NBEO Pharm Flashcards
Sulfacetamide (Sulamyd)
sulfonamide antibiotic (inhibits folic acid synthesis)
Amiodarone (Cordarone)
Anti-arryhythmic medication
- blocks K+ channels (some Na and Ca channels)
- ADRS
- NIAION
- whorl keratopathy
- anterior subcapsular deposits
Valacyclovir (Valtrex)
Anti-viral
oral
Tx: HSV 1 and 2, Shingles, herpes zoster ophthalmicus, HSV keratitis
Systemic DNA polymerase inhibitor
ADRs- HAs, GI effects
Cetirizine (Zyrtec)
H1 blocker - second generation
Tx- allergic rhinitis and chronic urticaria
ADRs:
- abnormal EOM contractions (oculogyric crisis)
- less CNS/anticholinergic effects vs first generation
Celecoxib (Celebrex)
NSAID- selective COX 2 inhibitor
- protects gastric mucosa and limits GI bleeding
ADRs
- conjunctivitis
- blurry vision
- Stevens Johnson sydrome
Pralidoxime (Protopam)
Reverse effects of irreversible AchE inhibitors
allows breakdown of ACh - reverse effects of pesticide poisoning
Chloroquine (Aralen)
Anti-parasitic drug
build up of heme= toxic to plasmodium parasite (responsible for malaria)
also inhibits phospholipase A - decrease inflammation (Tx of RA/lupus)
ADRs - whorl keratopathy (reversible) - bull’s eye maculopathy (initial stage- RPE mottling)
Phenobarbital (Luminal)
Anti-convulsant
- reduces glutamatergic excitatory transmissions
- Tx- seizures and sedation
- ADRs
- mydrasis
- increased IOP
- cycloplegia
- sedation, respiratory depression
Pemirolast (Alamast)
Mast cell stabilizer
Cholestyramine (Questran)
Antihyperlipidemic agent
Bile acid binding resin
- binds bile acid- prevents reabsoprtion
- ADRS
- constipation and fatty stools
Lidocaine
Amine local anesthetic
Simvastatin (Zocor)
Antihyperlipidemic agent
- HMG CoA reducases inhibitor (used in synthesis of cholesterol)
- lower LDL and triglycerides
- increases HDL
- first line tx for high cholesterol
- ADRs
- hepatotoxicity
- myopathy
- contraindicated in pregnancy
Clarithromycin (Biaxin)
macrolide antibiotic (50S protein inhibitor)
oral - respiratory infections
Edrophonium (Enlon)
*Indirect Cholinergic Agonist* - Dx of MG (Tensilon test)
Amitriptyline (Elavil)
Anti-depressant - TCA
anti- cholinergic
- inhibits NorE and serotonin uptake
- ADRs
- anticholinergic effects (anti- sluds)
- overdose can be life threatening!!!
Botulina toxin (botox)
blocks release of Ach at NMJ - Tx of blepharospam and strabismus
Augmentin
amoxicillin + clavulonic acid (penicillinase/ beta lactamse inhibitor)
Cimetidine (Tagamet)
H2 blocker
Tx- stomach ulcers and acid reflux
ADRs:
- Diarrhea
- drug interactions
- gynecomastia and loss of libido
Amantadine (Symmetrel)
Antiparkinsonian med
- potentiates dopamine effects
Glycerine (Osmoglyn)
Hyperosmotic agent
acute angle closure attack
contraindicated in DM pts
Topiramate
anti-convulsant
ADRS
- blurred vision
- diplopia
- nystagmus
- choroidal swelling - acute secondary angle closure
Aggrenox
combo of Aspirin and Dipyridamole
anticoagulant
Tx- pts with h/o of ischemic strokes
Triamcinolone (Kenalog)
Systemic steroid
Opthalmic uses
- DME
- Graves
- intermediate/ non resolving uveitis
- Chalazia
- recalcitrant irvine gass cystoid mac edema
- mac edema 2^CRVO
Systemic uses
- dermatoses, asthma, MS and arthritis
ADR
- elevated IOP
- depigmentation of eyelid skin in dark skinned pt
Neosporin
Bacitracin + polymyxin + neomycin
Dexamethasone (Maxidex)
Potent steroid
Indomethacin (Indocin)
NSAID- Reversible COX 1 and COX 2 inhibitor
Tx- scleritis and episcleritis
ADRS
- increase risk of bleeding complications in eye
- GI bleeding
- cardiovascular events (MI or stroke) (contraindicated in pts with coronary artery disease/ stroke)
- pigmentary retinopthaty
- whorl keratopaty
Nepafenac (Nevanec)
NSAID
Carteolol (Ocupress)
*Adrenergic antagonist*- Non- selective beta blocker
- intrinsic sympathomimetic activity (ISA)
- less bradycardia vs other beta blockers (less side effects
Rosiglitazone (Avandia)
Thiazolidinedione (oral DM medication)
- activate peroxisome proliferator- activated receptor gamma to increase glucose uptake in muscles and fatty tissue
- used to combat insulin resistance
Ketorolac Tromethamine (Acular LS)
NSAID
only one approved from topical tx of seasonal allergic conjunctivitis
Cell wall synthesis blockers
bacitracin
penicillins
cephalosporins
Neostigmine (Prostigmin)
*Indirect Cholinergic Agonist* - Treatment of MG
Cyclobenzaprine (Flexeril)
Muscle relaxant
anti- cholinergic
Furosemide (Lasix)
Loop diuretic
HTN med
- inhibits Na/2Cl/K co-transporters in thick ascending loop of Henle
- increases Ca
- ADRS
- hypokalemia
- nephrotoxicity
- ototoxicity
- DES
Cromolyn sodium (Crolom)
Mast Cell Stabilizer
Acetaminophen (Tylenl)
Non-opiate analesic
- NO anti inflam properties
- can be used in infants
- ADRs
- hepatotoxicity
Phenylephrine (Neo-Synephrine)
Adrenergic agonist (alpha 1 )
- dilation without cycloplegia
- palpebral widening
- differentiate scleritis from episcleritis
- horner’s syndrome (post lesion= dilation, pre lesion= no dilation)
- 10% break posterior synechiae (but adverse cardiovascular effects)
contraindicated in ppl taking MAOIs, TCA, atropine, Graves pts.
Chlorpromazine (Thorazine)
Antipsychotic (Phenothiazine)
Anti- cholinergic
- dopamine receptor antagonist
- ADRs
- parkinson like side effects
- pigmentation effects (pigment on corneal endo, anterior stellate cataracts, hyperpigmentation of RPE)
- anticholinergic effct- dry eye, mydriasis, increase IOP
- oculogyric crisis
Fluorometholone (FML)
Soft steroid
Clopidogrel (Plavix)
Anticoagulant
- inhibits ADP receptor on platelet cell membranes - needed for platelet aggregation and clot formation
- ADRs
- increased risk of bleeding, GI upset, rash
- effects = irreversible
Prednisolone acetate
Steroid- potent
SHAKE!
Rifampin (Rifadin)
Tb drug
- prevents mRNA synthesis by binding to RNA polymerase
- ADR- hepatoxicity, orange/pink tear and urine discoloration
Acylovir (Zovirax)
Anti-viral
oral
Tx: HSV 1 and 2, Shingles, herpes zoster ophthalmicus, HSV keratitis
Systemic DNA polymerase inhibitor
ADRs- HAs, GI effects
Fluoroquinolones (names and facts)
antibiotic-
- inhibits DNA gyrase and topoisomerase IV
- ciprofloxacin, ofloxacin, levofloxacin, gatifloxacin, moxifloxacin, besifloxacin
- all gram -
- 3rd and 4th generation have imporved gram +
- uses:
- CL related corneal uclers, abrasions, bacterial conjunctivits
- systemic uses
- cipro- gram - urinary infections
- moxi- pneuomia, sinusitis, intra ab and skin infections
ADRS
- oral - affect bones= tendinitis. contraindicated in pregnancy, and <18yo
- topical - use in 1yo and older (except Levo)
Latanoprost (Xalatan)
Prostaglandin analog
Tx of GL
- 27-35% IOP reduction (increases uveoscleral outflow of AQ)
- nighttime dosing
- ADRS
- iris heterochromia
- increase pigmentation and growth of eyelashes
- skin darkening around eyes
- conjunctival hyperemia
- itching
- Contraindications - CME -Active inflammation - previous HSV keratitis
Sulfonamides
antibiotic (foltate synthesis inhibitor)
- inhibits dihydropteroate synthase (converts PABA–> dihydrofolic acid)- first step of folic acid synthesis
- bacteriostatic
- gram + and -
- ophthalmic: blepharitis and conjunctivitis (rare use)
- ADRs- stinging, burning, contact derm, local photosensitivity
- system: toxoplasmosis (sulfadiazine +pyrimethamine)
- ADRs- kernicterus in infants, induce myopic shift, steven johnson syndrome.
Famciclovir (Famvir)
Anti-viral
oral
Tx: HSV 1 and 2, Shingles, herpes zoster ophthalmicus, HSV keratitis
Systemic DNA polymerase inhibitor
ADRs- HAs, GI effects
Apraclonidine (Iopidine)
Adrenergic agonist (alpha 2)
- acute angle closure attack
- controls IOP spike (decrease AQ production and increase uveoscleral outflow)
- 30-40% decrease - not effective as chronic therapy b/c tachyphylaxis
- dx of Horner’s syndrome ( Horner’s dilates due to hypersensitivity of alpha 1 vs normal pupil= no dilation)
Trifluridine (Viroptic)
Anti-viral
tx herpes simplex keratitis
inhibits DNA polymerase
dose 9x/day
Oxycodone (Roxicodone)
Opiate analgesic
- agonist at Mu, Kappa and Delta opiate receptors
- potent analgesics
- addictive
- ADRs
- miosis
- resp depression
- drowsiness
- sedation
- nausea
Nifedipine (Procardia)
Calcium channel blocker
HTN med
- blocks L type Ca channels
- decrease peripheral vascular resistance
Lincomycin/ Clindamycin (Cleocin)
50S protein inhibitor antibiotic
reversible
Rx- MRSA and anaerobic infections
Azithromycine (zithromax- oral) (azasite- topcial)
macrolide antibiotic (50S protein inhibitor)
- oral- chlamydial infections - 1g single dose (empty stomach )
- topical- bacterial conjunictivits and blepharitis (contains BAK)
Dicloxacillin (Dynapen)
Penicllin
gram +
resistant to penicillinase
drug of choice for methicillin-sensitive staph aureus (MSSA)
Folate synthesis inhibitors
sulfonamides
trimethoprim
pyrimethamine
Chlorpropamide (Diabinese)
Sulfonylureas (oral DM medication)
- increases secretion of insulin
- ADRS
- hypoglycemia
- sulfa allergy
- with beta blockers incease risk of hypoglycemia
Olopatadine 0.2% (Pataday)
Mast cell stabilizer + antihistamine combo
Ketotifen (Zaditor)
Mast cell stabilizer + antihistamine combo
Brimonidine (Alphagan)
Adrenergic agonist (alpha 2)
GL treatment
- decrease AQ production and increase uveoscleral outflow
- Neuroprotective
- follicular conjunctivits - miosis - contraindicated with MAOIs
Lodoxamide (Alomide)
Mast cell stabilizer
Tetrazosin (Hytrin)
Alpha 1 antagonist
(prevent vasocontriction)
tx- BPH, HTN
ADRs- floppy iris sydrome
Homatropine
*Cholinergic antagonist*
standard tx of anterior uveitis
- dilates and mobilizes iris
- paralyzes ciliary and sphincter muscle (reduce pain)
- stabilizes blood AQ-barrier
Losartan (Cozaar)
Angiotensin II receptor antagonist- HTN med
- NO cough
Tamsulosin (Flomax)
Alpha 1 antagonist
(prevent vasoconstriction)
tx- BPH
ADRs- floppy iris sydrome
Levothyroxine (Synthroid)
Synthetic T4
ADRs
- hyperthyroid
- pseudotumor cerebri in kids
Loteprednol (Lotemax)
Soft steroid
Ester based
safest steroid
Atropine
*Choninergic antagonist*
longest duration
amblyopia treatment
use >3 yo - caution in Down’s syndrome, small children and elderly
Gentamicin (Garamycin)
aminoglycoside antibiotic (30s protein inhibitor)
Naproxen (Naprosyn)
NSAID- Reversible COX 1 and COX 2 inhibitor
Tx- scleritis and episcleritis
ADRS
- increase risk of bleeding complications in eye
- GI bleeding
- cardiovascular events (MI or stroke) (contraindicated in pts with coronary artery disease/ stroke)
Cyclobenzaprine (Flexeril)
Non-opiate analesic
- decrease motor activity by inhibiting tonic activiity of alpha and gamma motor neurons
- tx- muscle spasms
- ADRs
- drowsiness
- Loss of coordination
- anticholinergic effects
- caution in narrow angle GL
Donepezil (Aricept)
*Indirect Cholinergic agonist*
treatment of Alzheimer’s and dementia
- CNS acetylcholinesterase inhibitor
- ADRs
- cataracts
- blurred vision
- ocular irritation
- lower IOP
Spironolactone (Aldactone)
Potassium- sparing diuretic
- blocks action of aldosterone in late DCT and collecting ducts= increases excretion of sodium and water and decreases secretion of K+
- ADRs
- hyperkalemia
- gynecomastia
- antiandrogen effects
- DES
Metoprolol (Lopressor)
Beta blocker - beta 1 specific
HTN med
ADRS:
- CNS- disorientation, depression, fatigue
- Cardio - bradycardia, arrhythmias, syncope
- Pulmonary- dyspnea, wheezing, bronchospasm
- GI- nausea, vomitting, diarrhea, ab pain
- Reproductive- ED
Methazolamide (Neptazane)
Carbonic anhydrase inhibitor
oral
- Side effects - metallic taste, tingling, metabolic acidosis - bone marrow suppression and aplastic anemia (fatal!!) - malaise, fatigue, weight loss, impotence, depression, diarrhea - myopic shift contraindicated - COPD - pregnancy - sulfa allergy
Trimethoprim (Primsol)
antibiotic (folate acid synthesis inhibitor)
- inhibits dihydrofolate reductase (converts hydrofolic acid–> tetrahydrofolic acid) second step of synthesis
- gram + and - (not pseduomonas)
- effective against MRSA
- ADRs - bone marrow suppression –> anemia, leukopenia, granulocytopenia
Systane
ocular lubricant
Bromfenac (Xibrom, Bromday)
NSAID
Xibrom- contains sodium sulfite- beware with sulfa allergy
Antibiotics to take on empty stomach
PAT:
- penicillin
- azithromycin
- tetracyclines (exp- doxy)
Brinzolamide (Azopt)
Carbonic anhydrase inhibitor
topical - tx GL - sulfa based - ADRs- stings and metallic taste
Loratadine (Claritin)
H1 blocker - second generation
Tx- allergic rhinitis and chronic urticaria
ADRs:
- less CNS/anticholinergic effects vs first generation
Amoxicillin (Principen)
Penicillin
gram + and -
Optive
Ocular lubricant
Gatifloxacin (Zymar)
4nd generation fluoroquinolone
Theophylline (Theo Dur)
miscullaneous respiratory agent
ihibits phophodiesterase –> increased cAMP–> increased Epi
beta blockers can mitigate bronchodilatory effects
Diazepam (Valium)
Anxiolytic
anti- cholinergic
- benzodoazepine
- opens chloride channels by binding to GABA receptors= hyperpolarization of neurons in CNS
- ADRs
- sedation, depression, confusion, bradycardia, dyspnea
- mydrasis and nystagmus (contraindicated in narrow angle GL)
Besifloxacin (Besivance)
4nd generation fluoroquinolone - only topical
Cephalosporins (drugs + main points)
Cephalexin, ceftriaxone
- inhibit transpeptidase (inhibit cell wall synthesis)
- 1st generation: gram +
- 2nd generation: gram + and some gram -
- 3rd generation: gram + and -
- ADRs
- hypersensitivity rxns,
- alters absorption of vit K= excessive blood thinning if taking blood thinner
Macrolides (drugs and facts)
erythromycin, azithromycin, clarithromycin - 50S protein inhibitors
Ofloxacin (Ocuflox)
2nd generation fluoroquinolone
Antibiotics effective for MRSA
Bactrim (trimethoprim-sulfamethoxazole)
doxycycline
clindamycin
Propranolol (Inderal)
Beta blocker - non selective
HTN med
ADRS:
- CNS- disorientation, depression, fatigue
- Cardio - bradycardia, arrhythmias, syncope
- Pulmonary- dyspnea, wheezing, bronchospasm
- GI- nausea, vomitting, diarrhea, ab pain
- Reproductive- ED
Phenelzine (Nardil)
Anti-depressant - MAOI
anti- cholinergic
- inhibits MAO (respobsible for breakdown of NorE and serotonin)
- ADRs
- GL
- nystagmus
- interactions with tyramine (wine, cheese, dried meat)- causes lethal hypertensive crisis
Isotretinoin (Accutane)
Derm med
- reduces size and degree of oil production from sebaceous glands
- ADRS
- blepharoconjunctivitis
- DES
- pseudotumor cerebri
- lid edema
- loss of color vision
- nyctalopia
- cataracts
- teratogenic and contrindicated in pregnancy
Duloxetine (Cymbalta)
Anti-depressant- selective NorE reuptake inhibitor
- inhibits serotonin and NorE reuptake
- Tx- depression, anxiety, panic disorder
- ADRs
- mydraiassis (caution in narrow angle pt)
- serotonin syndrome
Montelukast (Singulair)
miscullaneous respiratory agent
leukotriene receptor antagonist
tx- asthma, bronchoconstriction, allergic rhinitis
Captopril (Capoten)
ACE ihbitior- HTN med
- prevents formation of angiotensin II and blocks metabolsim of bradykinins (= vasodilation)
- ADRs
- cough
Bactericidal antibiotics
Penicillins
bacitracin
aminoclycosides
cephalosporins
fluoroquinolones
Isoproterenol (Isuprel)
beta 1 and beta 2 agonist
short acting
tx- arrhythmias- IV treatment only (no longer used from asthma)
GL warning (b/c increased IOP)
Brompheniramine (Dimetane)
H1 blocker (first generation)
Anti- cholinergic
Tx- allergic skin reactions
ADRS
- sedation
- anticholinergic effects (mydrasis, dry eye, dry mouth, tachycardia)
Metformin (Glucophage)
Biguanide (oral DM medication)
- decreases gluconeogenesis in liver
- does not cause hyerglycemia
- ADRs
- diarrhea
- if renal insuff or hepatic impairment- at greater risk of lactic acidosis
Phenytoin (Dilantin)
anti-convulasant
- ADRs
- nystagmus
- diplopia
- EOM palsies
- ataxia
- gingival hyperplasia
Nystatin (Mycostatin)
Anti-fungal
binds ergosterol and forms pores- leaking out contents = cell death
Tx - Candida oral and vaginal yeast infections (no ophthalmic use)
Imipramine (Tofranil)
Anti-depressant - TCA
anti- cholinergic
- inhibits NorE and serotonin uptake
- ADRs
- anticholinergic effects (anti- sluds)
- overdose can be life threatening!!!
Cephalexin (Keflex)
1st generation cephalosporin antibiotic (inhibits cell wall syn)
gram +
tx
- dacryoadenitis/ cystitis
- preceptal cellulitis
Ranitidine (Zantac)
H2 blocker
Tx- stomach ulcers and acid reflux
ADRs: Diarrhea
Sumatriptan (Imitrex)
Migraine tx
- serotonin subtype 1B and 1D receptor agonists
- causes vasoconstriction and reduces inflammation in CNS
- ADRs- released to systemic vasoconstriciton
- NAION
- retinal artery occlusions and venous thromboses
- MI
- ischemic strokes
Apirin
Irreversible COX 1 and COX 2 inhibitor- NSAID
Tx- antipyresis, anti- inflam and analgesia
reduces risk of heart attacts
ADRS
- GI effects (ulcers, bleeding)
- bleeding complications in eye
- Reye’s sydrome (in kids)
Promethazine (Phenergan)
H1 blocker (first generation)
Anti- cholinergic
Tx- allergic skin reactions
chemical structure similar to antipsychotic meds (phenothiazine)
ADRS
- sedation
- anticholinergic effects (mydrasis, dry eye, dry mouth, tachycardia)
- eye
- corneal epithelail keratopathy
- corenal endothelail pigmentation
- lenticular changes
- pigmentary retinopathy
Levalbuterol (Xopenex)
Beta 2 agonist
short acting
tx- rescue inhaler for asthma and COPD
GL warning (b/c increased IOP)
Naphazoline (Naphcon)
Adrenergic (Alpha) agonist
ocular decongestant
Ketoconazole (Nizoral)
Anti-fungal
inhibits ergosterol synthesis
tx -severe fungal corneal uclers ,systemic fungal infections, acanthamoeba
ADR- hepatotoxicity
Cosopt
Timolol 0.5% + Dorzolamide 2%
Penicillins (drugs + main points)
Amoxicillin, Dicloxacillin
- inhibits transpeptidase (inhibits bacterial cell wall synthesis
- bacterial eyelid infections (hordeolum, preseptal celullitis)
- ADRs
- hypersensitivity rxns
- oral contraceptives ineffective
- stevens- johnson syndrome (amoxicillin)
Hydrochlorothiazide (Hydrodiuril)
Thiazide diuretic
HTN med
- inhibits NaCl reabsorption and decreases Ca excretion in DISTAL CONVOLUTED TUBULE
- ADRs
- acute transiet myopia and acute angle closure GL
- DES
Natamycin (Natacyn)
Anti-fungal
binds ergosterol and forms pores- leaking out contents = cell death
Tx - fungal blepharitis - conjunctivitis - keratitis
Famotidine (Pepcid)
H2 blocker
Tx- stomach ulcers and acid reflux
ADRs: Diarrhea
Polytrim
Polymyxin B (strong gram -) + trimethoprim
Isoniazid (Nydrazid)
Tb drug
- prevents cell wall synthesis by inhibiting mycolic acid synthesis
- ADRs: hepatoxicity, pyridoxine (vit B6) deficiency= peripheral neuropathy, optic neuritis (rare)
Bepotastine (Bepreve)
Mast cell stabilizer + antihistamine combo
Levobunolol (Betagan)
*Adrenergic antagonist*- non-selective beta blocker
Tamoxifen (Nolvadex)
Estrogen Antagonist
- agonist inhibitor of estradiol
- Tx- breast cancer
- ADRs
- crystalline retinopathy
- whorl keratopathy
- thromboembolism
- fatty liver
- hot flashes
- increased risk of uterine cancer
Polysporin
Bacitracin (gram +) + polymyxin B (gram -)
Warfarin (Coumadin)
Anticoagulant
- vitamin K antagonist- interferes with clotting factors (dependent on vit K for synthesis)
- ADRS
- d/c 96-115 hours (4 doses ) prior to catarct surgery
Ceftriaxone (Rocephin)
3rd generation cephalosporin antibiotic (inhibits cell wall syn)
gram + and -
- IV= tx of choice for gonococcal conjunctivitis and orbital cellulitis
Gemfibrozil (Lopid)
Antihyperlipidemic agent
Fibric Acid
- binds peroxisome proliferator activated receptor – increases activity of lipoprotein lipase- breaks down VLDL
- ADRS
- GI upset
- skin rash
- urticaria
- myositis
Hydrocortisone (Cortef)
Systemic steroid
- tx of adrenal insufficiency
Salmeterol (serevent)
Beta 2 agonist
long acting
tx: maintence therapy for asthma and COPD (not used as rescue inhaler)
does not have warning re: glaucoma pts
Thioridazine (Mellaril)
Antipsychotic (Phenothiazine)
Anti- cholinergic
- dopamine receptor antagonist
- ADRs
- parkinson like side effects
- pigmentation effects (pigment on corneal endo, anterior stellate cataracts, hyperpigmentation of RPE)
- anticholinergic effct- dry eye, mydriasis, increase IOP
- oculogyric crisis
Chlorothiazide (Diuril)
Thiazide diuretic
HTN med
- inhibits NaCl reabsorption and decreases Ca excretion in DISTAL CONVOLUTED TUBULE
- ADRs
- acute transiet myopia and acute angle closure GL
- DES
Digoxin (Lanoxin)
CHF medication
- inhibits Na/K ATPase enzyme = increased intracellular Ca
- ADRs
- retrobullblar optic neuritis
- B/Y color defects
- entopic phenomenon
Azathioprine (Imuran)
Immunosuppressive agent
- purine analog
- Tx- RA, prevent kidney rejection, ocular myasthenia
Fluoress
Fluorescein + Benoxinate
Escitalopram (Lexapro)
Anti-depressant- selective serotonin reuptake inhibitor
- ADRs
- mydraiassis (caution in narrow angle pt)
- serotonin syndrome
Metaproterenol (Alupent)
Beta 2 agonist
short acting
- no longer recommended for asthma b/c of cardio effects from beta 1 stimulation
GL warning (b/c increased IOP)
Albuterol (Ventolin)
Beta 2 agonist
short acting
tx- rescue inhaler for asthma and COPD
GL warning (b/c increased IOP)
Sildenafil (Viagra)
ED med
- PDE-5 inhibitor (increasing blood flow and prolong effects of cGMP)
- Systemic ADRs
- flushing, HAs, sustained erection
-
ocular ADRS
- color changes (cyanopsia- blue tint)
- blurred vision
- photosensitivity
Atorvastatin (Lipitor)
Antihyperlipidemic agent
- HMG CoA reducases inhibitor (used in synthesis of cholesterol)
- lower LDL and triglycerides
- increases HDL
- first line tx for high cholesterol
- ADRs
- hepatotoxicity
- myopathy
- contraindicated in pregnancy
Clonidine (Catapres)
Alpha 2 agonist
Aminoglycosides (drugs and main facts)
gentamicin and tobramycin
- gram - > gram +
- ADRs
- SPK and delayed corneal re-epithelialization
Levofloxacin (Quixin)
3rd generation fluoroquinolone
Acetazolamide (Diamox)
Carbonic anhydrase inhibitor
Oral
- Tx of acute angle attacks
- Side effects - metallic taste, tingling, metabolic acidosis - bone marrow suppression and aplastic anemia (fatal!!) - malaise, fatigue, weight loss, impotence, depression, diarrhea - myopic shift contraindicated - COPD - pregnancy - sulfa allergy
Ranibizumab (Lucentis)
Monoclonal antibody
targets VEGF - intravitreal injection
tx of ARMD
Pyridostigmine (Mestinon)
*Indirect cholinergic agonist* -
“rid” (treatment) of MG
Fluconazole (Diflucan)
Anti-fungal
inhibits ergosterol synthesis
ADR- hepatotoxicity
Methylphenidate (Ritalin)
dopamine agonist
tx- ADHD, narcolepsy, depression
- ADRs
- adrenergic agonist effects - mydriasis and dry eye (caution in narrow angle GL)
Pyrimethamine (Daraprim)
antibiotic (folate acid synthesis inhibitor)
- inhibits dihydrofolate reductase (converts hydrofolic acid–> tetrahydrofolic acid) second step of synthesis
- orally for ocular toxo
- ADRs - bone marrow suppression –> anemia, leukopenia, granulocytopenia
Fexofenadine (Allegra)
H1 blocker - second generation
Tx- allergic rhinitis and chronic urticaria
ADRs:
- less CNS/anticholinergic effects vs first generation
Miconazole (monostat-derm)
Anti-fungal
inhibits ergosterol synthesis
ADR- hepatotoxicity
Refresh Tears
ocular lubricant
Enalapril (Vasotec)
ACE ihbitior- HTN med
- prevents formation of angiotensin II and blocks metabolsim of bradykinins (= vasodilation)
- ADRs
- cough
Pegaptanib (Macugen)
Antieoplastic agent
inhibits VEG-F - intravitreal injection
tx of ARMD
Rimexolone (Vexol)
Steroid- potent
Ethambutol (Myambutol)
Tb drug
- inhibits synthesis of mycobacterial cell wall- inhibits arabinosyl transferase
- ADR- optic neurtitis (retrobulbar and bilateral)
Pilocarpine
*Direct Cholinergic agonist*
- 30% IOP reduction (increase outflow- corneal scleral)
- short half life
- uses
- s/p angle closure attack
- 1%- to differentiate 3rd CN palsy vs sphincter tear
- 0.125% dx of Adies pupil
- ADRs
- Brow ache, HAs, myopic shifts - Miosis - Cataracts - RD - Secondary angle closure GL
Bromocriptine (Parlodel)
dopamine agonist
tx- hyperprolacinemia
Olopatadine 0.1% (Patanol)
Mast cell stabilizer + antihistamine combo
Erythromycin
macrolide antibiotic (50S protein inhibitor)
- topical ung
- prophylaxis opthalmia neonatorum
Misoprostol (Cytotec)
Prostaglandin EI (synthetic)
- provention and treatment of NSAID induced stomach ulcers
ADRS- miscarriages and premature labor
Diclofenac sodium (Voltaren)
NSAID
corneal melting in generic form
Cyclopentolate
*Cholinergic antagonist*
Cycloplegic effects- fastest onset and shortest duration
standard cycloplegic agent
Hydroxychloroquine (Plaquenil)
Inhibits phospholipase A2 and causes build up of heme (similar to choloroquine)
uses:
- lupus, RA, malaria
ADRs
- whorl keratopathy
- Bull’s eye maculopathy
- >5mg/gk/day (or 400mg/ day )
- risk factors
- tx duration >5 years
- abnormal renal functions
- liver disease
- age > 60
- high body fat
- concomitant retinal disease
- 10-2 VF and OCT ( can also do multifocal ERG and fundus autofluorescence)
Mannitol (Osmitrol)
Osmotic diuretic
HTN med
- increases plasma osmolarity
- ADR
- contraindicated in pt with pulmondary edema, dehydration adn CHF
- DES
Piroxicam (Feldene)
NSAID- Reversible COX 1 and COX 2 inhibitor
Tx- scleritis and episcleritis
ADRS
- increase risk of bleeding complications in eye
- GI bleeding
- cardiovascular events (MI or stroke) (contraindicated in pts with coronary artery disease/ stroke)
Amphotericin B (Amphocin)
Anti-fungal
binds ergosterol and forms pores- leaking out contents = cell death
Tx - fungal keratitis (ung)
IV form- systemic and intraocular fungal infections
ADR- nephrotoxicity (IV form)
Cyclosporine (Neoral, Sandimmune, Restasis)
immunosuppressive agent
- inhibits release and production of interleukin 2 (responsible for T cell activiation)
- TX- topical- keratoconjunctivitis sicca
- ADRs
- opportunistic infections
- malignancies
- HTN
- kidney dysfunction
Ibuprofen (Advil, Motrin)
NSAID- Reversible COX 1 and COX 2 inhibitor
Tx- scleritis and episcleritis
ADRS
- increase risk of bleeding complications in eye
- GI bleeding
- cardiovascular events (MI or stroke) (contraindicated in pts with coronary artery disease/ stroke)
Tramadol (Ultram)
Non-opiate analesic
- agonist at Mu optiate receptors and inhibits serotonin and norE uptake
- ADRs
- dry mouth
- sedation
- dizziness
- nausea
Chlorpheniramine (Chlor-Trimeton)
H1 blocker (first generation)
Anti- cholinergic
Tx- allergic skin reactions
ADRS
- sedation
- anticholinergic effects (mydrasis, dry eye, dry mouth, tachycardia)
Scopolamine
*Cholinergic antagonist*
CNS toxicity!
Bactrim
Sulfamethoxazole + trimethoprim
Oseltamivir (Tamiflu)
Anti-viral inhibits influenza A and B viral neuroaminidase
Dipyridamole (Persantine)
Anticoagulant
- inhibits adenosine deaminase and phosphodiesterase = accumulation of cAMP and adensosine= inhibit platelet aggregation
- ADRS
- increased risk of bleeding
Sodium Chloride (Muro 128)
Hyperosmostic agent
reduces corneal edema
Zafirlukast (Accolate)
miscullaneous respiratory agent
leukotriene receptor antagonist
tx- asthma, bronchoconstriction
Chloramphenicol (chloroptic)
50S protein synthesis inhibitor
gram + and -
ADR
- fatal aplastic anemia
- optic neuritis
Venlafaxine (Effexor)
Anti-depressant- selective NorE reuptake inhibitor
- inhibits serotonin and NorE reuptake
- Tx- depression, anxiety, panic disorder
- ADRs
- mydraiassis (caution in narrow angle pt)
- serotonin syndrome
Combigan
Timolol 0.5% + Brimonidine 0.2%
Flurbiprofen (Ocufen)
NSAID
contains thimerosal
Amantadine (Symmetrel)
dopamine agonist
tx- Parkinson’s disease
Bacitracin
cell wall synthesis inhibitor antibiotic
inhibits transfer of peptidoglycans into cell wall - Gram +
tx:
- blepharitis
Lacrilube
ocular ointment
Nedocromil (Alocril)
Mast cell stabilizer
Diltiazem (Cardizem)
Calcium channel blocker
HTN med
blocks L type Ca channels
decrease peripheral vascular resistance
ADR
- have direct cardiac effects
- negative chronotropism (decrease HR)
- ionotropism (decrease contractility)
contraindicated in GL pts taking timolol (b/c greater risk of bradycardia and heart failure)
Epinastine (Elestat)
Mast cell stabilizer + antihistamine combo
Metronidazole (MetroGel)
Derm med
- topical agent for acne rosacea
- disrupts DNA and inhibits nucleic acid synthesis
- anti-inflammatory properties
- ADRs
- irritation of skin and eyes possible
Zidovudine (Retrovir) (AZT)
Antiviral HIV
- tx nucleosdie analog of thymidine inhibitor of reverse transcriptase
- ADRs - bone marrow suppression - lactic acidosis - muscle breakdown
Lovastatin (Mevacor)
Antihyperlipidemic agent
HMG CoA reducases inhibitor (used in synthesis of cholesterol)
- lower LDL and triglycerides
- increases HDL
- first line tx for high cholesterol
- ADRs
- hepatotoxicity
- myopathy
- contraindicated in pregnancy
Metipranolol (Optipranolol)
*Adrenergic antagonist*- non- selective beta blocker
Fluticasone (Flonase)
Systemic Steroid
= intranasal (topical) steroid
tx- allergic rhinitis
ADRS
- cataracts
- increased IOP
- conjunctivitis
- DES
Ciprofloxacin (Ciloxan, Cipro)
2nd generation fluoroquinolone
Tobramycin (Tobrex)
aminoglycoside antibiotic (30S protein inhibitor)
Sucralfate (Carafate)
Gastic lining protector
ADRs- interfere with absorption of oral meds
Acetylcysteine (Mucomyst)
miscullaneous respiratory agent
breaks disulfide bonds in proteins of mucus
topic opthalmic form
- filamentary keratitis
- DES
- corneal burns
Triamterene (Dyrenium)
Potassium- sparing diuretic
directly blocks epithelial sodium channels- blocks action of aldosterone in late DCT and collecting ducts= increases excretion of sodium and water and decreases secretion of K+
(does not have antiandrogen effects vs spironolactone)
ADRs
- hyperkalemia
- DES
Sulfisoxazole (Gantrisin)
sulfonamide antibiotic (inhibits folic acid synthesis)
Proparacaine (Opthaine)
topical local anesthetic (ester)
Dorzolamide (Trusopt) -
Carbonic anhydrase inhibitor
topical - tx GL - sulfa based - ADRs- stings and metallic taste
Lindane (Kwell)
Anti-parasitic drug
lipophilic structure absorbed through insect exoskeleton- leading to seizures and death
tx lice and scabies
ADRs- can cause conjunctivitis
Dextroamphetamine (Dexedrine)
dopamine agonist
- tx- ADHD, narcolepsy, depression
- ADRs
- adrenergic agonist effects - mydriasis and dry eye (caution in narrow angle GL)
Restasis (Cyclosporine)
T cell inhibitor (suppresses inflammation)
stops production of interleukin-2
Tx of DES
Methotrexate (Rheumatrex)
immunosuppressant
- inhibits dihydrofolate reductase
- TX- rheumatoid arthritis
- ADRs
- hepatotoxicity
- myelosuppresion
- increased risk of opportunistic infections
Azelastine (Optivar)
Mast cell stabilizer + antihistamine combo
Tobradex
tobramycin + dexamethasone
- Rx inflammatory ocular condition with associated bacterial infection
- eg. staph marginal keratitis, corneal infiltrates
Hydralazine (Apresoline)
HTN med
- increases cGMP = smooth muscle relaxation
- ADRS
- compensatory tachycardia
- fluid retention
- lupus like syndrome
- conjuctivitis and increased lacrimation
Betaxolol (Betoptic-S)
*Adrenergic antagonist*- Beta 1 specific blocker -
- Neuroprotective
Glipizide (Glucotrol)
Sulfonylureas (oral DM medication)
- increases secretion of insulin
- ADRS
- hypoglycemia
- sulfa allergy
- with beta blockers incease risk of hypoglycemia
Glyburide (Diabeta, Micronase)
Sulfonylureas (oral DM medication)
- increases secretion of insulin
- ADRS
- hypoglycemia
- sulfa allergy
- with beta blockers incease risk of hypoglycemia
Terbutaline (Brethine)
Beta 2 agonist
short acting
tx- rescue inhaler for asthma and COPD
GL warning (b/c increased IOP)
Foscarnet (Foscavir)
Anti-viral
IV solution
CMV retinitis (when ganciclovir fails or HSV resistant infections in AIDS pts
ADR - nephrotoxicity and seizures
Pseudoephedrine (Sudafed)
non specific alpha and beta agonist
Tx- cold medication
ADRS
- increaased SNS (tachycardia, bronchodilation, nervousness/ agitation)
- diplopia, blurred vision
- increased IOP
Moxifloxacin (Vigamox, Avelox)
4nd generation fluoroquinolone
Tetrahydrozoline (Visine)
Adrenergic (alpha) agonist
ocular decongestant
Pioglitazone (Actos)
Thiazolidinedione (oral DM medication)
- activate peroxisome proliferator- activated receptor gamma to increase glucose uptake in muscles and fatty tissue
- used to combat insulin resistance
- ADRS
- new or worsening macular edema
- peripheral tissue edema
- heart failure
- hypoglycemia
Echothiophate (Phospholine)
*Indirect Cholinergic Agonist*
Dx or treatment of accommodative Esotropia (rarely for GL)
IRREVERSIBLE AchE agent
Benoxinate
topical local anesthetic (ester)
Sulfamethoxazole (Gantanol)
sulfonamide antibiotic (inhibits folic acid synthesis)
Vardenafil (Levitra)
ED med
- PDE-5 inhibitor (increasing blood flow and prolong effects of cGMP)
- Systemic ADRs
- flushing, HAs, sustained erection
-
ocular ADRS
- color changes (cyanopsia- blue tint)
- blurred vision
- photosensitivity
Prazosin (Minipress)
Alpha 1 antagonist
(prevent vasocontriction)
tx- BPH, HTN
ADRs- floppy iris sydrome
Benazepril (Lotensin)
ACE ihbitior- HTN med
- prevents formation of angiotensin II and blocks metabolsim of bradykinins (= vasodilation)
- ADRs
- cough
Naloxone (Narcan)
Opioid antagonist
reverse effects of opiates
Difluprednate (Durezol)
Potent steroid
highest potential for steroid response
Labetolol (Trandate)
Beta blocker - non selective
HTN med
ADRS:
- CNS- disorientation, depression, fatigue
- Cardio - bradycardia, arrhythmias, syncope
- Pulmonary- dyspnea, wheezing, bronchospasm
- GI- nausea, vomitting, diarrhea, ab pain
- Reproductive- ED
Timolol (Timoptic)
*Adrenergic antagonist* non-selective beta blocker -
Tx GL
- decrease AQ production
- 25% IOP reduction
- dose in morning
- long term drift (IOP gradually rises) and short-term escape (IOP initially lowers but then returns to normal after weeks of starting tx)
- use with caution - DM (masks hypoglycemia) - hypertyroidism (masks sx) - MG (exacerbates sx of weakness)
Tropicamide
*Cholinergic antagonist*
- Mydriatic effect- fast onset and shortest duration
- safe drug
Diphenhydramine (Benadryl)
H1 blocker (first generation)
Anti- cholinergic
Tx- allergic skin reactions
ADRS
- sedation
- anticholinergic effects (mydrasis, dry eye, dry mouth, tachycardia)
Ganciclovir ophthalmic gel (Zirgan)
Antiviral
HSV keratitis and CMV retinitis (intraocular capsule)
inhibits DNA polymerase
dose 5x/day
ADRs - blurred vision and ocular irritation (reduced corneal toxicity vs Viroptic) - possible RD and vitreous hemorrhage
Ipratropium (Atrovent)
Anti-cholinergic
- muscarinic block= bronchodilation
caution in narrow angle GL (causes pupil dilation and anterior shift of iris)
Omeprazole (Prilosec)
Proton pump imhibitor
Tx- GERD
Emadastine (Emadine )
H1 Antihistamine
Tx of allergic conjunctivitis
Esomeprazole (Nexium)
Proton pump imhibitor
Tx- GERD
Tetracyclines (drugs and main facts)
tetracycline, doxycline, minocycline
- bind to 30S subunit
- inhibit protein synthesis
- doxy- meibomainitis and acne, chlamydial ocular infections and after RCE
- mino- acne vulgaris
- do not take with food (dairy, antacids and iron chealating componds) EXCEPT doxy (can take w/ food)
- excreted through kidneys (except doxy- though fecal matter)
- ADRs
- contraindicated in pregnancy and children
- pseduotumor cerebri
- bone growth retardation
- teeth discoloration
- minocycline– blue sclera, pigmented cysts on conj
Protein synthesis inhibitors antibiotics (names)
30S inhibitors
- aminoglycosides (gentamicin, tobramycin)
- tetracyclines (tetracycline, doxycycline, minocycline)
50S inhibitors
- chloramphenicol
- macrolides (erythromycin, azithromycin, clarithromycin)
- lincomycin
- clindamycin
Griseofulvin (Grifulvin)
Anti-fungal
inhibits fungal mitosis- interferes with microtubule formation
tx -scalp and skin infections
Naproxen sodium (Aleve)
NSAID- Reversible COX 1 and COX 2 inhibitor
Tx- scleritis and episcleritis
ADRS
- increase risk of bleeding complications in eye
- GI bleeding
- cardiovascular events (MI or stroke) (contraindicated in pts with coronary artery disease/ stroke)
Bacteriostatic antibiotics
tetracyclines
trimethoprim
sodium sulfacetamide
erythromycin
Bromocriptine (Parlodel)
Antiparkinsonian med
- dopamine agonist
- tx- prolactin secreting pituitary adenoma or parkinsons
Celluvisc
ocular ointment
Fluoxetine (Prozac)
Anti-depressant- selective serotonin reuptake inhibitor
- ADRs
- mydraiassis (caution in narrow angle pt)
- serotonin syndrome
Ribavirin (Copegus or Rebetol)
Antiviral
Hep C tx
- inhibits viral RNA polymerase
- ADRS - conjunctivitis
- (RIBAViriN:)
- Retinal detachment
- Ischemia (cotton wool spots)
- Bleeding (retinal hemorrhages)
- Arterial and venous occlusions
- Optic neuritis
- (RIBAViriN:)
Sulfadiazine (Microsulfan)
sulfonamide antibiotic (inhibits folic acid synthesis)
Lisinopril (Prinivil, Zestril)
ACE ihbitior- HTN med
- prevents formation of angiotensin II and blocks metabolsim of bradykinins (= vasodilation)
- ADRs
- cough
Atenolol (Tenormin)
Beta blocker - beta 1 specific
HTN med
ADRS:
- CNS- disorientation, depression, fatigue
- Cardio - bradycardia, arrhythmias, syncope
- Pulmonary- dyspnea, wheezing, bronchospasm
- GI- nausea, vomitting, diarrhea, ab pain
- Reproductive- ED
Verapamil (Calan, Isoptin)
Calcium channel blocker
HTN med
- blocks L type Ca channels
- decrease peripheral vascular resistance
ADR
- have direct cardiac effects
- negative chronotropism (decrease HR)
- ionotropism (decrease contractility)
contraindicated in GL pts taking timolol (b/c greater risk of bradycardia and heart failure)
Clonidine (Catapres)
CNS alpha 2 agonist
HTN med
- decreases sympathetic outflow–> decreased vascular resistance and decreased heart rate
- ADRs
- dry mouth
- sedation
- impotence
- severe rebound HTN
Parent compound of apraclonidine (cand decrease IOP)
Meperidine (Demerol)
Opiate analgesic
- agonist at Mu, Kappa and Delta opiate receptors
- potent analgesics
- addictive
- ADRs
- miosis
- resp depression
- drowsiness
- sedation
- nausea
build up of normeperidine - causes seizures, increased ICP and papilledema