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Systemic Pharm Flashcards

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1
Q

What are three targets of natimicrobials

A

Cell wall
DNA
Proteins

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2
Q

What parts of the cell wall in microbes do we target

A

Peptidoglyan (brick)

Transpeptidase (glue)

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3
Q

Cell wall synthesis blockers

A

Bacitracin
PNC
Cephalosporins

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4
Q

PCNs

A

Amoxicillin

Dicloxicilin

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5
Q

Cephalosporins

A

Cephalexin

Ceftriaxone

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6
Q

Protein synthesis inhibitors target

A

30s and 50s ribosomal subunits

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7
Q

30s protein synthesis inhibitors

A 
buy AT 30
Aminoglycosides
-gentamicin
-tobramycin
Tetracyclines 
-tetracycline 
-doxycline 
-minocycline
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8
Q

50s protein synthesis inhibitors

A

Collect Money at 50

  • macrolides: erythromycin, azithromycin, alrithromycin
  • Clindamycin (lincomycin)
  • Chloramphenacol
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9
Q

How do we inhibit DNA for microbes

A

Folic acid synthesis (synthase and reductase)

DNA gyrase and topopolymerase 4 (FQs)

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10
Q

Inhibitors of folate synthase

A

Sulfonamide
Trimethoprim
Pyrimethamine

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11
Q

DNA gyrase and topoisomerase inhibitors

A

FQs

  • 2nd G=ciprofloxain, ofloxacin
  • 3rd G=levofloxacin
  • 4th G=gatifloxacin, moxifloxicin, besifloxacin
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12
Q

Peptidoglycan

A

The structural building block of bacterial cell walls; it contains polysaccharide chains that are cross linked via the enzyme transpeptidase. Bacitracin inhibits the transfer of peptidoglycan into the growing bacterial cell wall. All PCNs and cephalopods inhibit cell wall synthesis by inhibiting transpeptidase

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13
Q

MOA of bacitracin

A

Prevents bacterial cell wall synthesis by inhibiting the transfer of peptidoglycans

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14
Q

Clinical indications of bacitracin

A

Bacterial agent that is only effectsi against gram +; only available in ointment form and is often RXed for the treatment of blepharitis (staph)

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15
Q

Polysporin

A

Broads spectrum topical ophthalmic antibiotic ointment that contains the gram + coverage of bacitracin with the gram - coverage of polymyxin B

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16
Q

Neosporin

A

Neomycin + polysporin

Polysporin=bacitracin + polymyxinB

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17
Q

MOA of PCN (amoxicillin and dicloxacillin)

A

Inhibits transpeptidase

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18
Q

Which has better gram - coverage, amoxicillin or dicloxacillin

A

Amoxicillin

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19
Q

Penicillinase

A

Amoxicillin is not resistance to this but dicloxacillin is

Amoxicillin + calvulonic acid=Augmentin and this IS resistant to penicillinase

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20
Q

Dicloxacillin and augmentin are RXed for

A

Combat bacterial infections of the eyelid (hordeolum, preseptal cellulitis) caused by S aureus

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21
Q

DOC for MSS

A

Dicloxacillin

Not effective against MRSA though

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22
Q

Adverse effects of PCN

A

Hypersensitivity reaction

  • type 1=anaphylactic shock and urticaria
  • type 4=contact dermatitis

Render oral BC ineffective
Can cause SJS

Generally PCNs are very safe in all trimesters of pregnancy

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23
Q

MOA of cephalosporins (cephalexin, Ceftriaxone)

A

Inhibit transpeptidase

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24
Q

Clinical indications of cephalosporins

A

Similar to PCNs, all have good gram + coverage. 3rd and 4th generation are more effective against gram negative

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25
Cephalexin uses
1st generation cephalosporin Skin infections (that are primarily caused by gram + bacteria) Dacryoadenitis, dacryocystitis, and preseptal cellulitis
26
Ceftriaxone
3rd generation cephalosporin Gonorrhea IV is treatment of choice for gonococcal conjunctivitis and orbital cellulitis
27
Treatment of choice for gonococcal conjunctivitis and orbital cellulitis
IV ceftriaxone | Gram negative
28
Adverse effects of cephalosporins
Hypersensitivity reactions Alters vit K absorption, thinning of hte blood Contraindicated in warfarin
29
Coverage cephalosporin
1st generation=gram + | 3rd and 4th generation gram + and -
30
Which has better gram negative coverage, aminoglycosides or tetracyclines
Aminoglycosides
31
Aminoglycosides
Gentamicin | Tobramycin
32
MOA of aminoglycosides (tobramycin/gentamicin)
Bind to the 30s subunit of the bacterial ribosome to inhibit bacterial protein synthesis; effective against gram negative and gram + bacteria, with better coverage of the gram negative spectrum
33
Ocular indications of aminoglycosides (tobramycin/gentamicin)
Tobramycin is available in topical ophthalmic form and ointment form. Gentamicin and tobramycin topical ophthalmic solutions are available in fortified concentration, and are RXed with fortified cefazolin for the treatment of sight threatening ulcers
34
Tobradex
Tobramycin + dexamethasone | Inflammatory ocular conditions with an associated bacterial infection (staph marginal keratitis, corneal infiltrates)
35
AmiNOglycOSides
Nephtotoxicity Ototoxicity Ocular surface disease
36
Drugs taken on an empty stomach
PAT PCNs, azithromycin, tetras *doxy is the exception
37
Adverse effects of aminoglycosides
Topical ophthalmic aminoglycosides cause SPK and delayed healing
38
Tetracyclines
30s Tetracycline Doxycycline Minocycline
39
MOA of tetracycline
Inhibit bacterial protein synthesis by binding to the 30s ribosomal subunit and preventing access to aminoacyl tRNA; they are bacteriostatic ABx
40
Clinical inidincations of doxycycline
Meibomianitis Acne rosacea Chlamydia ocular infections Post RCE TAKEN WITH FOOD
41
Minocyline indications
Low doses for long term managment of acne vulgaris
42
Pharmacokinetics of tetracyclines
The absorption in the GI tract is impaired by cations in dairy products, antacids, and iron-containing compounds. The primary route of excretion of through the kidney; thus tetras are contraindicated in pateitns with renal failure. Doxy is th excretion, it can be taken with food and is eliminated in fecal matter, and can therefore be RXed in patients with renal failure
43
Adverse affects of tetras
Contraindicated in pregnancy and in children. Side effects include pseudotumor cerebri, bone growth retardation, and discoloring of teeth. Minocyline may cause blue sclera and pigmented cysts on the conjunctiva
44
Blockers of the 50s ribosomal subunit
CM | Chloramphenicol, clindamycin,lincomycin, marolides (erythromycin, azithromycin, clarithromycin)
45
Chloramphenicol MOA
Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit; it is effective against gram + and gram - bacteria. It can be formulated as an ointment for topical ophthalmic solution Dinosaur We dont use it that much anymore
46
Drugs contraindicated in pregnancy
FAT FQs Aminoglycosides Tetras
47
Drugs that are safe in pregnancy
PAC Pens Azithromycin Cephalosporin
48
P cerebri drugs
``` CATS Contraceptive Acutane Tetra Synthroid/steroid ```
49
Drugs that can cause a blue scleral
Steroids | Minocycline
50
Adver effects of chloramphenicol
TOPICAL ophthalmic use has caused fatal aplastic anemia | Extended therapy may result in optic neuritis
51
What is the only topical drug that can cause fatal aplastic anemia
Chloramphenicol
52
MOA of macrolides (erythromycin, azithromycin, clarithromycin)
Inhibit the bacterial protein synthesis by binding to the 50S subunit of the bacterial ribosome
53
What can treat chlamydia
Doxy | Azithromycin
54
Uses of oral azithromycin
``` Chlamydia infections (trachoma and AIC) Single gram dose Taken on an empty stomach ```
55
Topical ophthalmic azithromycin uses
Bacterial conjunctivitis and blepharitis | BID x 2 days, then QD x 5 days
56
Topical ophthalmic erythromycin ointment uses
Uncommonly RXed for active bacterial infections due to its poor resistance profile; it is more commonly RXed for prophylaxis and is dosed at night. It is also RXed for prophylaxis of gonococcal ophthalmia neonatorum
57
Oral clarithromycin uses
Respiratory infections
58
Azasite
Contains the preservative BAK. Patients who wear CL are advised against CL wear during the treatment with azasite
59
MOA of lincomycin/clindamycin
Inhibit the bacterial protein synthesis by REVERSIBLY binding to the 50s subunit of the bacterial ribosome
60
Clinical indications of clindamycin/lincomycin
MRSA
61
Drugs for MRSA
Bacteria Can’t Decide Bactrim (TMP-sulf) Clindamycin Doxycycline
62
Sulfonamide MOA
Inhibit dihydropteroate synthase, an enzyme that converts PABA to dihydrofolic acid as the first step of folic acid synthesis; these drugs are bacteriostatic agents that are RXed to treat gram + and gram - infections
63
Ophthalmic indications of sulfonamide
Rarely used topically
64
Side effects of topical sulfonamide
Burning, stinging, contact dermatitis, and local photosensitization
65
Systemic indications of sulfonamide
Sulfadiazine + pyrimethamine=toxo treatment | Sulfamethoxazole + trimethorpim=bactrim
66
Adverse effects of sulfonamides
Can cause kernicterus in infants due to bilirubin accumulation within the brain (they are contraindicated during pregnancy); they may also have a myopic shift in the patients refractive error. Topical and oral sulfonamides may also cause SJS
67
Trimethoprim and pyrimethamine MOA
Inhibit dihycrofolate reductase, an enzyme that converts dihydrofolic acid to tetrahydrofolic acid in the second step of folic acid synthesis Trim reduces
68
Clinical indications of trimethoprim
Gram +/-, not as effective against pseudomonas | Combo with polymyxin B as polytrim
69
Indications of pyrimethamine
Given orally with sulfadi for toxoplasmosis
70
What is the best to use for bacterial conjunctivits in kids
Polytrim
71
Most potent ophthalmic ABX against MRSA
Trimethoprim and tobramycin Besifoxacin and vancomycin also
72
Adverse effects of trimethoprim/pyrimethamine
Oral trimethoprim can cause bone marrow suppression, resulting in aplastic anemia, leukopenia, and granulocytopenia, pyrmethamine can have similar toxicity
73
MOA of FQs
Rapidly inhibit bacterial DNA synthesis by inhibiting DNA gyrase and topoisomerase 4
74
2nd generation FQ
Cirpofloxacin | Ofloxacin
75
3rd generation FQs
Levofloxacin
76
4th generation FQs
Gatifloxacin Moxifloxacin Besifloxacin
77
Topical ophthalmic indications of FQs
Contact lens realted ulcers, corneal abrasions, and bacterial conjunctivitis
78
Systemic indications of FQs
Ciprofloxacin is RXed for gram - urinary and GI infections. Moxifloxacin is approved for the treatment of pneumonia, sinusitis, and intracranial-abdominal and skin infections
79
Adverse effects of FQs
ORAL fluroquinoLONES can hurt the attachment to your BONEs; causing tendinitis. Oral FQs are contraindicated in pregnancy, chidlren, and adolescents below the age of 18 due to damage in cartilage formation and inhibition of bone growth
80
Effectiveness of the differnt generations of FQs
There are 4 generations, 3 and 4 have been formulated with improved effectiveness against gram + infections, however these drugs continue to be potent against gram - bac as well
81
Topical FQs and kids
All of the TOPICAL (NEVER ORAL) FQs are approved for kids 1 year and older EXCEPT LEVOFLOXACIN
82
Bacteriostatic agents
Tetracyclines, trimethoprim, sulfacetamde, and to some degree, erythromycin
83
Bacteriocidal agents
PNS, Cephs, bacitracin, aminoglycosides, FQs
84
Number one symptom of TB
Night sweats
85
TB is caused by
Mycobacterium TB
86
Active TB
Treated with a combo therapy
87
Latent TB
Treated with isoniazid or rifampin monotherapy
88
Active TB treatment is
RIPE - rifampin - isoniazid - ethambutol Don’t need to know the P one
89
TB=RIPE Cheese
RIPE for the drugs | Cheese=caseous necrosis
90
MOA of rifampin
Prevents mRNA synthesis (transcription) by binding to the beta subunit of DNA dependent RNA POLYMERASE
91
Adverse effects of rifampin
Hepatotxicity (increased AST and ALT), orange/pink colored tears and urine
92
Isoniazid MOA
Prevents cell wall synthesis by inhibiting mycolic acid synthesis
93
Adverse effects of isoniazid
Hepatotoxicity, can also cause pyridoxine (vit B6) deficiency that may result in peripheral neuropathy. Rarely It can cause optic neuritis and optic atrophy, resulting in loss of vision
94
Ethambutol MOA
Inhibits synthesis of mycobacterium cell wall by inhibiting arabinosyl transferase
95
What are the two drugs that can be used in isolation for TB monotherapy (latent)
Rifampin | Isoniazid
96
Adverse effects of ethambutol
``` Optic neuritis (retrobulbar) May be reversible vision loss ```
97
What TB drug is known to cause retrobulbar optic neuritis
Ethambutol
98
Antivirals for the flu
Oseltamivir (tamiflu) -inhibits influenza A and B viral neuraminidase Conjunctivitis due to influenza in 1% pts has been reported
99
MOA of HIV therapy (Zidovudine [Retrovir])
Reverse transcriptase inhibitor
100
AIDs occurs at what CD 4 count
<200
101
Clinical indications of zidovudine (Retrovir)
Major component of three-drug therapy for HIV. Also used during pregnancy to lower the risk of transmitting HIV to the fetus (vertical transmission)
102
Adverse effects of zidovudine (Retrovir)
1. Bone marrow suppression 2. Lactic acidosis 3. Muscle breakdown Amblyopia and macular edema have also been reported
103
There is a vax for which Heps
A and B | None for C
104
Hepatitis C therapy
C=chronic | Ribavirin + interferon
105
MOA of ribivirin
Inhibits viral RNA polymerase | Always in combo with interferon for the treatment of hep C
106
Adverse effects of ribavirin
Conjunctivis Retinopathy Retinal vascular Occlusions
107
Ocular side effects of ribavirin
``` RIBAViriN RD Ischemia Bleeding Arterial and Venous occlusions Optic Neuritis ``` VA normally OK
108
Why kind of virus is herpes
DNA
109
What do all herpes meds do
Inhibit DNA polymerase
110
Trifluridine MOA
Inhibits DNA polymerase for the treatment of herpes simplex keratitis Not used often because 9x day dosing and thimerosol
111
Acyclovir, valacyclovir, famcyclovir MOA
DNA polymerase inhibitors
112
Indications of acyclovir, valacyclovir, and famcyclovir
Cold sores, genital sores, and shingles. They may also be RXed for HZO, HSV keratitis, and prophylaxis against recurrent HSV keratitis
113
Adverse effects of acyclovir, valacyclovir, and famcyclovir
Headaches and GI effects Renal dysfunction -be careful in those with renal dysfunction and the elderly. Monitor closely
114
Oral antivirals
Used to treat HSV epithelial keratitis, but topical ophthalmic treatment is considered the standard of care. Oral dosages should be decreased in patients with kidney disease
115
Gancylovir
- DNA polymerase inhibitor - reduced corneal toxicity, 5x/day dosing (better than viroptic) - BAK instead of thimerosol
116
Clinical indications for gancyclovir
HSV keratitis | Intraocular sustained-release capsule for the treatment of CMV retinitis
117
CMV
Opportunistic infection Vision threatening retinopathy in those with AIDS -most common intraocualr infection in patients with AIDs -treat with Zirgan (gancyclovir), if that doesnt work, use your safety “net” Foscarnet
118
Foscarnet
- SAfety net for CMV if gancyclovir fails - DNA polymerase inhibitor, IV - nehprotoxicity and seizures
119
Fungal ucler
Feathery edges Immunocompromised Chronic beat up cornea Tree branch
120
Fungus: ergosterol
Component of fungal cell membranes that is not found in human or animal cell walls.
121
Antifungal drugs
Natamycin, amphotericin B, nystatin Ketoconazole, fluconazole, and miconozole Griseofulvin
122
MOA of natamycin, amphotericin B, and nystatin
Bind to ergosterol and form pores
123
Clinical indictions for natamycin
Approved for the treatment of fungal blepharitis, conjunctivits, and keratitis caused by susceptible organisms of Candida, Aspergillus, and Fusarium
124
Clinical indications for Amphotericin B
Broad spectrum antifungal. Fungal keratitis, and IV form to treat systemic and intraocular fungal infections. Nephrotoxicity is common in IV form
125
Clinical indications of Nystatin
``` Candida oral (thrush) and vaginal (yeast) infections Not indicated for ophthalmic use ```
126
MOA of ketoconazole, fluconazole, and miconazole
Inhibit ergosterol synthesis
127
Clinical indications of ketoconazole
First oral azole antifungal drug and is indicated for the treatment of severe fungal corneal ulcers, systemic fungal infections, and acanthoemeba
128
Indications of fluconazole
Orally, topically, or through subconjunctival injections
129
Adverse effects of the azoles
Hepatotoxicity
130
MOA of griseofulvin
Inhibits fungal mitosis by interfering with microtubule formation
131
Clinical indictions of griseofulvin
Scalp and skin, fingernails and toenails
132
Treatment of toxoplasmosis
Sulfadi + pyrimethamine
133
Antiparasitic drugs
Chloroquine | Lindane
134
MOA of chloroquine
1. Results in the build up of heme within the RBCs; this accumulation is toxic to the “intra-erythrocytic” plasmodium parasite responsible for malaria 2. Inhibits phosphlipase A2 to decrease inflammation, not generally used for this
135
Adverse effects of chloroquine
Whorl K Bulls eye maculopathy: granular hyperpigmentation surrounded by zone of depigmentation Binds melanin=migration of RPE cells-permanent
136
What does a plaquenil screening consist of
10-2 VF | SD-OCT
137
Why does chloroquine cause bulls eye maculopathy
Binds to melanin of the RPE cells, causing localized RPE damage and subsequent migration of RPE cells to the outer nuclear and OPL. The initial sign of bulls eye maculopathy is RPE mottling within the macula
138
Risk of developing bulls eye maculopathy in chloroquine
- >2.3mg/kg body weight (Hydroxychloroquine is >5mg/kg) - treatment > 5 years - abnormal renal function - high body fat - >60yo - liver disease - concomitant retinal disease
139
Scotomas of chloroquine
Central and paracentral most common
140
Lindane
``` Antiparacytic MOA: lipophlic structure absorbed through the exoskeleton of insects, resulting in seizures and death -lice, scabies -causes conjunctivits -not for the eyes ```
141
Peptidoglycan
The structural building block of bacterial cell walls; it contains polysaccharide chains that are cross linked via the enzyme transpeptidase. Bacitracin inhibits the transfer of peptidoglycan into the growing bacterial cell wall. All PCNs and cephalopods inhibit cell wall synthesis by inhibiting transpeptidase
142
MOA of bacitracin
Prevents bacterial cell wall synthesis by inhibiting the transfer of peptidoglycans
143
Clinical indications of bacitracin
Bacterial agent that is only effectsi against gram +; only available in ointment form and is often RXed for the treatment of blepharitis (staph)
144
Polysporin
Broads spectrum topical ophthalmic antibiotic ointment that contains the gram + coverage of bacitracin with the gram - coverage of polymyxin B
145
Neosporin
Neomycin + polysporin | Polysporin=bacitracin + polymyxinB
146
MOA of PCN (amoxicillin and dicloxacillin)
Inhibits transpeptidase
147
Which has better gram - coverage, amoxicillin or dicloxacillin
Amoxicillin
148
Penicillinase
Amoxicillin is not resistance to this but dicloxacillin is Amoxicillin + calvulonic acid=Augmentin and this IS resistant to penicillinase
149
Dicloxacillin and augmentin are RXed for
Combat bacterial infections of the eyelid (hordeolum, preseptal cellulitis) caused by S aureus
150
DOC for MSS
Dicloxacillin Not effective against MRSA though
151
Adverse effects of PCN
Hypersensitivity reaction - type 1=anaphylactic shock and urticaria - type 4=contact dermatitis Render oral BC ineffective Can cause SJS Generally PCNs are very safe in all trimesters of pregnancy
152
MOA of cephalosporins (cephalexin, Ceftriaxone)
Inhibit transpeptidase
153
Clinical indications of cephalosporins
Similar to PCNs, all have good gram + coverage. 3rd and 4th generation are more effective against gram negative
154
Cephalexin uses
1st generation cephalosporin Skin infections (that are primarily caused by gram + bacteria) Dacryoadenitis, dacryocystitis, and preseptal cellulitis
155
Ceftriaxone
3rd generation cephalosporin Gonorrhea IV is treatment of choice for gonococcal conjunctivitis and orbital cellulitis
156
Treatment of choice for gonococcal conjunctivitis and orbital cellulitis
IV ceftriaxone | Gram negative
157
Adverse effects of cephalosporins
Hypersensitivity reactions Alters vit K absorption, thinning of hte blood Contraindicated in warfarin
158
Coverage cephalosporin
1st generation=gram + | 3rd and 4th generation gram + and -
159
Which has better gram negative coverage, aminoglycosides or tetracyclines
Aminoglycosides
160
Aminoglycosides
Gentamicin | Tobramycin
161
MOA of aminoglycosides (tobramycin/gentamicin)
Bind to the 30s subunit of the bacterial ribosome to inhibit bacterial protein synthesis; effective against gram negative and gram + bacteria, with better coverage of the gram negative spectrum
162
Ocular indications of aminoglycosides (tobramycin/gentamicin)
Tobramycin is available in topical ophthalmic form and ointment form. Gentamicin and tobramycin topical ophthalmic solutions are available in fortified concentration, and are RXed with fortified cefazolin for the treatment of sight threatening ulcers
163
Tobradex
Tobramycin + dexamethasone | Inflammatory ocular conditions with an associated bacterial infection (staph marginal keratitis, corneal infiltrates)
164
AmiNOglycOSides
Nephtotoxicity Ototoxicity Ocular surface disease
165
Drugs taken on an empty stomach
PAT PCNs, azithromycin, tetras *doxy is the exception
166
Adverse effects of aminoglycosides
Topical ophthalmic aminoglycosides cause SPK and delayed healing
167
Tetracyclines
30s Tetracycline Doxycycline Minocycline
168
MOA of tetracycline
Inhibit bacterial protein synthesis by binding to the 30s ribosomal subunit and preventing access to aminoacyl tRNA; they are bacteriostatic ABx
169
Clinical inidincations of doxycycline
Meibomianitis Acne rosacea Chlamydia ocular infections Post RCE TAKEN WITH FOOD
170
Minocyline indications
Low doses for long term managment of acne vulgaris
171
Pharmacokinetics of tetracyclines
The absorption in the GI tract is impaired by cations in dairy products, antacids, and iron-containing compounds. The primary route of excretion of through the kidney; thus tetras are contraindicated in pateitns with renal failure. Doxy is th excretion, it can be taken with food and is eliminated in fecal matter, and can therefore be RXed in patients with renal failure
172
Adverse affects of tetras
Contraindicated in pregnancy and in children. Side effects include pseudotumor cerebri, bone growth retardation, and discoloring of teeth. Minocyline may cause blue sclera and pigmented cysts on the conjunctiva
173
Blockers of the 50s ribosomal subunit
CM | Chloramphenicol, clindamycin,lincomycin, marolides (erythromycin, azithromycin, clarithromycin)
174
Chloramphenicol MOA
Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit; it is effective against gram + and gram - bacteria. It can be formulated as an ointment for topical ophthalmic solution Dinosaur We dont use it that much anymore
175
Drugs contraindicated in pregnancy
FAT FQs Aminoglycosides Tetras
176
Drugs that are safe in pregnancy
PAC Pens Azithromycin Cephalosporin
177
P cerebri drugs
``` CATS Contraceptive Acutane Tetra Synthroid/steroid ```
178
Drugs that can cause a blue scleral
Steroids | Minocycline
179
Adver effects of chloramphenicol
TOPICAL ophthalmic use has caused fatal aplastic anemia | Extended therapy may result in optic neuritis
180
What is the only topical drug that can cause fatal aplastic anemia
Chloramphenicol
181
MOA of macrolides (erythromycin, azithromycin, clarithromycin)
Inhibit the bacterial protein synthesis by binding to the 50S subunit of the bacterial ribosome
182
What can treat chlamydia
Doxy | Azithromycin
183
Uses of oral azithromycin
``` Chlamydia infections (trachoma and AIC) Single gram dose Taken on an empty stomach ```
184
Topical ophthalmic azithromycin uses
Bacterial conjunctivitis and blepharitis | BID x 2 days, then QD x 5 days
185
Topical ophthalmic erythromycin ointment uses
Uncommonly RXed for active bacterial infections due to its poor resistance profile; it is more commonly RXed for prophylaxis and is dosed at night. It is also RXed for prophylaxis of gonococcal ophthalmia neonatorum
186
Oral clarithromycin uses
Respiratory infections
187
Azasite
Contains the preservative BAK. Patients who wear CL are advised against CL wear during the treatment with azasite
188
MOA of lincomycin/clindamycin
Inhibit the bacterial protein synthesis by REVERSIBLY binding to the 50s subunit of the bacterial ribosome
189
Clinical indications of clindamycin/lincomycin
MRSA
190
Drugs for MRSA
Bacteria Can’t Decide Bactrim (TMP-sulf) Clindamycin Doxycycline
191
Sulfonamide MOA
Inhibit dihydropteroate synthase, an enzyme that converts PABA to dihydrofolic acid as the first step of folic acid synthesis; these drugs are bacteriostatic agents that are RXed to treat gram + and gram - infections
192
Ophthalmic indications of sulfonamide
Rarely used topically
193
Side effects of topical sulfonamide
Burning, stinging, contact dermatitis, and local photosensitization
194
Systemic indications of sulfonamide
Sulfadiazine + pyrimethamine=toxo treatment | Sulfamethoxazole + trimethorpim=bactrim
195
Adverse effects of sulfonamides
Can cause kernicterus in infants due to bilirubin accumulation within the brain (they are contraindicated during pregnancy); they may also have a myopic shift in the patients refractive error. Topical and oral sulfonamides may also cause SJS
196
Trimethoprim and pyrimethamine MOA
Inhibit dihycrofolate reductase, an enzyme that converts dihydrofolic acid to tetrahydrofolic acid in the second step of folic acid synthesis Trim reduces
197
Clinical indications of trimethoprim
Gram +/-, not as effective against pseudomonas | Combo with polymyxin B as polytrim
198
Indications of pyrimethamine
Given orally with sulfadi for toxoplasmosis
199
What is the best to use for bacterial conjunctivits in kids
Polytrim
200
Most potent ophthalmic ABX against MRSA
Trimethoprim and tobramycin Besifoxacin and vancomycin also
201
Adverse effects of trimethoprim/pyrimethamine
Oral trimethoprim can cause bone marrow suppression, resulting in aplastic anemia, leukopenia, and granulocytopenia, pyrmethamine can have similar toxicity
202
MOA of FQs
Rapidly inhibit bacterial DNA synthesis by inhibiting DNA gyrase and topoisomerase 4
203
2nd generation FQ
Cirpofloxacin | Ofloxacin
204
3rd generation FQs
Levofloxacin
205
4th generation FQs
Gatifloxacin Moxifloxacin Besifloxacin
206
Topical ophthalmic indications of FQs
Contact lens realted ulcers, corneal abrasions, and bacterial conjunctivitis
207
Systemic indications of FQs
Ciprofloxacin is RXed for gram - urinary and GI infections. Moxifloxacin is approved for the treatment of pneumonia, sinusitis, and intracranial-abdominal and skin infections
208
Adverse effects of FQs
ORAL fluroquinoLONES can hurt the attachment to your BONEs; causing tendinitis. Oral FQs are contraindicated in pregnancy, chidlren, and adolescents below the age of 18 due to damage in cartilage formation and inhibition of bone growth
209
Effectiveness of the differnt generations of FQs
There are 4 generations, 3 and 4 have been formulated with improved effectiveness against gram + infections, however these drugs continue to be potent against gram - bac as well
210
Topical FQs and kids
All of the TOPICAL (NEVER ORAL) FQs are approved for kids 1 year and older EXCEPT LEVOFLOXACIN
211
Bacteriostatic agents
Tetracyclines, trimethoprim, sulfacetamde, and to some degree, erythromycin
212
Bacteriocidal agents
PNS, Cephs, bacitracin, aminoglycosides, FQs
213
Number one symptom of TB
Night sweats
214
TB is caused by
Mycobacterium TB
215
Active TB
Treated with a combo therapy
216
Latent TB
Treated with isoniazid or rifampin monotherapy
217
Active TB treatment is
RIPE - rifampin - isoniazid - ethambutol Don’t need to know the P one
218
TB=RIPE Cheese
RIPE for the drugs | Cheese=caseous necrosis
219
MOA of rifampin
Prevents mRNA synthesis (transcription) by binding to the beta subunit of DNA dependent RNA POLYMERASE
220
Adverse effects of rifampin
Hepatotxicity (increased AST and ALT), orange/pink colored tears and urine
221
Isoniazid MOA
Prevents cell wall synthesis by inhibiting mycolic acid synthesis
222
Adverse effects of isoniazid
Hepatotoxicity, can also cause pyridoxine (vit B6) deficiency that may result in peripheral neuropathy. Rarely It can cause optic neuritis and optic atrophy, resulting in loss of vision
223
Ethambutol MOA
Inhibits synthesis of mycobacterium cell wall by inhibiting arabinosyl transferase
224
What are the two drugs that can be used in isolation for TB monotherapy (latent)
Rifampin | Isoniazid
225
Adverse effects of ethambutol
``` Optic neuritis (retrobulbar) May be reversible vision loss ```
226
What TB drug is known to cause retrobulbar optic neuritis
Ethambutol
227
Antivirals for the flu
Oseltamivir (tamiflu) -inhibits influenza A and B viral neuraminidase Conjunctivitis due to influenza in 1% pts has been reported
228
MOA of HIV therapy (Zidovudine [Retrovir])
Reverse transcriptase inhibitor
229
AIDs occurs at what CD 4 count
<200
230
Clinical indications of zidovudine (Retrovir)
Major component of three-drug therapy for HIV. Also used during pregnancy to lower the risk of transmitting HIV to the fetus (vertical transmission)
231
Adverse effects of zidovudine (Retrovir)
1. Bone marrow suppression 2. Lactic acidosis 3. Muscle breakdown Amblyopia and macular edema have also been reported
232
There is a vax for which Heps
A and B | None for C
233
Hepatitis C therapy
C=chronic | Ribavirin + interferon
234
MOA of ribivirin
Inhibits viral RNA polymerase | Always in combo with interferon for the treatment of hep C
235
Adverse effects of ribavirin
Conjunctivis Retinopathy Retinal vascular Occlusions
236
Ocular side effects of ribavirin
``` RIBAViriN RD Ischemia Bleeding Arterial and Venous occlusions Optic Neuritis ``` VA normally OK
237
Why kind of virus is herpes
DNA
238
What do all herpes meds do
Inhibit DNA polymerase
239
Trifluridine MOA
Inhibits DNA polymerase for the treatment of herpes simplex keratitis Not used often because 9x day dosing and thimerosol
240
Acyclovir, valacyclovir, famcyclovir MOA
DNA polymerase inhibitors
241
Indications of acyclovir, valacyclovir, and famcyclovir
Cold sores, genital sores, and shingles. They may also be RXed for HZO, HSV keratitis, and prophylaxis against recurrent HSV keratitis
242
Adverse effects of acyclovir, valacyclovir, and famcyclovir
Headaches and GI effects Renal dysfunction -be careful in those with renal dysfunction and the elderly. Monitor closely
243
Oral antivirals
Used to treat HSV epithelial keratitis, but topical ophthalmic treatment is considered the standard of care. Oral dosages should be decreased in patients with kidney disease
244
Gancylovir
- DNA polymerase inhibitor - reduced corneal toxicity, 5x/day dosing (better than viroptic) - BAK instead of thimerosol
245
Clinical indications for gancyclovir
HSV keratitis | Intraocular sustained-release capsule for the treatment of CMV retinitis
246
CMV
Opportunistic infection Vision threatening retinopathy in those with AIDS -most common intraocualr infection in patients with AIDs -treat with Zirgan (gancyclovir), if that doesnt work, use your safety “net” Foscarnet
247
Foscarnet
- SAfety net for CMV if gancyclovir fails - DNA polymerase inhibitor, IV - nehprotoxicity and seizures
248
Fungal ucler
Feathery edges Immunocompromised Chronic beat up cornea Tree branch
249
Fungus: ergosterol
Component of fungal cell membranes that is not found in human or animal cell walls.
250
Antifungal drugs
Natamycin, amphotericin B, nystatin Ketoconazole, fluconazole, and miconozole Griseofulvin
251
MOA of natamycin, amphotericin B, and nystatin
Bind to ergosterol and form pores
252
Clinical indictions for natamycin
Approved for the treatment of fungal blepharitis, conjunctivits, and keratitis caused by susceptible organisms of Candida, Aspergillus, and Fusarium
253
Clinical indications for Amphotericin B
Broad spectrum antifungal. Fungal keratitis, and IV form to treat systemic and intraocular fungal infections. Nephrotoxicity is common in IV form
254
Clinical indications of Nystatin
``` Candida oral (thrush) and vaginal (yeast) infections Not indicated for ophthalmic use ```
255
MOA of ketoconazole, fluconazole, and miconazole
Inhibit ergosterol synthesis
256
Clinical indications of ketoconazole
First oral azole antifungal drug and is indicated for the treatment of severe fungal corneal ulcers, systemic fungal infections, and acanthoemeba
257
Indications of fluconazole
Orally, topically, or through subconjunctival injections
258
Adverse effects of the azoles
Hepatotoxicity
259
MOA of griseofulvin
Inhibits fungal mitosis by interfering with microtubule formation
260
Clinical indictions of griseofulvin
Scalp and skin, fingernails and toenails
261
Treatment of toxoplasmosis
Sulfadi + pyrimethamine
262
Antiparasitic drugs
Chloroquine | Lindane
263
MOA of chloroquine
1. Results in the build up of heme within the RBCs; this accumulation is toxic to the “intra-erythrocytic” plasmodium parasite responsible for malaria 2. Inhibits phosphlipase A2 to decrease inflammation, not generally used for this
264
Adverse effects of chloroquine
Whorl K Bulls eye maculopathy: granular hyperpigmentation surrounded by zone of depigmentation Binds melanin=migration of RPE cells-permanent
265
What does a plaquenil screening consist of
10-2 VF | SD-OCT
266
Why does chloroquine cause bulls eye maculopathy
Binds to melanin of the RPE cells, causing localized RPE damage and subsequent migration of RPE cells to the outer nuclear and OPL. The initial sign of bulls eye maculopathy is RPE mottling within the macula
267
Risk of developing bulls eye maculopathy in chloroquine
- >2.3mg/kg body weight (Hydroxychloroquine is >5mg/kg) - treatment > 5 years - abnormal renal function - high body fat - >60yo - liver disease - concomitant retinal disease
268
Scotomas of chloroquine
Central and paracentral most common
269
Lindane
``` Antiparacytic MOA: lipophlic structure absorbed through the exoskeleton of insects, resulting in seizures and death -lice, scabies -causes conjunctivits -not for the eyes ```
270
What is the first step in the arachidonic pathway
Phospholipase A2
271
What are leukotrienes synthesized by
Lipoxygenase
272
Thromboxanes
Induce platelet aggregation
273
COX2
Synthesizes PGs that mediate inflammation - pain - fever - swelling
274
COX1
Synthesizes PGs that inhibit gastric secretions and influence gastric motility -protects our ONE stomach
275
MOA of hydroxychloroquine (plaquenil)
1. Inhibits phospholipase A2 | 2. Build up of heme
276
Clinical indications for hydroxychloroquine
Lupus RA Malaria
277
Adverse effects of hydroxychloroquine
``` Corneal deposition (whorl K) Bulls eye maculopathy (greatest threat to vision) ```
278
Ideal daily dose of hydroxychloroquine
toxic I’d >5mg/kg body weight | Do not exceed 400mg per day
279
Toxic dose of chloroquine
>2.3mg/kg body weight
280
Risk factors for maculopathy in hydroxychloroquine include
``` Treatment duration > 5 years Abnornal renal function Liver disease Age > 60 High body fat Concomitant retinal Disease ```
281
Baseline exam for hydroxychloroquine
- baseline dilated retinal exam within 1 year of beginning drug. - annual screenings initiated after 5 years - 10-2 HVF, SD-OCT - if patient is at a greater risk of development of bulls eye maculopathy, exams should occur every 6 months to 1 year after the baseline exam. - risk much higher with chloroquine than hydroxychloroquine - 2.3mg/kg chloroquine and 5mg/kg hydroxychloroquine
282
Which is more toxic, chloroquine or hydroxychloroquine
Chloroquine
283
Strong topical steroids
Pred acetate Rimexolone Difluprednate Dexamethasone
284
Weak topical steroids
Loteprednol | Fluorometholone (FML)
285
What are the systemic steroids
Fluticasone Triamcinolone Hydrocortisone
286
MOA of steroids
Inhibition of phospholipase A 2
287
Steroids side effects
``` Increased blood sugar Insulin resistance Peptic ulcer (decreased PGs) Decreased fibroblasts (decreased healing) Osteoporosis HTN Psychiatric ```
288
Ocular side effects of steroids
PSC cataracts (dose dependent, irreversible) Glaucoma Increased risk of secondary infections (HSV K) Central serous chorioretinopathy
289
What to inquire about before RXing oral steroids
Pregnancy Peptic ulcers Diabetes
290
Hydrocortisone RXed for
Adrenal insufficiency | May also be used as a potent anti inflammatory medication
291
What steroid should not be give to dark skinned patients
Triamcinolone
292
Ophthalmic indications of triamcinolone via injection
- DM mac edema - graves - intermediate or non resolving posterior uveitis - chalazia - recalcitrant Irvine gass CME - CME associated with noninfectious posteiror uveitis - mac edema secondary to CRVO
293
Systemic indications for triamcinolone
Dermatoses Asthma exacerbations of MS Arthritis
294
Adverse effects of triamcinolone
``` Elevated IOP (decreased TM outflow) Endophthalmitis Depigmentation of the eyelid skin in darker skinned patients (permanent) ```
295
Fluticasone
``` Steroid Intrnasal corticosteroid (topical) indicated for treatment of allergic rhinitis ```
296
Adverse effects of fluticasone
Cataract, increased IOP, conjunctivitis, and dry eye disease, CSCR
297
Topical NSAIDs
``` Diclofenac Nepfenac Bromfenac Ketorolac Flurbiprofen ```
298
Oral NSAIDs
Aspirin Indomethacin/ibuprofen/naproxen/naproxen sodium/piroxicam Celecoxib
299
What is the only irreversible COX 1 and 2 inhibitor
Aspirin
300
MOA of apirin
Salicylate that inhibits the synthesis of PGs and thromboxanes by acting as an irreversible COX 1 and 2 inhibitor
301
Clinical indications of Aspirin
Antipyresis (fever) Anti-inflammtory effects Analgesia Reduces the risk of recurrent heart attacks in pts with heart disease
302
Adverse effects of aspirin
``` GI effects (decreased COX1=increased acid) Antiplatelet effects=bleeding complications in the eye (retinal and subconjunctival heme) Reye’s syndrome in kids ```
303
What are the reversible COX 1 and 2 inhibitors
``` Indomethacin Ibuprofen Naproxen Sodium naproxen Piroxicam ```
304
``` Clinical indications for Indomethacin Ibuprofen Naproxen Sodium naproxen Piroxicam ```
Scleritis and episcleritis
305
``` Indomethacin Ibuprofen Naproxen Sodium naproxen Piroxicam Contraindicated in ```
Patients with heart disease
306
``` Adverse effects of Indomethacin Ibuprofen Naproxen Sodium naproxen Piroxicam ```
All increase the risk of bleeding complications in the eye Risk if GI bleed Fatal MI/stroke
307
Which NSAIDs are safe for pateitns with cardiovascular disease
Aspirin ONLY ``` Indomethacin Ibuprofen Naproxen Sodium naproxen Piroxicam ALL contraindicated in heart disease patients. Can increased BP ```
308
Which NSAIDs can cause Reye’s syndrome
Aspirin ONLY ``` Indomethacin Ibuprofen Naproxen Sodium naproxen Piroxicam DO NOT ```
309
Which NSAID can be safely RXed in kids 6m and older
Ibuprofen
310
What should NSAIDs be taken with in order to decrease effects on GI
Food
311
Pigmentary retinopathy drugs
Chlorpazamine Thioridazine Indomethacin
312
Ocular side effects of indomethacin
Increases the risk of bleeding in the eye Whorl K Retinary pigmentary changes (mottling)
313
Misoprostol
Synthetic PG E1 that is chemically similar to PGE-2, the PG that protests the stomach lining. It is used for prevention and treatment of NSAID induced stomach ulcers. It’s main adverse effect is that is can cause miscarriages and premature labor
314
MOA of celecoxib
Selective COX2 inhibitor | Spares the COX1 pathway and protects the stomach
315
Adverse effects of celecoxib
SJS
316
Contraindications of systemic NSAIDs
Patients with a history of an allergic reaction to other NSAIDs or to aspirin
317
Parasympathetic acts on ___receptros
Cholinergic (muscarinic) receptors that target organs; promotes bronchoconstriction, miosis, rest and digest, and increase in secretions (SLUD: salivation, lacrimation, urination, defacation)
318
Sympathetic acts on _____ receptors
Adrenergic (a and b) receptors on target organs; promotes bronchidilation, mydriasis, a decrease in secretions and fight or flight
319
Direct cholinergic agonist (ocular)
Pilo
320
Indirect cholinergic agonists (ocular)
Edrophonium Echothiophate Pyridostigmine Neostigmine ACHase blockers
321
Donepizil
CNS ACHase inhibitor that is indicated for the treatment of Alzheimer’s (indirect cholinergic agonsit)
322
Cholinergic antagonists
- First generation H1 blockers: diphenhydramine, brompheniramine, chlorpheniramine, promethazine - antipsychotics: chlorpromazine, thioridazine - antidepressants: TCAs (amitriptyline, imipramine), MAOI (phenylzine) - muscle relaxant: cylcobenzaprine - anti-anxiety: diazepam - ipratropium
323
Systemic A2 agonist
Clonidine
324
Systemic B1/B2 agonist
Isoproteronol
325
Systemic B2 agonist
``` Salmeterol Albuterol Levabuterol Terbutaline Metaproterenol ```
326
systemic B agonists and IOP
Increase aqueous humor production. Salmeterol is the only long acting B2 agonists and the only drug that does not carry a specific warning regarding use in patietns with glaucoma
327
What is the only long acting B2 agonist that does not have a specific warning regarding use in glaucoma patients
Salmeterol
328
Nonspecific alpha and beta agonist
Pseudoephedrine
329
Dopamine agonsits
Bromocripitine Methylphenidate Dextroamphetamine Increase adrenergic acitivtiy, do not give to narrow angle patients
330
Parkinson’s drugs
Amantadine Dopamine agonist Adrenergic agonist, do not give to narrow angle patients
331
Alpha 1 blockers
Prazosin Tamsulosin Terazosin BPH drugs
332
B-blockers
Propanolol Labetolol Atenolol Metoprolol
333
Nonselective B agonsits
Labetolol | Propranolol
334
B1 specific antagonists
Atenolol, metoprolol
335
Which BBlockers would have least affect on IOP
BEAM - betaxolol - atenolol - metoprolol B1 selective
336
Cold medication is targeted at
Ameliorating symptoms
337
Pseudoephedrine
Cold medicine | MOA: nonspecific alpha and b agonist for nasal decongestion
338
Adverse effects of pseudoephedrine
Tachycardia (b1), bronchodilator (b2), nervousness Ocular: diplopia, and blurred vision, caution with increased IOP (B2)
339
H1 receptors
In the smooth muscle of the bronchi, blood vessels, and intestines. Activating of H1 causes itching, vasodilation, increased vascular permeability, and contraction of smooth muscel in the GI tract
340
H2 receptors
Located in the gastric parietal cells, the heart, pulmonary blood vessels, and cells of the immune system. Activation of H2 receptors causes itching, vasodilation, mucous discharge, and gastric secretions
341
Which H receptor is found in the eye
Mostly H1
342
Histamine release in the eye
H1 receptors | Itching, tearing, chemosis, dilation of conjunctival blood vessels and papillary reaction.
343
First generation antihistamines
Diphenhydramine Chlorpheniramine Brompheniramine Promethazine
344
Which generation of anti histamine drugs causes anticholinergic type reactions in the eye and what are the reactions
First generation | Increased IOP, dry eye, mydriasis
345
MOA of first generation H1 blockers
Block the interaction between histamine and H1 receptors
346
Clinical indications of first generation H1 blockers
Allergic skin reactions
347
Adverse reactions of first generstion H1 blockers
Sedation due to CNS penetration (BBB). All antihistamines especially first generation drugs, have anticholinergic effects including mydriasis, increased IOP, dry eye, dry mouth, and tachycardia
348
What’s special about promethazine
First generation H1 blocker Chemical structure similar to antipsychotic medications (phenothiazines) Ocular side effects specific to this drug result from the phenothiazine structure and include corneal epithelial Keratopathy, corneal endothelial pigmentation, lenticular changes, and pigmentary retinopathy
349
Second generation H1 blockers
Loratadine Fexofenadine Cetirizine
350
Clinical indications of second generation H1 blockers
Allergic rhinitis, and chronic urticaria (hives)
351
Adverse effects of secondary generation H1 blockers
Less CNS penetration and less CNS side effects. Cetirizine can cause abnormal EOM contractions (oculogyric crisis)
352
Majority of peptic ulcer disease is caused by
Helicobacter pylori and/or NSAID use
353
H2 blockers
Cimetidine Ranitidine Famotidine
354
MOA of H2 blockers
Prevent histamine stimulation of gastric acid (HCl)secretion by blocking H2 receptors on gastric parietal cells
355
Clinical indications of H2 blockers
Healing and preventing stomach ulcers and acid reflux
356
Adverse effects of H2 blockers
Diarrhea; cimetidine has numerous drug interactions and can cause gynecomastia and loss of libido
357
Proton pump inhibitors
Omeprazole | Esomeprazole
358
MOA of PPIs
Inhibit H+/K+ ATPase (proton) pumps
359
Clinical indications of PPIs
1st line therapy for peptic ulcer disease and GERD
360
Sucralfate
Gastric lining protector | MOA: forms a paste like substance by binding to positively charged proteins and damaged ulcer tissue in the stomach.
361
Adverse effects of sucralfate
Interfere with absorption of other oral medications, dont use within 2 hours of otherdrugs
362
Bronchodilators stimulate ____ nervous system
Sympathetic
363
Long acting B2 agonists
Salmeterol
364
uses of salmeterol
Only long lasting B2 agonist we need to know | Maintenance therapy for COPD and asthma but NOT as a rescue inhaler
365
Short acting B2 agonsits
Albuterol, levalbuterol, terbutaline Metaproterenol Isoproterenol
366
Clinical indications of albuterol, levalbuterol, and terbutaline
Short acting B2 agonsits | Rescue inhaler for patients with asthma and COPD
367
Clinical indications of metaproterenol
no longer recommended for asthma due to excessive cardiovascular effects from B1 stimulation
368
Clinical indications of isoproterenol
No longer RXed for the treatment of asthma. Nonspecific B agonsits primarily indicated for the treatment of arrhythmias through B1 stimulation
369
Adverse effects of short acting B2 agonsits
They have greater B2 than B1 activity, but the effects come from B1 activity on the heart -tachycardia, heart palpitations, nervousness, tremors, nausea
370
Short acting B2 agonsits and IOP
All have warnings about their use in glaucoma patients due to the risk of IOP increase
371
Muscarinic antagonist for asthma
Ipratropium - blocks muscarinic receptors - inhibits bronchoconstricion - caution in narrow angle glaucoma due to pupil dilation
372
Miscellaneous respiratory agents
Montelukast and Zafirlukast Theophylline Acetylcysteine
373
Montelukast and Zafirlukast
Leukotriene receptor antagonists Treat asthma and bronchoconstriction Montelukast also used for allergic rhinitis
374
Theophylline
Inhibits PDEs, leading to increase cAMP and increased release of epi. Narrow TI BBlockers, including topical ophthalmic agents such as timolol, have the potential to mitigate the bronchodilatory effects of theophylline
375
Acetylcysteine
Mucolytic agent that breaks disulfide bonds in proteins of mucus in order to reduce its viscosity. The topical opthalmic form can be RXed as QID for filamentary keratitis, dry eye syndrome, and corneal burns
376
Immunosuppressant medications
Methotrexate Cyclosporine Azathioprine
377
Methotrexate MOA
Inhibits dihydrofolate reductase (like TMP and pyromethamine)which inhibits DNA synthesis MOA in RA involves immunosuppressant and anti inflammatory mechanisms
378
Adverse effects of methotrexate
Hepatotoxicty and myelosuppreison, increases the risk of opportunistic infections and lymphomas Aplastic anemia Optic neuritis
379
Cyclosporine MOA
Prevents rejection of organ transplants by inhibiting the release of and production of interluelin-2 (IL-2), a chemical mediator responsible for T lymphocyte activation
380
Restasis
RXed BID | Inhibits T cell activation by inhibiting production if IL-2
381
Adverse effects of cyclosporine
Opportunistic infection
382
Most common cause of reversible posteiror leukoencephalopathy syndrome (RPLS)
Oral cyclosporine -HA, altered consciousness, seizures, and visual disturbances. DX based on MRI findings. Discontinue if this is diagnosed
383
Azathioprine
Purine analong that inserts into DNA and RNA and stops replication Used for RA and to prevent rejection of kidney transplant, ocular MG
384
Tamoxifen
- a competitive partial agonsit inhibitor of estradiol, which inhibits estrogen effects at the breast - treatment for breast cancer
385
Adverse effects of tamoxifen
-crystalline retinopathy, whorl Keratopathy, thromboembolism (BRVO, CRVO)
386
Cessation of tamoxifen and whorl K and crystalline maculopathy
Whorl K is generally reversible but maculoapthy can affect vision and is not always reversible
387
Analgesics
OTC agents such as NSAIDS and acetaminophen. RX includes some NSAIDs, muscle relaxants, and tramadol
388
Non opiate analgesics
Acetaminophen Cyclobenzaprine Tramadol
389
MOA of acetaminophen
Not completely understood | DOES NOT HAVE ANTI INFLAMMATORY PROPERTIES
390
What is the max amount of acetaminophen you can take in a day
4000mg
391
Who can take acetaminophen
Anyone | Kids and pregs too
392
Adverse effect of acetaminophen
Hepatotoxicity TylenoL=liver metabolism
393
Cyclobenzaprine MOA
Muscle relaxant | Inhibit alpha and gamma motor neurons
394
Clinical indications for cyclobenzaprine
Muscle spasms
395
Adverse effects of cyclobenzaprine
Drowsiness, loss of coordination, and anticholinergic effects; caution in pateitns with narrow angle glaucoma Dry eye, mydriasis, increased IOP
396
MOA of tramadol
Acts on Mu opiate receptors (although not considered a true opiate) Inhibits serotonin and NE uptake within ascending pain pathways
397
Adverse effects of tramadol
Dry mouth Sedation Dizziness Nausea
398
Opiate analgesics
Meperidine, oxycodone
399
MOA of meperidine/oxycodone
Agonists of the Mu, Kappa, and Delta opiate receptors
400
Adverse effects of opiate analgesics
Pin point miosis Mydriasis with withdrawal
401
Naloxone
Opioid antagonsit that is used to reverse the effects of opiates
402
Migraine therapy
Sumatriptan
403
MOA of sumatriptan
5-HT1B and 1D (serotonin subtype 1B and 1D) receptor agonists. Vasoconstriction of cranial arteries Reduces inflammation in the CNS
404
Adverse effects of sumatriptan
NAION | Retinal artery occlusions and retinal venous thrombosis
405
ANTIpsychotics
PHenothiazines - chlorpromazine - thioridazine
406
MOA of antipsychotics (chlorpromazine, thioridazine)
Dopamine receptor antagonists
407
Adverse effects of antipsychotics (chlorpromazine, thioridazine)
High doses can result in Parkinson’s like effects. Ocular side effects include - pigmentation effects: pigment on the corneal endothelium, anterior stellate catracts, and hyperpigmentation of the RPE (promethazine also, 1st gen H1 blocker) - anticholinergic effects: dry eye, mydriasis, and increased IOP - oculogyric crisis (also Zyrtec)
408
Parkinson’s disease
``` Dopamine deficiency TRAP -tremor at rest -rigidity -akinesia (hard time initiating movement) -postural reflexes lost ```
409
Antiparkinsons drugs
Amantadine | Bromocriptine
410
Amantadine
Parkinson’s | -potentials dopamine effects by blocking its reuptake or augmenting it’s release in the brain
411
Bromocriptine
Parkinson’s -a dopamine agonsit that is most commonly used to treat prolactin secreting pituitary adenomas. But can also be used to treat parkinsons
412
Bromocriptine can treat what conditions
Parkinson’s | Pituitary adenoma
413
ADHD meds
Methylphenidate, dextroamphetamine
414
MOA of methylphenidate and dextroamphetamine
Increase dopamine release
415
Clinical indications for methylphenidate and dextroamphetamine
ADHD, narcolepsy, and depression
416
Adverse effects of methylphenidate and dextroamphetamine
Mydriasis and dry eyes | Caution in acute angle glaucoma
417
All medications that act as dopamine agonists in the CNS (ADHD and parkinsons drugs) and narrow angle glaucoma
Have adrenergic agonist side effects any may cause mydriasis that can precipitate angle closure in patients with narrow angles. For this reason, narrow angle glaucoma is a contraindication for these medications
418
Donepizil
- CNS ACHase inhibitor (like MG) that is RXed for alzheimers - will cause lower IOP due to muscarinic effects. Sudden discontinuation of the drug may lead to elevations in IOP
419
What are the 4 main classes of antidepressants and what do they all ultimately do
TCAs MAOIs SNRI SSRI Increase serotonin TCA, SNRI, and MAOIs also increase NE
420
What are the side effects of all antidepressant drugs
Sedation, weight gain, and sexual dysfunction
421
The primary method of treating depression involves
Increased serotonin levels in the CNS. Serotonin selective reuptake inhibitor are the first line treatment for depression
422
What is the first lien treatment for depression
SSRIs
423
Which antidepressants increase dopamine
NONE
424
what are the SSRIs
Fluoxetine | Escitalopram
425
MOA of SSRIs
Fluoxetine and escitalopram | -inhibits serotonin reuptake
426
Adverse effects of SSRIs
Fluoxetine and escitalopram - fewer side effects compared to other anti depressants. They can cause mydriasis and should be used with caution in narrow angle glaucoma patients - serotonin syndrome may occur if Rxed with TCAs and especially MAOIs
427
Serotonin syndrome
Due to excess serotonin activity in the CNS and is marked by a change in mental status (anxiety, confusion), autonomic hyperactivity (increased BP, pulse, temp), and neuromuscular problems (tremor, hyperreflexia)
428
What are the SNRIs
Venlafaxine | Duloxetine
429
MOA of SNRIs
Venlafaxine and duloxetine | Inhibits serotonin and NE reuptake
430
Bupropion
Is an NDRI (inhibits the reuptake of dopamine and NE) and is RXed to treat depression and smoking cessation
431
What are the TCAs
Amitriptyline | Imipramine
432
MOA of TCAs
Amitriptyline and imipramine | Inhibitions NE and serotonin reuptake
433
Adverse affected of TCAs
Amitriptyline and imipramine Dry eye, increased IOP, blurred vision, and mydriasis. A TCA overdose is LIFE threatening. DO NOT RX FOR SUICIDAL PATIENTS
434
What antidepressant should you never RX for a suicidal patient
TCAs, fatal overdose
435
What is the MAOI
Phenelzine
436
MOA of MAOI
Phenelzine | Inhibits MAO, the enzyme responsible for breaking down NE and serotonin
437
Adverse effects of MAOI
Phenelzine Glaucoma and nystagmus are reported ocular affects, caution in narrow angles Foods with tyramine (wine, cheese, dried meats) cause lethal hypertensive crisis
438
What drugs can exacerbate systemic effects of topical ophthalmic phenylephrine and other adrenergic agonists
MAOIs and TCAs
439
ANTIanxiety medication
Diazepam
440
MOA of diazepam
ANTIanxiety | Opens chloride channels by binding to GABA receptors
441
GABA and anxiety
Increased GABA=decreased sympathetic activity **increased sympathetic paradoxical effect in extreme populations
442
Adverse effects of diazepam
Antianxiety drug - sedation, depression, confusion, bradycardia, and dyspnea; can be fatal if combined with alcohol or drugs. Occasionally cause mydriasis and nystagmus. Caution in narrow angle glaucoma - increased sympathetic paradoxical effect in extreme populations
443
What are the anticonvulsants
Phenytoin Phenobarbital Topiramate
444
Phenytoin MOA
Anticonvulsant | -acts on multiple NTs including NE, ACH, and GABA
445
Adverse effects of phenytoin
Nystagmus, diplopia, EOM palsies, ataxia, and gingival hypoplasia Funny-toin=funny looking eyes and gums
446
Phenobarbital
Anticonvulsant - reduces glutamatergic excitatory transmission by blocking AMPA receptors - mydriasis, increased IOP, and cycloplegia
447
Topiramate
Anticonvulsant | -MOA: multiple CNS effects that prevent seizures
448
Adverse effects of topiramate
Blurred vision, diplopia, nystagmus, myopic shift (huge shift, not permanent) May cause choroidal swelling, which moves the uvea forward and results in acute secondary angle closure glaucoma
449
MOA of insulin
Binds to cell surface receptors, leading to activation of tyrosine kinase receptors and a phosphorylation cascade; it promotes the formation and storage of glycogen, proteins, and triglycerides within the liver, fat, and muscle tissue. The primary signal for insulin release is the presence of glucose in the blood
450
Oral agents for diabetes
Biguanides: metformin Sulfonylureas: glipizide, glyburide, chlorpropamide Thiazolidinediones: pioglitazone, rosiglitazone
451
MOA of Biguanides
Metformin -decreases gluconeogensis in the liver and increases glucose uptake; it is usually the first oral medication RXed for DM because it DOES NOT CAUSE HYPOGLYCEMIA
452
Which diabetes medication does not cause hypoglycemia
Metformin
453
Adverse effects of metformin
Diarrhea, if patient has renal insufficiency or hepatic impairment they are greater risk of lactic acidosis
454
MOA of sulfonylureas
Glipizide, glyburide, chlorpropamide -increase the secretion of insulin by beta cells in the pancreases, decrease glucagon release, and increase the sensitivity of cells to insulin
455
Adverse effects of sulfonyureas
Glipizide, glyburide, chlorpropamide - hypoglycemia - caution in those with sulfa allergies
456
Beta blockers and DM
Increase the risk of hypoglycemia if taken with sulfonyureas. They may also mask the sympathetic response to hypoglycemia caused by any diabetic medication, as they prevent the usually symptoms associated with hypoglycemia such as tachycardia and tremors. The risk is lower, but still exists, with ocular beta blockers
457
MOA of thiazolidinediones
Pioglitazone, rosiglitazone - Active peroxisome proliferator-activated receptor gamma - combat insulin resistance
458
Adverse effects of thiazolidinediones
Pioglitazone and rosiglitazone | -new or worsening macular edema
459
What does TSH do
Released from the anterior pituitary gland and binds to TSH receptors on the thyroid glandin the neck, stimulating the production of thyroid hormones (primarily T4). Hashimotots is an AI condition that is the most common cause of primary hypothyroidism, and requires a replacement of T4
460
Levothyroxine
Synthetic T4 hormone Can cause pseudotumor cerebri in kids Used for hypothyroidism (hashimotos)
461
Adverse ocular effects of estrogens
``` Dry eyes ON disease (optic neuritis, pseudotumor cerebri, papilledema) Venous clotting (CRVO/BRVO) ```
462
What is the class of drugs used to treat erectile dysfunction
PDE-5 inhibitors
463
What are the PDE-5 inhibitors
Sildenafil and vardenafil
464
MOA of PDE-5 inhibitors
Sildenafil and Vardenafil -cGMP, which is broken down by PDE-5, relaxes vascular smooth muscle in the penis during an erection. These drugs inhibit PDE_5, thereby increased blood flow to the penis by prolonging the effects of cGMP=vasodilation
465
Systemivside effects of PDE-6 inhibitors
Flushing and HA are common; priapism may occur and requires immediate medical attention
466
Ocular adverse affects of PDE-5 inhibitors
Cyanopsia, blurred vision, and photosensitivity | -due to minor PDE-6 inhibition, which is found in rods and cones
467
Link between ED meds and NAION
There is an increased incidence of NAION in men taking ED meds, but they already have reduced blood flow anyways, so not sure if its from the drug or their underlying problem
468
BPH drugs
Alpha-1 blockers | -prazosin, terazosin, tamsulosin
469
MOA of BPH drugs (zosins)
A1 blocker to relax smooth muscle in the bladder neck and prostate, thereby decreasing urinary outflow obstruction in men with BPH
470
Adverse effects of BPH meds (zosins)
Interoperative floppy eyelid syndrome from tamsulosin (flomax)
471
What are the classes of antihypertensive medications
``` ACE inhibitors Angiotensin II receptor agonists (ARBS) BBlockers Ca Channel blockers Diuretics Clonidine Hydralazine ```
472
ACE inhibitor drugs
Lisinopril Benazepril Enalapril Captopril
473
MOA of ACE inhibitors
1. Prevent the formation of angiotensin II by inhibiting angiotensin converting enzyme (ACE) 2. Block the metabolism of bradykinins, resulting in vasodilation
474
Adverse effects of ACE inhibitors
Cough
475
Angiotensin II receptor agonist (ARBs)
Losartan
476
MOA of losartan
Reduces BP by inhibiting angiotensin II directed contraction of vascular smooth muscle and stimulation of aldosterone secretion
477
What’s better about ARBs than ACE inhibitors
No cough
478
What are the BBlockers used for HTN
Propranolol, labetalol | metoprolol, atenolol
479
Propranolol and labetalol MOA
Non selective beta 1 and beta 2 receptor antagonists; they also block the release of renin from the kidneys
480
MOA of metoprolol and atenolol
Selective B1 receptors agonists Less IOP effect here “MA on the heart”
481
CNS effects of BBlockers
Disorientation, depression, fatigue
482
Cardiovascular effects of BBlockers
Bradycardia, arrhythmias, syncope
483
Pulmonary affects of BBlockers
Dyspnea, wheezing, bronchospams
484
GI effects of BBlockers
Nausea, vomiting, diarrhea, abdominal pain
485
Reproductive effects of BBclokers
ED
486
What are the calcium channel blockers
Nifedipine Verapamil Diltiazem
487
MOA of Ca channel blockers for HTN
Verapamil, diltiazem, nifedipine | -block L type Ca channels, resulting in a marked decrease in intracellular free Ca2+
488
Ca and smooth muscle
Decreased Ca and decreased smooth muscle contraction
489
Cardio affects and Ca channel blockers
Verapamil and diltiazem more commonly have direct cardio effects “VD-dipines” Heart——>BV
490
Ca Channel blockers and glaucoma
Some studies have suggested prescribing Ca channel blockers for the treatment of low tension glaucoma, as these drugs may increase perfusion to the optic nerve, how ever, this is not considered standard of care
491
What part of the nephron do CAIs work
PCT
492
What part of the nephron do HCTZ/CTZ work
DCT
493
What part of the nephron does furosemide work in
Ascending loop of henle
494
What part of the nephron does triamterene and spironolactone work
Collecting duct
495
What is reabsorbed in the PCT
Bicarbonate, Na, H20
496
What is reabsorbed in the descending loop of Henle
Last place H20 is reabsorbed without hormone help
497
What reabsorbed in the DCT
Na, chloride
498
What is reabsorbed in the ascending loop of henle
Na, Cl, K
499
What is reabsorbed in the collecting duct
H20 with the help of aldosterone
500
What part of the nephron does mannitol work
Works across the entire nephron
501
What diuretic can cause hypokalemia
Furosemide
502
Diuretics can treat
CHF, HTN, kidney disease
503
What is the loop diuretic
Furosemide
504
MOA of furosemide
Inhibits Na/2Cl-/K+ co-transporter in the thick ascending loop of henle. It also increased CA2+ secretion
505
Adverse effects of furosemide
Hypokalmiea Nephrotixicity Ototoxicity
506
MOA of the thiazides (HCTZ/CZ)
Inhibits NaCl reabsorption and decreased CA2+ excretion at the early DCT
507
Adverse effects of thiazides
Acute transient myopia and acute angle closure glaucoma
508
What are the potassium sparing diuretics
Spironolactone and triamterene
509
Aldosterone stimulation
Aldosterone release is stimulated in response to decreased blood volume (angiotensin II) and increased K+ concentration. It increases Na+ reabsorption and K+ secretion in the collecting duct by opening epithelial sodium channels (ENaCs) and by activating the Na+/K+ ATPase pumps. The net effect is increased Na+ and Cl- reabsorption, and increased K+ and H+ secretion
510
What the weak diuretics
Sprinolactone | Triameteren
511
MOA of spironolactone
Blocks the action of aldosterone at the late DCT and collecting duct
512
Adverse effects of spinrolactone
Hyperkalemia, gynecomastia, and antiandrogen effects
513
MOA of triamterene
Directly blocks ENaCs in the late DCT and the late collecting ducts Does not have antiandrogen effects like spironolactone
514
Mannitol
Osmotic diuretics | -incapable of being absorbed
515
What diuretics can cause dry eye
All of them
516
Clonidine MOA
CNS a2 agonist that decreases sympathetic outflow and increases parasympathetic tone, resulting in decreased vascular resistance and decreased heart rate
517
Adverse reaction of clonidine
Dry mouth, sedation, impotence, and severe rebound HTN
518
What other drug is clonidine related to
Apraclonidine | It could decreased IOP
519
MOA of hydralazine
Increases cGMP, resulting in smooth muscle relaxation; it also decreases afterload as it vasodilates arterioles more than veins
520
Adverse effects of hydralazine
Compensatory tachycardia, fluid retention, and lupus like syndrome, conjunctivitis and increased lacrimation have also been reported
521
Digoxin MOA
Inhibits the Na+/K+/ ATPase enzyme, which normally pumps Na+ out and K+ in; this leads to increased intracellular Ca2+
522
Adverse effects of digoxin
Retrobulbar optic neuritis, BY color defects, and entropic phenomenon (snowy vision), blocks NAK channels in the PR
523
Drugs to treat CHF
Digoxin BBlockers ACE inhibitors Diuretics
524
Amiodarone
Antiarrythmic drug | -primarily blocks K+ channels, but also blocks some Na+ and Ca2+ channels as well
525
Clinical indications of amiodarone
Arrhythmias
526
Adverse effects of amiodarone
1. NAION 2. Whorl K 3. Anteiror supcasular lens deposits
527
Anticoagulants
Warfarin Clipidogrel Dipyridamole
528
Warfarin
Vitamin K antagonist | Interferes with clotting factors 2, 7, 9, 10
529
What drug is contraindicated in patietns taking anticoagualtans
Cephs
530
Adverse effects of warfarin
Should be stopped 96-115 hours prior to cataract surgery | Contraindicated in pregnancy and may also result in skin necrosis
531
How can warfarins effects be reversed
Vit K
532
Clopidogrel
Inhibits ADP receptor on platelet cell membranes that is needed for platelet aggregation and clot formation
533
Adverse effects of clopidogrel
Irreversible effect on platelets (like aspirin)
534
Dipyridamole
Inhibitions adenosine deaminase and PDE, resulting in the accumulation of cGMP and adenosine, which inhibits platelet aggregation and may cause vasodilation
535
Adverse effect os dupyridamole
Aggrenox=this + aspirin | Risk of bleeding
536
Meds that can cause bleeding problems in the eye
``` Warfarin Clopidogrel Dipyridamole NSAIDs Aspirin ```
537
Antihyperlipidemic agents
- HMG CoA inhibitors - Fibric acid - bile acid binding resin
538
Lovastatin, simvastatin, atorvastatin
HMG CoA reductase inihibitors -Rate limiting step in cholesterol synthesis in liver Lower LDL and trigs, and increase HDL
539
Fibric acid for HDL
Gemfibrozil
540
Gemfibrozil MOA
Binds to PPAR-a and increases the activity of lipoprotein lipase, which breaks down VLDL. Lowers LDL and trigs (does not increase HDL)
541
Cholestyramine
Bile acid binding resin - prevents bile acid reabsoprtion for HLD control - lowers LDL levels (does not increase HDL or lower trigs)
542
MOA of isotretinoin
Reduces the size and degree of oil production from sebaceous glands -affects meibomian glands
543
Adverse effects of isotretinoin
Blepharoconjunctivitis Dry eyes pseudotumor cerebri Also teratogenic and contraindicated in pregnancy
544
Metronidazole
NOT FOR USE ON EYES -topical agent RXed for acne rosacea, disrupts DNA and inhibits nuclei acid synthesis; also has anti-inflammtory properties
545
Alcohol withdrawal
Can be life threatening
546
Alcohol and vitamin deficiency
Chronic alcoholics can lead to thiamine deficiency (B1), resulting in an acute presentation of Wernickes encephalopathy, which is characterized by ophthalmoplegia, confusion, and ataxia. Untreated thiamine deficiency can lead to irreversible korsakoff syndrome, which is characterized by amnesia and confabulation Give them B1 and this goes away (except korsakoff)
547
Opioid withdrawal
Not life threatening | Pin point pupils when they are on it, mydriasis when they are going through withdrawal
548
Cocaine addiction
Mydriasis Withdrawal is not life threatening

BOARDS (14 decks)

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