Pharmacology Flashcards
1
Q
Parasympathetic
A
Rest/digest
Bronchoconstriction/miosis
SLUD (salivation, lacrimation, urination, defecation)
2
Q
What does the pre and post-ganglion of the parasympathetic nervous system release?
A
ACH
3
Q
What receptors are found on parasympathetic?
A
M1, M2, M3
M3 is mostly likely to be found
4
Q
What breaks down ACH?
A
acetylcholinesterase
5
Q
What is released at the pre and post ganglionic of the sympathetic nervous system?
A
Pre - ACH
Post - Epi and norepi (same as adrenaline) Think adrenergic
6
Q
What is the function of the sympathetic nervous system?`
A
- flight/fight
- bronchodilation/mydriasis -
peripheral vasoconstrict - dry
7
Q
What is the purpose of MAOI?
A
increase epi and norepinephrine
8
Q
What is an example of MAOI (Monoaminoxidase inhibitor)?
A
Phenylephrine
9
Q
What does tropicamide do?
A
Stops ACH - sympathetic goes uninhibited
9
Q
What does tropicamide do?
A
Stops ACH - sympathetic goes uninhibited
10
Q
What are the receptors of the sympathetic system?
A
a1,a2,b1,b2
11
Q
How does phenylephrine work?
A
a1 agonist
12
Q
Pilocarpine
A
cholinergic agonist - increase salivation in sjogrens
13
Q
What 3 drugs increase outflow?
A
Pilocarpine
Prostaglandins
Alpha 2 agonist
14
Q
What is the only drug that increases corneoscleral outflow?
A
pilocarpine by binding to the ciliary muscle - the anchor is the scleral spur > pulls to the ciliary muscle > and opens the TM
15
Q
What are the side effects for pilocarpine?
A
myopic shift, brow ache, HAs, RD - turning on the accommodation system like crazy
16
Q
Cholinergic Agonist
A
- Direct
- Pilocarpine
- Indirect ( increase ACH)
- Neostigmine (tx MG)
- Pyridostigmine (tx MG)
- Edrophonium (Ed diagnoses)
- Echothiophate (irreversible SE)
- Donepezil
17
Q
What is pilocarpine used for?
A
Angle closure attack, ADies .125%
18
Q
What happens in ADies tonic pupil?
A
EW (preganglion para - starts in midbrain) –> CG (post para) –> SM
Ciliary ganglion lesion - iris is starved which is why we give .125% pilo
19
Q
2 major ocular sx of MG
A
- ptosis
2. diplopia at the end of the day
20
Q
Drug that exacerbate ocular effects of MG worse
A
B-blockers
21
Q
Cholinergic Antagonist MOA?
A
stops ach
22
Q
Longest to the shortest duration of cycloplegic/mydriatic effect?
A
ASH CT
Atropine > scopolamine > homatropine > cyclopentolate > tropicamide
23
Q
Which cholinergic agonist penetrates the BBB best?
A
scopolamine (THINK CNS) - hallucination, amnesia, confusion
Also used for motion sickness
24
Atropine should be avoided in which patients?
Down syndrome
25
Which cholinergic antagonist is the safest drug?
Tropicamide - 25 min
26
What is it called when you put atropine in the good eye?
penalization
27
Homatropine
- keeps iris mobile
- paralyze sphincter and ciliary muscle to reduce pain
- stabilize BAB
28
Tight junctions in which 3 spots?
1. NPCE
2. Iris stroma (minor circle)
3. schlemms canal
29
List the drugs in cholinergic antagonist
STOP ACH
ANTI, ANTI, ANTI (antidepressants, antipsychotics, antihistamines)
30
Which receptors can cause glaucoma a1, a2, b1, b2
| Examples of B2 agonist - can cause glaucoma
a1 and b2
31
List drugs for adrenergic agonist
a1 - phenyl
a2 - apraclonidine, brimonidine
Nonspecific - naphazoline, tetrahydrozoline (visine)
32
2 MOA for a2
increase uveoscleral outflow
| decrease aqueous production
33
What is the MOA for tetrahydrozoline (visine)
ocular decongestant/vasoconstrictor - acts on a1 (dilates pupil)
34
Phenylephrine acts on which receptors?
- a1, cant do a fixed dilated pupil
- crappy dilation
- pupil widening acts on Mueller muscle (2-3 mm)
- phenyl 10% breaks posterior synechiae (USE EXTREME CAUTION increase BP)
35
When is 10% phenyl contraindicated?
1. Phenelzine
2. TCA
3. Graves Dz
B/c it can increase sympathetic activity
36
TCA has 3 MOA
1. increase NE and epi
2. increase anticholinergic activity
3. Increase serotonin
37
Apraclonidine
- weak alpha 1 - no dilation
- used in Horner's syndrome - which dilates pupil
- think ACUTE - acts within an hour and awesome reduction in IOP - great in acute situations
- NOT good long term b/c of tachyphylaxis side effect ****
38
Brimonidine
works on a2
- alphagan (0.2%)
- alphagan P (0.1%) - purite preservative
- causes follicular conjunctivitis inferior palpebral conj
- cause miosis**
39
A2 acts as what?
sympathetic off switch - when bind to a2 receptor = shut down sympathetic affects
40
Epiphenephrine vs norepinephrine
Epi - think epi pen, opens lungs, acts on all 4 receptors
NE - does NOT act on B2
B2 - lungs
B1 - heart
41
Adrenergic antagonist
Alpha blockers & B- blockers
```
Timolol
Carteolol
Metipranolol
Betaxolol
Levobunolol
```
MOA: Knocks out B1 & B2 receptors
42
Which b-blocker only blocks B1
betaxolol (spare the lungs)
43
Which beta-blocker is the least efficatious?
betaxolol
44
What other drugs contain timolol?
Consopt & combigan
45
Carteolol
has ISA activity, sympathomimetic activity
46
Which drugs have neuroprotective properties
Brimonidine & Betaxolol
47
Which drug causes impotence?
B-blockers
48
Side effects of B-blocker
bradycardia and bronchoconstriction
49
Average IOP reduction of timolol
25%
50
Which type of drugs are "unstable"
b-blockers
51
Which drug has a cross over effect?
timolol
52
Name CAI drugs
Topical
- brinzolamide
- dorzolamide
Orals
- acetazolamide
- drozolamide
53
Side effects of oral CAI
acetazolamide & methazolamide
```
- tingling of hands and feet
metabolic acidosis ** (also occur in diabetics)
- metallic taste
- myopic shift
- aplastic anemia **
```
54
Which eye drop causes aplastic anemia
chloramphenicol
55
Drugs that causes myopic shifts
- topamax (bilateral angle closure)
- Acetazolamide
- cataracts
- pilocarpine
56
3 major prostaglandins
- Travatan (more effective in AA)
- Zalatan
- Lumigan
57
MOA for prostaglandins
Acts on the ciliary muscle & phospholipase C (incr eyelash growth)
Permanent side effects - iris heterochromia **
58
Which layer does CME happen in?
OPL
59
Type 1 involves which antibody?
IgE = Allergy
| - hayfever, anaphylaxis, allergic conjunctivitis
60
Emedastine
H1 receptor blocker
61
Antihistamine & mast cell stabilizer combos
BEZPOP
```
B: Bepotastine (bepreve)
E: Epinastine (Elestat)
Z: Ketotifen (Zaditor)
P: Olopatadine (Patanol)
O: azelastine (Optivar)
P: Olopatadine (Pataday)
```
62
Mast cell stabilizers
Cromolyn sodium
Alocril
Alomide
Almast
63
Which cells have histamine?
Basophils & mast cell
64
Which region does the antibody bind?
Fab portion (have heavy & light chains) > ca2+ enters cell > histamine releases
65
Mast cell stabilizers MOA
stabilize calcium gated voltage channels
66
ACTH is released and acts on ___
adrenal gland (to release steroids)
67
ACTH is released from what?
anterior pituitary
68
ocular side effects of steroids
- PSC cataracts
- secondary infections (herpes simplex) b/c immune response is decreased
- glaucoma (corneoscleral meshwork damaged)
69
list 6 top steroids
Strong steroids
- Pred acetate
- Rimexolone
- Diflurprednate
- Dexamethasone
Weak steroids
- Fluorometholone
- Loteprednol
70
How would you dose pred acetate vs durezol in a pt with uveitis?
Pred acetate - dose q1hr
| Diflurprednate (Durezol) - dose q2hrs (very strong steroid)
71
Which steroid is the safest & why?
Loteprednol = ester base
the rest is ketone base
72
MOA of steroids
knocks out phospholipase A2
- hydroxychloroquine and chloroquine can also inhibit phospholipase A2 & increase heme & RBC
73
MOA of NSAIDs
Block COX 1 and COX 2
74
Rosebengal staining simplex vs zoster
Simplex - stain borders
| Zoster - stain entire thing
75
Muro 128
Hyperosmotic
| - ions needs to be higher than the tear s
76
what is the osmolarity of the tears?
308
77
Which ions are higher in tears compared to blood?
potassium
78
Examples of hyperosmotic agents?
1. Glycerin
2. Muro 128
3. Isosorbide
79
MOA of Restasis
inhibit interleukin 2 - takes 3 months to work (always pair with FML)
Targets T cells - STOPS new T cells from being born
80
Preservatives
BAK = SPK
81
EDTA
think chelated calcium
82
Thimerosal
mercury - used in virioptic (9x for herpetic dendrite
83
NSAID = NSAD.. why?
beat up cornea
84
What can cause corneal melting?
- diclofenac sodium (voltaren) major side effect
| - proparacaine (10-20 seconds to work and 10-20 mins in duration)
85
MOA for anesthetics
block sodium channels
86
NSAID drugs end with what ?
-fenac, -rolac, -flurbiprofen
87
MOA for diclofenac
- block COX 1 and COX 2
88
MOA celecoxib
selective COX inhibitor for COX 2
89
What causes CME?
- cataract surgery (irvine gass syndrome)
| - prostaglandins
90
Another name for OPL
Henle's layer - axons of photoreceptors
91
6 layers of the fovea
RPE OHI
```
R: RPE
P: Photoreceptors
E: ELM
O: ONL
H: Henles layer
I: ILM
```
92
Drugs that work on the 30 S subunit
Azithromycin
| Tetracylines
93
Drugs that work on the 30 S subunit
```
Azithromycin
- tobramycin (fortified Ab)
- gentamycin
Tetracylines
- doxycyclines
- minocyclines
```
94
Drugs that work on the 50S subunit
Chloramphenicol
Erythromycin/azithromycin/clarithromycin
Lincomycin/clindamycin
95
Avoid tetracyclines in which population?
Children & Pregnant women
- teeth discoloration
- bone growth
- pseudotumor cerebri
96
Aminoglycosides causes what?
SPK - delayed corneal healing
97
Drugs that causes pseudotumor cerebri
CATS
- Contraceptives
- Accutane
- Tetracyclines
- Synthroid
98
What drugs should you avoid in pregnancy?
FAT
- Fluroquinolones (tedonitis/bones)
- AmiNOglycoside (nephro/ototoxicity)
- Tetracyclines
99
What drugs are safe for pregnancy?
PAC
- Penicillin
- Azithromycin
- Cephalosporins
100
Doxycycline
- tx chlamydia
| - can be taken with food
101
What drugs should you take on an empty stomach?
PAT
- Penicillin
- Azithromycin
- Tetracyclines (EXCEPT doxycycline)
102
Side effects of minocycline
Not a minnow but a blue shark
- blue sclera
- Pigment
103
What eye drop causes aplastic anemia?
Chloramphenicol
104
Which drug is used for ophthalmia neonatorum (chlamydia)?
erythromycin
105
What is azithromycin used for?
Azasite - tx blepharitis and bacterial conjunctivitis
Oral - needs to be taken on an empty stomach,
106
What is clarithromycin use for?
respiratory infection
107
Drugs used for MRSA
"Bacteria Can't Decide"
Bactrim
Clindamycin
Doxycycline
108
Logs of bacteria
peptidoglycan or mucopeptide
109
glue of bacteria
transpeptidase
110
What inhibits the transfer of peptidoglycan?
Bacitracin
111
What inhibits transpeptidase?
penicillin and cephalosporin
112
Severe reaction that can occur with penicillin
Type 1 hypersensitivity reaction - anaphylaxis & urticaria
113
Which drug is NOT resistant to penicillinase?
amoxicillin ( broadspectrum
114
Augmentin is a combination of which 2 drugs?
clavulanic acid and amoxicillin
115
Cephalexin
- 1st generation cephalosporins
| - aka keflex (hordelum, preseptal cellulitis)
116
Higher generation of cephalosporins provides what type of coverage?
Ceftriaxone (3rd generation) - gram (-) - tx gonorrhea
117
Which drugs inhibit synthesis of dihydrofolic acid by competing with PABA?
- Sulfamethoxazole
| - sufladiazine
118
Which drugs binds to dihydrofolate reductase & inhibits reduction of dihydrofolic acid to tetrahydrofolic acid?
- trimethoprim
119
bactrim is made up of which 2 drugs?
sulfamethoxazole & trimethoprim
120
How would you treat toxoplasmosis?
sulfadiazole & pyrimethamine
121
2nd & 3rd gen fluoroquinolones provide which coverage?
(-)
increases as you increase to 4th generation
122
Caseous necrosis & phlyctenules is seen in which systemic disease?
TB?
123
Drugs use to treat TB?
RIPE
- Rifampin
- Isoniazid
- P
- Ethambutol
124
SE of rifampin?
Rifles the liver & pink/orange tears
125
TB is which type of hypersensitivity reaction?
Type 4 hypersensitivity reaction = T lymphocyte involved
126
(+) PPD test and (-) TB
latent TB - use only one drug (rifampin or isoniazid)
"isoniazid used in isolation"
" ison - myson = MYCOLIC acid MOA" = inhibits mycolic acid
127
isoniazid MOA
"isoniazid used in isolation"
- " ison - myson = MYCOLIC acid MOA" = inhibits mycolic acid
- can cause optic neuritis (rare SE)
128
How do you tx active TB?
Use all 3 medication - rifampin, isoniazid, ethambutol
129
Ethambutol SE
Retrobulbar optic neuritis
130
MOA for zidovudine (retrovir)
reverse transcriptase inhibitor
- tx pt with AIDs
131
Oseltamivir (tamiflu) is used to treat what?
influenza
132
MOA of herpes drug
inhibits DNA polymerase
133
how often should you dose viroptic?
9x/day
134
how often you dose zirgan?
5x/day
135
BAK is perservative found in which herpes drug?
zirgan
136
Thimerosol is a perservative found in which herpes drug?
viroptic
137
Foscarnet
"safety net" - used if gancyclovir therapy is not effective
138
List the oral antivirals
Valcyclovir
Acyclovir
Famcyclovir
**reduces risk of disciform by 50% ... AVOID in kidney or liver dz.. othewise it is a safe drug**
139
Antifungal drugs =
ergosterol = -azole
140
Number one cause of fungal ulcer
1. tree branch
2. immune suppression
3. chronically beat up cornea (chronic dry eye)
141
Griseofulvin MOA
interfere with microtubules
- exception that does not effect ergosterol
142
natamycin & amphotericin B MOA
bind and punches holes in ergosterol
143
-azole drugs
= INHIBIT ERGOSTEROL SYNTHESIS
144
Chloroquine
- increase heme (toxic to RBC & cause it to burst in pts with malaria)
- SE: bulls-eye maculopathy & whorl keratophaty
- MOA: inhibits phospholipase A2
- TX RA/Lupus/Malaria
- Binds to melanin and effects RPE = bulls eye maculopathy
- 200mg ( <135lbs) vs 400mg (>135 lbs) - for hydroxy
- pay attention to renal/liver function
- macular degeneration can increase risk for bulls eye maculopathy
145
Topical steroids SE
1. PSC
2. glaucoma
3. increased risk of 2ndary infections (herpes)
146
List the strong steroids
1. pred acetate
2. rimexolone
3. diflurprednate
4. dexamethosone
147
List the weak steroids
1. loteprednol
| 2. fluorometholone
148
endings for steroids
- lone, -sone, pred
149
Systemic steroids
1. Fluticasone
2. Triamcinolone (inject into chalazion - but never do it on pt with DARK skin)
3. Hydrocortisol
150
Drugs that are insulin sensitizer
1. Rosiglitazone
2. Pioglitazone
** remember steroids are insulin resistant - make liver less sensitive to insulin b.c they release sugar **
151
Steroid users
** DM - 65 yo male who is overweight **
1. BS
2. insulin resistance
3. peptic ulcers
4. fibroblast fxn
5. osteoporosis
6. HTN
152
Topical NSAIDs
1. Diclofenac sodium (generic --> cause corneal melting)
2. Nepofenac (tx CME)
3. Bromfenac (tx CME)
4. Keterolac (tx CME)
5. Flurbiprofen
153
Systemic NSAIDs
1. Misoprostol (missing prostaglandins - synthetic prostaglandins)
2. Celecoxib (selective COX 2 inhibitor)
*COX 1 protects the stomach
154
NSAID
- Naproxen
- Naproxen sodium
- AspIRin (Irreversible)
- Indomethacin (thinking pigmentary retinopathy, whorl keratopathy)
- Ibuprofen
155
MOA of NSAIDS
Block COX 1 and COX 2
156
What 3 drugs causes pigmentary retinopathy
1. chlorpromazine
2. thioridazine
3. Indomethacin (rx for gout)
157
MOA for steroids
Phospholipase inhibitor:
| stops everything from the top of the pathway
158
Bucket 1
Cholinergic Agonist
1. Direct & indirect
```
Direct - pilocarpine
Indirect - increase acetylcholine
- neostigmine
- pyridostigmine
- echothiphate
- edrophonium (tensilon test)
- donepizil
```
159
Bucket 2
STOP ACH
ANTI, ANTI, ANTI
Antiaxiety - Diazepam
Antipsychotics - Chlorpromazine, thioridazine
Antidepressants - amitriptyline, imipramien, phenelzine (HTN)
Antihistamines - promethazine, bropheniramine, chlorpheniramine, diphenydramine
160
SE of bucket 2
1. dry eye
2. increase IOP
3. Mydriasis (angle closure)
161
Bucket 3
Adrenergic agonist - a1, a2, b1, b2
a1 - phenylephrine
a2 -
--------------------------------------------
B2 (BUTTS)- albuterol, levabuterol, terbutaline, metoproterenol, isoproterenol
Dopamine agonist - methylphenidate/dextroamphetamine, bromocriptine, amantadine
162
Which receptors causes glaucoma?
a1, B2
163
Adrenergic Antagonist
Alpha blockers - prazosin, terasozin, tamsulosin = floppy iris syndrome, acts on a1
Beta blockers - propranolol, labetalol, atenolol, metoprolol
= bronchoconstriction, bradycardia, impotence, erectile dysfunction, exacerbate MG
164
Beta blockers that are B1 selective - which beta blocker effects IOP the least?
BEAM of B1 blockers
- Betaxolol
- Atenolol
- Metoprolol
165
Antihistamines
Topical - emedastine (always used in combo never by itself), alo, alo, ala crom, BEZPOP
1st - pro
2nd - cetirizine, fexofenadine, loratidine
166
Which drugs stabilize voltage gated ca channels?
Mast cell stabilizers - alocril, alomide, alomast, cromolyn sodium
"ALOMASK"
167
What cause thiamine deficiency?
chronic alcholism resulting in acute presentation of wernickes encephtalopathy
- withdrawal is life threatening
168
Wernicke's encephalopathy
ophthalmoplegia confusion ataxia due to alcoholism
169
Korsafkoff syndrome
associated with alcoholism
- amensia confabulation
170
Opiods/Morphine withdrawal sx
mydriasis, anxiety, lacrimation, rhinorrhea, sweating, tremor, nausea/vomiting
- withdrawal is non-life threatening
- increases heart rate/BP
171
Cocaine
blocks dopamine/NE uptake in reward centers of the brain
- increase sympathetic
- can cause mydriasis, elevation in mood, tremors, chest pain, heart palp
- withdrawal is non-life threatening
172
"zosin" drugs
alpha 1 blockers = relax smooth muscle bladder & prostate to decrease urinary outflow obstruction
- Prazosin, terazosin, tamsulosin
- bucket #4
SE: orthostatic hypotension, FES
173
PDE-5 Inhibitors
Sildenafil, vardenafil
- relaxes smooth muscle in the penis during an erection
- SE flushing, HAs, priapism, NAION, cyanopsia, blurred vision, photosensitivity
174
levothyroxine
- synthetic T4 hormone for hypothyroidism, Hashimotos thyroiditis
- SE = hypothyroidism sx, psueduotumor cerebri in children
175
Drugs that treat CHF
ABCD + hydralazine
A = ACE INHIBITORS & ARBS
B = beta blockers
C = Calcium channel blockers
D = Diuretics/Digoxin/
vasoDilators
*ALL DROP BLOOD PRESSURE EXCEPT DIGOXIN*
176
ACE inhibitors think AAA
- pril
A = Antihypertensive (lowers BP)
A = Avoid pregnancy
A = Adds potassium " hyperkalemia
177
Beta blockers
MOA and SE
- lol, block beta receptors
L = LOWERS HR
L = LOWERS BP
decreases resistance, workload, and cardiac output = AVOID IN PTS WITH CARDIAC PROBLEMS
Dyspnea, wheezing, syncope, arrhythmias, impotence, erectile dysfunction, fatigue, disorientation
think BBBB (Avoid in pts)
B = bradycardia
B = breathing problems
B = Bad for heart failure pts
B = blood sugar masking
178
Calcium Channel blockers
Lowers HR and BP
- Nifedipine, cardizem, verapamil
- stops effects of angiotensin II
- low tension glaucoma, HAs
179
Digoxin
Lowers HR
- cardiac glycoside
D = DEEP contraction, helps w/ forceful contraction or pts with low systolic pressure
- vision changes, nausea, dizziness,
THIS IS A TOXIN:
- retrobulbar ON
- color defects b/y
- entoptic phenomenon
180
Vasodilators
Nitroglycerin, Hydralazine, Isosorbide
- lowers BP and relaxes the heart
- also given for chest pains
181
Diuretics
D = decrease BP
D = Drain fluid (pee)
D = Dehydrates (dries body)
182
K+ wasting diuretic
-IDE
Furosemide
Hydrochlorothiazide
NOT isosorbide (VASODILATOR)
183
Potassium sparing
Spironolactone, spares K+
AVOID GREEN LEAFS
Potassium pumps muscles
184
What do we look for in a kidney lab?
BUN and Creatinine
185
Mannitol
Osmotic diuretics, used for acute angle closure glc
186
Warfarin
anticoagulant
- Inhibits clotting factor 2, 7, 9, 10, protein C and S
- inhibit vit K-dependent gamma-carboxylation of these molecules
- without this carboxylation, these factors are unable to bind to endothelial surface of blood vessels to contribute to clotting
187
Valacyclovir
- pro drug of acyclovir
- high bioavailability and requires less frequent dosing
- 1 gram TID for 7-14 days
- pregnancy category B drug
188
What causes bulls eye maculopathy?
chloroquine and hydroxychloroquine
189
What drug causes salt and pepper pigmentary changes in the midperipheral retina
Thioridazine
190
What causes crystalline maculopathies?
Tamoxifen and canthaxanthin
191
What can Pilocarpine be used for?
Direct cholinergic agonist (directly binds to ach receptors)
- tx dry eye and dry mouth (sjogren's)
- 0.125% can be used to dx Adies tonic pupil
- dysphotopia post cataract sx
