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SUNY Therapeutics ZA > Ocular infection & inflammation pharmacology > Flashcards

Ocular infection & inflammation pharmacology Flashcards

1
Q

Infection considerations

A
  • barriers (skin & mucous membranes)
  • Immune status
  • organisms (bacteria, virus, fungi)
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2
Q

Gram positive Cocci

A
  • staph aureus
  • staph epidermidis
  • strep pneumonia
  • strep pyogenes
  • strep faecalis
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3
Q

Gram negative Rods

A
  • Haem Influenzae
  • Pseudomonas aeruginosa
  • Serratia Marcescens
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4
Q

Gram negative Cocci

A
  • Neisseria gonorrhoeae
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5
Q

Bacteria def

A
  • single celled

- subdivided by shape and gram stain

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6
Q

Gram Stain

A
  • pos = violet = thick peptidoglycan layer in cell wall

- neg = red = thinner petidoglycan layer

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7
Q

unique structural bacteria

A
  • Rickettsia (gram - found in ticks, fleas & mammals)(zoonotic)
  • Chlamydia (mimic virus)
  • Treponema palladium (syphilis - the masqarader)
  • Mycobaterium tuberculosos
  • Actinomyces (anaerobic - resemble fungal hyphae)
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8
Q

Bact uniqueness

A
  • Peptidoglycan Cell wall (penicillin vulnerability)

- Ribosome cell membrane

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9
Q

Bactericidal

A
  • destroys cell wall - peptidoglycan - Penicillin
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10
Q

Bacteriostatic

A
  • inhibit cell growth - Tetracycline
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11
Q

Selective toxicity

Bact vs human

A
  • Bact has cell walls - antibacterial inhibits synthesis of cell wall
  • Cell membranes are similar
  • Ribosomes - diff size and composition
    • inhibit bact protein synthesis
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12
Q

Selective toxicity

Drugs

A
  • biosynthetic pathways (intermediary metabolism)(Folic acid - bact produce/synthesize)
  • Enzyme DNA gyrasee (prevents supercoiling of DNA during replication & transcription)
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13
Q

Mechanisms of Resistance

A
  • Bact produces enzymes that degrade/inactivate antibiotics
  • pump mechanisms (pump out) or decrease permeability of antibiotics
  • resistance genes
  • alteration for bact ribosomes
  • chromosomal mutation
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14
Q

Cross resistance

A
  • Misuse/overuse/non-compliance - SYSTEMIC mostly
  • excess from animal feed
  • leads to resistance to similar groups of antibiotics
  • penicillin vs cephalosporins (similar drug structure)
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15
Q

Indications for oral antibiotics

A
  • Meibomianitis
  • Internal Hordeolum
  • Ocular Rosacea
  • Dacryocystitis
  • Preseptal Cellulitis
  • Chlamydial Conj
  • Prophylaxis (fractures, sinusitis)
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16
Q

Topical Anti-biotics Use

A
  • Ant Segment infection
  • Conjunctivitis
  • Corneal Ulcer
  • Blepharitis
  • Prophylaxis
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17
Q

Drug considerations

A
  • selective toxicity
  • spectrum of activity (narrow vs broad)
  • resistance
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18
Q

Guideline for effective therapy

A
  • accurate dx
  • microorganism sensitivity to anti-infective
  • least toxic drug
  • adequate drug level
  • optimum route of admin
  • appropriate dosage
  • appropriate tx time
  • augment with physical procedures
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19
Q

Antimicrobial Failure - why?

A
  • inaccurate Dx
  • resistance (drug)
  • inadequate dosage
  • noncompliance
  • inadequate suppl physical procedures
  • inadequate immune system response
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20
Q

Drugs affecting Cell Wall

A
  • Penicillins
  • Cephalosporin
  • Vancomycin
  • Bacitracin (ung)
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21
Q

Vancomycin

A

-think = last line for MERSA

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22
Q

Chloramphenicol

A
  • think = aplastic anemia
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23
Q

Penicillins

A
  • Augmentin (Amoxicillin + clavulanate)

- Dicloxacillin

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24
Q

Cephalosporins

A
  • Cephalexin (Keflex)

- Cefaclor (Ceclor)

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25
B-Lactam antibiotics
- Penicillins & Cephalosporins - B-lactam ring (similarity) - resistant bact produces enzyme to disrupt B-lactam ring
26
Penicillins use | systemic
- Hordeolum - Preseptal cellulitis - Dacryocystitis - Dacryoadenitis
27
Penicillin adverse reaction
- Hypersensitivity response (type 1 - 4) (2%) - GI irritation (nausea, vomit, diarrhea) - diarrhea is common - kills normal flora - Superinfection (Tx but gets worse)
28
Penicillin vs Cephalosporin
- if Penicillin hypersensitive less than 2% cross-react to cephalosporin - less likely in 3rd + 4th gen Cepalos
29
``` clavulanate mechanism (Augmentin) ```
- B-Lactamase inhibitor - protects penicillin from penicillanse - weak anti-microbial activity
30
Cephalosporins
- B-lactam ring (similar to Penicillin) - addition of acyl side chains (1-4 gen) - Broad spectrum - Bactericidal - Resistance (B-lactamase)
31
Cephalosporin Use
- same as Penicillins | - other (ophthalmically fortified use)
32
Bacitracin
- Gram + - Bactericidal - Ointment (unstable in sol) - Combo = Polycin (Bacitracin + Polymyxin B)(for Gram - ) - Blepharitis - Dose - QD > TID
33
Vancomycin | cell wall destroyer
- highly active for gram + - Bactericidal - Dosage - Sol-inject, capsule, powder for fort - Highly toxic - anaphylaxis, vasculitis, nephrotoxic, ototoxic (delayed), neutropenia, more
34
Vancomycin use
- Bact endopthalmitis - Methicilin/Penicillin resistant infections - Bact Keratitis - vision threat - Ruptured globe - Orbital cellulites
35
Cytoplasmic Membrane affectors
- Polymyxin B - Gramicidin - disrupts cell membrane permeability
36
Polymyxin B
- disrupts cell osmotic integrity - bactericidal - Gram - (pseudomonas) - use - conj & lid infects -
37
Polymyxin B combos
- Polymyxin B/Neomycin/Gramcidin (generic) -Polymyxin B/Trimethoprim (Polytrim) - Polymyxin B/Bacitracin (Polycin) - Polymyxin B/Bacitracin/Neomycin (Neo-Polycin) with Steroids: Polymyxin B/bacitracin/neomycin/hydrocortison (generic)
38
Gramicidin
- Bactericidal (with static act) - Gram + - Combo = Neosporin Polymyxin B/Neomycin/Gramicidin
39
AntiBact affecting Protein Synthesis
- Aminoglycosides - Macrolides - Tetracyclines - Chloramphenicol - Clindamycin
40
Aminoglycosides | Ocular - mostly topical
- Neomycin - Gentamicin - Tobramycin - Amikacin - inhibit bact protein synthesis by binding to ribosome (30s subunit) - bactericidal - gram + & -
41
Macrolides
- Erythromycin - Azithromycin (chlamydia*) - Clarithromycin
42
Tetracyclines
- Tetracycline - Doxycycline - Minocycline
43
Neomycin
- Broadspectrum gram +& - - ineffective against P.aeruginosa - Combo's - ADR = contact dermatitis
44
Gentamicin
- broad spect - better with P.Aeruginosa - not effective Streptococcus - Use - Ant seg infections - ADR - cornea & conj tox & allergy (less than neomycin) - Dose - sol/ung - q4h
45
Tobramycin (best choice)
- broad spec c Pseudomonas - similar to Gentamicin except: * sensitive to gentamicin resistant pseudomonas strains * more potent with P. aeruginosa - Use - ant seg inf - Combo with dexamethasone (Tobradex)(HSV worse!) - ADR's - less than other Aminoglycosides
46
Tetracyclines | also anti-inflam effects!
- Block protein synthesis & bacteriostatic - Broad spec +&- & chlamydia - S.aureus resistance - short, intermediate, long acting - topical = Trachoma
47
Tetracycline Oral use
- Chlamydia (inclusion conj + trachoma) - Acne rosacea, Meibomianitis - Nontuberculous phlyctenular keratoconjunctivitis - noninfected corneal ulcers (relates to anticollagenolytic action or oral tetra)
48
lateral canthus bubbles (sign)
- sign of free fatty acids - bact in sebum - bact releasing lipases increase free fatty acids - irritation & inflammation - Meibomianitis!
49
Tetracycline Topical use
- gonococcal ophthalmia neonatum (prophylaxis) | - trachoma
50
Tetracycline (class) considerations
- absorption affected by: * food (not doxy) * iron containing tonics * antacids containing Ca, Mg or Alu * Sodium Bicarbonate - when use restrict: Antacids, iron, zinc, dairy, vit/mineral preps
51
Tetracyclines ADR's
- Hypersensitivity reactions - Anaphylaxis, urticaria, rash, periorbital edema - Photosensitivity/photo toxic - GI irritation (better with food but reduced absorption) - Epigastric distress (sore throat/ glossitis - tooth development (staining, caries, dysgensis & discolor)(under 8 yrs) - depress bone growth (attracted to embryonic & bone growing tissue) - pseudotumor cerebri !! watch teenagers!! - blood dyscrasias (watch blood thinners-coumadin) - vestibular toxicity (minocycline)(tinnitus, dizzy)
52
Tetracycline Contra
- pregnancy (CatD) - okay short term during breast feeding - no kids under 8 yrs
53
Tetracycline (generic) Uses
- Chlamydia - Acne Rosacea - Meibomianitis - Resistant sebaceous blepharitis * accumulate in Sebaceous Glands * resistance can be a problem
54
Doxycycline uses
- best choice for Chlamydia/acne rosacea - Meibomianitis - Ocular surface inflammatory disease
55
Tetracyline Ophthalmic
- not used in US | - replaced by erytrhomycin ophth ung
56
Doxycycline dosage
- 100mg BID (1-2 wks then taper), maintenance PRN (20-100mg daily or less) - Oracea (imm & sustained release) = 40mg QD am's empty tummy
57
Macrolides Pharmacology
- binds to 50S ribosomal subunit - inhibits protein synthesis - low toxicity - Bacteriostatic - spectrum can include: * gram - & + * streptococci * staphylococci * Chlamydia * Neiserria * H influenzae
58
Macrolides clinical use
- chlamydial infections | - sebaceous gland dysfunction
59
Erythromycin
- oral & topical - Cat B - safer for pregnant, nursing & kids under 8 - ung only - ADR's = mild - Uses: * lid infection * prophyl ophth neonatorum * Gonococcal conj * Chlamydial inf
60
Azithromycin (Zithromax) Oral - single dose 1000mg Extended half life > QD
- semisynthetic derivate of erythro - Cat B - ADR - skin rash/GI upset - Uses: * Chlamydia * gono conj * ocular rosacea
61
Azithromycin 1% Ophthalmic | AzaSite
- Durasite-vehicle - Growing resistance - useful for trachoma not chlamydia
62
anti-inflammatory efffect of anti-biotics
- anti-inflammatory effect helps control bacterial colonization and lid inflammation - Doxy treats MGD via antimicrobial, anti-inflamm and antimetalloproteinase prop - Azithro inhibits pro-inflamm cytokines - 5 day oral Azithro was better than doxy for MGD - better signs, shorter tx
63
Trachoma
``` Oral - Azithromycin drug of choice *children 20mg/kg single dose * adult 1g single dose - Erythormycin = Alt Tx * children 30-50mg/Kg/day Q6H x 7days * adult 250mg q6h x 2wks Doxy = Alt Tx 100mg BID x 3 wks ``` Topical Tetra or erythro ung BID-QID x 3-6wks Cochrane favours oral Azithro to topical Tetra
64
Chloramphenicol
- binds to 50s ribosomal subunit - Bacteriostatic (some bactericidal act) - broad spectrum (P.Aer resistant) - Chlamydia - Bacillus anthracis - anthrax (systemic) - systemic risk for APLASTIC ANEMIA (watch infants on topical) - not dose dependent - Avail topical, oral, IV or IM
65
Antibacterials Affecting Folic Acid
- Sulfonamides - Pyrimethamine - Trimethoprim
66
Sulfonamides
- Broad spectrum - also Chlamydia & Toxoplasma (great systemic) - Resistance: Staph & Pseudomonas - Mainly used orally - Topically too much resistance - Inactivated by PABA (local anesthetics - procaine, teracaine - esters of PABA - Inhibited by blood, pus - purulent exudates contain PABA - Bacteriostatic
67
Topical Sulfonamide - Sulfacetamide (Bleph10)
- sol or ung - broad spec - resistance++ not useful : (
68
Trimethoprim
- Use - surface ocular infection - typical combo with Polymixin B (Polytrim) - gram +&- (not pseudomonas) - approved for infants 2mths and older - ADR's mild - great for kids
69
Antibiotics affect DNA synthesis - Fluoroquinolones
- interferes with DNA synthesis during replication - inhibits DNA gyrase - inability to unwind DNA helix for replication - results in cell death and ability to replicate - resistance is forming
70
Fluoroquinolones Topical Uses
- conj - Keratitis - Corneal ulcer - pre/post Sx
71
Fluoroquinolones Systemic Uses
- UTI - GI - Respiratory & skin infections
72
Fluoroquinolones resistance
- reduced cellular accumulation - decrease passive transport into cell & Efflux pumps - Single step mutation - bact alter DNA gyrase - Ciprofloxacin - 10% resistant S. pneumo - increasing MRRSA
73
Fluoroquinolones family
- Norfloxacin - Ofloxacin - Ciprofloxacin - Levofloxacin - Gatifloxacin - Moxifloxacin - Besifloxacin (ocular only)
74
Fluoroquinolones systemic ADR's
``` Common - GI upset - CNS (HA & dizzy) Uncommon - tendon rupture - prolongation of QT interval - Arthroplasty - hepatitis - POSSIBLE RD's ```
75
2nd gen Fluoroquinolones
- Nor, Cipro, Oflox - better activity to common paths than: * Aminoglycosides * Chloramphenicol * Tetracycline * Erythromycin - coneal precipitates with Cipro - goes away with discont
76
3rd gen Fluoroquinolones
- maintained excellent gram- cover with improved gram+ cover - less resistance - ineffective if cipro/oflox resistance - levoflox 0.5% & 1.5% - superior to 2nd gen esp Streptococcus
77
4th gen Fluoroquinolones
- 2 mutations required for resistence - Gati 0.3%/0.5% - Moxi 0.5% - Besi 0.6%
78
Moxifloxacin 0.5%
- bact conj - no preservative - peds use (4mths +) - xanthum gum vehicle (better staying power) - Cat C - Dose 1 gtt BID x 7days
79
Gatifloxacin 0.5%
- bact conj | - Q2H day 1; BID - QID day 2-7
80
Besifloxacin 0.6%
- bact conj - SUSPENSION - DuraSite delivery system - broad spectrum - Cat C - 1yr old +
81
Considerations for Oral Antibiotics
- Probiotics add in - food = yoghurt, sauerkraut, kimchi - do not take with anti - after - caution px on chemo/compromised immune & proton inhibitors
82
Antibiotics and contraceptives
- possible but not proven - 13 fold risk - enzyme-inducing drugs - carbazapine, topiramate, rifampicin - 7 fold risk in antibiotics general

SUNY Therapeutics ZA (4 decks)

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