Exam One Drugs to Know and MOA Flashcards
1
Q
what are some antivirals drugs
A
viroptic ( cat. C), Zirgan ( Cat C), Acyclovir ( Cat.B), Valacyclovir ( Cat B), Famciclovir ( Cat B), Betadine ( Cat C)- oral antivirals are B and topicals are C
2
Q
this drug inhibits DNA synthesis of the both the virus and the host ; inhibits thymidine synthetase ( topical)
A
1 % Trifluridine ( Viroptic)
3
Q
what is the dosage for 1% Trifluridine ( Viroptic)
A
1 gt q.2.h x 7 days up to 9 gtt/d ; then q.4-6.h
4
Q
whats 1% Trifluridine ( Viroptic ) indicated for
A
recurrent HSV keratitis and stromal HSV
5
Q
what are SE of 1% Trifluridine ( Viroptic )
A
SPK or Superficial puntate epithelial erosions; conj edema; delayed wound healing
6
Q
this drug selectively targets virus infected cells ; its a prodrug; effective as Viroptic with less SE ( topical )
A
Ganciclovir gel ( Zirgan)
7
Q
whats the indication for Ganciclovir ( Zirgan)?
A
HSV dendritic keratitis
8
Q
whats the dosage for Gangiclovir gel ( ZIrgan)
A
1 gt in affected eye 5 times per day until the ulcer heals; then 1 drop tid x 7 days
9
Q
what are the topical drugs for treating viral infections
A
1% Trifluridine ( Viroptic) and Ganciclovir Gel ( Zirgan)
10
Q
what are the orals for treating viral infections
A
acyclovir, Valacyclovir, and famcyclovir
11
Q
this drug is phosphorylated to active compound by HSV thymidine kinase ; specific for viral infected cells. does not affect host
A
acyclovir ( oral): indicated for HSV dendritic keratitis
12
Q
what is the antiviral MOA
A
all are placebo in nature until conversion to active form by viruses -> viral thymidine kinase activates antivirals via process of phosphorylation-> antivirals get spliced into viral DNA/RNA which screws up replication cycle -> viral death ensues
13
Q
this drug is used for the acute tx of HSV keratitis; also inhibits recurrent HSV epithelial keratitis and genital herpes ( maintenance dose )
A
Acyclovir ( Zovirax) - ointment and oral available
14
Q
what is the dosage for acyclovir ( Zovirax ) for acute HSV keratitis
A
400 mg q.4.h. to 5xd for 7-14 days - use this if pt allergic to viroptic
15
Q
whats the maintenance dose of acyclovir ( Zovirax) for recurrent HSV epithelial keratitis
A
400 mg b.i.d x 12 mos .
16
Q
what are the preps for Acyclovir
A
oral tabs ( 200,400, and 800 mg tabs) , IV , and non ophth. ung
17
Q
this drug is the prodrug to acyclovir ; has greater GI absorption
A
Valacyclovir ( Valtrex)
18
Q
whats the dosage of Valacyclovir ( Valtrex)
A
one gm tid . VZV and 500 mg tid HSV ( caps are 500mg and 1000 mg)
19
Q
whats the maintenance dose of valacyclovir
A
1 gm qd x 1 year
20
Q
this drug is indicated for HSV: genital and ophthalmic ; it inhibits viral DNA ; pro drug of penciclovir
A
Famciclovir ( Famvir)
21
Q
whats the dosage of Famciclovir
A
250 mg tid x 7 days ; for suppression of recurrent HSV 250 mg b.i.d. x 1 year
22
Q
what are the topical options for acute HSV dendritic keratitis
A
Viroptic or Zirgan
23
Q
What are the oral options for acute HSV dendritic keratitis
A
acyclovir, Valacyclovir, and famcyclovir
24
Q
which drug is mainly used for Herpes / VZO ( recurrent ) HZO- shingles
A
Acyclovir : Zovirax
25
what is the dosage and tx for recurrent HZO with acyclovir ( Zovirax)
initiate within 72 hrs; 800 mg 5x/d x 7 days
26
this drug is used for acute Herpes Zoster Opththalmicus and Shingles ; does is 500 mg tid x 7 days
Famciclovir : Famvir
27
this drug is used for recurrent orolabial herpes
penciclovir aka denavir
28
how does the dosage changer for HSV versus VZV treatment
Simplex: Acyclovir is 400 mg five x day for 7-10 days, Valacyclovir is 500 mg TID for 7-10 days, and Famciclovir is 250 mg tid x 7-10 days
Herpes: Acyclovir 800 mg 5x day for 7-10 days, Valacyclovi r is 1000 mg tid for 7-10 days , and Famciclovir us 500 mg tid for 7-10 days
29
what is a negative caveat of oral antivirals
all are excreted via the kidney so CI in pts with kidney failure and or on dialysis
30
this is a vaccine used to prevent Shingles ( Herpes Zoster), its a live attenuated vaccine and it boosts VZV specific immunity
VZV: Zostavax vaccine
31
with the shingles prevention study, what % had a decreased total risk
51% ( with the ZEST trial, 70% decreased risk)- recommend vaccine for anyone over 50 ; cate. C drug
32
this drug is used " off label" for EKC aka adenovirus; FDA cat. C ; use 1 gtt proparacaine and NSAID; 4-6 gtts of this drug, then after a min saline rinse ; then instill 2 gtts NSAID in office and Rx steroid gt qid x 4 days
betadine :povidone - iodine ( betadine decreased the viral load and the steroid is used to take care of the inflammation)
also can use Ganciclovir Gel: Zirgan
33
this is a new combo drug under study to treat adenovirus
dexamethasone 0.1% and betadine 0.4%
34
what are some antiviral agents for cytomegalovirus
ganciclovir, zidovudine, foscarnet, and Cidofovir ( all are injected or taken orally)
35
these are the polyenes antifungal agents; they increase cell membrane permeability and are fungicidal
natamycin, nystatin , and amphotericin B
36
this antifungal agent impairs DNA synthesis ; fungistatic
flucytosine
37
these are azoles; they block ergosterol synthesis -> increase cell membrane permeability ; fungistatic first and fungicidal later
miconazole, ketoconazole, viroconazole, itraconazole
38
this is the only FDA approved topical antifungal ; has a board spectrum against candida, aspergillus, cephalosporin, fusarium, and penicillium
Natamycin ( Natacyn 5%) susp.
39
these drugs disrupt the cytoplasm of the cellular membranes of acanthamoebas;
diamidines and biguanides
40
these are used in the tx of acanthamoebas: types include Brolene and Demodine
Diamidines
41
these are used in the tx of acanthamoeba; types include PHMB and chlorhexadine
biguanides
42
these drugs target the cell wall and break down the peptidoglycan
bacitracin and vancomycin
43
these drugs target the cell wall and break down transpeptidase enzyme
PCN and cephalosporins
44
this drug is only available in ung; most commonly rx for blepharitis
bacitracin ( fights gram +)
45
which drugs form polysporin
(+) bacitracin and - polymixin B
46
which drugs form neosporin
+- polysporin and +- neomysin
47
this drug is mainly given as IV for MRSA and endophthalmitis; SE = ototoxicity, nephrotoxicity, and red man syndrome
vancomycin
48
this drug can be compounded for ophthalmic use ( topical or subconj injection)
vancomycin ( used when other Ab are not effective esp in corneal ulcer)
49
which types of drugs are standard therapy for bacterial keratitis
fortified Ab ( ie gentamycin, tobramycin, amikacin, vancomycin, and cephalozin )
50
which PCN affect gram pos bacteria
natural PCN
51
which PCN affect gram +/-
amino PCN
52
what is a gen 1 cephalosporin
gen 1- cephalexin
53
what is a gen 2 cephalosporin
cefuroxime
54
what Is a gen 3 cephalosporin
ceftriaxone
55
what happens with bacteria that contain beta lactamase
the beta lactam Ab contains the beta lactam ring- this becomes inactivated by beta lactamase and penicillinase resistant bacteria
56
SE pf PCN?
type I and IV hypersensitivity, nausea and vomiting, decreased effectiveness of Birth control pills
57
what are natural PCNs mainly used for
gram +, syphilis, gonorrhea
58
what are some amino PCNs
ampicillin- oral , amoxicillin - oral suspension , augmentin
59
what makes up augmentin
amoxicillin + clavulanic acid ( clavulanic acid is a penicillinase inhibitor)
60
these drugs are indicated for dacryoadenitis, dacryocystitis, Preseptal cellulitis, internal hordeolum
amino PCNs
61
how do we dose amino PCNs
```
moderate infection ( 250 mg PO tid or 500 mg PO bid)
severe infection ( 500 mg PO tid , 875 mg PO bid )
```
62
T or F: if pt allergic to PCN don not give cephalosporin gen 1
T
63
this is a gen 1 cephalosporin that is used for Preseptal cellulitis, internal hordeolum
cephalexin ( Keflex) - oral 250-500 mg bid-tid x 7-10 days
64
what is mainly rx in hospital setting and is used in orbital cellulitis
cephalosporin gen 3,. ceftriaxone
65
these drugs disrupt folic acid production in bacteria
sulfanomides and trimethoprim
66
these drugs disrupt the DNA gyrase and Topoisomerase IV in bacteria
Gen 2 FLQ, Gen 3 FLQ, and Gen 4 FLQ
67
which drug is often used with pyrimethamine to tx toxoplasmosis
sulfadiazine
68
which drug is often used in combo with trimethoprim
sulfamethoxazole : Bactrim = sulfamethoxazole + trimethoprim
69
what is the DOC for MRSA
trimethoprim
70
SE of sulfonamides
oral: nephrotoxicity, kernicterus, myopia
| topical : stevens johnsons syndrome, drug allergies . CI in pregnancy
71
T or F: Trimethoprim is not effective against Pseudomonas
T
72
this drug is the DOC for MRSA in Ocular Trust Study ; available as oral ; SE = bone marrow suppression; CI in pregnancy ; available as ung in combo with Polymixin B ( polytrim)
trimethoprim
73
which generation of flouroquinolones are more effective against gram + and pseudomonas
gens 3 & 4 ( ciprofloxacin gen 2. is close in efficacy to gen. ; DOC in pseudomonas)
Besivance is a fourth generation FQL
74
what are the generation 2 FQL
Ciloxan ( oral, ung, soln) and Ocuflox ( oral, soln)
75
what are the gen. 3 FQL
Quixin ( oral, soln) and Iquix ( oral, soln)
76
what are the gen 4. FQL
ZYmar ( soln), Zymaxid ( Soln), Moxeza, VIgamox ( oral, soln), and Besivance ( susp)
77
which FQL are indicated for bacterial corneal ulcers
Ciloxan and Ocuflox
78
what is the dosing schedule for corneal ulcer
Ocuflox or Ciloxan : days 1-2: instill 1-2 drops q 30 mins while awak . Awaken at aprox, q4-6 hr after retiring and instill 1-2 drops
days 3-7: instill 1-2 drops hourly, while awake.
days 7- tx completion; instill 1-2 drops 4x/day
79
Can you use FQL for bacterial conj
Yes
80
what is the dosing schedule for FQL bacterial conj
Ocuflox : days 1-2 instill 1 -2 drops q 2-4 hours
days 3-7 instill 1-2 drops 4x/day
Besivance; instill 1 drop tid x 7 days
81
SE of FQL
tendonitis, CI in pregnancy and anyone
82
these drugs inhibit the 30S ribosome subunit
aminoglycosides and tetracyclines
83
these drugs inhibit the 50 S ribosome subunit
chloramphenicol, macrolides, lincomycin, and clindamycin
84
this drug can be fortified for a corneal ulcer but has ocular SE of SPK
gentamicin - oral, soln
85
this drug is a DOC for Pseudomonas and also is a DOC for MRSA ; less SPK then gentamicin ; available in combo with steroid
tobramycin ( tobrex) - sol, ung
86
how do you make tobradex (susp., ung)
tobramycin + dexamethasone
87
this drug is mainly used in combo with other drugs; not effectvie against pseudomonascauses type IV hypersensitivity - but broad spectrum
neomycin
88
how do you make Neosporin ( ung)
neomycin + bacitracin + polymixin B
89
how do you make maxitrol ( susp, ung )
neomycin + polymixin B + dexamethasone
90
this drug is injected into the anterior/posterior chamber and is used for endophthalmitis ; resistance bacteria
amikacin
91
these class of drugs have a broad spectrum against gram positive, gram netative, rickettsia, and chlamydia ; dairy inhibits their absorption
tetracyclines
92
how often is tetracycline dosed
q4h
93
how often is doxycycline dosed
BID , OR QDAY ( current DOC)
94
what are some oral uses of tetracyclines
acne rosacea, lyme disease, chlamydia, MGD, Hordeolum, recurrent corneal erosion, pterygium
95
how is doxycycline dosed for chlamydia
100 mg, 1 tablet PO bid x 7-10 days
96
how is tetracycline dosed for Chlamydia
500 mg PO, 1 tablet PO qid x 3-6 weeks ( we don't usually Rx tetracycline because it has to be taken for so long )
97
which tetracyclines can be used for blepharitis ( MGD, Rosacea
Doxycycline, Periostat, and Aldox kit
98
how is doxycycline dosed for blepharitis
50 mg tablet bid x 4 weeks, then q day x 4-6 mos
99
how is periostat dosed for blepharitis
20 mg Doxy bid x 4 wks, then qd x 4-6 mos
100
how is the aldox kit dosed
(60) 20 mg tablets of Doxy + ocusoft lid scrubs foam and pads , heat goggles
101
when are tetracyclines CI
in pregnancy, children
102
this drug is not used commonly in the US ; SE = irreversible, aplastic anemia, gray baby syndrome, optic neuritis
chloramphenicol
103
this drug has narrow spectrum against gram + cocci, chlamydia, lyme, rickettsia, gonorrhea, H Influenzae; used for prophylaxis for ophthalmic neonatorum, ped. conjunctivitis, and staph blepharitis
erythromycin Ung
104
this drug is the DOC for atypical pneumonia; alternative to PCN and tetracycline
erythromycin oral
250 mg qid
for chlamydial infection its dosed 500 mg qid x 3 wks
105
this drug is an oral with broad spectrum- against gram +/- and chlamydia ; cant be given to children
Azithromycin oral - 1 gm one dose at one time
106
this drug is an opth. soln that can be used for bacterial conjunctivitis, but is not as effective as other drugs
Azithromycin ( Azasite) oph soln
107
what is the dose for azithromycin for bacterial conjuncitivitis
1 drop bid x 2 days, then 1 day x 3-5 days
108
these drugs have narrow spectrum and are used in severe infections as an oral or injection; used as alternative tp PCN
lincomycin, clindamycin
109
this drug binds to the cell membrane and alters its structure, making it more permeable ; used in combo with other drugs - effective against gram -
polymixin B
110
how do you make polysporin ung
polymixin B + bacitracin + neomycin
111
how do you make polytrim soln
polymixin B + trimethoprim
112
when do we use topical versus oral meds
if its on the conj or cornea then use topical, if its deeper or really severe then use oral
113
Review: which oral drugs can you use for anything deep : dacryocystitis, dacryoadenitis, hordeola, MGD, Preseptal cellulitis
Keflex 500 mg bid x 1 wk
Augmentin 500-875 mg bid x 1 wk
Levofloxacin 500 mg q day x 7-10 days for PCN allergy
114
Review : which oral drugs can you use for MRSA
Bactrim/septra 2 double strength bid x 1 wk
| doxycycline 100 mg bid x 7-10 days if sulfa allergy
115
which oral drugs can you use for chlamydia and inclusion conj.
azithromycin (2) 500 mg tablets one time or (1) 1 g tablet at one time
116
what are some topical meds for MRSA
polytrim, Besivance, and tobramycin
117
what are some good ung for superficial skin infection
polysporin, Neosporin, maxitrol, tobradex
118
what are some good drops for bacterial conj or bacterial keratitis
gentamicin, tobramycin, polytrim, Besivance, fortified Ab
119
what are some systemic oral steroids
hydrocortisone, prednisone, prednisolone, methylprednisolone
120
when are oral steroids indicated
posterior seg inflammation : retina, choroid, optic nerve ; orbital inflammation; severe anterior uveitis
121
T or F: the body produces cortisol equal to 5 mg of prednisone
T: so we have to give more than 5 mg
122
how do we dose prednisone
for mild to moderate inflammation : 20-40 mg initial daily dose
for severe inflammation: 40-80 mg initial daily dose ; if no improvement after 3 days increase to 80-100 mg
123
how do you dose Methyprednisolone
"Medrol Dosepak" comes in 4 mg, 5 mg, or 10 mg blister packs that are proportioned for a 6 day course- " as directed" label
124
T or F: Steroids resolve inflammation
F: Steroids suppress inflammation not resolve inflammation
125
how does tapering work for prednisone
taper by 10 mg increments if taking more than 40 mg of prednisone
taper by 5 mg increments if taking 40 mg of prednisone
taper by 2.5 mg increments if taking 20 mg of prednisone
taper by 1 mg if taking 10 mg of prednisone
126
what are some injectable steroids
methylprednisolone acetate ( depo Medrol) and triamcinolone ( kenalog)
127
when is methylprednisolone acetate ( depo Medrol) indicated
sympathetic ophthalmic, temporal arteritis, uveitis and ocular inflammatory conditions
128
what is Triamcinolone ( kenalog ) most often used for
off label for chalazion
129
what is the dosage for kenalog
0.1 to 1 cc
130
what are the local injectable steroid routes
sub conj, intralesional, and intravitreal
131
what are the periocular injectable steroid routes
sub tenon , and retrobulbar
132
when are injectable steroids indicated
anterior seg inflammation ( non compliant pts), posterior seg patients , chalazia ( granuloma formation)
133
this was the first intravitreal implant FDA approved in 2005; indicated for chronic non infectious posterior uveitis
retisert
134
this was an intravitreal implant approved in 2014 for diabetic macular edema
iluvien
135
this was an intravitreal implant apprived in 2009 ( sustained delivery of dexamethasone) used for diabetic macular edema, macular edema following BRVO or CRVO , and for chronic non infectious uveitis
Ozurdex
136
these are intracanalicular plugs used in clinical trials for allergic conjunctivitis ; sustained delivery of dexamethasone
dextenza
137
this is an ester based steroid indicated for allergic conjunctitivitis
loteprednol 0.2% susp. ( Alrex) ( great for chronic use)
138
T or F: Loteprednol comes in a 0.5% preparation of susp. ung, and gel
T
139
this is a ketone based steroid that is one of the most efficacious drops ; good for severe inflammatory conditions ; must be shaken
prednisolone acetate 1% susp ( Pred Forte)- generic brand not as good
dosed qh
140
this is a ketone based steroid that does NOT require shaking ; another efficacious drop l good for severe cases of inflammatory conditions
Durezol
141
why is Durezol so good for inflammation
fluorinated at C6 and C9 for increased potency ; hydroxyl group at C17 replaced with butyric acid for increased inflammatory activity ; hydroxyl group at C21 replaced with acetic acid for increased epithelial penetration and lipophilicity; BAK free, longer duration of action; BUT its expensive ; dosed q 2h
142
this is a ketone based steroid generic that you must shake l high efficacy and good for mild to moderate acute inflammatory conditions
prednisolone acetate 1% suspc
143
this is a ketone based generic that you DONT have to shake ; inexpensive with high efficacy - mild to moderate acute inflammatory conditions
prednisolone sodium phosphate 1% soln
144
Which of the flourometholone steroids must you shake
flourometholone acetate 0.1% susp. , and flourometholone alcohol 0.1% susp. , DO Not shake the flourometholone alcohol 0.1 % ung ; these are moderate efficacy ; less SE so if Loteprednol too expensive we can Rx this for chronic use
145
how do you make tobradex
tobramycin + dexamethasone
146
how do you make maxitrol
polymixin B + neomycin + dexamethasone
147
what is the only CI to topical steroids
epithelial herpetic infection- steroid wll make it worse
148
how do we dose topical steroids
one drop q 1-2 hrs for the first 24-48 hours ( while awake) ; min is qid; a 3,2,1 taper is common
149
T or F: there are no oral steroid/ AB combos
T
150
this steroid /Ab combo is prednisolone acetate .2% and Na Sulfacetamide
Blephamide
151
this steroid /AB combo is a prednisolone acetate 1% and Neomycin , POlymixin B
Poly- Pred; use for short periods
152
this steroid /Ab combo is prednisolone acetate 1% and gentamicin
Pred- G
153
this steroid/ Ab combo is dexamethasone 0.1% and neomycin, polymixin B
maxitrol
154
this steroid /Ab combo is dexamethasone 0.1% and tobramycin
tobradex
155
this steroid Ab combo is dexamethasone 0.05%, tobramycin with a xanthum gum delivery system
tobradex ST; the drop is more viscous increases retention time
156
this steroid Ab combo is loteprednol 0.5% and tobramycin
zylet
157
for combo steroid ab drugs whats the dosing schedule
ung are dosed 3-4x/day, susp, dosed q3h- q6h ( tapering not recommended bc of Ab)
158
when are combo ab /steroid drugs indicated
inflammatory conditions with bacterial infection or risk of bacterial infections
159
what are the newer topical NSAIDS used
Bromfenac and Nepafenac ( older ones are Ketorolac and Diclofenac)
160
this topical NSAID is used for post op inflammation after cat extraction and for pain and photophobia in pts undergoing corneal refractive Sx
Voltaren ( diclofenac 0.1%)
161
this topical NSAID stings and is used for ocular itching due to seasonal allergic conj, its used 1 gt qid and for post op inflammation after cat extraction
acular ( ketorolac 0.5%)
162
what is acular LS 0.4%
topical NSAID used for reduction of pain following lasik Sx; 1 gt QID doesn't sting as much as Acular
163
what is Acuvail
topical NSAID that's preservative free ; tx of pain and inflammation after cataract extraction
164
this drug is for the tx of postoperative inflammation and reduction of ocular pain in pts who have undergone cat sx
Prolensa ( Bromfenac 0.07%) ; 1 drop qd ( begin one drop prior to sx, then continue on the day of sx, and then through the 14 days post sx )
165
this topical NSAID Is used to tx pain and inflammation and is used in Cat Sx ; 1 drop TID ; used off label for CME
Nevanac ( Nepafenac 0.1%) ; an alternative is Ilevro ( Nepafenac 0.3%) - dosed at 1 drop qd- go with whichever is cheaper
166
SE of NSAIDS
SEI formation ( infiltrates), delayed woung healing, corneal melt syndrome, burning, stinging, SPK, and conj hyperemia ; CI in soft CLs wearers
167
this was the original / first ocular anti vegf molecule ; selectively inhibits vegf A 165 isoform; one injection q 4 wks in affected eye ; cat B
Magugen
168
this drug is from the treat and extend approach for wet armd; injection q 4 wks x 3-4 mos then PRN; inhibits ALL isoforms of vegf; cat C
Lucentis
169
this drug is used for wet armd, dme, rvos , inhibits all isoforms of vegfA ; cheap ; injection q 4 weeks
avastin
170
this is the newest agent approved for wet armd, dme, rvos; blocls placental growth factor ; q 8 wk injection
eyelea
171
AE of Anti Vegf
endophthalmitis, retinal detachments, IOP spikes, thromboembolic events, cataracts, vitreous floaters, conj hemes
172
this drug is indicated for chemical vitreolysis in Tx of VMT; dissolves the protein matrix of vitreoretinal interface
jetrea- single one time injection
173
this drug is used for chemocautery of conj bv and off label for superior limbic keratoconj
silver nitrate solution
174
this is an antimetabolite used in sx to prevent scarring during the healing process
5- FU / Mitomycin C ( MItomycin C is 5 times more potent than 5 FU)
175
this is injected IV just prior to or during MRI;
Gadolinium ( it decreases the relaxation time of T1 images - enhanced scan contrast)
176
this angiography is better for visualizing the choroid
ICG ( Indocyanine Green Angiography)
177
these are aka rock inhibitors ; they lower IOP ; one drop qd- bid ; MOA : cytoskeletal reorganization in TM; site of action Is TM- increases spaces between TM cells
rho kinase inhibitors
178
this drug is a rho kinase inhibitor
Rhopressa 0.02% ( qd - bid dosing ) and Roclatan ( rhopressa + latanoprost) - qd dosgin
179
these drugs are used to increase TM outflow ; 200-500 qd PO
adenosine receptor mimetic agonist ( trabodenoson)
180
MOA of marijuana for glaucoma
Cannabinoid receptor agonism-> decreased aqueous production
181
what is the active ingredienct molecule for crosslinking the cornea for keratoconus
riboflavin: it stiffens and flattens the cornea
182
this is a synthetic PEG hydrogel that seals the corneal incision like glue ; approved for cat sx
resure corneal sealant gel
