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Block 3 > Pharm 3 > Flashcards

Pharm 3 Flashcards

1
Q

open angle glaucoma cause vs risk factors vs tx goals

A

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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2
Q

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

A

 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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3
Q

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

A

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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4
Q

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

A

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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5
Q

AE of CAI vs cholinergic agonists vs Rho kinase inhib

A

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

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6
Q

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

A

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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7
Q

dry vs wet AMD w/ tx

A

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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8
Q

intravitreal corticosteroids MOA vs AE vs CI

A

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

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9
Q

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

A

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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10
Q

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

A

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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11
Q

what’s ocuvite? MOA vs AE vs DI

A

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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12
Q

conjunctivitis sxs

A

 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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13
Q

bacterial conjunctivitis cause vs sxs vs local & systemic therapy

A

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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14
Q

bacterial conjunctivitis txs vs AE

A

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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15
Q

which viruses cause viral conjunctivitis?

A

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

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16
Q

how to nonpharm vs pharm tx viral conjunctivitis?

A

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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17
Q

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

A

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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18
Q

Topical mast cell stabilizers MOA vs AE vs clinical pearls

A

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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19
Q

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

A

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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20
Q

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

A

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

21
Q

Kerato-conjunctivitis Sicca causes vs sxs vs complications

A

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

22
Q

artificial tears: Carboxymethylcellulose
Propylene glycol MOA vs AE

A

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

23
Q

Hydroxypropyl Cellulose Ophthalmic Insert MOA vs AE

A

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

24
Q

Topical Cyclosporine MOA vs AE vs CI

A

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

25
Q

Lifitegrast MOA vs AE vs clinical pearls

A

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

26
Q

otitis externa vs cause vs sxs. know ALCENO

A

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

27
Q

which abx to give for otitis externa? MOA?

A

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

28
Q

Topical Acetic Acid MOA vs AE vs CI

A

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

29
Q

Isopropyl Alcohol/Glycerin MOA vs AE vs CI

A

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

30
Q

allergic rhinitis vs common cold sxs, onset, duration

A

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

31
Q

seasonal vs persistent/perennial allergic rhinitis

A

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

32
Q

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

A

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

33
Q

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

A

JP study guide pg 10

34
Q

nonpharm tx for allergies

A

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

35
Q

immunotherapy? proposed mech? allergy shots w/ AE?

A

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

36
Q

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

A

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

37
Q

ex of complementary tx w/ sublingual therapy?

A

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

38
Q

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?

A

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

39
Q

if pt has viral URI, what supplements to take?

A

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

40
Q

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

A

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

41
Q

how to tx mild/mod vs severe OM?

A

<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

42
Q

how to prevent OM?

A

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

43
Q

acute Sinusitis. viral vs bacterial causes?

A

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

44
Q

general approach for txing sinusitis

A

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

45
Q

know how to tx acute sinusitis in children vs adults

A

JP pharm guide pgs 17-18

46
Q

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

A

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

47
Q

what’s acute epiglottitis?

A

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

48
Q

Acute Pharyngitis. tx for peds vs adults

A

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

49
Q

abx resistance contributing factors

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

Block 3 (23 decks)

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