MT 1

Question 1

Imipramine (Tofranil)

Answer 1

Anti Depressant, Tricyclic Amine (TCA)
FDA approved: Depression Enuresis (bed wetting)
Off Label: Neuropathic Pain (ex: diabetic neuropathy)
Opto Rxn: Accommodative disturbance, angle-closure glaucoma, blurred vision, mydriasis

Question 2

Amitriptyline (Elavil)

Answer 2

Anti Depressant, Tricyclic Amine (TCA)
FDA approved: Depression
Off Label: Neuropathic Pain (ex: diabetic neuropathy)
Opto Rxn: Accommodative disturbance, blurred vision, mydriasis, increased IOP

Question 3

Topiramate (Topamax)

Answer 3

Anti Convulsant
FDA approved: Epilepsy, migraine prophylaxis

Question 4

Gabapentin (Neurontin)

Answer 4

Anti Convulsant
FDA Approved: Seizures, post herpetic neuralgia (PHN)
Off Label: Diabetic Neuropathy
Opto Rxn: Nystagmus

Question 5

Bevacizumab (Avastin)

Answer 5

Anti Neoplastic, VEGF Inhibitor monoclonal antibody (mAb)
Off Label: age-related macular degeneration

Question 6

Etanercept (Enbrel)

Answer 6

Tumor Necrosis Factor (TNF) Inhibitor
a recombinant DNA - derived protein – linked to human IgG1
treatment of rheumatoid arthritis

a disease modifying antirheumatic agent (DMARD)

Question 7

Infliximab (Remicade)

Answer 7

Tumor Necrosis Factor (TNF) Inhibitor
mnoclonal antibody (mAb) binds to human tumor necrosis
Treatment of rheumatoid arthritis, Crohn disease,& ulcerative colitis

A Disease modifying antirheumatic agent & gastrointestinal agent (DMARD and GI)

Question 8

Moxifloxacin (Vigamox, Moxeza)

Answer 8

fluoroquinolone antibiotic for the treatment of bacterial conjunctivitis

Vigamox 3x a day
Moxeza 2x a day

Question 9

Opto Antibiotics that can have Chelation (altered drug mech)

Answer 9

Binding of metal ion, Al, Mg, Ca, Fe

Tetracyclines (Doxycycline - Vibramycin)
Fluoroquinolones (Ciprofloxacin - Cirpo)
Levoflaoxacin (Levaquin)

Question 10

Combined drug effects of :
Diphenhydramine (Benadryl)
Opioid Agonists
Sleep Medications

Answer 10

Can have CNS additive CNS depressant effects

Question 11

Vancomycin and Gentamicin

Answer 11

Drug Interaction : Synergism “1+1=3”

Vancomycin and Gentamicin used in combination to treat bacterial endocarditis

Vancomycin inhibits bacterial wall synthesis
gentamicin interferes with bacterial protein synthesis

Question 12

Naloxone (Narcan)

Answer 12

Drug interaction: Antagonism “1+ (-1) = 0”

administered in opioid overdose – reverses effects of morphine/ CNS depressant effects of substance drug

Question 13

Amoxicillin with Clavulanate (Augmentin)

Answer 13

Drug Interaction: Potentiation “0+1=2”

amoxicillin = penicillin antibiotic
clavulanate (clavulanic acid) has now killng action

combined clavulanic acid protects the amoxicillin molecule by binding to beta-lactamases produced by bacteria

Question 14

NSAIDs

Answer 14

Nonsteroidal inflammatory Drugs
ex: Ibuprofen (Motrin, Advil)

Affects Hearts, GI, and Kidneys

Question 15

Drugs that have Extensive Volume of Distribution
2 drugs

Answer 15

Zithromax (Azithromycin)
Vibramycin (Doxycycline)

Question 16

Drug Examples with Drug Deposition
2 Drugs

Answer 16

Amiodarone (Pacerone, Codarone)
Corneal microdeposits, >90%, 10% have visual disturbances
Optic Neuritis (1%)

Vibramycin (Doxycycline)
may induce hyperpigmentation, oral cavities
Pediatrics: tooth enamel hypoplasia (permanent tooth discoloration)

Question 17

Nepafenac (Nevanac and Ilevro)

Answer 17

nonsteroidal antiflammatory (NSAID) ophthalmic drug
for pain and inflammation post-cataract surgery

Hydrolyzed in ocular tissue to amfenac (active drug)

Question 18

Clopidogrel (Plavix)

Answer 18

Pro drug - antiplatelet agent – to reduce platelet aggregation and maintain vessel patency

Black Box Warning
Clinical Importance for Poor Metabolizers
CYP450 2C19 target enzyme
Lower conversion to active metabolite may result in reduced platelet inhibition
Higher risk of Cardiovascular event

Do not take Omeprazole or Esomeprazole

Question 19

Codeine

Answer 19

Opioid analgesic – Prodrug –> active metabolite is Morphine

BBW
Clinical importance
CYP450 2D6
Ultra-rapid metabolizer
May experience morphine toxicity – respiratory depression
–> high morphine levels

Question 20

Warfarin

Answer 20

Anticoagulant

Poor Metabolizers
Will NOT metabolize warfarin as effectively to an inactive metabolite
– requires lower doses of warfarin

Question 21

Example of Maintenance Doses

Answer 21

Provastatin (Pravachol) : 20mg tab
Moxifloxacin (Vigamox) - one drop to affected Eye

Question 22

Omeprazole (Prilosec)
& Esomeprazole (Nexium)

Answer 22

Proton Pump Inhibitor

Gastroesopheal reflux disease, peptic ultcer and heart burn

suppress gastric acid secretion by inhibit proton pumps

can be replaced with:
Lansoprazole (prevacid)
Pantoprazole (protonix)
Rabeprazole (aciphex)
Dexlansoprazole (Dexilant)

Question 23

Trastuzumab (Herceptin)

Answer 23

Antineoplastic agent (Anti-Her2) monoclonal antibody

Tx: breast and gastric cancer

mech: binds to HER2 protein
^requires + HER2 genomic testing to ensure efficacy

IV infusion

Question 24

Oral Tryosine Kinases Inhibitors (TKIs)

Answer 24

chemotheapy that inihibits enzyme tyrosine kinase

inhibits cancer cell proliferation