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Ocular Pharmacology > Allergy Therapy: Topical Allergy Medications > Flashcards

Allergy Therapy: Topical Allergy Medications Flashcards

1
Q

which histamine receptor type is involved in immediate hypersensitivity reaction?

A

H1

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2
Q

which histamine receptor type promotes gastric acid production & immune cell activation?

A

H2

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3
Q

which histamine receptor type causes presynaptic feedback inhibition?

A

H3

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4
Q

which histamine receptor type involves immunomodulation, inflammation, & has nociception roles?

A

H4

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5
Q

where are H1 receptors more commonly found?

what happens when histamine binds to H1?

A

nerve endings

triggers the itch response

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6
Q

where are H2 receptors more commonly found?

what happens when histamine binds to H2?

A

vasculature

causes vasodilation → redness

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7
Q

which hypersensitivity reaction is antibody independent?

A

type IV

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8
Q

which hypersensitivity reaction is not responsive to antihistamines & most responsive to steroid therapy?

A

type IV

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9
Q

in type IV hypersensitivity, what is it called when cytotoxic T-cells attach to similar antigens in healthy tissue & destroys it?

A

autoimmune reaction

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10
Q

H1 & H2 antihistamines are what type of agonists? & what do they do?

A

inverse agonists → binds to same receptor & modifies the reaction

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11
Q

why is histamine always being produced?

A

to counteract sympathetic nervous system to prevent complete vasoconstriction

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12
Q

when histamine binds to the active state receptor, what happens?

A

increased vasodilation & itching

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13
Q

when antihistamines bind to the inactive state receptor, what happens?

A

inactivation & less histamine is produced

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14
Q

decrease in vascular permeability (less swelling), vasodilation (less redness) & sensory nerve stimulation (less itch) is caused by what mechanism of action?

A

antihistamines bind to H1 receptor

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15
Q

which antihistamine is highly lipophilic & can therefore enter the CNS (blood-brain barrier) and other tissues readily?

A

1st generation (classic) antihistamines

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16
Q

which class of antihistamines cause decrease in alertness, cognition, learning, memory & psychomotor performance (dizziness) and increases impairment with or without sedation?

A

1st generation antihistamines

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17
Q

which class of antihistamines do not readily enter the CNS and therefore have less associated side effects?

A

2nd generation antihistamines

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18
Q

both classes of antihistamines have what kind of property? and what do they bind to?

A

anticholinergic properties

bind to muscarinic receptors of the parasympathetic pathway

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19
Q

the anticholinergic properties of antihistamines cause what?

A

decrease mucous production & tear production, causes mydriasis

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20
Q

oral chlorpheniramine is in which chemical class & what class of antihistamine is it?

A

1st gen alkylamines

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21
Q

cetirizine (Zyrtec) belongs to which chemical class & which class of antihistamines?

A

2nd gen piperazines

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22
Q

OTC topical ketotifen belongs to which chemical class & which antihistamine class?

A

1st gen piperidines

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23
Q

which 1st gen medication is OTC and used for allergic conjunctivitis?

A

ketotifen

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24
Q

bepotastine, loratadine (Claritin), fexofenadine (Allegra) & alcaftadine are common drugs in which chemical class & which antihistamine class?

A

2nd gen piperidines

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25
Q

diphenhydramine (Benadryl) belongs to which chemical class & which class of antihistamines?

A

1st gen ethanolamines

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26
Q

azelastine & olopatadine are which class of antihistamines?

A

2nd gen

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27
Q

what are oral agents believed to block Ca2+ influx into mast cells (& other immune cells) to prevent degranulation & chemical release?

A

mast cell stabilizers

28
Q

mast cell stabilizers are useful for which hypersensitivity reaction?

A

type I

29
Q

which one of these topical mast cell stabilizers are fast acting?

  • pemirolast 0.10%
  • nedocromil 2%
  • lodozamide 0.10%
  • cromolyn 4%
A

nedocromil 2%

30
Q

what allergy medication is an adrenergic agonist & is more effective in binding to α1 receptors than norepinephrine?

A

decongestants

31
Q

imidazolines are which class of allergy medications?

A

decongestants

32
Q

what occurs when imidazolines are stopped?

A

rebound effect

33
Q

what are some OTC imdazolines (decongestants)?

A
  • naphazoline
  • tetrahydrozoline
  • oxymetazoline
34
Q

how is brimonidine 0.025% different from imidazolines? & what are its effects?

A

it is highly selective for α2 receptors (vs α1)

- no rebound congestion, no tachyphylaxis & improved oxygenation

35
Q

when decongestants are used alone, what does it do for allergies?

A
  • vasoconstriction reduces redness (hyperemia)

- vasoconstriction reduces vessel leakage or tissue

36
Q

when decongestants are combined with other allergy therapies, what occurs?

A
  • reduce vascular absorption → reduces systemic toxicity
  • reduces systemic metabolism/drug clearance
  • sustains local effect of applied drugs
37
Q

how do decongestants cause mydriasis?

A

because of their α1 sympathetic effects

38
Q

when are decongestants contraindicated?

A

in patients with angle closure glaucoma or narrow angles

39
Q

these drugs are all?

  • antazoline + naphazoline (Vasocon-A)
  • pheniramine + naphazoline (Visine-A)
  • pheniramine + naphazoline (Naphcon-A)
  • pheniramine + naphazoline (Opcon-A)
A

OTC 1st gen antihisamines + decongestants

40
Q

antihistamine+decongestants have drug interactions with which drugs?

A

MAOI, EtOH

41
Q

what are the contraindications for using 1st gen antihistamines + decongestant combos?

A
  • hypersensitivity
  • CVD, uncontrolled DM
  • narrow anterior chamber angles
  • precautionary use with dry eyes
42
Q

which class of drugs are these?

  • ketotifen fumarate 0.035% + imidazoline (Zatidor)
  • ketotifen 0.025% + imidazoline (Alaway, Claritin Eye, Zrytec Itchy Eye, Refresh Eye Itch)
A

acute care OTC 1st gen antihistamines + MCS

43
Q

1st gen antihistamine + MCS combos are what compared to antihistamines + decongestants?

A

far more effective & have less side effects

44
Q

these drugs belong to which class?

  • bepotastine 1.5% (Bepreve)
  • epinastine 0.05% (Elestat)
  • alcaftadine 0.25% (Lastacaft)
  • azelastine 0.05% (Optivar)
  • olopatadine 0.2% (Pataday)
  • olopatadine 0.7% (Pazeo)
A

acute care 2nd gen antihistamien + MCS

45
Q

what is Zerviate? what is it used for?

A

first ever topical formulation of cetirizine 0.24% (2nd gen)

- indicated for allergic conjunctivitis

46
Q

oral chlorpheniramine (Chlor-Trimeton) is what class of antihistamine? is it mildly, moderately, or strongly sedating?

A

1st gen antihistamine → mildly sedating

47
Q

oral clemastine (Tavist) is which class of drug? is it mildly, moderately, or strongly sedating?

A

1st gen oral antihistamine → mildly sedating

48
Q

oral diphenhydramine (Benadryl), promethazine (Phenergan) & hydroxyzine (Vistaril) belong to which class of drugs? are they mildly, moderately, or strongly sedating?

A

1st gen oral antihistamines → strongly sedating

49
Q

what allows oral 1st gen antihistamines to be sedating?

A

their lipophilic structures cross the blood brain barrier

50
Q

what drugs do 1st gen oral antihistamines interact with?

A
  • potassium supplements
  • codeine & opioids
  • anticholinergics
51
Q

what is an ocular contraindication for oral 1st gen antihistamines?

A

angle closure glaucoma

52
Q

these drugs belong to which drug class?

  • fexofenadine (Allegra)
  • loratadine (Claritin)
  • loratadine + pseudoephedrine (Claritin D)
  • desloratadine (Clarinex)
  • cetirizine (Zyrtec)
A

oral 2nd gen antihistamines

53
Q

2nd gen antihistamines are less likely to cause what even with oral use?

A

drowsiness

54
Q

what class of drugs do these belong to? & what are they used for?

  • cimetidine (Tagamet)
  • famotidine (Pepcid)
  • nizatidine (Acid)
A

oral anti-H2 antihistamines → indicated for GERD & gastric ulcers

55
Q

what are the two ancillary therapies for allergies?

A
  • NSAIDs

- steroids

56
Q

which ancillary allergy therapy is most likely to sting?

A

NSAIDs

57
Q

which ancillary allergy therapy may cause an increase in IOP & cataract formation?

A

steroids

58
Q

under the OTC Code of Federal Regulations, topical 1st gen vasoconstrictors should not be used more than how many times?

A

4x/day

59
Q

do topical or oral allergy therapies may require more frequent dosing?

A

topical

60
Q

are topical or oral allergy therapies better for deeper ocular involvement?

A

oral

61
Q

are topical or oral allergy therapies better for moderate-severe eyelid edema & conjunctival chemosis?

A

oral

62
Q

what is the most common site of ocular allergy

A

conjunctiva

63
Q

what are the three types of allergic conjunctivitis? what type of hypersensitivity is this?

A
  • acute allergic conjunctivitis
  • seasonal allergic conjunctivitis (SAC)
  • perennial allergic conjunctivitis
  • type I hypersensitivity
64
Q

what ocular allergy is common in the spring & presents with giant papillae, shield ulcer, & Horner Trantas dots? what type of hypersensitivity is it?

A 
vernal keratoconjunctivitis (VKC)
- type I & IV hypersensitivity
65
Q

what ocular allergy presents with lid eczema & has corneal involvement such as SPK, corneal ulceration, neovascularization, pannus & scarring? what type of hypersensitivity is this?

A 
atopic keratoconjunctivitis (AKC)
- type I & IV hypersensitivity
66
Q

what ocular allergy is associated with CL wear and has a more mechanical etiology than immune? what type of hypersensitivity is this?

A

giant papillary conjunctivitis (GPC)

- type I & IV hypersensitivity

Ocular Pharmacology (9 decks)

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