Pharm 3 Topical Agents pt1

Question 1

Name 5 common classes of Anti-infectives

Answer 1

quinilones, sulfanomides, aminoglycosides, macrolides, combinations, and antivirals

Question 2

6 categories of Opthalmic drugs

Answer 2

Anti-infectives
Anti-inflammatory/anti-infective combinations
Non-steroidal Anti-inflammatories (NSAIDS)
Steroid Anti-inflammatories
Mast cell wall stabilizers
Antiglaucoma agents

Question 3

4 classes of Antiglaucoma agents

Answer 3

-adrenergic blocking agents, parasympathomemetics, carbonic anhydrase inhibitors, cholinesterase inhibitors

Question 4

5 types of other opthalmic meds that don’t belong to any of the already-mentioned categories

Answer 4

sympathomemetic agents, vasoconstrictors, lubricants, eye-irrigation solutions, anesthetics

Question 5

Bacterial conjunctivitis is most often caused by (3). Which is common in children?

Answer 5

Streptococcus pneumonia, Haemophilus pneumonia, or Staphylococcus aureus
Gram-positives more common than gram-negatives
Haemophilus is common in children

Question 6

Defining characteristics to distinguish btwn viral and bacterial conjunctivitis

Answer 6

Viral conjunctivitis: clear/yellow, stringy discharge,

Bacterial conjunctivitis: any color, preauricular lymphadenopathy

Question 7

The first thing to write when writing up a description of an eye complain is __. Then do what?

Answer 7

Make sure and write: “Globe and Lids intact.”

Then do visual acuity.

Question 8

Open angle glaucoma vs narrow angle glaucoma (obstructions)

Answer 8

Open-angle glaucoma has no mechanical obstruction to outflow

Narrow-angle glaucoma results from a mechanical obstruction by the iris

Question 9

Open angle glaucoma’s pathology

Answer 9

The trabecular network does not permit adequate rapid egress (exiting) of aqueous with a resultant pressure elevation
Aqueous secretion by the ciliary body is normal
Flow between the lens and iris thru the pupil into the anterior chamber is normal

Question 10

What are the s&s of someone who presents with acute angle glaucoma

Answer 10

headache, nausea, they see yellow haloes around lights.

Question 11

Closed angle glaucoma pathology

Answer 11

Results from a mechanical aqueous outflow obstruction through the trabecular network by peripheral iris apposition (near) to the cornea
Underlying mechanism is pupillary block
Can be acute, sub-acute or chronic

Question 12

The __ interferes with the outflow. If we give a drug that changes the size of the __ we can induce glaucoma in a patient who has a predisposition to it.

Answer 12

The iris interferes with the outflow. If we give a drug that changes the size of the pupil we can induce glaucoma in a patient who has a predisposition to it.

Question 13

Beta-Blocker drops for Glaucoma

Example, Action, how it’s administered, side effects

Answer 13

Example: Timolol ophthamlic drops
Supress aqueous production (so there’s less fluid)
Administered topically
Systemic side effects: acute exacerbation of asthma, CHF, bradycardia, CNS disturbances

Question 14

Parasympathomemetics for Glaucoma.

Example, action, side effects, common systemic side effects.

Answer 14

Example: Pilocarpine
Increase aqueous outflow (open up the canal)
Side effects: constricted pupils, other ocular effects
Common systemic side effects: diarrhea, sweating, bronchospasm

Question 15

What’s a problem associated with Pilocarpine?

Answer 15

It constricts the pupil…problem: Patient may not be able to see well in dark environments, such as driving home at night.

Question 16

Carbonic Anhydrase inhibitors (oral) for Glaucoma.

Example, action, common side effects

Answer 16

Example: Acetazolamide (Diamox)
Suppress aqueous production
Common side effects: electrolyte imbalances

Question 17

: Cabonic Anhydrase Inhibitors also act as ___.

Answer 17

Diuretics

Question 18

Prolonged use of topical antibiotics may result in __.

Anti-infectives are limited to:

Answer 18

overgrowth of non-susceptible organisms, including fungi.

limited to no more than 1 week

Question 19

Quinolone

Example, indication, safety fact

Answer 19

Example: ofloxacin (Ocuflox)
Indicated for the treatment of ocular bacterial infections caused by susceptible bacterial strains, esp. S. aureus, S. epidermidis, S. pneuomnia, H. flu, and others
Safety/effectiveness not established in children < 1 yoa

Question 20

Take home message: Levofloxacin is FDA approved down to what age orally? Or systemically?

Answer 20

18
However, these ‘eye’ preparations are approved down to age 1 b/c an eyedrop is unlikely to disturb someone’s knee hyaline cartilage formation.

Question 21

Aminoglycosides

Example, indication

Answer 21

Example: gentamycin (Garamycin)
Indicated for the treatment of ocular bacterial infections caused by susceptible bacterial strains, esp. S. aureus, S. epidermidis, S. pyogenes, S. pneumonia, N. gonorrhea

Question 22

Gentamycin’s caveats

Answer 22

Bacterial resistance to gentamycin may develop

If purulent discharge, inflammation or pain develops, discontinue medication

Question 23

Sulfonamides
Example, indication.
What 2 organisms it not adequately cover?

Answer 23

Example: sulfacetamide sodium (Bleph-10)
Indicated for the treatment of ocular bacterial infections caused by a wide range of susceptible gram-positive and gram-negative bacterial strains, esp. E. coli, S. aureus, S. pneumonia, H. flu
Topically applied, sulfonamides do not provide adequate coverage against N. gonorrhea and P. aeruginosa

Question 24

Macrolides
Example, indication.
This is/isn’t prescribed in whom?

Answer 24

Example: erythromycin
Indicated for the treatment of ocular bacterial infections caused by susceptible bacterial strains, esp. S. pyogenes, S. viridans, S. aureus, S. pneumonia, M. pneumonia, H. flu, N. gonorrhea, C. trachomatis
Tend not to prescribe in adults. But it is prescribed in kids.