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NBEO Part 1 > Pharmacology > Flashcards

Pharmacology Flashcards

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1
Q

Tx for preseptal cellulitis

A

Oral antibiotics: augmentin 875 mg po BID
For 7-10 days

*augmentin = amoxicillin-clavulanate

If allergic to penicillin can use Cleocin (clindamycin)

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2
Q

Upneeq

Generic name?
MOA?
Tx?

A

Generic name: oxymetazoline
MOA: works on alpha-1 receptors to activate muller’s (which elevates eyelid 2-3mm)
Tx: ptosis

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3
Q

What is the primary mechanism of action of pilocarpine?

A

Pilocarpine pulls on the ciliary muscle, which opens the trabecular meshwork (TM)

This action facilitates corneoscleral outflow, accounting for 80% of the conventional route.

*direct cholinergic agonist, increases outflow via corneoscleral route

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4
Q

What condition can pilocarpine help treat after angle closure?

A

It can help make the iris tight again by inducing miosis

This is relevant for conditions like acute angle-closure glaucoma.

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5
Q

What are some adverse effects of pilocarpine?

A

Headaches, brow aches, myopic shift

Myopic shift can cause accommodation issues.

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6
Q

What is the effect of a 0.1% pilocarpine solution on the pupil?

A

It causes pupil constriction

This is a direct result of cholinergic stimulation.

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7
Q

What is the role of neostigmine in relation to acetylcholine?

A

It inhibits acetylcholinesterase (AChE)

This action increases the availability of acetylcholine at the neuromuscular junction.

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8
Q

Name two medications used to treat myasthenia gravis.

A

Neostigmine, Pyridostigmine

Both inhibit AChE to enhance neuromuscular transmission.

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9
Q

What is the distinguishing feature of echothiophate?

A

It is an irreversible inhibitor of acetylcholinesterase

This characteristic leads to prolonged effects.

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10
Q

What condition could beta blockers exacerbate in the context of cholinergic agonists?

A

Myasthenia gravis

Beta blockers can worsen symptoms by reducing cholinergic activity.

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11
Q

What is a common side effect of cholinergic agonists related to vision?

A

Diplopia

This can occur due to the effects on ciliary muscle function.

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12
Q

Fill in the blank: Pilocarpine is used to induce _______ in the treatment of glaucoma.

A

miosis

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13
Q

True or False: Donepezil is used to treat Alzheimer’s dementia.

A

True

Donepezil is a cholinesterase inhibitor that helps improve cognitive function.

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14
Q

What does the ciliary muscle do when stimulated by pilocarpine?

A

It contracts, leading to an opening of the trabecular meshwork

This mechanism is crucial for reducing intraocular pressure.

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15
Q

What is the effect of pilocarpine on the sphincter muscle?

A

It stimulates the sphincter muscle

This results in pupil constriction and is important in treating certain types of glaucoma.

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16
Q

MOA: inhibit acetylcholinesterase

A

Neosytgmine
Pyridostigmine
Edrophonium
Echothiophate

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17
Q

Topical ophthalmic indications of fluoroquinolones

A
  • CL related corneal ulcers
  • corneal abrasions
  • bacterial conjunctivitis
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18
Q

Adverse effects of oral trimethoprim

A

Aplastic anemia
* bone marrow suppression leads to aplastic anemia
Leukopenia
Granulocytopenia

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19
Q

Metformin
Class?
MOA?
Tx?

A

Biguanide
* decrease blood glucose by inhibiting gluconeogenesis in liver and by promoting glucose reuptake by liver and muscles
Tx: diabetes

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20
Q

What drug based factors allow for better ability of medication to pass through plasma membranes?

A
  1. Smaller molecular structure
  2. Lipid-soluble
  3. Non-ionized
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21
Q

Name two examples of sedating antihistamines

A

Diphenhydramine (Benadryl®), chlorpheniramine (ChlorTrimeton®)

Other examples include promethazine (Phenergan®) and hydroxyzine (Atarax®)

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22
Q

Name four examples of non-sedating antihistamines

A

Fexofenadine (Allegra®), loratadine (Claritin®), desloratadine (Clarinex®), cetirizine (Zyrtec®)

Non-sedating antihistamines are designed to minimize drowsiness.

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23
Q

True or False: Non-sedating antihistamines cannot cause drowsiness at all.

A

False

While considered non-sedating, drowsiness is still possible with these medications.

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24
Q

What is a key reason why non-sedating antihistamines are less likely to cause drowsiness?

A

They don’t cross the blood-brain barrier as much as older antihistamines

This reduced penetration into the central nervous system is why they are less sedating.

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25
What is the sedative effect of Fexofenadine at high doses?
No sedative effect ## Footnote Studies have shown that Fexofenadine maintains no sedative effects even at high doses.
26
At what doses can loratadine and desloratadine have a low sedative effect?
Higher doses ## Footnote At recommended doses, loratadine and desloratadine have no sedative effect.
27
Fill in the blank: Cetirizine can have a _______ sedative effect at recommended doses.
low ## Footnote At higher doses, cetirizine can have a moderate sedative effect.
28
Fill in the blank: The sedative effect of cetirizine at higher doses is considered _______.
moderate ## Footnote This indicates that cetirizine can cause more drowsiness compared to other non-sedating antihistamines at increased dosages.
29
What do Class I agents affect?
Sodium channels ## Footnote Class I agents ultimately serve to either lengthen or shorten the duration of the action potential and help to prevent ventricular arrhythmias.
30
What is the primary function of Class II agents?
Decrease sympathetic activity of the heart ## Footnote Class II agents block beta adrenergic receptors and aid in preventing recurrence of myocardial infarction.
31
How do Class III agents prevent arrhythmias?
By blocking potassium channels ## Footnote Class III agents prolong repolarization.
32
What do Class IV agents block?
Calcium channels ## Footnote Class IV agents decrease conduction through the AV node.
33
True or False: Class I agents help in preventing ventricular arrhythmias.
True
34
Fill in the blank: Class II agents aid in preventing recurrence of _______.
myocardial infarction
35
What is the effect of Class III agents on repolarization?
They prolong it
36
What is the impact of Class IV agents on the AV node?
Decreases conduction
37
Mannitol
* Intravenous osmotic agent * decrease IOP in acute glaucoma * osmotic diuretic affect proximal convoluted tubule, descending loop of Henle, collecting ducts nephron * administer hospital only
38
39
Absolute contraindication of 10% phenylephrine
TCA (tricyclic antidepressant)
40
Which topical ocular medications have been linked to development of drug-induced anterior uveitis?
Topical prostaglandins Topical brimonidine *with prostaglandins, anterior uveitis can occur within 6 months of initiation, CME can also occur *rare with brimonidine, develops 11-15 months after initiation of therapy, granulomatous uveitis. If uveitis occurs discontinue and imitate topical steroids and cycloplegics to tx
41
True or false Atropine can act as both a cycloplegic and a mydriatic
TRUE * atropine can cause both * cycloplegic: paralysis of ciliary muscle * mydriatic: stimulates iris dilator muscle
42
MOA Vyzulta
Dual MOA 1. Decrease IOP by increasing uveoscleral outflow 2. Enhancing trabecular meshwork outflow through the impact of nitric acid (additional action of nitric oxide results in an external IOP reduction of approximately 1 mmHg vs latanoprost alone) total decrease in IOP 7.5 to 9.1 mmHg *new prostaglandin analog
43
Atropine can be used in treatment if what conditions? (3)
1) Posterior synechiae (mydriatic, prevent formation and promote breakdown of synechiae) 2) Anteiror uveitis (aids in pain management by controlling pupil size and avoiding unnecessary movement of iris muscles) 3) Amblyopia (cycloplegic forces child to utilize weaker eye, strengthening and increasing visual acuity in that eye)
44
Which steroid is least likely to cause formation of PSC?
Loteprednol *ester-based steroid, instead of ketone group * PSC forms from interaction between ketone group and crystalline lens proteins, causing formation of a Schiff base intermediate and leading to posterior sub capsular cataract
45
To which class of intraocular pressure-lowering medications does Rhopressa® belong?
Rho-kinase inhibitor ## Footnote Rhopressa® (netarsudil) was released in 2017 for elevated intraocular pressure.
46
What is the mechanism of action of Rho-kinase inhibitors like Rhopressa®?
Increase aqueous outflow through the trabecular meshwork ## Footnote This is achieved by decreasing actin and myosin-driven cellular contraction and reducing extracellular matrix protein production.
47
What does Rhopressa® inhibit aside from Rho-kinase?
Norepinephrine transporter (NET) ## Footnote This makes it a ROCK/NET inhibitor.
48
How does the inhibition of NET by Rhopressa® affect aqueous production?
Decreases aqueous production ## Footnote This occurs due to reduced blood flow to the ciliary body through norepinephrine-induced vasoconstriction.
49
What year was Rhopressa® released?
2017 ## Footnote Rhopressa® is a newer medication specifically for treating elevated intraocular pressure.
50
What role does Rho-kinase play in the trabecular meshwork?
Promotes the association of actin stress fibers and regulates cell contraction ## Footnote This activity is crucial for maintaining proper intraocular pressure.
51
Fill in the blank: Rhopressa® is considered a _______ inhibitor.
Rho-kinase
52
True or False: Rhopressa® is a beta blocker.
False ## Footnote Rhopressa® is a rho-kinase inhibitor, not a beta blocker.
53
Fill in the blank: The action of Rhopressa® on the trabecular meshwork leads to increased _______.
aqueous outflow
54
Vicodin is composed of which 2 drugs?
Acetaminophen (500mg) + hydrocodone (5 mg)
55
_________ is a combination of 120 mg of acetaminophen and 5mg of oxycodone
Percocet
56
Percodan is a combo of which 2 drugs?
325 mg aspirin + 4.5 mg oxycodone HCL
57
Lortab is a combo of?
Hydrocodone 2.5 mg and acetaminophen 120 mg
58
MOA of topical corticosteroid
inhibit phospholipase A2, which in turn blocks both cyclo-oxygenase and lipoxygenase arms of the inflammatory cascade * blocking the cyclo-oxygenase arm causes decrease vascular permeability, thus reducing redness and edema *blocking lipoxygenase arm leads to keeping polymorphonnucleus and other blood cells sequestered from site of inflammation
59
Which pain reliever is MOST likely to cause liver damage?
Acetaminophen (Tylenol®) ## Footnote Acetaminophen is metabolized by the liver and should not be given to those with liver impairment or chronic alcoholism.
60
What is the primary function of Tylenol®?
Works well for mild to moderate, acute or chronic pain without inhibiting platelet aggregation. ## Footnote It is an oral analgesic.
61
Why is Tylenol® contraindicated for people with liver impairment?
It is metabolized by the liver. ## Footnote This increases the risk of liver damage.
62
What are the contraindications for Aspirin?
* Upper gastrointestinal (GI) disease * Asthma * Nasal polyps * Bleeding disorders * Chronic renal or hepatic disease ## Footnote Aspirin can prolong bleeding time as it interferes with platelet aggregation.
63
Which two pain relievers are classified as nonsteroidal anti-inflammatory drugs (NSAIDs)?
* Motrin® * Naprosyn® ## Footnote NSAIDs work well for mild to moderate pain relief.
64
What potential side effects do NSAIDs like Motrin® and Naprosyn® have?
* GI irritation * Mild inhibition of platelet aggregation * Kidney damage ## Footnote These side effects can occur with inappropriate use.
65
True or False: All pain relievers listed can cause liver problems if used inappropriately.
True ## Footnote However, Tylenol® has a greater propensity to cause liver problems.
66
What is the effect of Tylenol® on platelet aggregation?
It does not inhibit platelet aggregation. ## Footnote This makes it different from Aspirin.
67
What is cyclosporine commonly used for?
Topically to treat certain eye conditions including keratoconjunctivitis sicca (KCS) ## Footnote Keratoconjunctivitis sicca (KCS) is commonly known as dry eye syndrome.
68
What is a known mechanism of action for cyclosporine?
Inhibition of T cell activation ## Footnote The mechanism involves inhibition of calcineurin in CD4+ T helper cells.
69
What does IL-2 normally stimulate?
Activation and proliferation of cytotoxic T cells and other helper T cells ## Footnote IL-2 is interleukin-2, a key cytokine in the immune response.
70
What condition is a major cause of KCS?
Autoimmune destruction of lacrimal cells by T cells ## Footnote Lacrimal cells are responsible for tear production.
71
Fill in the blank: Cyclosporine prevents the activation of _______.
T cells
72
True or False: Cyclosporine acts as an anti-inflammatory.
True
73
What is one of the controversial aspects of cyclosporine's mechanism of action?
The exact mechanism of action remains controversial ## Footnote While inhibition of calcineurin is accepted, there may be additional mechanisms.
74
Which type of T cells does cyclosporine primarily inhibit?
CD4+ T helper cells
75
What does cyclosporine protect against in the treatment of KCS?
Autoimmune destruction of lacrimal cells ## Footnote This protective action helps in managing dry eye symptoms.
76
True or false Topical corticosteroids solutions are phosphate-based
True * phosphate based is water soluble and marked as solutions
77
True or false Topical corticosteroid suspensions have prolonged contact time and higher penetration
TRUE * acetates are prepared as suspensions *must shake suspensions

NBEO Part 1 (18 decks)

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