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Ocular Pharmacology > Anti-Infective Medications Used in Eyecare Part 1 > Flashcards

Anti-Infective Medications Used in Eyecare Part 1 Flashcards

Exam 1

1
Q

What types of drugs inhibit cell wall synthesis?

A

Penicillins (PCN)
Cephalosporin
Bacitracin
Vancomycin

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2
Q

What types of drugs disrupt cell membranes?

A

Polymyxin B

Gramicidin

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3
Q

What types of drugs inhibit protein synthesis?

A

Aminoglycosides
Tetracyclines
Macrolides
Chloramphenicol

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4
Q

What drugs inhibit folate synthesis?

A

Sulfonamides

Trimethoprim

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5
Q

What drugs inhibit DNA gyrase and topoisomerase?

A

Fluoroquinolones

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6
Q

You should never taper a(n) __________.

A

antibiotic

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7
Q

What is a possible side effect of taking oral antibiotics?

A

Decreased effectiveness of birth control pills, rifampin has the most impact

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8
Q

What percent of ocular infections are caused by G+ bacteria? G-?

A

G+ 70%

G- 30%

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9
Q

What are the most common G+ organisms that cause ocular infections?

A

S. aureus
S. epidermidis
S. pneumoniae

Lesser extent: Listeria

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10
Q

What are the most common G- organisms that cause ocular infections?

A

Moraxella
H. influenza
P. aeruginosa

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11
Q

Is bacterial conjunctivitis more common in children or adults in the US?

A

Children
23% in 0-2 years of age
28% in 3-19 years of age

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12
Q

What are the most common pathogens in adults?

A

S. aureus G+
H influenzae G-
S. pneumoniae G+
Moraxella catarrhalis G-

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13
Q

What are the most common pathogens in kids?

A

H. influenza G-
S. pneuomiae G+
S. aureus G+
Moraxella catarrhalis G-

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14
Q

What special population is associated with MRSA?

A

Nursing homes/group living setting

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15
Q

What special population is associated with N. gonorrhoeae and Chlamydia?

A

Sexually active

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16
Q

What percent of patients with bacterial keratitis are contact lens wearers?

A

19-42%

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17
Q

What are the most common pathogens related to CL bacterial keratitis?

A

S. aureus G+

Pseudomonas a. G-

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18
Q

What is the worst-case scenario for corneal infection?

A

Corneal perforation

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19
Q

What are the organisms that can penetrate an intact cornea?

A 
Acanthamoeba
Shigella 
Listeria G+
N. gonorrhoeae G-
Corynebacteria 
Haemophilus G-

AS LUNCH

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20
Q

What is the most common pathogen that causes a hordeolum?

A

S. aureus G+

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21
Q

What are the most common pathogens that cause preseptal cellulitis? (5)

A 
S. aureus G+
S. epidermidis G+
S. pneumoniae G+ 
H. influenza G- 
Anaerobes
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22
Q

What are the most common pathogens that cause acute dacryocystitis?

A

S. aureus G+

Pseudomonas G-

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23
Q

What are the most common pathogens that cause chronic dacryocystitis?

A

Coagulase-negative staphylococci
S. aureus G+
S. pneumoniae G+

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24
Q

What is the difference between bacteriocidal and bacteriostatic drugs?

A

Bacteriocidal drugs kill microbes

Bacteriostatic drugs prevent their growth and the immune system is responsible for ridding the body of the pathogen

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25
What is the MOA of penicillins?
Inhibit cell wall synthesis by targeting peptidoglycan
26
Are penicillins bacteriocidal or bacteriostatic?
Bacteriocidal meaning it kills bacteria
27
What is the main cause of penicillin resistance?
Penicillinases: Enzymes in bacteria that inactivate penicillin
28
What are the three penicillins we need to know?
Amoxicillin Augmentin Dicloxacillin
29
What is the spectrum of amoxicillin? Is amoxicillin resistant to penicillinase
Mostly G+ with some G- | Amoxicillin is NOT resistant to penicillinase
30
What is the spectrum of augmentin? Is augmentin resistant to penicillinase?
Augmentin = amoxicilin + clavulonic acid | Clavulonic acid inhibits penicillinase
31
What is the drug of choice for pediatric soft tissue disease?
Mostly G+ with some G- Augmentin Soft tissue diseases like preseptal or hordeolum
32
What is the spectrum of dicloxacillin? Is dicloxacillin resistant to penicillinase?
Mostly G+ with some G- (Not as good as amoxicillin for G-) | Resistant to penicillinase
33
What are some adverse effects of penicillins?
Hypersensitivity, the second reaction is often worse than the first. Cross allergenicity between different penicillins GI disturbance
34
Which penicillin has an association with Stevens-Johnson Syndrome?
Amoxicillin
35
What other drug do penicillins have a cross-sensitivity with that should be considered when a patient has a penicillin allergy?
Cephalosporins have 1-10% cross-sensitivity, avoid if a patient has anaphylaxis with penicillins.
36
What is the MOA of cephalosporins?
Similar to penicillins, cephalosporins inhibit cell wall synthesis
37
Are cephalosporins bacteriostatic or bacteriocidal?
Bacteriocidal
38
How do cephalosporins vary between generations?
Newer generations have less cross-sensitivity than older generations Newer generations have less resistance Newer generations have a broader spectrum Gen 1: G+ Gen 2: G+ and some G- Gen 3: G+ and G-
39
What are the cephalosporins we need to know?
Keflex (Cephalexin) | Rocephin
40
What is Keflex? What is the spectrum of coverage for Keflex?
Keflex is a 1st generation cephalosporin that is effective on G+ organisms like staph and strep
41
What is Keflex a great treatment option for?
Adult soft tissue disease like a hordeolum, preseptal, dacryocystitis, and dacryoadenitis
42
What is the typical dose of Keflex for eyelid infections?
500mg BID for 1 week
43
What is Rocephin? What is Rocephin the treatment of choice for?
Rocephin is a 3rd generation cephalosporin and is the treatment of choice for gonorrhea.
44
What are some adverse effects of cephalosporins?
Hypersensitivity Destroys normal intestinal flora, which impairs absorption of vitamin K, so don't use with blood disorders or blood thinners
45
What is the MOA of bacitracin?
Inhibits cell wall synthesis by inhibiting peptidoglycan transfer
46
What is the only available formulation of bacitracin? Why?
Bacitracin is only available as an ointment because it is unstable as a solution
47
What spectrum does bacitracin treat?
G+ only
48
What are the ocular indications of bacitracin containing ointments?
Staph blepharitis
49
What is the difference between Polysporin and Neosporin?
Polysporin does not have neomycin as a component
50
What is the MOA of vancomycin?
Inhibits the synthesis of cell wall formation by binding to the precursor of cell walls
51
What is the spectrum of vancomycin?
Good G+ | Poor G-
52
What are some ocular indications for vancomycin?
S. aureus Bacterial endophthalmitis MRSA (Drug of choice!)
53
What is the MOA of polymyxin B?
Disrupts cell membranes of bacterial cells
54
Is polymyxin B bacteriostatic or bacteriocidal?
Bacteriocidal
55
What is the spectrum of polymyxin B?
Good G-
56
Why are polymyxin B and Bacitracin combined?
Bacitracin: G+ Polymyxin B: G- Each is added to the other to increase the antibacterial spectrum
57
What is the difference between Neosporin solution and Neosporin ointment?
Neosporin solution used gramicidin because bacitracin is not stable as a solution Neosporin ointment uses bacitracin
58
What is the difference between Polytrim and Polysporin?
Polytrim is a solution of Polymyxin + Trimethoprim, Bacitracin is not stable as a solution Polysporin Ointment: Polymyxin + Bacitracin
59
What is the drug of choice for pediatric bacterial conjunctivitis?
Polytrim (Polymyxin + Trimethoprim) | Remember, bacterial conjunctivitis in kids is commonly caused by the G- H. influenzae
60
Explain the function of each component of Polysporin/Polytrim/Neosporin
Bacitracin: G+ Coverage, targets cell walls Polymyxin: G- Coverage, targets cell membrane Trimethoprim: Good G+ coverage, good against MRSA. Trimethoprim inhibits folate synthesis Gramicidin: G+ and G- Coverage, targets cell membranes
61
What is the MOA of aminoglycosides?
Inhibit protein synthesis by binding 30s ribosomes
62
Are aminoglycosides bacteriostatic or bacteriocidal?
Bacteriocidal
63
What is the spectrum of aminoglycosides?
G+ and G-, better G- INCLUDING pseudomonas
64
What are the aminoglycosides we need to know?
Neomycin Tobramycin Gentamycin
65
What is Neomycin used in?
Polymyxin B combinations (Neosporin)
66
What is Gentamycin used for?
corneal ulcers with cephalosporin
67
What are some adverse effects of aminoglycosides?
Cause toxic effects in/on the cornea/conjunctiva. Can cause delayed re-epithelialization
68
What is the MOA of tetracyclines?
Prevent bacterial protein synthesis by binding 30s ribosomes.
69
Are tetracyclines bacteriostatic or bacteriocidal?
Bacteriostatic
70
What is the tetracycline we need to know?
Doxycycline
71
What are the indications for tetracyclines?
Acne rosacea and MGD Chlamydial infections Recurrent corneal erosions (Decreases recurrence)
72
What are some contraindications for tetracyclines?
Pregnancy and children <8 years old Avoid patients with renal failure Avoid with food (Except doxycycline)
73
What are some adverse effects of tetracyclines?
Bone growth retardation and tooth discoloration if taken during pregnancy or by children GI disturbances Pseudotumor cerebri
74
What is the MOA of macrolides?
Inhibit protein synthesis by binding 50s ribosomes
75
What are the macrolides we need to know?
Erythromycin | Azithromycin tablets and solution
76
What are the ocular indications for erythromycin?
Adult inclusion conjunctivitis Trachoma Neonatal chlamydia
77
What are the indications for azithromycin tablets
Chlamydial infections | MGD or rosacea (Off label)
78
What are the indications for azithromycin solution?
Superficial bacterial infection | Bacterial conjunctivitis
79
What is the MOA of chloramphenicol?
Inhibits protein synthesis by binding 50s ribosomes.
80
Is chloramphenicol bacteriostatic or bacteriocidal?
Bacteriocidal
81
What is the spectrum of chloramphenicol?
G+ and G-
82
What are the adverse effects of chloramphenicol?
Fatal aplastic anemia (body stops producing enough blood cells)
83
What is the MOA of sulfonamides?
Blocks folic acid synthesis.
84
Are sulfonamides bacteriostatic or bacteriocidal?
Bacteriostatic
85
What is Bactrim composed of? What are the indications of Bactrim? What kind of drug is Bactrim?
Bactrim composition: Sulfamethoxazole + Trimethoprim Indications: Hordeolum/preseptal when allergic to penicillin Bactrim is a sulfonamide
86
What are the adverse effects of sulfonamides?
Stevens-Johnson Syndrome | Don't take while pregnant
87
What is the MOA of trimethoprim?
Inhibits folic acid synthesis
88
Is trimethoprim bacteriocidal or bacteriostatic?
Bacteriostatic
89
What is trimethoprim not effective against?
Pseudomonas
90
Why is Polytrim great for kids? What size bottle is Polytrim available in?
Effective against H. influenzae and S. pneumoniae | Available in 10ml bottle
91
What is trimethoprim MODERATELY effective against?
MRSA
92
What are some adverse effects of trimethoprim?
Bone marrow suppression leading to aplastic anemia, leukopenia, and granulocytopenia
93
What is the MOA of fluoroquinolones?
Inhibits DNA synthesis
94
Are fluoroquinolones bacteriostatic or bacteriocidal?
Bacteriocidal
95
What are the fluoroquinolones that we need to know? Sort them by generation.
``` Ciprofloxacin 2nd gen Ofloxacin 2nd gen Levofloxacin 3rd gen (Not used much) Moxifloxacin 4th gen Gatifloxacin 4th gen Besifloxacin 4th gen ```
96
What is a potential event that can occur when taking ciprofloxacin?
Sterile corneal deposits can appear around an infectious site of the cornea. This may trick you into believing that there is still an infection present
97
What is the difference between different generations of fluoroquinolones?
Newer generations have better coverage against G+
98
Which fourth-generation fluoroquinolone has a broad spectrum and includes anaerobes, MRSA, MRSE, and pseudomonas?
Besivance
99
When/why would you combine an antibiotic with steroids?
Many bacterial infections have inflammation, so once you are sure that the causative agent is bacterial (discharge) you can combine an antibiotic with a steroid to prevent further infection and further damage from the immune system.
100
If you see a severe corneal ulcer and you want to start a patient on a compounded antibiotic-steroid drop you will have to wait for the pharmacy to make it. What should you prescribe until the patient can get the drug?
Besivance
101
Which drugs are best for MRSA?
Besivance: Fluoroquinolone Vancomycin Trimethoprim
102
Which drugs can be used to treat a corneal ulcer?
Cefazolin + Gentamycin or Tobramycin Becivance Ciprofloxacin Ofloxacin
103
Which drugs can cause Stevens-Johnson Syndrome?
Penicillins Cephalosporins Sulfonamides

Ocular Pharmacology (8 decks)

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