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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
Q

What is the MOA of penicillins?

A

Inhibit cell wall synthesis by targeting peptidoglycan

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26
Q

Are penicillins bacteriocidal or bacteriostatic?

A

Bacteriocidal meaning it kills bacteria

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27
Q

What is the main cause of penicillin resistance?

A

Penicillinases: Enzymes in bacteria that inactivate penicillin

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28
Q

What are the three penicillins we need to know?

A

Amoxicillin
Augmentin
Dicloxacillin

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29
Q

What is the spectrum of amoxicillin? Is amoxicillin resistant to penicillinase

A

Mostly G+ with some G-

Amoxicillin is NOT resistant to penicillinase

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30
Q

What is the spectrum of augmentin? Is augmentin resistant to penicillinase?

A

Augmentin = amoxicilin + clavulonic acid

Clavulonic acid inhibits penicillinase

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31
Q

What is the drug of choice for pediatric soft tissue disease?

A

Mostly G+ with some G-
Augmentin
Soft tissue diseases like preseptal or hordeolum

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32
Q

What is the spectrum of dicloxacillin? Is dicloxacillin resistant to penicillinase?

A

Mostly G+ with some G- (Not as good as amoxicillin for G-)

Resistant to penicillinase

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33
Q

What are some adverse effects of penicillins?

A

Hypersensitivity, the second reaction is often worse than the first.
Cross allergenicity between different penicillins
GI disturbance

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34
Q

Which penicillin has an association with Stevens-Johnson Syndrome?

A

Amoxicillin

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35
Q

What other drug do penicillins have a cross-sensitivity with that should be considered when a patient has a penicillin allergy?

A

Cephalosporins have 1-10% cross-sensitivity, avoid if a patient has anaphylaxis with penicillins.

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36
Q

What is the MOA of cephalosporins?

A

Similar to penicillins, cephalosporins inhibit cell wall synthesis

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37
Q

Are cephalosporins bacteriostatic or bacteriocidal?

A

Bacteriocidal

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38
Q

How do cephalosporins vary between generations?

A

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-

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39
Q

What are the cephalosporins we need to know?

A

Keflex (Cephalexin)

Rocephin

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40
Q

What is Keflex? What is the spectrum of coverage for Keflex?

A

Keflex is a 1st generation cephalosporin that is effective on G+ organisms like staph and strep

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41
Q

What is Keflex a great treatment option for?

A

Adult soft tissue disease like a hordeolum, preseptal, dacryocystitis, and dacryoadenitis

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42
Q

What is the typical dose of Keflex for eyelid infections?

A

500mg BID for 1 week

43
Q

What is Rocephin? What is Rocephin the treatment of choice for?

A

Rocephin is a 3rd generation cephalosporin and is the treatment of choice for gonorrhea.

44
Q

What are some adverse effects of cephalosporins?

A

Hypersensitivity
Destroys normal intestinal flora, which impairs absorption of vitamin K, so don’t use with blood disorders or blood thinners

45
Q

What is the MOA of bacitracin?

A

Inhibits cell wall synthesis by inhibiting peptidoglycan transfer

46
Q

What is the only available formulation of bacitracin? Why?

A

Bacitracin is only available as an ointment because it is unstable as a solution

47
Q

What spectrum does bacitracin treat?

48
Q

What are the ocular indications of bacitracin containing ointments?

A

Staph blepharitis

49
Q

What is the difference between Polysporin and Neosporin?

A

Polysporin does not have neomycin as a component

50
Q

What is the MOA of vancomycin?

A

Inhibits the synthesis of cell wall formation by binding to the precursor of cell walls

51
Q

What is the spectrum of vancomycin?

A

Good G+

Poor G-

52
Q

What are some ocular indications for vancomycin?

A

S. aureus
Bacterial endophthalmitis
MRSA (Drug of choice!)

53
Q

What is the MOA of polymyxin B?

A

Disrupts cell membranes of bacterial cells

54
Q

Is polymyxin B bacteriostatic or bacteriocidal?

A

Bacteriocidal

55
Q

What is the spectrum of polymyxin B?

56
Q

Why are polymyxin B and Bacitracin combined?

A

Bacitracin: G+
Polymyxin B: G-

Each is added to the other to increase the antibacterial spectrum

57
Q

What is the difference between Neosporin solution and Neosporin ointment?

A

Neosporin solution used gramicidin because bacitracin is not stable as a solution
Neosporin ointment uses bacitracin

58
Q

What is the difference between Polytrim and Polysporin?

A

Polytrim is a solution of Polymyxin + Trimethoprim, Bacitracin is not stable as a solution
Polysporin Ointment: Polymyxin + Bacitracin

59
Q

What is the drug of choice for pediatric bacterial conjunctivitis?

A

Polytrim (Polymyxin + Trimethoprim)

Remember, bacterial conjunctivitis in kids is commonly caused by the G- H. influenzae

60
Q

Explain the function of each component of Polysporin/Polytrim/Neosporin

A

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
Q

What is the MOA of aminoglycosides?

A

Inhibit protein synthesis by binding 30s ribosomes

62
Q

Are aminoglycosides bacteriostatic or bacteriocidal?

A

Bacteriocidal

63
Q

What is the spectrum of aminoglycosides?

A

G+ and G-, better G- INCLUDING pseudomonas

64
Q

What are the aminoglycosides we need to know?

A

Neomycin
Tobramycin
Gentamycin

65
Q

What is Neomycin used in?

A

Polymyxin B combinations (Neosporin)

66
Q

What is Gentamycin used for?

A

corneal ulcers with cephalosporin

67
Q

What are some adverse effects of aminoglycosides?

A

Cause toxic effects in/on the cornea/conjunctiva. Can cause delayed re-epithelialization

68
Q

What is the MOA of tetracyclines?

A

Prevent bacterial protein synthesis by binding 30s ribosomes.

69
Q

Are tetracyclines bacteriostatic or bacteriocidal?

A

Bacteriostatic

70
Q

What is the tetracycline we need to know?

A

Doxycycline

71
Q

What are the indications for tetracyclines?

A

Acne rosacea and MGD
Chlamydial infections
Recurrent corneal erosions (Decreases recurrence)

72
Q

What are some contraindications for tetracyclines?

A

Pregnancy and children <8 years old
Avoid patients with renal failure
Avoid with food (Except doxycycline)

73
Q

What are some adverse effects of tetracyclines?

A

Bone growth retardation and tooth discoloration if taken during pregnancy or by children
GI disturbances
Pseudotumor cerebri

74
Q

What is the MOA of macrolides?

A

Inhibit protein synthesis by binding 50s ribosomes

75
Q

What are the macrolides we need to know?

A

Erythromycin

Azithromycin tablets and solution

76
Q

What are the ocular indications for erythromycin?

A

Adult inclusion conjunctivitis
Trachoma
Neonatal chlamydia

77
Q

What are the indications for azithromycin tablets

A

Chlamydial infections

MGD or rosacea (Off label)

78
Q

What are the indications for azithromycin solution?

A

Superficial bacterial infection

Bacterial conjunctivitis

79
Q

What is the MOA of chloramphenicol?

A

Inhibits protein synthesis by binding 50s ribosomes.

80
Q

Is chloramphenicol bacteriostatic or bacteriocidal?

A

Bacteriocidal

81
Q

What is the spectrum of chloramphenicol?

82
Q

What are the adverse effects of chloramphenicol?

A

Fatal aplastic anemia (body stops producing enough blood cells)

83
Q

What is the MOA of sulfonamides?

A

Blocks folic acid synthesis.

84
Q

Are sulfonamides bacteriostatic or bacteriocidal?

A

Bacteriostatic

85
Q

What is Bactrim composed of? What are the indications of Bactrim? What kind of drug is Bactrim?

A

Bactrim composition: Sulfamethoxazole + Trimethoprim
Indications: Hordeolum/preseptal when allergic to penicillin
Bactrim is a sulfonamide

86
Q

What are the adverse effects of sulfonamides?

A

Stevens-Johnson Syndrome

Don’t take while pregnant

87
Q

What is the MOA of trimethoprim?

A

Inhibits folic acid synthesis

88
Q

Is trimethoprim bacteriocidal or bacteriostatic?

A

Bacteriostatic

89
Q

What is trimethoprim not effective against?

A

Pseudomonas

90
Q

Why is Polytrim great for kids? What size bottle is Polytrim available in?

A

Effective against H. influenzae and S. pneumoniae

Available in 10ml bottle

91
Q

What is trimethoprim MODERATELY effective against?

92
Q

What are some adverse effects of trimethoprim?

A

Bone marrow suppression leading to aplastic anemia, leukopenia, and granulocytopenia

93
Q

What is the MOA of fluoroquinolones?

A

Inhibits DNA synthesis

94
Q

Are fluoroquinolones bacteriostatic or bacteriocidal?

A

Bacteriocidal

95
Q

What are the fluoroquinolones that we need to know? Sort them by generation.

A 
Ciprofloxacin 2nd gen 
Ofloxacin 2nd gen 
Levofloxacin 3rd gen (Not used much) 
Moxifloxacin 4th gen 
Gatifloxacin 4th gen
Besifloxacin 4th gen
96
Q

What is a potential event that can occur when taking ciprofloxacin?

A

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
Q

What is the difference between different generations of fluoroquinolones?

A

Newer generations have better coverage against G+

98
Q

Which fourth-generation fluoroquinolone has a broad spectrum and includes anaerobes, MRSA, MRSE, and pseudomonas?

99
Q

When/why would you combine an antibiotic with steroids?

A

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
Q

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?

101
Q

Which drugs are best for MRSA?

A

Besivance: Fluoroquinolone
Vancomycin
Trimethoprim

102
Q

Which drugs can be used to treat a corneal ulcer?

A

Cefazolin + Gentamycin or Tobramycin
Becivance
Ciprofloxacin
Ofloxacin

103
Q

Which drugs can cause Stevens-Johnson Syndrome?

A

Penicillins
Cephalosporins
Sulfonamides

Ocular Pharmacology (8 decks)

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