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Module 3 Ocular Therapeutics And Pharmacology > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Is the corneal epithelium hydrophilic or lipophilic?

Which means water soluble drugs or lipid soluble drugs cross more easily?

A

Lipophilic

Lipid soluble drugs cross more easily

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2
Q

Is the corneal endothelium hydrophilic or lipophilic?

Which means water soluble drugs or lipid soluble drugs cross more easily?

A

Lipophilic

Lipid soluble drugs cross more easily

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3
Q

Is the corneal stroma hydrophilic or lipophilic?

Which means water soluble drugs or lipid soluble drugs cross more easily?

A

Hydrophilic

Water soluble drugs cross more easily

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4
Q

Unpreserved eye drops should be used for less than how many days

What temperature?

A

<7days

2-8’C

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5
Q

Are ionised or non ionised eye drops hydrophilic?

A

Ionised

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6
Q

Are ionised or non ionised eye drops lipophilic?

A

Non ionised

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7
Q

What can be added to eye drops to improve penetration (2)?

A

Organic salts (eg. Prednisolone acetate)

Preservatives (eg. Benzalkonium chloride or thimersol)

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8
Q

What pH do eye drops need to be between to be comfortable?

Size?

A

pH 4.5-9

10mum

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9
Q

Do hydrophilic or lipophilic drugs penetrate the sclera better?

Anionic or cationic drugs?

A

Hydrophilic

Anionic

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10
Q

Does systemic amoxycillin clavulanic acid have good or bad ocular penetration in the non inflamed eye? Inflamed eye?

Are they good at gram positive or gram negative bacteria?
Bacteriostatic or bacteriocidal?

What does it target?

A

Poor in the non inflamed eye, ok in the inflamed eye

Gram positive

Bacteriocidal

Cell wall synthesis

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11
Q

First generation cephalosporins (cephalexin and cefazolin) are good against gram positive or gram negative bacteria?

Bacteriostatic or bacteriocidal?

What is cefazolin useful for?

What does it target?

A

Gram positive

Bacteriocidal

IV administration, good intraocular penetration. Prophylactic for phaco

Cell wall synthesis

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12
Q

Second generation cephalosporin has gram positive or gram negative action?

Cefuroxime is an example, what is this useful for?

A

Both!

Phaco

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13
Q

Is bacitracin bacteriocidal or bacteriostatic?

Gram positive or gram negative?

Target?

Use in ophtho?

Corneal penetration?

A

Bacteriocidal

Gram positive

Cell wall synthesis

Superficial bacterial keratitis

Little to no corneal penetration

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14
Q

Which bacteria is vancomycin effective against?

Gram positive or gram negative?

Bacteriostatic or bacteriocidal?

A

MRSA

Gram positive

Bacteriocidal

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15
Q

What does polymixin in B target?

Gram positive or gram negative?

Bacteriostatic or bacteriocidal?

Which bacteria is it good against?

Good penetration in the corneal epithelium?

A

Cell membrane

Gram negative

Bacteriocidal

Pseudomonas aeruginosa

Poor!

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16
Q

Gramcidin

Target?

Gram positive or gram negative?

Bacteriostatic or bacteriocidal?

Why shouldn’t it be used systemically?
Which bacteria is it good against?

A

Cell membrane

Gram positive

Bacteriocidal

Causes haemolytic anaemia

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17
Q

Aminoglycosides

Target?

Gram positive or gram negative?

Bacteriostatic or bacteriocidal?

How should it be given?

A

Inhibit Bacterial protein synthesis

Gram negative (some gram positive)

Bacteriocidal

Parenterally or topically, poor oral absorption

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18
Q

Neomycin

What type of drug?

Which bacteria is it good against?
Not good against?

Good penetration in the cornea?

A

Topical aminoglycoside

Good against pseudomonas
Not good against beta haemolytic streptococcus

Bad corneal penetration?

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19
Q

What type of drug is gentamicin?

What does it do if injected Intravitreally?

Use?

A

Aminoglycoside

Destroys ciliary body and retina

End stage glaucoma

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20
Q

What is tobramycin good against?

How is it used?

What type of drug is it?

A

Pseudomonas

Topically

Aminoglycoside

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21
Q

Tetracyclines

Bacteriostatic or bacteriocidal?

What infections are they good for?

What conditions are they indicated in?

A

Bacteriostatic

Rickettsial infections

Indolent ulcers
Keratomalacia

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22
Q

What do tetracyclines inhibit?

Where can doxycycline reach after oral dosing?

What side effects in young animals can doxy cause?

Other side effects?

A

Matrix metalloproteinase

Tear film

Discolouration of teeth

GI
Photosensitivity reactions

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23
Q

Macrolides and Lincosamides

Target?

Gram positive or gram negative?

Bacteriostatic or bacteriocidal?

A

Inhibiting bacterial protein synthesis

Gram negative and mycoplasma, chlamydophila, Bartonella

Bacteriostatic

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24
Q

What type of drugs are erythromycin, azithromycin, clarithromycin?

A

Macrolides and lincosamides

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25
Q

Clindamycin is what type of drug?

What is it good against?

A

Macrolides and lincosamides

Toxoplasma gondii

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26
Q

Chloramphenicol

Target?

Gram positive or gram negative?

Bacteriostatic or bacteriocidal?

If used systemically what can it cause?

A

Inhibits protein synthesis

Gram positive and negative

Bacteriostatic

Haematopoietic disorders and aplastic anaemia (even months after stopping)

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27
Q

Does choramphenicol ointment or drops reach a higher corneal and aqueous humour drug concentration?

A

Ointment

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28
Q

Fluoroquinolones

Target?

Gram positive or gram negative?

Bacteriostatic or bacteriocidal?

A

DNA synthesis

Both

Bacteriocidal

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29
Q

Which fluoroquinolone can cause retinal degeneration in cats?

A

Enrofloxacin

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30
Q

Does ciprofloxacin or ofloxacin have better aqueous penetration?

A

Ofloxacin

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31
Q

Are most antifungals fungistatic or fungicidal?

Where do they normally target?

A

Fungistatic

Fungal cell wall

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32
Q

What side effects does amphotericin B cause if given IV?

Good penetration through the corneal epithelium?

What is it used for?

A

Renal, hepatic and haematological side effects

Poor

Ulcerative fungal keratitis

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33
Q

Natamycin has a good or poor corneal penetration?

A

Poor

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34
Q

What can ketoconazole cause (side effect)?

A

Hepatic toxicity

Cataractogenesis

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35
Q

Do triazole antifungals have good penetration in the cornea/ aqueous etc?

Orally?

A

Yes

Yes

36
Q

What side effects can voriconazole cause in cats?

What class of antifungal is it?

A

Inappetence
Lethargy
Neuro signs
Azotaemia

Triazole

37
Q

Does topical echinocandins (caspofungin and micafungin) have good or poor intraocular penetration?

A

Poor

38
Q

Does aciclovir have good efficacy in cats?

What are the side effects?

A

No

Bone marrow suppression
Hepatic and renal necrosis

39
Q

Does penciclovir have good efficacy in cats?

A

Good in vitro!

40
Q

What treatment is used for E cuniculi in rabbits?

A

Fenbendazole 20mg/kg for 4weeks

41
Q

What is the treatment of angiostrongylus vasorum (2)?

A

Moxidectin

Fenbendazole

42
Q

What is the treatment of leishmania in dogs?

A

Sodium stibogluconate +/- allopurinol

43
Q

What is the treatment of thelzia callipaeda and T californiensis in dogs?

What does it cause?

A

Imadoclopride 10% and moxidectin 2.5% (advocate)

Conjunctivitis
Dacryocystitis

44
Q

Where do corticosteroids target?

A
45
Q

What topical steroid is the most efficacious anti inflammatory agent for the anterior segment?

A

1% prednisolone acetate

46
Q

How do corticosteroids promote keratomalacia?

A

Lytic activity of collagenases

47
Q

Corticosteroids reduce migration of what and reduce phagocytosis of pathogens by what?

A

Leukocytes

Macrophages

48
Q

Where is Cox 1 expressed?

Use?

A

Endoplasmic reticulum of cells

Normal tissue homeostasis

49
Q

Where is Cox 2 expressed?

What causes it to be expressed?

A

Inflamed tissue

Cytokines

50
Q

Do topical NSAIDs inhibit or enhance corneal vascularisation?

Increase or decrease IOP?

Do topical NSAIDs delay corneal re epithelialisation?
Stromal healing?

A

Inhibit corneal vascularisation

Increase IOP

Delay corneal re epithelialisation but not stromal healing

51
Q

What does cyclosporin do?

A

Inhibits calcineurin, which blocks the production of IL-2 and the activation of T cells

52
Q

What are the side effects of azothioprine?

Does it affect B or T lymphocytes?

A

GI signs
Hepatotoxicity
Pancreatitis
Bone marrow suppression

Both (more T)

53
Q

What has oral megoestrol acetate been used for?

A

Feline eosinophilic keratoconjunctivitis

54
Q

What receptors do prostaglandin analogues work on?

Where are these receptors?

How do they work?

A

F prostanoid

Uveal tract and trabecular network

Increase uveoscleral outflow

55
Q

What are the side effects with prostaglandin analogues?

What cases are they contraindicated in?

A

Conjunctival hyperaemia
Miosis

Anterior lens luxation

56
Q

Concurrent use of topical anti inflammatories with prostaglandin analogues does what to the IOP lowering effect?

A

Decreases it

57
Q

How do carbonic anhydrase inhibitors work?

A

Reduce aqueous production by limiting production of bicarbonate ions in the non pigmented ciliary epithelium and therefore the associated active secretion of sodium ions and water in to the posterior chamber

58
Q

Which one is effective at lowering iop in NON glaucomatous eyes in dogs/ cats/ both?

Dorzolamide (trusopt)
Brinzolamide (azopt)

Which is better for glaucomatous cats? Why?

A

Dorzolamide - dogs and cats
Brinzolamide - just dogs (works in glaucomatous cats)

Brinzolamide - reduced ocular irritation, pH 7.5 whereas Dorzolamide pH 5.6

59
Q

What are the side effects of systemic carbonic anhydrase inhibitors?

A

Electrolyte disturbances

Inappetance/ V+/ lethargy - cats

60
Q

What do beta blockers do, 3 mechanisms?

A

Reduce aqueous production;

  • Blocking beta receptors on ciliary epithelium, inducing a decrease in cAMP levels and therefore reduction in secretory function
  • blocking sodium ATPase, reducing active transport and aqueous production
  • modulation of ciliary body blood flow
61
Q

What patients should beta blockers be avoided in?

What are the side effects?

A

Cardiovascular or pulmonary disease

Bradycardia
Hypotension
Bronchoconstriction
Miosis

62
Q

How does pilocarpine work in glaucomatous eyes?

Which cases of glaucoma has it been proven to work in?

A

Increases conventional aqueous outflow

Primary angle glaucoma in beagles

63
Q

How often should beta blockers be used in glaucomatous eyes?

A

Every 8-12hours

64
Q

What is the side effect of pilocarpine?

A

Constricts pupil

Low pH cause ocular irritation

65
Q

How do alpha 2 adrenergic agonists work in glaucoma?

Use in dogs/ cats?

A

Reduction of aqueous production
Increase uveoscleral outflow

Not in cats
Can use in cats but not in narrow angle glaucoma as it causes mydriasis which may compromise outflow more!

66
Q

What dose of IV mannitol should be used in emergency glaucoma?

How long does this take to work? How long does it last for?

What can cause this to work less?

What can enhance osmotic diuretic to work?

A

0.5-2g/kg IV over 30mins

Takes 1h to work, lasts for 24h

Uveitis- blood ocular barrier breakdown

Withholding water for 2-4h after administration

67
Q

What dose of oral glycerol should be used?

How long does it take to work? How long does it last for?

What condition shouldn’t this be used in?

A

1-2g/kg

Takes 1h to work
Lasts 10h

Diabetics- it is metabolised to glucose

68
Q

What does cycloplegic mean?

A

Paralyse ciliary body musculature

69
Q

What type of drugs are tropicamide and atropine?

How do these work?

A

Anticholinergic agents

Reversibly Blocking cholinergic receptors in the iris sphincter muscle causing pupil dilation

70
Q

How long does tropicamide 0.5-1% take to work?

How long does it last for?

How does it affect IOP?

Tear production?

A

10-20mins

6-8hours

Increase IOP
Doesn’t reduce tear production in dogs but will in cats

71
Q

Atropine 1%

How long does it take to work?

How long does it last for?

How does it affect IOP?
Tear production?

A

40mins

3-14days

Increase IOP
Reduces tear production

72
Q

Cyclopentolate 1%

What type of drug?

What side effects?

A

Anticholinergic agent

Chemosis in dogs

73
Q

What type of drugs are Phenylephrine and Adrenaline?

A

Sympathomimetics

74
Q

How can Phenylephrine be used to distinguish between conjunctival hyperaemia and episcleral hyperaemia?

A

Conjunctival hyperaemia- blanched quickly, few seconds

Episcleral hyperaemia- blanches more slowly 1-2mins

75
Q

How can adrenaline be used in the eye?

A

Ineffective topically

Can use intracamerally (intraocular surgery for mydriasis and haemostasis

76
Q

How do local anaesthetics work?

A

Reversibly block nerve depolarisation by inhibiting axonal sodium ion influx

77
Q

How long does proxymetacaine take to work?
How long does it last?
Peak effect?

A

1min
45mins
15mins

78
Q

How long does lignocaine 1% last?

How long does bupivacaine 0.5% last?

A

45-60mins

5-10hours

79
Q

What type of viscous agents are viscotears/ lubrithal/ optixcare?

Advantage?

A

Carbomer polymer

Last longer

80
Q

What is the disadvantage of hypromellose?

A

Doesn’t last long

81
Q

What benefits does sodium hyaluronate based tear replacements have over others?

A

Improve corneal epithelial cell migration

82
Q

What does cyclosporin and tacrolimus block?

A

Production of IL-2 and activation of T cells

83
Q

How can cyclosporin help with qualitative dry eye?

What else can it do?

A

It is also mucinomimetic

Reduce corneal pigment/ angiogenesis

84
Q

What does tissue plasminogen factor do?

How is it administered?

A

Coverts plasminogen to plasmin in the presence of fibrin. Fibrinolysis

Intracameral or Intravitreal

85
Q

What type of drug is mitomycin C?

What can it be used for?

How is it administered?

A

Anti fibrotic

Glaucoma implants
Squamous cell carcinoma along with keratectomy

Soaked sponge

Module 3 Ocular Therapeutics And Pharmacology (1 decks)

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