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KMK Part 2 Pharm > Direct Cholinergic Antagonists > Flashcards

Direct Cholinergic Antagonists Flashcards

1
Q

What is the 1 direct cholinergic agonists on the drug list?

A

Pilocarpine

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2
Q

What is the MOA of pilocarpine as an IOP lowering agent?

A

Interaction with ciliary muscle receptors

Pulls scleral spur posteriorly and opens the TM

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3
Q

Pilocarpine can be used to diagnose which pupil dysfunction?

A

Adie’s tonic pupil

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4
Q

What are the 5 potential side effects of Pilocarpine?

A 
Browaches
Headaches
Myopic shifts
Cataracts
Secondary angle-closure
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5
Q

What are 4 the indirect cholinergic agonists?

A

Edrophonium
Echothiophate
Pyridostigmine
Neostigmine

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6
Q

How do the indirect cholinergic agonists work?

A

Inhibit acetylcholinesterase, making them parasympathomimetics

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7
Q

What is the indication for edrophonium?

A

Tensilon test for MG

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8
Q

What are the 2 possible indications for echothiophate?

A

Accommodative esotropia

Glaucoma (rarely)

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9
Q

What is the indication for pyridostigmine?

A

Tx of MG

-60mg every 4 hours

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10
Q

What is the indication for neostigmine?

A

Evaluate limb strength in suspected myasthenics

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11
Q

What do cholinergic antagonists do?

A

Mimic the sympathetic system by blocking the parasympathetic system

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12
Q

What are the 5 ocular cholinergic antagonists?

A 
"STop ACH"
Scopolamine
Tropicamide
Atropine
Cyclopentolate
Homatropine
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13
Q

What is the 1 systemic cholinergic antagonist?

A

Succinylcholine

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14
Q

Which med has the higher possibility of CNS toxicity, scopolamine or atropine? Why?

A

Scopolamine

Better penetrance of the blood-brain barrier

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15
Q

What is the most potent mydriatic and cycloplegic med?

A

Atropine

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16
Q

What is the duration of atropine?

A

Up to 10 days dilation

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17
Q

Atropine should not be used in what patient population?

A

Down’s syndrome

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18
Q

Which anti-cholinergic is most often used in conjunction with Pred Forte for uveitis?

A

Homatropine 5% BID

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19
Q

What is the indication for the systemic cholinergic antagonish succinylcholine?

A

Muscle relaxant prior to surgery

*contraindicated for intraocular Sx

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20
Q

What is the general MOA of adrenergic agonists?

A

Promote the sympathetic system

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21
Q

Which 3 adrenergic agonists work primarily on alpha-1 receptors?

A

Phenylephrine
Tetrahydrozoline
Naphazoline

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22
Q

Which 2 adrenergic agonists work primarily on alpha-2 receptors?

A

Apraclonidine

Brimonidine

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23
Q

Which adrenergic agonist works primarily on neorepinephrine activitiy?

A

Hydroxyamphetamine

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24
Q

Care should be taken if using phenyl 10% on patients with what conditions?

A 
Heart conditions
HTN
Grave's
MAOI use
TCA use
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25
Q

What is the major drawback to using apraclonidine for glaucoma?

A

Tachyphylaxis

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26
Q

Other than tachyphylaxis, what issue of commonly found with long term use of apraclonidine?

A

Allergy (50% if used for more than 1 year)

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27
Q

Which alpha agonist is more alpha-2 selective, apraclonidine or brimonidine?

A

Brimonidine

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28
Q

Which IOP lowering drop may have neuroprotective properties?

A

Brimonidine

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29
Q

What is the typical dosing schedule for brimonidine?

A

TID

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30
Q

What is the most common systemic side effect to the alpha agonist IOP gtts?

A

Dry mouth

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31
Q

Brimonidine is contraindicated in patients taking what class of drug?

A

Monoamine oxidase inhibitors

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32
Q

What is the clinical use of hydroxyamphetamine?

A

Lesion location in Horner’s

-if pt doesn’t dilate with HA, lesion is postganglionic

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33
Q

What are the 6 adrenergic agonists?

A 
Phenylephrine
Tetrahydrozoline
Naphazoline
Apraclonidine
Brimonidine
Hydroxyamphetamine
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34
Q

What is the typical dosage schedule for naphazoline and tetrahydrozoline?

A

No more than QID

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35
Q

What class of drug is metaproterenol, and what is its indication?

A

Beta-2 agonist

Bronchodilator for asthma

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36
Q

Ritalin and Dexedrine are in which class of drugs, and may cause what side effects?

A

Adrenergic agonists for ADD, narcolepsy and depression
Mydriasis and dry eyes
(possible angle closure with narrow angles)

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37
Q

What is the MOA of clonidine?

A

Alpha-2 agonist

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38
Q

What is the indication for Clonidine?

A

HTN

-decreases vascular resistance and heart rate

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39
Q

Cocaine blocks which type of channels?

A

Na

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40
Q

Cocaine has what effect on healthy eyes?

A

Mydriasis

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41
Q

What is the MOA of Albuterol, and its indication?

A

Beta 2 agonist

Asthma, COPD

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42
Q

What are the potential side effects of albuterol?

A 
Tachycardia (due to Beta-1 activity)
Heart palpitations
Nervousness
Tremor
Nausea
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43
Q

What is levalbuterol?

A

A new derivative of albuterol, with fewer side effects

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44
Q

What are the 4 ocular beta blockers?

A

Timolol
Levobunolol
Betaxolol
Metipranolol

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45
Q

What are the 4 systemic beta-blockers?

A

Labetolol
Propranolol
Atenolol
Metoprolol

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46
Q

Which ocular beta blocker is safest for lung conditions, due to primary beta-1 activity?

A

Betaxolol

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47
Q

Timolol should be used cautiously in patients with which 3 systemic conditions? Why?

A

Diabetes
Hyperthyroidism
MG (worsened by Timolol)
Can mask clinical signs/symptoms

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48
Q

What is the typical dosing schedule of timolol for IOP reduction?

A

BID, but QD is acceptable

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49
Q

If dosed QD, when should timolol be administered?

A

AM - it has better daytime efficacy

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50
Q

Ocular beta-blockers can lose efficacy due to what 2 reasons?

A

Long-term drift

Short-term escape

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51
Q

Cosopt is a combo of what 2 meds?

A

Timolol

Dorzolamide (CAI)

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52
Q

What is the typical dosing schedule for Cosopt?

A

BID

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53
Q

Combigan is a combo of what 2 meds?

A

Timolol

Brimonidine (a-agonist)

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54
Q

Which beta-blocker should be most avoided in patients with heart problems?

A

Betaxolol

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55
Q

What class of med is tamsulosin?

A

Alpha-blocker

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56
Q

What class of med and what is the indication for prazosin?

A

Alpha blocker

HTN

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57
Q

What class of med is dapiprazole, and what is its indication?

A

Topical alpha blocker (only one)

Reverses dilation

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58
Q

What are the 2 ocular carbonic anhydraze inhibitors?

A

Brinzolamide (Azopt)

Dorzolamide (trusopt)

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59
Q

What is the typical dosing schedule of dorzolamide?

A

TID

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60
Q

What is the typical dosing schedule of brinzolamide?

A

BID

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61
Q

What are the 3 oral CAIs?

A

Acetazolamide
Methazolamide
Dichlorphenamide

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62
Q

What is the dosing of oral acetazolamide for angle closure?

A

500mg

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63
Q

What are the common adverse effects of oral acetazolamide?

A 
Metallic taste
Tingling hands/feet
Metabolic acidosis
Aplastic anemia
Diarrhea
Myopic shifts
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64
Q

Acetazolamide is contraindicated in what conditions?

A

COPD
Pregnancy
Sulfa allergy
Renal disease

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65
Q

What are the potential side effects of prostaglandin analogs?

A

Increased pigmentation/growth of lashes
Skin darkening
Iris heterochromia
Conj hyperemia

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66
Q

Prostaglandin analogs are contraindicated in patients with what?

A

CME
Active inflammation
Previous herpes simplex keratits

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67
Q

If used during acute angle closure, which med is best for diabetics, glycerine or isosorbide?

A

Isosorbide

-Glycerin breaks down into carbs

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68
Q

What is the typical dosing of Muro 128 soln?

69
Q

Which 2 meds are cell wall synthesis inhibitor via inhibition of peptidoglycan?

A

Bacitracin

Vangomycin

70
Q

Which 2 types of ABx inhibit cell wall synthesis via inhibition of transpeptidase?

A

Penicillins

Cephalosporins

71
Q

Bacitracin is selective to which type of bacteria?

72
Q

What ABx are in polysporin?

A 
Bacitracin (+)
Poymyxin B (-)
73
Q

What ABx are in neosporin?

A

Polysporin

Neomycin

74
Q

Vancomycin is strong, but has what 3 severe potential side effects?

A

Ototoxicity
Nephrotoxicity
Red Man Syndrome

75
Q

What are the 2 major indications for IV Vancomycin?

A

Endophthalmitis

MRSA

76
Q

Penicillins are good for which gram type?

A

(+)

Strep, syphilis, meningitis, pneumococcal

77
Q

Which 2 types of penicillins have more gram (-) coverage than standard penicillin?

A

Ampicillin

Amoxicillin

78
Q

Augmentin is a combination of amoxicillin and what?

A

Clavulonic acid (penicillinase inhibitor)

79
Q

If a patient is allergic to penicillin, they may also be allergic to which class of ABx?

A

Cephalosporins

80
Q

Which 3 penicillins are penicillinase resistant?

A

Methicillin
Nafcillin
Dicloxacillin

81
Q

Keflex is commonly prescribed for what 3 ocular conditions?

A

Dacryoadenitis
Dacryocystitis
Preseptal cellulitis

82
Q

What is the IV treatment of choice for gonococcal conjunctivitis and orbital cellulitis?

A

Ceftriaxone

83
Q

Which 4 ABx types impact DNA synthesis?

A

Fluoroquinolones
Sulfonamides
Trimethoprim
Pyrimthamine

84
Q

Fluoroquinolones inhibit bacterial DNA synthesis by acting on what 2 things?

A

DNA gyrase

Topoisomerase IV

85
Q

What are the possible side effects of fluoroquinolones?

A

Tendonitis

Inhibition of cartilage and bone growth in kids

86
Q

Fluoroquinolones primarily work agains which gram of bacteria?

A

(-)

Later generations have increased (+) coverage

87
Q

What are the 4 sulfonamides?

A

Sulfisoxazole
Sulfacetamide
Sulfamethoxazole
Sulfadiazine

88
Q

How do sulfonamides work?

A

Inhibit the 1st step of folic acid synthesis

89
Q

Why aren’t topical sulfonamides prescribed often?

A

Resistance

90
Q

Sulfadiazine is used in combination with pyrimethamine to treat what?

A

Toxooplasmosis

91
Q

Which 2 antibiotics inhibits the second step of folic acid synthesis?

A

Trimethoprim

Pyrimethamine

92
Q

What meds make up polytrim?

A

Trimethoprim

Polymyxin B

93
Q

What types of ABx impact protein synthesis?

A 
Aminoglycosides (30S)
Tetracyclines (30S)
Chloramphenicol (50S_
Lincomycin (50S)
Macrolides (50S)
Clinadmycin (50S)
94
Q

What are the 3 macrolide ABx?

A

Erythromycin
Azithromycin
Clarithromycin

95
Q

What are the 2 aminoglycosides?

A

Tobramycin

Gentamycin

96
Q

Why aren’t aminoglycosides commonly used?

A

Corneal toxicity

97
Q

Which gram coverage do aminoglycosides offer?

A

broad spectrum, but (-) > (+)

98
Q

Which aminoglycoside is available in both topical ophthalmic and ointment forms?

A

Tobramycin

99
Q

Why aren’t oral aminoglycosides common?

A

Nephrotoxicity

Ototoxicity

100
Q

What gram coverage to tetracyclines offer?

A

Broad spectrum

101
Q

What is the typical dosing of doxycycline for MGD?

A

100mg BID x 4 weeks

Then QD 3-6 months

102
Q

What is the dosing of doxycycline for chlamydial conjunctivitis?

A

100mg BID x 10 days

103
Q

What are the important side effects of doxycycline?

A 
Pseudotumor cerebrii
Bone growth retardation
Tooth discoloration
Photosensitivity
GI distress
104
Q

Which oral ABs should be taken without food?

A

“PAT”
Penicillin
Azithromycin
Tetracycline

105
Q

What is the major side effects of chloramphenicol that makes it an uncommonly prescribed med?

A

Aplastic anemia
Optic neuritis
Gray baby syndrome

106
Q

What are the 3 macrolides?

A

Erythromycin
Azithromycin
Clarithromycin

107
Q

Macrolides act on which bacterial subunit?

108
Q

Which macrolide is commonly used for chlamydial conjunctivitis Tx?

A

Azithromycin

Single 1g dose on empty stomach

109
Q

What is the dosing of topical azithromycin soln (AzaSite) for blepharitis?

110
Q

What are the 4 TB drugs?

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

111
Q

Which TB drug can cause orange tears?

112
Q

Which of the TB drugs can cause optin neuritis?

A

Isoniazid

Ethambutol

113
Q

What is the common suffix of anti-fungal drugs?

114
Q

What type of drug is amphotericin B?

A

Anti-fungal

-Ung and soln

115
Q

What are the common Tx choices for fungal keratitis?

A

Natamycin
Amphotericin B
Q1-2H
Possible systemic anti-fungals

116
Q

What is the Tx for acanthamoeba?

A

Oral ketoconazole 200mg x several weeks

Topical anti-fungal Q1-2H

117
Q

What is the only FDA approved topical for fungal infections?

118
Q

What topical med is prescribed for HSK?

A

Trifluridine (viroptic)

119
Q

What is the Tx for HSK?

A

Trifluridine Q2H until re-epithelialization

Then 5x/day for 5-7 days

120
Q

What are the 3 oral Tx for HZO?

A

Acyclovir
Valacyclovir
Famciclovir

121
Q

What is the dosing of the 3 oral antivirals for HZO?

A

Acyclovir 800mg 5x/day 7 days
Valacyclovir 1000mg TID x 7 days
Famciclovir 500mg TID x 7 days

122
Q

What is the dosing of the 3 oral antivirals for HSK?

A

Acyclovir 400mg 5x/day 7 days
Valacyclovier 500mg TID x 7 days
Famciclovier 250mg TID x 7 days

123
Q

Which 2 antivirals may be prescribed for CMV?

A

Ganciclovir IV

Foscarnet (if ganciclovir fails)

124
Q

What are the 2 important antiparacitic drugs?

A

Chloroquine

Kwell

125
Q

What is the dosing of Choroquine that increases risk of bull’s eye maculopathy?

A

3mg/kg

5 years

126
Q

What is the Tx for ocular pediculosis?

A

Removal of lice and eggs

Topical ABx ung TID 1-2 weeks

127
Q

Which common OTC analgesic has no anti-inflammatory properties?

A

Acetaminophen (Tylenol)

128
Q

What is the overdose risk of acetaminophen?

A

Hepatotoxicity - 4000mg/day

129
Q

What are the ocular side effects of opioids?

130
Q

What are the typical systemic side effects of opioids?

A 
Respiratory depression
Drowsiness
Euphoria
Nausea
Vomiting
GI depression
131
Q

What are alprazolam and diazepam used to treat?

A

Anxiety

Xanax and Valium

132
Q

What are the side effects of alprazolam and diazepam?

A 
Mydriasis
Nystagmus
Drowsiness
Sedation
Confusion
133
Q

Anti-anxiety meds should never be taken with what?

134
Q

What are the 2 important antipsychotic meds?

A

Chlorpromazine (Thorazine)

Thioridazine (Mellaril)

135
Q

What are the side effects of the antipsychotics?

A 
Hyperpigmentation of RPE
Endothelial pigment
Anterior cataracts
Dry eye
Mydriasis
Increased IOP
136
Q

What are the 4 anti-parkinson’s drugs?

A

Carbidopa-Levodopa (Sinemet)
Bromocriptine (Parlodel)
Selegeline (Eldepryl
Amantadine (Symmetrel)

137
Q

Anti-parkinson’s meds can also be used to treat what ocular condition?

A

Benign essential blepharospasm

138
Q

What is Donepezil (Aricept) used for?

139
Q

What are the ocular side effects of Donepezil?

A

Cataracts
Blurred vision
Irritation

140
Q

What class of med is phenelzine (Nardil)?

141
Q

What common ocular med is contraindicated with phenelzine use?

A

Phenylephrine 10%

-HTN crisis

142
Q

What class of med is Amitriptyline (Elavil)?

143
Q

How to tricyclic antidepressants work?

A

Inhibit norepinephrine and serotonin reuptake

144
Q

What are the 2 ocular side effects of TCAs?

A

Dry eye

Increased IOP

145
Q

What common ocular med is contraindicated with TCA use?

A

Phenylephrine 10%

-HTN crisis

146
Q

What are the 2 SSRIs?

A

Fluoxetine (Prozac)

Setraline (Zoloft)

147
Q

What is the common ocular side effect of all antidepressant meds (MAOIs, TCAs, SSRIs)?

148
Q

What are the 3 anticonvulsant meds?

A

Phenytoin (Dilantin)
Topriamate (Topomate)
Phenobarbitol (Luminal Na)

149
Q

What are the potential ocular side effects of phenytoin?

A

Nystagmus

Diplopia

150
Q

What is the most common side effect of topiramate?

A

Blurry vision

-May have acute secondary angle closure glaucoma

151
Q

What class of med in Metformin?

152
Q

What is the indication for Furosemide (Lasix)?

A

HTN

Pulmonary edema

153
Q

What is the indication for hydrochlorothiazide?

A

HTN
CHF
Hypercalciuria

154
Q

What are the 4 ACE inhibitors?

A

Lisinopril
Benazepril
Enalapril
Captopril

155
Q

What is the most common side effect of ACE inhibitors?

156
Q

What class of med is Losartan?

A

Angiotensin II receptor Antagonist

157
Q

What is the indication for losartan?

158
Q

What is the indication for oral beta-blockers?

159
Q

What are calcium channel blockers used for?

A

Angina

HTN

160
Q

What are the 3 Ca channel blockers?

A

Verapamil
Diltiazem
Nifedipine

161
Q

What is the indication for Clonidine?

162
Q

What are the ocular side effects of Digoxin?

A

Blue/yellow color defects
Entoptic phenomenon
Retrobulbar optic neuritis

163
Q

What is the indication for amiodarone?

A

Arrhythmia (K channel blocker)

164
Q

What is the dosing of amiodarone that makes whorl keratopathy inevitable?

165
Q

What are the 4 stand alone mast cell stabilizers?

A

Cromolyn Na
Lodoxamide
Pemirolast
Nedocromil

166
Q

What are the 2 stand alone topical antihistamines?

A

Emedastine

Pheniramine

167
Q

Why might a steroid be used on a corneal ulcer?

A

Reduce scarring (once defect is almost healed)

168
Q

If using a mild steroid for allergic conjunctivitis, what is the typical dosing regimen?

A

QID x 7 dyas

Then BID 4-8 weeks

169
Q

Which NSAID has whorl keratopathy as a potential side effect?

A

Indomethacin

KMK Part 2 Pharm (1 decks)

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