Eye/Skin Drugs, Antiinfectives, Antineoplastics

Question 1

Narrow Angle Glaucoma (Primary Glaucoma)

Answer 1

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.

Question 2

Wide Angle Glaucoma (Primary Glaucoma)

Answer 2

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.

Question 3

Secondary Glaucoma

Answer 3

Develops secondarily to other eye disease e.g. inflammation or cataract surgery (which may prevent proper drainage).
Drug treatment: corticosteroid or antiinfective

Question 4

Congenital Glaucoma

Answer 4

Requires surgery to correct (remove tribicular meshwork or LASER treatment)

Question 5

Miotics

Cholinergic Drugs

Answer 5

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

Question 6

Carbonic Anhydrase Inhibitors

Prostaglandin Analogs

Answer 6

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

Question 7

Adrenergic Drugs

Mydriatics

Answer 7

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

Question 8

Beta blockers

Timolol maleate

Answer 8

Indicated for: Wide angle glaucoma
MOA: Decrease production of aqueous humor, without changing pupil size
Cautions: Asthma, heart block, heart failure

Question 9

Prostaglandin Analogs

Answer 9

Indicated for: Glaucoma (drug of choice, especially wide angle glaucoma)
MOA: Decrease IOP by 25-30%, stabilize IOP, and increase fluid outflow

Question 10

Osmotic diuretics

Mannitol

Answer 10

Indicated for: Acute glaucoma attacks, postoperative use
MOA: Removes trapped fluid from the eye, decreasing pressure
Side effects: Headache, dryness, and fluid/electrolyte imbalance

Question 11

Anticholinergics

Mydriatics

Answer 11

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

Question 12

Eye Antiinfectives

Answer 12

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

Question 13

Eye Steroids

Answer 13

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

Question 14

Local eye anesthetics

Answer 14

Indicated for: Eye pain

Caution: Eye may dry out due to decreased blink reflex

Question 15

Emollient

Answer 15

Fatty or oily substance used to soften or soothe irritated skin or mucous membrane

Question 16

Antiseptic

Answer 16

Substance used on living tissue to inhibit or kill microorganisms capable of producing infection

Question 17

Keratolytic

Answer 17

Keratin dissolvers, used on warts and noninflammatory acne

Question 18

Topical corticsteroids

Answer 18

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.

Question 19

Tretinion

Retinoic acid

Answer 19

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

Question 20

Benzoyl peroxide

Answer 20

Indicated for: Acne (especially whiteheads)

May be used concurrently with tretinoin

Question 21

Tetracycline

Answer 21

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.

Question 22

Erythromycins

Answer 22

Indicated for: Acne
May cause: Gastric upset, vaginitis, skin infection and fungal infection.
Caution: Possible effects upon pregnancy. Superinfection possible.

Question 23

Oral contraceptives

Answer 23

Indicated for: Acne

MOA: Estrogens suppress sebum production

Question 24

Oral 13

Cisretinoic acid

Answer 24

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.

Question 25

Infection

Answer 25

Presence of an organism on or within tissue resulting in an immune response and/or destruction of the tissue

Question 26

Colonization

Answer 26

Presence of an organism on or within tissue which does not result in an immune response nor destruction of the tissue

Question 27

Antibiotic

Answer 27

A product of a living microorganism that can exert a deleterious effect on other microorganisms

Question 28

Antimicrobial

Answer 28

Any naturally occurring or synthetic substance which kills or inhibits growth of microorganisms

Question 29

Broad spectrum

Answer 29

Effective against more than one class of microorganisms and sometimes nonbacterial parasites. Best used topically

Question 30

Narrow spectrum

Answer 30

Effective against a limited number of microorganisms. More desirable systemically

Question 31

Disinfectant

Answer 31

An agent used on objects that kills microorganisms capable of producing infection. Doe not kill spores, viruses, or some very resistant bacteria

Question 32

Antiseptic

Answer 32

Agent used on living tissue that inhibits or kills microorganisms capable of producing infection. Not as strong as disinfectant

Question 33

Bactericide

Answer 33

Agent that kills bacteria independent of the immune system. Generally affect bacterial cell walls or membrane permeability. Penicillins, cephalosporins, polymyxin, and vancomycin

Question 34

Bacteriostatic

Answer 34

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

Question 35

Superinfection

Answer 35

Development of an infection suprimposed on the one being treated, possibly due to overgrowth of a resistant strain or minimized competition from helpful bacteria

Question 36

Penicillin

Answer 36

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.

Question 37

Penicillinase resistant drugs

Answer 37

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.

Question 38

Beta lactamase inhibitors | Clavulanic acid, Sulbatctam, Tazobactam

Answer 38

Used if bacteria have beta lactamase. | MOA: "Rejuvenate" penicillins by inhibiting beta lactamase

Question 39

Probenacid

Answer 39

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

Question 40

Cephalosporins

Answer 40

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.

Question 41

Carbapenems

Answer 41

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

Question 42

Monobactams

Answer 42

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

Question 43

Glycopeptides | Vancomycin, bacitracin

Answer 43

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.

Question 44

Aminoglycosides | Streptomycin, Amikacin, Gentamicin, Neomycin, Tobramycin

Answer 44

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

Question 45

Streptomycin

Answer 45

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

Question 46

Quinolones/Fluoroquinolones | "Floxacins"

Answer 46

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

Question 47

Macrolides | Erythromycin, Azithromycin

Answer 47

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.

Question 48

Lincosamides | Clindamycin, lincomycin

Answer 48

Used for: Patients with penicillin allergies. MOA: Bacteriostatic. Caution: Possible toxicity. Possible serious adverse effects, may wipe out natural flora.

Question 49

Chloramphenicol

Answer 49

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).

Question 50

Sulfonamides

Answer 50

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.

Question 51

Trimethoprim | Septra

Answer 51

Used for: UTI, URI, GI infections. | Caution: Folate deficiency.