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Summer Pharmacology 2 > Ocular Lecture 1 > Flashcards

Ocular Lecture 1 Flashcards

1
Q

ocular drugs that inhibit nucleic acid or protein synthesis

A

antivirals

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2
Q

Ocular viral infections more common in elderly

A

HSV

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3
Q

Ocular viral infections more common in immunocompromised

A

CMV

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4
Q

purine nucleoside analog 3% ointment intervenes with DNA synthesis, discontinued from market, treats HSV 1/2 and VZV

A

Vidarabine

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5
Q

topical thymidine analog that inhibits DNA synthesis DOC for HSV Keratitis, Corneas with lesions only, used with lubricant due to severe dry eye SE

A

Trifluridine

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6
Q

Topical antiviral, DNA synthesis inhibitor, Gel, herpetic keratitis, off label use for EKC, SE Blurred Vision (b/c gel)

A

Gancyclovir

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7
Q

Antiviral 200 and 400 mg for HSV1/2 and 800mg for VZV. Prophylactic treatment in patients with history of HSV Stromal Disease and treat HZO, start tx within 72 hours of symptoms,after that, tx is not effective SE: Diarrhea, maculopapular rash, CI in elderly, immunocompromised with renal disease

A

Acyclovir

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8
Q

Oral Antiviral, , hydrolyzed by esterase liver and GI tract for improved bioavailability, used for HSV keratitis and HZO

A

Valacyclovir

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9
Q

DNA synthesis and replication inhibitor, Bioavilability of 65-77%, used to Decrease Twofold Duration of Post-Herpetic Neuralgia (pain) SE: MIGRAINES, Parathesia

A

Famciclovir

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10
Q

Antiviral injection, acyclic nucleoside analog, used for CMV retinitis in HIV patients (severe manifestations)

A

Cidofovir

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11
Q

IV antiviral that inhibits DNA and RNA polymerase, for CMV retinitis in immunocompromised patients, SE: retinal toxicity, azotemia, Anemia, CNS, GI

A

Foscarnet

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12
Q

Fungal infection common in CLS patients

A

Aspergillus Umigatus

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13
Q

4 Fungal ocular infections

A

Candida albicans, Aspergillus, Fusarium, Curvularia

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14
Q

Predisposing factors for ocular fungal infections

A

CLS, Vegetative Trauma, Immunocompromised

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15
Q

Limited treatment, requires laboratory evidence from spears, scrapping and cultures

A

Fungal Treatment

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16
Q

Limitations of Fungal treatment

A

SE’s, Narrow spectrum, Poor penetration, Fungal resistance

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17
Q

Type of antifungal that inhibits ergosterol synthesis

A

Azoles- Ketoconazole, Miconazole, Fluconazole, Voriconazole

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18
Q

Type of antifungal that binds to ergosterol to interrupt it, binds less to human cells, less toxic

A

Polyene- Ampho B, Natamycin

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19
Q

Polyene antifungal used to treat candida and histoplasmosis ulcers, orbital infections, and endophthalmitis, has good corneal penetration, SE tissue necrosis, yellow cornea (toxicity), monitor kidney function

A

Amphotericin B

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20
Q

TOPICAL antifungal polyene, very aggressive tx, DOC for Anterior segment infections (keratitis/blepharitis/conjunctivitis), uses dropper that CANNOT touch cornea, well tolerated, SE allergic rxn, corneal opacity

A

Natamycin

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21
Q

Oral antifungal azole, topical and oral, second line for corneal ulcurs after natamycin. Less toxic than ampho b, effective against candida albicans and aspergillums, careful with antacids SE papilledema, cross rxn with other meds

A

Ketaconazole

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22
Q

Azole anti fungal suspension/ sonconj. depot/ oral, effective against aspergillus and fusarium, used clinicaly to treat corneal ulcers and endophthalmitis, Third Line after natamycin and ketaconazole

A

Miconazole

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23
Q

Azole anti fungal, 90% bioavailability, DOC for Fungal Keratitis, fights against candida and cryptococcus, , SE drug interactions, resistance in HIV, potent teratogenic

A

Fluconazole

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24
Q

2nd gen broad spectrum azole antifungal, first line against Keratitis by Aspergillus. SE blurred vision PHOTOPHOBIA, altered perception, CI in many systemic medications

A

Voriconazole

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25
Q

Anti protazoal, Folic acid antagonist -requires supplement- combo with sulfonamide, treats Toxoplasmosis, SE folate deficiency, carcinogenic, skin rash- stop immediately, anorexia, CI in renal and hepatic disease, pregnant, children

A

Pyrimethamine

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26
Q

Antihelminthic drug, 200 mcg per kg body weight, that targets GABA receptors, treats onchovcerca volvulus, used clinically to treat River Blindness, SE anorexia, constipation, dizzy, peripheral and facial edema

A

Ivermectin

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27
Q

Anti inflammatory drugs that targets phospholipase A2 to prevent prostaglandin formation, will reduce immune system with long term use

A

Steroids

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28
Q

Anti inflammatory drugs that target cyclo-oxygenase to prevent prostaglandin formation

A

NSAIDs

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29
Q

Form of Corticosteroids with best penetration

A

Acetate

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30
Q

Which type of treatment of corticosteroids crosses the BBB and can cause ovular hypertension and psuedoendopthalmitis?

A

Intravitreal

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31
Q

Category of treatment that causes adrenal insufficiency, CUSHINGS syndrome, peptic ulcers, osteoporosis, hypertension, muscle weakness or atrophy, stunted growth, DIABETES (causes hyperglycemia), mood changes, delayed wound healing

A

Corticosteroids

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32
Q

Prednisolone, fluorometholone, dexamethasone, rimexolone, diflruoprednisolone- type of corticosteroids

A

Ketones - corticosteroids

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33
Q

Loteprednol- type of corticosteroid

A

Ester - corticosteroids- less SE

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34
Q
  1. Ocular anti inflammatory, oral cortisol analog, acetate, often combined with sulfacetamide antibiotic, more frequent tx = more effective, but more likely SE’s
A

Prednisolone

35
Q
  1. Stronger than prednisolone, cortisol analog, usually in combo with tobramycin, neomycin, or as implant 0.7%,
A

Dexamethasone

36
Q
  1. progesterone analog, Not as strong but comparable anti inflammatory to prednisolone but is good at reducing inflammation
A

Fluoremetholone

37
Q

Ester corticosteroid “soft drug”, 0.2% for allergic conjunctivitis and 0.5% for general inflammation, combo with tobramycin, little to no IOP elevation

A

Loteprednol

38
Q

Similar to Loteprednol, but only used for reducing inflammation after cataract sx, no effect on IOP

A

Rimexolone

39
Q

Newest corticosteroid derived from prednisolone that effects IOPS after 10 days, also used for inflammation after surgery AND Anterior Uveitis, only needed 2x per day.

A

Difluprednate

40
Q

SE of Corticosteroids- most common, seen in both eyes, more common with oral tx, common in SLE and RA pts due to extended use, 80% occurrence in doses above 15mg

A

Cataracts- posterior subcapsular

41
Q

SE of Corticosteroids- due to ouflow resistance, mostly prednisolone or dexamethasone 2 to 8 weeks after therapy, History is important: POAG, fam hx, age, myopia 5D or more, Krukenberg’s spindles

A

Ocular hypertension or Glaucoma, AVG 4.6 - 6.6 mmHG increase

42
Q

SE of Corticosteroids- reason to avoid use in bacterial infections with no scarring, not used alone in active infection, usually in combo also

A

Increased susceptibility to infections

43
Q

SE of Corticosteroids- more common in black patients with discontinuation of prolonged therapy

A

Corticosteroid Uveitis

44
Q

SE of Corticosteroids- Involving Pupil size and Eyelids

A

mydriasis and ptosis

45
Q

CAUTION for what category of drugs? DM, infection, renal failure, CHF, HTN, potentiates Barbiturates and reduces anticoagulants

A

CAUTION with Corticosteroids

46
Q

CONTRAINDICATIONS for what category of drugs? Peptic ulcer, osteoporosis, psychosis, GLAUCOMA

A

Contraindications with Corticosteroids

47
Q

Drug category used for mild to moderate inflammation, but mostly for PAIN, do NOT increase IOP and are not toxic, better tolerance, mostly used to reduce pain after surgery

A

NSAIDs

48
Q

Drug for pain reduction after REFRACTIVE surgery, off label post op CME, seasonal allergic conjunctivitis, and inflamed pterygium, 0.4% solution, used with phenylephrine for post cataract sx

A

Keterolac

49
Q

First opthalmic NSAID in US, clinical DILATION after cataract surgery

A

Flurbifrofen

50
Q

Pos op PAIN MANAGEMENT in post op cataract surgery, refractive surgery, and strabismus, also filamentary keratitis

A

Diclofenac sodium

51
Q

NSAID with LESS side effects than most NSAIDs, used for post op INFLAMMATION and pain reduction after cataract surgery

A

Bromfenac

52
Q

SUSPENSION for Post op inflammation and pain reduction after cataract surgery

A

Nepafenac

53
Q

are NSAID’s used for corneal abrasions, allergic conjunctiitis- mild, FB removal, adapting hard contact lens, adapting punctal plugs?

A

Other “beneficial” uses for NSAIDs, but not necessary or best

54
Q

NSAID with SE of delayed wound healing

A

Ketorolac

55
Q

NSAID with SE of corneal melting

A

Diclofenac

56
Q

NSAIDs are CI in patients hypersensitive to this drug

A

Aspirin

57
Q

Anti inflammatory Immunomodulator- inhibits T-cell activation, used to treat KERATOCONJUNCTIVITIS SICCA (severe DES), refractivs surgery DES, Behcet’s disease, Uveitis, contra in children/pregnant, NO IMMEDIATE RELIEF so need paired with something else, expensive so use as last resort

A

Cyclosporin A

58
Q

Immediate or anaphylactic hypersensitivity, takes 15 to 30 min, mediated by IgE, lots and lots of Itching,

A

Type 1 Hypersensitivity

59
Q

Delayed hypersensitivity, involves T lymphocytes and granular monocytes or macrophages: CKC, GPC, contact dermatitis

A

Type 4 Hypersensitivity

60
Q

Clinical Use and Time Constraint for Decongestants

A

Histamine induced erythema, used no more than 48 to 72 hours after symptoms

61
Q

Decongestants are CI in what kind of patients?

A

Narrow angle, risk of angle closure

62
Q

First gen Anti Histamines, OTC and combo with decongestants

A

Pheniramine maleate and Antazoline phosphate

63
Q

OTC Anti allergic TRIPLE ACTION drug, for allergic conjunctivitis, mild CKC and GPC

A

Ketotifen fumarate

64
Q

Anti allergic drug, treats seasonal allergic conjunctivitis, mild VKC and GPC, same as ketotifen

A

Olapatadine HCL

65
Q

Dual Action H1 inhibitor and Mast Cell stabilizer, aproved for allergic conjunctivitis, >2 years old

A

Bepotastine

66
Q

Dual action anti allergic for ITCHING PREVENTION in allergic conjunctivitis

A

Epinastine HCL

67
Q

Dual action anti allergic for allergic conjunctivitis, like bepotastine, epinastine, and olapatidine SE: HEADACHES

A

Emedastine Difumarate

68
Q

anti allergic TRIPLE ACTION with RAPID ONSET used for allergic conjunctivitis

A

Azelastine HCL

69
Q

PEDIATRIC anti allergic triple action for allergic conjunctivitis, Bepotastine also works for children over 2

A

Alcaftadine

70
Q

Which causes burning stinging, first or second gen antihistamines? Which can occlude the angle?

A

FIRST, also FIRST

71
Q

First Gen antihistamines- cross BBB, sedation

A

brompheniramine, chlorphenirmine, clemastine, diphenhydraine, promethazine

72
Q

Second Gen antihistamines- selective for H1

A

loratadine, desloratadine,

73
Q

drug category used to treat moderate to severe lid edema and chemosis, subconjunctival and nasal itching, watery and red eyes.

A

Oral Antihistamines

74
Q

2 mast cell stabilizers approved for VKC

A

Cromolyn sodium and lodoxamide

75
Q

Pemirolast, nedocroil, lodoxamide, cromalyn sodium

A

Mast cell stabilizers

76
Q

mast cell stabilizers are used instead of antihistamines when?

A

prophylactic tx, for prevention of allergic reaction

77
Q

Corticosteroid used for allergic reactions

A

loteprednol etabonate

78
Q

NSAID used for chemosis in allergic reaction

A

Keterolac tromethamine

79
Q

3 main pain mediator substances

A

PG- from damaged tissue
Bradykinins- enter damaged tissue from circulation
Substance P- from highly myelinated nerve endings

80
Q

Non-opioid analgesic used for mild to moderate ocular pain

A

Aspirin

81
Q

Most commonly prescribed analgesic, used when aspirin and NSAIDS are CI, caution in chronic alcoholism

A

Acetaminophen

82
Q

Side Effect of Decongestants-Pupils

A

Pupil Dilation then Rebound Miosis

83
Q

Antihistamines that cause Verticillate-type Keratopathy (2)

A

Naphazoline and Antazoline

Summer Pharmacology 2 (11 decks)

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