Pharm 3 Flashcards by TT Nguyen

open angle glaucoma cause vs risk factors vs tx goals

dec aq humor drain -> inc fluid/IOP -> optic n dmg -> loss retinal n fibers & periph VF vs inc IOP, intraoc HTN; fhx, age, race; HTN, maybe myopia, DM vs dec aq humor/inc outflow, dec IOP by >30%

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closed angle glaucoma (MEDICAL EMERGENCY) cause & sxs vs tx/goals

 Aq humor cannot drain thru angle b/c blocked by iris
 Sudden inc in eye pressure –> eye pain, red, blurred vision, nausea, BLIND vs clear blockage, dec IOP, protect vision, laser surg or intraoc meds

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which glaucoma drugs dec aq prod vs inc aq outflow? what do topical corticosteroids (-one, Loteprednol) do; AE; CI?

beta blockers, alpha2 agonists, carbonic anhydrase inhibitors vs PG analogs, alpha2 agonists, cholinergic agonists, Rho kinase inhibitors. delay wound healing after ocular or glaucoma filtering surg, Dec inflam assoc w/ allergy; inc IOP, iritis; corneal abrasion, eye infxn

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AE & DI of PG analogs vs Beta-Blockers vs Alpha-2 Agonists

iris hyperpig, eyelash growth; pilocarpine dec lavastoprost vs brady, depression; take bexatolol if exac pulm airway dz, careful in brady/COPD/asthma vs allergic conjunctivitis; MAOI

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AE of CAI vs cholinergic agonists vs Rho kinase inhib

bitter taste, corneal decompensation, exfoliative rashes, angioedema vs corneal clouding, retinal detach vs instillation pain, conjunctival hyperemia/hem
cornea verticillata*

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what’s diabetic macular edema vs cause vs risk factors?

manifestation of diabetic retinopathy affecting center macula -> retinal hem (temporary); retinal detach or macular ischemia (permanent) -> vision loss vs long-term, uncontrolled blood glucose (& maybe Uncontrolled HTN) vs genetics/fhx, age, race, smoke/alc, comorbidities

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dry vs wet AMD w/ tx

drusen under RPE -> RPE detach/atrophy. laser photocoag, PDT vs choroid vessels thru Brusch mem under RPE -> exudate, hem -> dmg photoreceptors. grid laser photocoag, antiVEGF

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intravitreal corticosteroids MOA vs AE vs CI

dec inflamm in DME by inject q3mo or implant for 36mo vs cataract, inc IOP/glaucoma vs ocular infxns, glaucoma

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VEGF inhib Pegaptanib MOA vs AE vs CI. Aflibercept MOA vs AE vs CI.

wet only. bind to VEGF -> VEGF can’t bind to receptors -> no neovasc vs eye pain, inc IOP, floaters, retinal detach, iatrogenic cataract vs infxn. same w/ pegaptanib + VEGFA; conjunctival hem, arterial thrombosis, MI or CVA

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VEGF inhib Bevacizumab (off-label), Ranibizumab MOA vs AE vs BBW

wet AMD/DME, prolif DR. bind to VEGF -> VEGF can’t bind to receptors -> no neovasc vs HTN, impaired wound healing, VTE vs GI perforation, surgical/wound healing complications

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what’s ocuvite? MOA vs AE vs DI

antioxidant vit (A, E, C) + zinc; zeaxanthin, copper, selenium, lutein; AREDS/2. reduces progression of intermediate to advanced AMD vs beta-carotene (vitA) -> lung ca; vit E -> heart fail vs chelation with other drugs

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conjunctivitis sxs

 Mattering and adherence of eyelids upon waking
 purulent, mucus, watery d/c
 Dil conjunctival vessels; hyperemia, edema
 Itching (allergic conjunctivitis > viral and bacterial)

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bacterial conjunctivitis cause vs sxs vs local & systemic therapy

from infected person or abnl flora growth; S pneu, H flu, Moraxella in kids; S pneu, H flu, Staph in adults; pseudomonas in contacts vs purulent d/c, red, eye pain vs topical ophth drops w/ low AE; for chlamydia/gono

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bacterial conjunctivitis txs vs AE

ophth abx: aminoglycosides, macrolides, polymixins, FLQ, folate synthesis inhibitors vs itch/burn/irrit, hypersensitivity, periorbital edema, Neomycin allergy worsens infxn. JP study guide pg 5

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which viruses cause viral conjunctivitis?

HSV keratitis -> uni, thin/watery d/c, vesicular eyelids; CMV retinitis; adenoviruses; herpes zoster ophthalmicus -> corneal involved -> ophth referral

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how to nonpharm vs pharm tx viral conjunctivitis?

hand wash, cold compress; artifical tears, antihist vs val/acyclovir for HSV to inhib DNA elong; Topical trifluridine for HSV keratitis (max 21d) to thymidylic phosphorylase and DNA
polymerase but can get burning/irrit

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topical antihist (-stine, -adine) MOA vs AE vs clinical pearls

H1 receptor antagonist vs hyperemia vs
 Wait 5 min b/w other ophthalmic solutions
 Wait 10 min for inserting contacts
 Can use with systemic antihistamines for allergies

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Topical mast cell stabilizers MOA vs AE vs clinical pearls

inhibits hist release from sensitized mast cells vs unpleasant taste, dry eye, blurry vs must be used before symptoms start (no going back if hist release alrdy started); nedocromil not as good; cromolyn & ketotifen = OTC

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topical NSAID/ketorolac MOA vs AE vs CI vs other indic

analgesic like oral NSAIDs; prevents PG complex formation vs corneal edema or perforation vs allergy vs pain (post-op refractive keratoplasty), cataract surg

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topical decongestants: Napha/Tetrahydrozoline MOA vs AE vs CI vs clinical pearls

sympathomimetic, alpha-adrenergic stim w/o beta-adrenergic stim (vasoconstrict oph blood vessels to dec redness) vs mydriasis vs narrow angle glaucoma, MAOI, TCA? vs
 Don’t wear contacts w/ these products
 Surreptitious oral admin -> facilitate sexual abuse in both adults &children
 Available OTC

Kerato-conjunctivitis Sicca causes vs sxs vs complications

dry eye dz, Sjorgen; any abnlity in lacrimal production or drainage system, immune activation, Meibomian gland dysfxn -> inc evap, aq defic vs dry/gritty/irrit, FB sens, hyperemia, mucous d/c, excess tears vs corneal ulcers, scar

artificial tears: Carboxymethylcellulose
Propylene glycol MOA vs AE

1st line tx for keratoconjunctivitis sicca. replaces lost tear film vs burn, sting, red eye

Hydroxypropyl Cellulose Ophthalmic Insert MOA vs AE

slow-release eye lubricant in inf cul-de-sac of eye to stabilize and thicken tear film for mod/severe dry eye dz vs blurry (transient), ocular discomfort, matting of eyelashes, photophobia, hyperemia, corneal abrasion

Topical Cyclosporine MOA vs AE vs CI

inhib calcineurin -> dec inflam cells and cytok in conjunctiva; block IL2 -> no T cell activ vs burn, eye pain, visual disturb vs active oc infxn

Lifitegrast MOA vs AE vs clinical pearls

binds lymphocyte function associated antigen (LFA)-1 and inhib interaction w/ intercellular adhesion molecule 1 on T-cell -> no T cell activ vs altered taste, ocular irrit, dec visual acuity vs insert contacts 15min after admin

otitis externa vs cause vs sxs. know ALCENO

Inflammation or infection of the external auditory canal and/or auricle vs obstructive/absent cerumen, trauma/water activities, altered pH vs Ear pain/pressure, hearing loss, tinnitus, pruritus, d/c, typically unilateral. JP pharm guide pg 8

which abx to give for otitis externa? MOA?

Ciprofloxacin + dexamethasone; hydrocortisone, Ofloxacin, Corticosporin, Gentamicin. inhib DNA gyrase

Topical Acetic Acid MOA vs AE vs CI

acidic antibacterial and antifungal w/anti-inflam to inc acidic environ against P. aeruginosa, Candida., Aspergillus spp. vs sting, skin irrit, nec vs perforated TM

Isopropyl Alcohol/Glycerin MOA vs AE vs CI

antiseptic, promotes water evaporation from the ear/ relieve minor discomfort and protect irritated skin vs burn, irrit vs perforated TM

allergic rhinitis vs common cold sxs, onset, duration

Runny Nose with thin watery discharge, no fever; immediate; as long as exposure vs Runny Nose with thin watery or thick yellow discharge, low fever; 1-3d post viral exposure; 3-7d

seasonal vs persistent/perennial allergic rhinitis

respond to specific allergens at predictable times (pollen/grass in spring) vs year round dz caused by nonseasonal allergens (mold, dust mites, animal dander)

immune response to allergens: sensitization vs exposure vs immediate rxn vs late phase rxn

B cells activ -> igE made -> IgE bind to mast cells vs mast cell-bound igE interacts allergen -> degran -> release inflam/cytok vs sec/min; hist, cytok, LT/PG/TX -> rhinorrhea, sneeze, nasal obstruct vs 8-12h after exposure; cytok, LT -> activ migrating cells -> chronic sxs & nasal congestion

know H1/2/3/4 receptors and what they do and where they live

JP study guide pg 10

nonpharm tx for allergies

avoid, remove dander & mold; avoid wall to wall carpets & smoking, ctrl moisture, minimize outdoor activities during pollen seasons

immunotherapy? proposed mech? allergy shots w/ AE?

administering doses of ag ot induce tol when nat exposure occurs. induce anti igG, dec igE, shift Th1 to Th2, alter Treg. get ag based on skin test, dilute soln 1-2x/wk, give shot under direct med observation; mild local rxn, urt, bronchospasm, ana

advantages vs disadvantages/AE of sublingual therapy (v subQ). when not to do sublingual?

Lower ana risk, self admin, avoid swallowing 1 min after vs limit avail ag, expensive; pruritus of mouth/ear/tongue/throat, mouth edema; can get similar AE to subQ. unctrlled asthma, eos esophagitis. life threatening allergic rxns -> pts should get/use epipen unless not susceptible to epi; wait 30min after 1st dose

ex of complementary tx w/ sublingual therapy?

probx esp in eczema, butterbur w/ antiLT & antihist activity, acupuncture

which type of meds to tx fever, myalgia/arthralgia vs nasal congestion vs rhinorrhea/sneeze vs pharyngitis vs nonprod cough vs prod cough. avoid these drugs at what age?

analgesics, APAP, NsAIDs vs decongestants vs antihist vs analgesics, topical anesth vs opioids, dex, benzon vs guanefesin. <2yo, OTC <6yo

if pt has viral URI, what supplements to take?

inc water/electrolytes, zinc lozenges, vit C; avoid abx

what's acute otitis media? bacterial causes? dx?

pathogens from nasopharynx into the fluid in mid ear -> inflam. s pneu, H flu, Morax. pneumotic otoscopy

how to tx mild/mod vs severe OM?

<6mo; 6mo-2yo with mid ear inflam; bil, immunocomp, TM perforation -> amox, cefdinir (3), cefuroxime (2), azith vs fever 39C -> Amox+clavulanate (high dose), Ceftriaxone(3) (IV,IM), Clindamycin, tympanocentesis

how to prevent OM?

Pneumococcal conjugate vaccine (Prevnar 13 & Pneumovax 23), flu vax; in develop: H flu & Morax vax

acute Sinusitis. viral vs bacterial causes?

inflamed max > eth > front > sphenoid sinus. rhinovirus, parainfluenza, flu vs s pneu, H flu, Morax(children)

general approach for txing sinusitis

sinus drainage w/ oral/topical decongestants or nasal saline lavage; fluticasone or mometasone for chronic sinusitis/allergies; empirical narrow spectrum agents against s pneu/H flu for bacterial

know how to tx acute sinusitis in children vs adults

JP pharm guide pgs 17-18

Larygnotracheal-bronchitis/Croup cause -> sx. tx?

parainfluenza > adenovirus, RSV, flu -> barking cough w/ low grade fever. Stridor, restless, fever 102.2F -> intub, tracheostomy; heliox, aerosol epi, or corticosteroids if not intub/sedated

what's acute epiglottitis?

Hemophilus influenza type B that can be confused with viral croup. A lateral x-ray of nasopharynx and upper airway = helpful to differentiate.

Acute Pharyngitis. tx for peds vs adults

group A β-hemolytic Streptococcus (S. pyogenes) -> sore throat; assoc w/ acute glomerulonephritis and acute rheumatic fever. Amox, or PCN VK, Cephalexin, Benzathine penicillin G vs PCN VK, Amox erythromycin, or Benzathine penicillin G

abx resistance contributing factors

1. Impaired influx of Antibiotics(Ab) 2. Increased efflux protein expression 3. Mutation/mod/overprod in Ab binding proteins 6. Factor-associated protection 7. Drug mod/degrad