Eye/Skin Drugs, Antiinfectives, Antineoplastics Flashcards
Narrow Angle Glaucoma (Primary Glaucoma)
Caused by poor drainage of fluid in the eye due to position of the iris, blocking the Canal of Schlemm.
May experience blurred vision.
Rare. May occur after trauma, e.g. pupil constricting too rapidly. Usual unilateral.
Drug treatment: Pupil constrictors to open the angle between the iris and the Canal of Schlemm.
Wide Angle Glaucoma (Primary Glaucoma)
Caused by poor drainage of fluid in the eye, possibly due to abnormal blood vessel permeability or deterioration of the tribicular meshwork leading to the Canal of Schlemm.
Common, requires permanent drug therapy.
Drug treatment: Pupil constriction and reduction of aqueous humor formation.
Secondary Glaucoma
Develops secondarily to other eye disease e.g. inflammation or cataract surgery (which may prevent proper drainage).
Drug treatment: corticosteroid or antiinfective
Congenital Glaucoma
Requires surgery to correct (remove tribicular meshwork or LASER treatment)
Miotics
Cholinergic Drugs
Indicated for: Narrow and wide angle glaucoma (especially narrow angle)
MOA: Contraction of the sphincters of the iris and vasodilation of vessels draining the eyes
Side effects: Ciliary muscle spasms, possible headache, salivation, sweating, diarrhea, increased asthma attacks, decreased blood pressure
Caution: Will affect night driving due to pupil constriction and blurred vision
Carbonic Anhydrase Inhibitors
Prostaglandin Analogs
Indicated for: Acute glaucoma attack
MOA: Inhibits production of enzyme required for aqueous humor production
Side effects: Cross-allergy w/sulfa drugs
tingling in extremities, tingling in lips, tingling in anus, long-term flaccid paralysis, and convulsions
Caution: Teratogenic in first trimester of pregnancy
Usually given in conjunction with other glaucoma meds
Adrenergic Drugs
Mydriatics
Indicated for: Wide angle primary glaucoma, glaucoma secondary to inflammation (given after cholinergic agent to counteract pupil dilatory effect), ocular exam, and congestion relief
MOA: Decrease formation of aqueous humor, dilate pupils, constrict conjunctival blood vessels
Side effects: Not serious
Caution: Narrow angle glaucoma, cardiovascular disease
Beta blockers
Timolol maleate
Indicated for: Wide angle glaucoma
MOA: Decrease production of aqueous humor, without changing pupil size
Cautions: Asthma, heart block, heart failure
Prostaglandin Analogs
Indicated for: Glaucoma (drug of choice, especially wide angle glaucoma)
MOA: Decrease IOP by 25-30%, stabilize IOP, and increase fluid outflow
Osmotic diuretics
Mannitol
Indicated for: Acute glaucoma attacks, postoperative use
MOA: Removes trapped fluid from the eye, decreasing pressure
Side effects: Headache, dryness, and fluid/electrolyte imbalance
Anticholinergics
Mydriatics
Indicated for: Pupil dilation to rest intraocular muscles and relieve pain/inflammation, for eye exam, and for pre/postoperative rest
MOA: Prevention of pupil constriction
Side effects: Photophobia, systemically causes dry mouth, tachycardia, and fever sue to reduced sweating
Cautions: Narrow angle primary glaucoma
Eye Antiinfectives
Indicated for: Eye infections/inflammation
MOA: Bacteriacidal/bacteriostatic, intivirals
Topical cautions: Possible local sensitivity (eye inflammation), interference with normal flora
Systemic cautions: Possible sensitivity to antiinfective, bacterial/viral resistance may develop
Eye Steroids
Indicated for: Allergic reactions in eye, severe eye injury, and non-pus producing inflammation
MOA: Reduction of scarring/impaired vision, reduction of inflammation to prevent proteins/blood cells from entering aqueous humor and increasing IOP
Cautions: Pus-producing inflammation, prolonged therapy may cause systemic side effects, secondary glaucoma, and cataracts
Local eye anesthetics
Indicated for: Eye pain
Caution: Eye may dry out due to decreased blink reflex
Emollient
Fatty or oily substance used to soften or soothe irritated skin or mucous membrane
Antiseptic
Substance used on living tissue to inhibit or kill microorganisms capable of producing infection
Keratolytic
Keratin dissolvers, used on warts and noninflammatory acne
Topical corticsteroids
Antiinflammatory agents used topically for itchy skin, may cause capillary dilation, skin atrophy, and decreased skin pigmentation. Allergies possible. Not to be used for skin infection, as they are immunosuppressive.
Tretinion
Retinoic acid
Indicated for: Acne (especially blackheads)
May cause: Light sensitivity and possible acceleration of carcinogenic effects of UV light
May be used concurrently with benzoyl peroxide
Benzoyl peroxide
Indicated for: Acne (especially whiteheads)
May be used concurrently with tretinoin
Tetracycline
Spectrum: Broad. Many gram-positive and gram-negative bacteria.
Indicated for: Acne, chlamydia/STIs, animal-borne infections.
May cause: Gastric upset, vaginitis, skin infection, and fungal infection. Children’s teeth may be permanently discolored. May decrease effectiveness of contraceptives. Possible interaction with calcium and magnesium, should not be taken with milk.
Caution: Decreases effectiveness of contraceptives. Contraindicated in pregnancy. Superinfection possible.
Erythromycins
Indicated for: Acne
May cause: Gastric upset, vaginitis, skin infection and fungal infection.
Caution: Possible effects upon pregnancy. Superinfection possible.
Oral contraceptives
Indicated for: Acne
MOA: Estrogens suppress sebum production
Oral 13
Cisretinoic acid
Indicated for: Acne, especially severe case
MOA: Inhibits sebum production
May cause: Cracked skin, alopecia, hypertriglyceridemia, hepatitis, acute pancreatitis, pseudotumor cerebri joint/musckuloskeletal pain and skeletal hyperostoses.
Caution: Contraindicated in pregnancy, highly teratogenic. Women must take monthly pregnancy tests to continue medication.
Infection
Presence of an organism on or within tissue resulting in an immune response and/or destruction of the tissue
Colonization
Presence of an organism on or within tissue which does not result in an immune response nor destruction of the tissue
Antibiotic
A product of a living microorganism that can exert a deleterious effect on other microorganisms
Antimicrobial
Any naturally occurring or synthetic substance which kills or inhibits growth of microorganisms
Broad spectrum
Effective against more than one class of microorganisms and sometimes nonbacterial parasites. Best used topically
Narrow spectrum
Effective against a limited number of microorganisms. More desirable systemically
Disinfectant
An agent used on objects that kills microorganisms capable of producing infection. Doe not kill spores, viruses, or some very resistant bacteria
Antiseptic
Agent used on living tissue that inhibits or kills microorganisms capable of producing infection. Not as strong as disinfectant
Bactericide
Agent that kills bacteria independent of the immune system. Generally affect bacterial cell walls or membrane permeability. Penicillins, cephalosporins, polymyxin, and vancomycin
Bacteriostatic
Substance that inhibits growth and replication of bacteria. Requires assistance from the body’s immune system. Generally function as antimetabolites or inhibitors of protein synthesis. Infection may be life-threatening if the hosts’s immune system is malfunctioning. Tetracyclines, sulfonamides, erythrmocycin, and lincomycin
Superinfection
Development of an infection suprimposed on the one being treated, possibly due to overgrowth of a resistant strain or minimized competition from helpful bacteria
Penicillin
Spectrum: Narrow. Chiefly gram-positive, but useful for many common infections.
MOA: Beta-lactam ring inhibits cell wall synthesis. Bactericidal.
Caution: Renal disease. High doses may lead to CNS stimulation and convulsions. Allergy possible.
Penicillinase resistant drugs
Used if bacteria resistant to penicillin.
MOA: Not affected by penicillinase
Caution: IV forms include sodium and potassium, may cause electrolyte imbalance in patients with kidney failure.
Beta lactamase inhibitors
Clavulanic acid, Sulbatctam, Tazobactam
Used if bacteria have beta lactamase.
MOA: “Rejuvenate” penicillins by inhibiting beta lactamase
Probenacid
Used for gout and to inhibit renal secretion of penicillins, cephalosporins, and some quinolones
MOA: Keep some drugs in the body longer by inhibiting renal secretion
Cephalosporins
Spectrum: 5 generations with varying spectrums, generally narrow spectrum. Chiefly gram-positive in earlier generations, switches to gram-negative in later generations. 5th generation works against MRSA. Meningitis.
MOA: Beta lactam ring inhibits cell wall synthesis. Bactericidal.
Used prophylactically before, during, and after surgery
Caution: Must be used with sensitivity tests to indicate effectieness. Allergy possible.
Carbapenems
Spectrum: Most gram-positive and gram-negative bacteria. May be used for mixed infections.
MOA: Beta lactam ring, resistant to beta lactamase
Given IV or IM. May be given with glycopeptides. May be given with cylastin to decrease kidney excretion and prolong effects
Caution: Renal disease, may cause CNS stimulation and convulsions
Monobactams
Spectrum: Effective against more resistant gram-negative organisms (UTI, URI, intra-abdominal and gynecological infections).
MOA: Beta lactam ring, inhibits cell wall synthesis.
May cause: Elevated liver values, nausea, vomiting, rashes and phlebitis
Little to no cross-allergenicity to penicillins and cephalosporins
Glycopeptides
Vancomycin, bacitracin
MOA: Inhibit cell wall synthesis by depolarizing the bacterial cell membrane. No beta lactam ring. Bactericidal.
Vancomycin does not absorb through the gut. Bacitran is strictly used topically.
May cause: Red Man Syndrome. Systemic toxicity if absorbed.
Aminoglycosides
Streptomycin, Amikacin, Gentamicin, Neomycin, Tobramycin
Spectrum: Broad, especially aerobic gram-negative organisms. Resistance uncommon.
MOA: Protein synthesis inhibitor. Bactericidal.
Used parenterally, expect for GI parasites. Does not cross blood-brain barrier adequately.
May cause: Ototoxicity, renal damage, neuromuscular blockade at neuromuscular junction
Streptomycin
An aminoglycoside. Bactericidal.
Used for tuberculosis
May cause: Hearing loss, renal disease, neuromuscular blocking and respiratory paralysis if low blood calcium. Avoid prune, plum, and cranberry juice
Quinolones/Fluoroquinolones
“Floxacins”
Spectrum: Broad spectrum, most gram-negative and gram-positive bacteria. Works against pseudomonas.
MOA: Synthetic. Inhibit DNA synthesis. Bactericidal. Resistance less likely due to destruction of DNA.
May cause: Fewer adverse reactions, but can cause nausea, anaphylaxis, rashes, visual disturbances, phototoxicity, depressed bone marrow, acute interstitial nephritis, arthritis, and tendonitis. Activation of CP450.
Contraindicated for: Pregnancy
Macrolides
Erythromycin, Azithromycin
Spectrum: Narrow, chiefly gram-positive but some gram-negative.
MOA: Inhibits protein synthesis. Bacteriostatic. Resistant strains develop easily.
May cause: Epigastric pain, jaundice, ototoxicity, Possible allergy. Some antiinflammatory effects.
Lincosamides
Clindamycin, lincomycin
Used for: Patients with penicillin allergies.
MOA: Bacteriostatic.
Caution: Possible toxicity. Possible serious adverse effects, may wipe out natural flora.
Chloramphenicol
Spectrum: Broad. Typhoid fever, systemic salmonella, meningeal infections (especially from influenza), and anaerobic infections.
MOA: Protein synthesis inhibitor. Bacteriostatic.
May cause: Blood abnormalities, toxic build up in infants (Grey Baby Syndrome).
Sulfonamides
Spectrum: Broad. UTI., otitits media, and vaginal infections. Resistance common.
MOA: Inhibition of cell metabolism. Bacteriostatic.
Low cost and easily administered.
May cause: Kidney damage possible.
Trimethoprim
Septra
Used for: UTI, URI, GI infections.
Caution: Folate deficiency.
