evidence)

Answer 15

MOA:
○ Activates PPAR-a receptors > expression of genes for FFA oxidation
○ Decreases VLDLs and LDLs, increases HDLs
Indicated hyperlipidaemia, T2DM
Studies:
○ FIELD / ACCORD: No significant improvment for major cardiovascular events
○ FIELD: Reduced progression of early DR
Decreases oxidative stress and inflammation

Question 18

Azithromycin pharm:

Answer 18

Macrolide bacteriostatic: inhibits bacterial protein synthesis
○ Binds 50S ribosomal subunit
○ Inhibits peptidyl transferase enzyme
Prevents protein synthesis

Question 19

Latanoprost pharm:

Answer 19

Prostaglandin F2a analog:
○ Remodels ECM in ciliary muscle > ^Uveoscleral outflow
Side effects:
○ Iris/Lash/skin pigmentation
Contra:
○ Active inflammation
○ Pseudophakia > macular edema
Concurrent use with other prostaglandin analogues > IOP increase

Question 20

Timolol pharm:

Answer 20

Non-selective B-blocker:
○ Inhibits B2 receptors in ciliary body > decreased aqueous production
Systemic effects:
○ Decreased heart rate, BP
○ Bronchoconstriction
Side effects:
○ Bradycardia, Hypotension
○ Bronchospasm
Contra:
○ Asthma, COPD
○ Heart failure
○ Hypotension
DM (masks hypoglycaemia)

Question 21

Aprachlonidine pharm:

Answer 21

A-2 Adrenergic agonist
○ A2 simulation on CB > decreased aqueous humor secretion
○ Stimulation > increased uveoscleral outflow
Side-effects:
○ Tachyphylaxis
Allergic conjunctivitis

Question 22

Janumet pharmacology:

Answer 22

Sitagliptin and Metformin: DPP-4 inhibitor and Biguanide
* Metformin:
○ Decreases hepatic glucose production
○ Increased insulin sensitivity
○ Decreased intestine glucose absorbtion
* Sitagliptin
○ DPP-4 enzyme inhibition > increased incretin (GLP)
○ GLP > increased insulin > decreased glucagon
Indicated for T2DM

Question 23

Perindopril pharmacology:

Answer 23

Angiotensin-Converting Enzyme inhibitor (ACE)
○ Blocks AT1 from forming AT2 > decreased aldosterone
○ Vasodilation > decreased BP
Indicated for HT

Question 24

Aspirin pharmacology:

Answer 24

Acetylsalicylic acid NSAID COX inhibitor
○ COX-1 inhibition > decreased Thromboxane A2 > Decreased platelet aggregation
COX-2 inhibition > decreased prostaglandins > decreased inflammation

Question 25

Zyrtec pharmacology:

Answer 25

Cetirizine H1 receptor antagonist Prevents mast cell degranulation

Question 26

Maxidex pharm:

Answer 26

Dexamethasone corticosteroid * Lipophilic diffusion through cell membrane * Binds cytoplasmic glucocorticoid receptors > complex formation * Translocates to nucleus 1. Upregulates anti-inflammatory genes: a. Lipocortin-1: inhibits phospholipase A2 > decreased synthesis of prostaglandin/leukotines 2. Suppressess pro-inflammatory genes: NF gene suppression > decreases cytokines (IL-1/2, TNF-a)

Question 26

Ventolin pharmacology:

Answer 26

Salbutamol B2 adrenergic receptor agonist * Stimulation in smooth muscle of airways > ○ Bronchodilation ○ Mast cell inhibition Increased mucocilliary clearance

Question 27

Anti-VEGF pharmacology:

Answer 27

Binds free VEGF in vitreous and retina > inhibits interaction with Receptors (VEGFR) on endothelial cells ○ Decreased angiogenesis (New vessel formation) Decreased leakage

Question 27

Anti-VEGF studies:

Answer 27

ANCHOR: Wet AMD * Ranibizumab superior to PDT MARINA: Wet AMD * Ranibizumab prevents vision loss CATT: Wet AMD * Bevacizumab equal to ranibizumab DRCR.net: DME * Aflibercept, bevacizumab, ranibizumab equal Aflibercept superior for poor baseline VA

Question 28

Vytorin pharm:

Answer 28

Ezetimbe and Simvastatin * Ezetimibe NPC1L1 inhibitor ○ decreased cholesterol absorption ○ Upregulation of LDL * Simvastatin HMG-CoA reductase inhibitor ○ Decreased cholesterol synthesis ○ Decreased HDL Indicated for hyperlipidemia

Question 29

Exforge pharm:

Answer 29

Amlodipine and Valsartan * Amlodipine Ca channel blocker ○ Inhibits Ca channel in vascular smooth muscle ○ Vasodilation > decreased BP * Valsartan Angiotensin 2 receptor blocker ○ Prevents AT2 effects of vasoconstriction Indicated for hypertension

Question 30

Atropine pharm:

Answer 30

Anticholinergic * Competitive antagonist of acetylcholine receptors (M1, M5) ○ Iris sphincter mydriasis ○ Ciliary paralysis Inhibits signalling pathways in scleral fibroblasts

Question 31

Cyclopentolate pharm:

Answer 31

Anticholinergic * Competitive antagonist of acetylcholine receptors (M3) ○ Iris sphincter mydriasis Ciliary paralysis

Question 31

Ocular topical bacterial antibiotics:

Answer 31

Chloramphenicol * Binds 50s ribosomal subunit > peptidyl transferase inhibition > inhibited bacterial synthesis * Broad spectrum Tobramycin and Gentamicin * Binds 30s > altered mRNA/tRNA selection > faulty protein synthesis > Apoptosis * Aminoglycoside (Gram-) Ofloxacin * Inhibits DNA topoisomerase IV > inhibited DNA replication/transcription * Fluroquinolone Azithromycin * Binds 50s > inhibited protein synthesis Macrolide

Question 32

Atozet pharmacology:

Answer 32

Atorvastatin and Ezetimibe * Statin ○ HMG-CoA reductase inhibitor ○ Decreased hepatic cholesterol production ○ Increased LDL clearance * NPC1L1 inhibitor ○ Decreased cholesterol absorbtion Indicated for hypercholesterolimia

Question 33

Paracetamol and Neurofen pharmacology:

Answer 33

Acetaminophen (NOT AN NSAID) * Inhibits cyclooxygenase-3 ○ Decreased prostaglandin synthesis Ibuorifen NSAID * Inhibits COX-1/2 Decreased prostaglandin synhesis

Question 34

Diamox pharm:

Answer 34

Acetazolamide Carbonic anhydrase inhibitor * CA enzyme inhibition > decreased catalyst for bicarb formation Decreased bicarb > decreased osmotic gradient for CSF influx (IIH) and aqueous influx (ACG)