Pharm Flashcards
What is the proper name of vitamin B2?
Riboflavin
Why is Riboflavin (B2) important?
Metabolism of nutrients
What are the ocular complications of a Riboflavin (B2) deficiency?
Photophobia
Corneal neo
KCS
What are the systemic manifestations of a Riboflavin (B2) deficiency?
Dry, cracked lips
Ulcers of the mouth
Sore throat
How are large, hydrophilic drugs absorbed ocularly?
Transconjunctival route
How are small, lipophillic drugs absorbed ocularly?
Transcorneal route
Which class of glaucoma drugs should not be prescribed when there is active inflammation?
Prostaglandins
What would be the best glaucoma drug to prescribe to a pt with active inflammation?
Brimonadine - often used after trabeculoplasty
What are the 2 major complications with Ethambutol therapy?
Retrobulbar optic neuritis
Blue/yellow color defects
How long after beginning Ethambutol to ocular side effects typically arise?
2-5 months
What is the proper name of vitamin B1?
Thiamine
Why is Thiamine (B1) important?
Carbohydrate metabolism
What disease occurs in Thiamine (B1) deficiency?
Beriberi
What are the symptoms of Beriberi from Thiamine (B1) deficiency?
Difficulty walking Peripheral neuropathy Paralysis Nystagmus Speech difficulty Mental confusion Ophthalmoplegia CHF
Beriberi can also arise due to malnutrition from what lifestyle choice?
Alcoholism
What is the proper name of Vitamin B3?
Niacin
What is Niacin (B3) responsible for?
Carbohydrate metabolism
Pellagra is caused by a deficiency of what?
Niacin (B3)
What are the symptoms of Pellagra?
Diarrhea
Dementia
Dermatitis
Which vitamin can be used to treat hyperlipoproteninemia?
Niacin (B3)
What is the proper name of vitamin B6?
Pyridoxine
What is the purpose of pyridoxine (B6)?
Coenzyme for formation of hemoglobin
Amino acid and protein metabolism
The aminoglycoside antibiotics are known for corneal toxicity. Which is worse over the same period of time, Tobramycin or Gentamycin?
Gentamycin
Why were aminoglycosides frequently used in the past?
Broad spectrum coverage
What class of drug and generation is diphenhydramine?
H1 blocker
1st generation
What are the side effects of 1st generation H1 blockers?
CNS dysfunction resulting in impairment of cognitive function or performance
Which generation of H1 blockers is sedating?
1st generation
Name at least 3 2nd generation H1 blockers.
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Loratidine (Claritin)
What class of drug is Erythromycin?
Antibiotic - Macrolide
What gram does Erythromycin cover?
(+)
Name at least 4 opoid analgesics.
Codeine
Hydrocodone
Oxycodone
Morphine
Which of the opioid analgesics is most associated with constipation?
Codeine
What is the common name of acetylsalicylic acid?
Aspirin
Patients with which color irides are most likely to have increased pigmentation with prolonged prostaglandin use?
Light brown
Scurvy results from a deficiency of what vitamin?
C
Vitamin C facilitates the absorption of what?
Dietary iron
What are the symptoms of scurvy?
General weakness Anemia Brown spots on skin Spongy gums Petechial hemorrhage of skin/mucous membranes Proptosis Feelings of paralysis
Name 3 conditions that atropine can be used to treat.
Amblyopia
Anterior uveitis
Posterior synechiae
What class of drug is atropine?
Anti-cholinergic
What are the 2 ocular alpha-2 agonists?
Apraclonidine
Brimonidine
How do alpha-2 agonists work in glaucoma therapy?
Increases uveoscleral outflow
Decreases production of aqueous
How do alpha-2 agonists reduce production of aqueous?
Constricting ciliary body vessels
Which class of antibiotics has a risk of causing idiopathic intracranial hypertension?
Tetracyclines
How do tetracyclines function as an antibiotic?
Disrupt bacteria protein synthesis by disrupting the 30s subunit
Which of the tetracyclines carries the highest risk of IIH?
Minocycline
Why does minocycline have the highest risk of IIH amongst the tetracyclines?
High lipid solubility gives it a higher affinity to pass into the CSF
What category of drug is Fluticasone?
Corticosteroid
What is the MOA of Salmeterol?
Long acting Beta-2 agonist
What is Salmeterol most frequently used for?
Asthma - to relax smooth muscle in/near the bronchioles, allowing for bronchodilation
What is the most common OTC decongestant?
Pseudoephedrine
What is the MOA of pseudoephedrine?
Adrenergic agonist
Pseudoephedrine should be used with caution in persons with what condition?
Cardiovascular disease
Which of the topical anti-cholinergics has the shortest duration of mydriatic effect?
Phenylephrine
What is the duration of action of phenylephrine?
3 hours
What is the duration of action of tropicamide?
6 hours
What is the duration of action of cyclopentolate?
24 hours
What is the duration of homatropine?
2 days
What is the duration of atropine?
2 weeks
1st generation cephalosporins have cross-sensitivity with what drug class?
Penicillins
Why do penicillins and cephalosporins have cross reactivity?
They both have a beta-lactam ring
If an organism is listed as “susceptible” on a sensitivity report, what does that mean?
The organism is sensitive to the standard dose
It is important to measure BP and pulse before prescribing which class of glaucoma meds?
Beta-blockers
Which drop carries a risk of retinal detachment?
Pilocarpine
What are the possible ocular side effects of pilocarpine?
Early cataracts
RD
Brow ache
Myopic shift
Why might a drop that is close to physiological pH increase the efficacy of a topical drug?
Less stinging, producing less reflex tearing, keeping more of the drug on the eye
Which type of drop is typically more efficacious, suspension or emulsion? Why?
Emulsion
Pts don’t remember to shake the suspension
What typically causes talc retinopathy?
IV drug use
If talc retinopathy is present, where else in the body may have talc accumulated?
Small blood vessels of: Lungs Liver Spleen Kidneys Lymph nodes
What condition may be caused stemming from talc retinopathy?
Ischemia from blocked vessels
Which glaucoma med may have a neuroprotective effect?
Brimonidine
Acetazolamide should be used with extreme caution in persons with what condition?
Sickle-cell anemia
What is drug class does acetazolamide belong to?
CAIs
Why is acetazolamide contraindicated in sickle cell anemia?
CAIs can lead to metabolic acidosis, causing additional sickling of RBCs
To which class of drug does ketorolac belong?
NSAIDs
Percocet is a combination of what 2 drugs?
Oxycodone
Acetaminophen
What may hydroxyurea be used to treat?
Sickle cell - to prevent sickling
What class of medications can be used to treat myokmia?
H1 blockers
H-1 antihistamines can be used to treat what type of hypersensitivity reaction?
Type I - immediate/anaphylactic
What mediates type I hypersensitivity?
IgE
What mediates type II hypersensitivity?
IgG/IgM
What mediates type III hypersensitivity?
Antibody/antigen complex
What mediates type IV hypersensitivity?
T cells
Name a disinfectant that is both bactericidal and virucidal.
H2O2
How does BAK function as a preservative?
Denatures bacterial cell membranes
What solution can be used in intraocular surgical procedures?
Balanced salt solution (BSS)
Why can thimerisol be toxic?
Contains mercury
Why should BSS be used in intraocular surgical procedures?
To maintain the proper isotonicity of the corneal endothelium
How do beta blockers work in hypertension?
Antagonize the beta receptors, allowing for vasodilation and diminished cardiac output
How can renin be used to decrease blood pressure?
Reducing renin decreases amounts of angiotensin II, which is a vasoconstrictor
How do ACE inhibitors work to lower blood pressure?
ACE converts angiotensin 1 to 2, which is a vasoconstrictor, so by inhibiting the conversion, BP is lowered
What is the primary MOA of statins?
Decreasing LDL
Why do elevated levels of LDL and triglycerides increase the risk of heart disease?
They can lead to plaque formation, narrowing the lumen of the vessels
Name 2 MOAs to reduce cholesterol.
Reduce LDL (statins) Inhibit HMG-CoA reductase, ultimately reducing LDL
What demographic of patient is most likely to be a steroid responder?
Kids under 10
Which type of steroid poses the least risk of causing a steroid response?
Ester based steroids
Name a topical ester based steroid.
Loteprednol
Which glaucoma drop causes eyelash growth?
Bimatoprost (Lumigan)
What are the potential ocular side effects of bimatoprost?
Hyperemia Iris color changes SPK CME Pseudodendrites Photophobia Irritation
Folic acid is required by the body to manufacture what?
RBCs
Folic acid can be used to help treat what type of anemia?
Megaloblastic anemia
Heparin and Warfarin decrease coagulation by binding to what?
Factor Xa
How do aspirin and ibuprofen act as blood thinners?
Inhibiting the synthesis of THA2 (THA2 works with ADP for platelet adhesion)
Oral contraceptives carry a risk of what cardiovascular issue?
Blood clot formation
What do class I antiarrhythmic agents affect?
Sodium channels
What do class II antiarrhythmic agents do?
Decrease sympathetic activity of the heart by blocking beta receptors, and helping prevent recurrent MI
How do class III antiarrhythmic agents work?
Prolong repolarization by blocking K channels
How do class IV antiarrhythmic agents work?
Block calcium channels, decreasing conduction through the AV node
What is the mechanism that might cause topiramate to lead to glaucoma?
Increased choroidal effusion, leading to swelling of the ciliary body, and a subsequent narrowing of the angle (angle closure glaucoma)
What may topiramate be used to treat?
Seizures Migraines Depression Bipolar disorder Weight loss promotion
How long after beginning topiramate therapy do signs of angle closure typically appear?
3-14 days
Patients with sulfonamide allergy shouldn’t be prescribed which combo antibiotic?
Bactrim (trimethoprim and sulfamethoxazole)
What makes up Bactrim?
Trimethoprim
Sulfamethoxazole
Which drop is commonly used to help treat Fuch’s dystrophy?
Muro-128
What class of drug is Muro-128
Hyperosmotic
What do topical anesthetics do the the cornea?
Loosen epithelium
Which drug softens the corneal epithelium more, proparacaine or tetracaine?
Tetracaine
Which drug is most known to cause crystalline retinopathy?
Tamoxifen
What is tamoxifen used to treat?
Breast cancer
Where do the crystals in crystalline retinopathy typically accumulate?
Paramacular region
What are the potential ocular side effects of tamoxifen?
Corneal deposits CME Gray lesions of RPE Retinal hemes Optic disc edema
What may Plaquenil be used to treat?
SLE
RA
Malaria
What is the most well-known ocular side effect of Chloroquine?
Bull’s eye maculopathy
Why does chloroquine cause bull’s eye maculopathy?
The drug binds to melanin and accumulates in the retina
What type of drug is Amiodarone?
Anti-arrhythmic
What are the potential ocular side effects amiodarone?
Vortex keratopathy
NAION
What is the major risk with oral fluoroquinolones?
Tendon rupture
Name 4 relative contraindications of topical phenylephrine.
Arteriosclerosis
Cardiac disease
Orthostatic hypotension
Hypertension
Which oral antibiotic is capable of inhibiting collagenase?
Doxycycline
Which class of glaucoma drugs shouldn’t be used in a patient with sulfonamide allergy?
CAIs
Why shouldn’t CAIs be prescribed to pts with sulfa allergy?
CAIs are sulfonamide derivatives
Which of the NSAIDs is potentially hepatotoxic?
Acetaminophen
Acetaminophen lacks which property that most NSAIDs possess?
Blood thinning
Which NSAID is least harmful to the stomach?
Celecoxib
What meds make up Vicodin?
Acetaminophen and hydrocodone
What trade names are combinations of acetaminophen and hydrocodone?
Vicodin
Percocet
Percodan
Lortab
How do tetracyclines help in posterior blepharitis?
Inhibit bacterial lipase production, reducing the concentration of free fatty acids
What is the MOA of cyclosporin?
Inhibition of activated T cells
Name the 5 things that may cause whorl (vortex) keratopathy.
Fabry's disease Tamoxifen Chlorpromazine Chloroquine Indomethacin
What are the 2 major routs of drug loss via topical instillation in the eye?
Spillover onto the cheek
Drainage via nasolacrimal sac
About how long does it take for a steroid responder to “respond”?
3-4 weeks
Alcohol consumption may lead to what type of nystagmus?
End gaze nystagmus
Which drug has potential to cause a serious interaction with amiodarone?
Warfarin - enhanced blood thinning
Why do you taper steroids?
To reduce risk of rebound inflammation
What is common side effect of oral and topical H1 blockers?
Headache
What are the potential side effects of topical steroid use?
PSC IOP increase Reduced resistance to fungal, viral, and bacterial infections Delayed would healing Mydriasis Ptosis development
Why might caffeine be added to NSAIDs?
Enhance their effects
-Typically added to acetaminophen or aspirin
Which HTN drug is associated with transient myopia?
Diuretics (thiazides)
Which topical steroid is least likely to cause PSC?
Loteprednol (ester=safer)
Drugs with which property can cross the BBB?
Lipid solubility
Which cycloplegic/mydriatic drugs are contraindicated in trisomy 21?
Atropine
Scopolamine
- may cause hypersensitivity reaction
A deficiency of which vitamin causes rickets and osteomalacia?
Vitamin D
What is the role of vitamin D in the body?
Regulation of calcium and phosphate levels
FA should be performed with caution in people taking which meds?
Beta blockers
Why is caution needed in FA when a patient is on beta blockers?
Rare anaphylactic reactions are harder to control when beta blockers are being used
Which topical NSAID can be used for seasonal allergic conjunctivitis?
Ketorolac
What conditions may ketorlac be used to treat?
Conj inflammation
Post cataract inflammation
CME
Seasonal allergic conjunctivitis
What are the 5 drugs that may cause optic neuritis?
Chloramphenicol Ethambutol Isoniazid Digitalis Ribavirin
What are the 3 drugs that may cause NAION?
(VIA)
Viagra
Immatrex
Amiodarone
Why can digitalis be harmful to the eye?
It works on Na/K pumps (for the heart), and there are a ton in the PRs, endo, and NPCE
What are the 3 drugs that affect bone marrow?
Chloramphenicol
Trimethoprim
Retrovir
What are the 7 causes of whorl keratopathy?
(CCHAI-T and Fabry's) Chloroquin Chlorpromazine Hydroxychloroquin Amiodarone Indomethacin Tamoxifen Fabry's disease
What are the causes of bull’s eye maculopathy?
Chloroquin
Hydroxychloroquin
What drugs cause pigment changes?
Indomethacin
Premoethazine
Thioridazine
Chlorpromazine
What 3 drugs may cause SJS?
Amoxicillin
Trimethoprim
Celecoxib
What drugs may cause oculogyric crisis?
Cetrizine
Chlorpormazine
Thioridizine
What antibiotics shouldn’t be used during pregnancy?
(FAT)
Fluoroquinolones
Aminoglycosides
Tetracyclines
What antibiotics are OK in pregnancy?
(PAC)
Penicillins
Azithromycin
Cephalosporins
What are the common broad spectrum antibiotics?
Aminoglycosides
Tetracyclines
Fluoroquinolones
What are the 5 X-linked disease?
Fabry’s
Alport
Albinism
Cone dystrophy
What are the 3 hormones that will increase blood pressure?
Anti-diuretic hormone (ADH)
Angiotensin II
Aldosterone
How does angiotensin II increase BP?
Causes vasoconstriction
How does aldosterone increase BP?
Increases blood volume
How does ADH increase BP?
Increases blood volume
Which hormone is the most potent in terms of increasing BP?
Angiotensin II
Where does ADH work?
On the collecting duct