Ocular Pharm Flashcards
1
Q
Solubility for Tear Lipid Layer
A
lipid soluble
2
Q
Solubility for Tear Aqueous Layer
A
water soluble
3
Q
Solubility for Tear Mucous Layer
A
lipid and water soluble
4
Q
Solubility for Corneal Epithelium and Endothelium
A
lipid soluble (lipophilic/ hydrophobic)
5
Q
Solubility for Corneal Stroma
A
water soluble (hydrophilic/ lipophobic)
6
Q
Best drugs to penetrate cornea
A
small, uncharged, lipid soluble
weak bases
7
Q
Receptor on Iris Sphincter
A
M3
8
Q
Receptor on Ciliary Muscle
A
M2, M3
B2
9
Q
Receptor on Lacrimal Gland
A
M2, M3
10
Q
Receptor on Iris Dilator
A
a1
11
Q
Receptor on Trabecular Meshwork
A
B2
12
Q
Receptor on NPCE
A
B2, B1
13
Q
Receptor on CB vasculature
A
a2
14
Q
Pilocarpine MOA
A
cholinergic agonist
CM pulls on SS to open TM- increase outflow
15
Q
Pilocarpine SE
A
browache, headache myopic shift- lens moves forward
RD
miosis
angle closure glaucoma- pupillary block
16
Q
Pilocarpine Use
A
LPI
1% for 3rd nerve palsy (will constrict)
0.125% for Adie’s (will constrict)
17
Q
Edrophonium Use
A
Diagnose MG
aka Tensilon Test
18
Q
Edrophonium MOA
A
anticholinesterase inhibitor - indirect cholinergic agonist
19
Q
Neostigmine Use
A
MG treatment
20
Q
Neostigmine MOA
A
anticholinesterase inhibitor - indirect cholinergic agonist
21
Q
Echothiophate Use
A
diagnosis and treatment of accommodative esotropia and rarely glaucoma
22
Q
Echothiophate MOA
A
anticholinesterase inhibitor - indirect cholinergic agonist
23
Q
Pyridostigmine Use
A
MG treatment
24
Q
Pyridostigmine MOA
A
anticholinesterase inhibitor - indirect cholinergic agonist
25
Examples of Cholinergic Antagonists
```
Atropine
Scopolamine
Homatropine
Cyclopentolate
Tropicamide
(Also order of potency)
```
26
Scopolamine Use
patch for motion sickness
27
Scopolamine MOA
blocks Ach
28
Scopolamine SE
CNS toxicity- penetrates BBB
29
Cholinergic Agonist with fastest onset and shortest duration of mydriasis
Tropicamide
30
Max effect time of Tropicamide
25 min
31
Duration of Tropicamide
4-6 hours
32
SE of Tropicamide
SAFE AF
33
Tropicamide MOA
block Ach
34
Atropine MOA
blocks Ach
35
Atropine onset and duration
onset- 60-180 min
| duration- 7-12 days of cyclo
36
Atropine Use
amplyopia penalization
| uveitis
37
Atropine contraindications
no with Down's and elderly
38
Cholinergic Antagonist with fastest onset and shortest duration of cycloplegia
cyclopentolate
39
Time of Max Effect of Cyclopentolate
45 min
40
Cyclopentolate Use
cycloplegic refractions
| uveitis
41
Cyclopentolate MOA
blocks Ach
42
Homatropine Use
primary for anterior uveitis- keeps iris mobile
reduces pain by paralyzing ciliary and sphincter muscles
constricts iris and CB vasculature to seal BBB
43
Homatropine MOA
blocks Ach
44
Cholinergic Antagonist Toxicity
Symp effects
| hot as a hare, red as a beet, dry as a bone, mad as a hatter, blind as a bat
45
Botulina Toxin MOA
blocks release of Ach at neuromuscular junction- stops muscle contraction
46
Botulina Toxin Use
blepharospasm
| strabismus
47
Phenylephrine MOA
Adrenergic agonist- a1
48
Phenylephrine Use
dilation without cycloplegia- does not give fixed dilated pupil
gives 2.5mm lid lift from activating Muller's Muscle
differentiate scleritis from episcleritis
49
Dose of Phenylephrine to break posterior synechiae
10%
50
Dose of Phenylephrine for diagnosing Horner's Syndrome
1%
51
Contraindications for Phenylephrine
MOAI
TCAs
atropine
Grave's Disease
52
Phenylephrine SE
cardiovascular effects- hypertensive crisis, cardiac arryhthmias
53
Naphzoline
Tetrahydrazoline (Visine)
MOA
adrenergic agonist- more a than B
| constricts conjunctival blood vessels
54
Naphzoline
Tetrahydrazoline (Visine)
SE
depress CNS
| fixed dilated pupil (a1)
55
Brimonidine (Alphagan) MOA
adrenergic agonist- a2
lowers IOP by increasing uveoscleral outflow and constricting CB vessels- less aqueous production
miosis to reduce glare postop LASIK/ PRK
56
Added anti-glaucoma benefit of Brimonidine (Alphagan)
neuroprotective properties
57
Brimonidine (Alphagan) SE
```
follicular conjunctivitis (not likely in Alphagan P) (.1%)
dry mouth
```
58
Dosing Brimonidine (Alphagan)
TID
59
Brimonidine (Alphagan) Contraindications
MAOI
60
Apraclonidine MOA
adrenergic agonist- a2 and some a1
lowers IOP by increasing uveoscleral outflow and constricting CB vessels- less aqueous production
diagnosing Horner's Syndrome
61
Apraclonidine Use
prevent IOP spikes before and after surgery
| acute angle closure glaucoma
62
Apraclonidine SE
not effective long term
| greater allergic response long term
63
Horner's and Cocaine
will not dilate if has Horner's
| dilates normal eye
64
Horner's and Apraclonidine
dilates if has Horner's
| will not dilate normal
65
Horner's and Hydroxyamphetamine
dilates if preganglionic lesion
| will not dilate if post
66
Horner's and Phenylephrine 1%
will not dilate if preganglionic lesion
| dilates if postganglionic
67
B blocker systemic SE
CNS depression
bradycardia
bronchoconstriction
ED
68
Contraindications for B blockers
cardiovascular disorders
| respiratory disorders
69
Examples of B blockers
-olol
70
MOA of B blockers
decrease aqueous production
71
Only topical B1 selective B blocker
Betaxolol- spares lungs
72
Timolol Dosing
every morning
73
Timolol superpower
crossover effect- drop in one eye can effect both
74
Downside to Timolol
long term drift- IOP slowly rises
| short term escape- works for a week and then stops
75
Timolol should be used cautiously in....
diabetics- masks hypoglycemia
hyperthyroidism- masks signs and symptoms
MG- made worse
76
Cosopt
Timolol + Dorzolamide
77
Combigan
Timolol + Brimonidine
78
Carteolol Systemic Use
reduce nocturnal bradycardia
| tiny cholesterol reduction
79
B blocker with least SE
Carteolol
80
Betaxolol Use
B1 selective- avoids lungs
possibly neuroprotective
worse at lowering IOP
81
Levobunolol
| Metipranolol
B blockers on the outline with nothing special about them
Levo similar effectiveness as timolol
meti no longer used because it sucks
82
Allergies for CAIs
sulfa allergies
83
Examples of Topical CAIs
Brinzolamide
| Dorzolamide
84
Oral CAIs
Acetazolamide
| Methazolamide
85
CAI MOA
inhibits carbonic anhydrase- stops flow of Cl and Na into posterior chamber- decrease aqueous production
86
Acetazolamide Use
given with liquid for acute angle closure
87
Oral CAI SE
metallic taste, tingling in extremities, metabolic acidosis, thrombocytopenia, agranulocytosis
myopic shift
88
Contraindications for CAIs
severe COPD
pregnancy
sulfa allergy
liver and renal disease
89
Fatal SE CAIs
aplastic anemia
| bone marrow suppression
90
First line treatment for POAG
prostaglandins
91
Examples of Prostaglandins
-prost
92
Prostaglandin MOA
act on PGFA2 in CB- causes reduction of collagen- decreased resistance to uveoscleral outflow
93
Dosing Prostaglandins
bedtime
94
Contraindications for Prostaglandins
CME
active inflammation
past HSV infections
95
SE of Prostaglandins
iris heterochromia
extra lash growth and pigmentation
conjunctival hyperemia and pruritis- worst with Bimatoprost (Lumigan)
96
MOA of Anesthetics
stop influx of Na- nerve cannot depolarize
97
Use of epinephrine in injected anesthetics
constricts blood vessels to keep drug localized
98
Examples of Amide Anesthetics
Lidocaine
99
Examples of Esters Anesthetics
all topical anesthetics
100
Characteristics of Amides
longer duration of action
| metabolized by liver- less toxic
101
Characteristics of Esters
shorter duration of action
| metabolized locally
102
Onset and Duration of Proparacaine and Benoxinate
15 sec onset
| 15 min duration
103
Fluoress combo
fluorescein + benoxinate
104
SE of Proparacaine and Benoxinate
corneal melt
105
MOA of Emedastine
blocks H1 receptors
106
Emedastine Use
mild allergic conjunctivitis
107
Examples of Mast Cell Stabilizers
Crolom
Alomide
Alamast
Alocril
108
Mast Cell Stabilizer MOA
inhibiits degranulation of mast cells by preventing Ca influx
109
Use of Mast Cell Stabilizers
chronic conditions- vernal conjunctivitis, atopic keratoconjunctivitis, chronic allergic conjunctivitis
110
Mast Cell- Antihistamine Combo Examples
```
Bepotastine (Bepreve)
Epinastine (Elestat)
Ketotifen (Zaditor)
Olopatadine .1% (Patanol)
Azelastine (Optivar)
Olopatadine .2% (Pataday)
BEZPOP
```
111
Use of Mast Cell- Antihistamine Combos
long term management of itching/ conjunctivitis and relief of acute symptoms
112
Steroid MOA
inhibits phospolipase A2
113
Steroid SE
risk of secondary infections
PSC cataract
glaucoma- blocks TM (corneoscleral)
114
Examples of Strong Steroids
Prednisolone Acetate
Rimexolone (Vexol)
Difluprednate (Durezol)
Dexamethasone
115
Examples of Soft Steroids
Fluoromethalmone (FML)
| Loteprednol (Lotemax)
116
Steroid most likely to cause a steroid response
Difluprednate (Durezol)
117
Steroid to be shaken
shake that ASSetate
| Pred Acetate
118
Examples of NSAIDs
```
Diclofenac (Voltaren)
Ketorolac (Acular)
Nepafenac (Nevanec)
Bromfenac (Xibrom/ Bromday)
Flurbiprofen (Ocufen)
```
119
NSAID MOA
block COX 1 and 2
120
SE of Diclofenac (Voltaren)
corneal melt
121
Dosing Diclofenac (Voltaren)
QID
122
Dosing Ketorolac (Acular)
QID
123
Dosing Nepafenac (Nevanac)
TID
124
Dosing Bromfenac (Xibrom)
BID
125
Dosing Bromfenac (Bromday)
QD
126
Dosing Flurbiprofen (Ocufen)
1 drop every 30 min 2 hours before surgery
127
Uses of NSAIDs
post op cataracts to decrease inflammation- CME
| RCE, corneal abrasions, allergic conjunctivitis
128
Only NSAID approved for allergic conjunctivitis
Ketorolac (Acular)
129
Bromfenac (Xibrom) SE
has BAK and Sodium sulfite- sulfa allergy
130
Fluorescein Use
evaluating tear film quality and epithelial defects
131
Rose Bengal
stains dead and damaged cells
132
Rose Bengal and Herpes Dendrites
borders stain- HSV
| entire stain- HZV
133
Fluorescein and Herpes Dendrites
stains well for HSV but not for HZV
134
Stains that are anti-bacterial
Methylene Blue
135
Stains that are anti-viral
lissamine green
| rose bengal
136
Lissamine Green
stains dead and damaged cells
used often for dry eye evals
stings less than Rose Bengal
137
Methylene Blue
stains corneal nerves
138
Pegaptanib (Macugen) MOA and Use
anti-VEGF for macular degeneration
139
Ranibizumab (Lucentis) MOA
anti-VEGF
140
Glycerine Use
acute angle closure
141
Glycerine MOA
makes plasma hypertonic and sucks out fluid from anterior chamber to decrease IOP
142
Glycerine SE
rapidly breaks down carbs to increase blood sugar- do not give to diabetics
143
Alternate of Glycerine that is better suited for diabetics
Isosorbide
144
Muro 128 Use
hyperosmotic for corneal edema
145
Product in artificial tears that increases viscosity and contact time on eyeball
Methylcellulose (better)
| Polyvinyl alcohol
146
Examples of Artificial Tears
Optive
Systane
Refresh
147
Examples of Tear Ointments
Celluvisc
| Lacrilube
148
Restasis MOA
inhibits T cell activation by stopping production of IL-2
149
BAK
causes SPK
| increases drug penetration
150
Thimerosal
used in Trifluridine (Viroptic)
| mercury toxicity
151
EDTA
chelates Ca
| primarily used for band keratopathy
