PHARMACOLOGY - Clinical (IOP, Steroids, Immunosuppressors etc) Flashcards
What are the most frequent side effects for prostaglandin analogues? (7)
- Increased iris pigmentation
- Iris cyst formation
- Increased peri-ocular skin pigmentation
- Eyelash hypertrichosis
- Iritis
- Peri-orbital fat atrophy
- CMO
What is ciclosporin’s main side effect?
nephrotoxicity, does not cause bone marrow suppression
- What are the main HIV medications?
- What are their main side effects?
- Ritonavir - nausea and diarrhoea
- Zidovudine - cytopaenia
- Zalcitabine - peripheral neuropathy
- Didanosine - pancreatitis
dida goalkeeper - brown - pancreatitis
zido/zico - is white - cytopaenia
Ribosomes are inhibited by which drug?
Chloramphenicol
What is the mechanism of action of fluoroquinolones?
Inhibit DNA replication by action on bacterial DNA gyrase
what is the mechanism of action of the imidazole antimicrobial?
inhibit cell membrane synthesis by inhibiting synthesis of sterols (important constiutent of fungal cell membranes)
What is the mechanism of action of aciclovir?
aciclovir inhibits DNA polymerase - an acyclic analogue of guanosine –> works better in infected cells.
Which drug can cause xanthopsia (yellow-blue discoloration), photopsia and pain on eye movements?
digoxin
What are the main side effects of carbonic anhydrase inhibitors (9) (-AMIDES)
- Paraesthesia
- Malaise complex (fatigue, weight loss)
- GI complex: diarrhoea, nausea, cramps due to potassium depletion
- Renal stone formation (calcium oxalate/phosphate)
- Steven-Johnson’s
- Bone marrow suppression/aplastic anaemia/agranulocytosis
- Thrombocytopaenia
- use in caution in patients with corneal endothelial dysfunction - affects endothelial pump mechanism
9, Teratogenic
What type of beta blocker is betoxalol? What is its protective effect?
Cardioselective (greater effect on B1 on myocardium vs B2 on respiratory/ocular system)
Protective effect on VF preservation due to effects on microperfusion of optic disc
What are the effects of betoxalol? (2)
- Less oculohypotensive effect than timolol
- Greater effect on visual field preservation due to effects on microperfusion of optic disc
Which immunosuppressant has an enhanced effect with allopurinol?
azathioprine –> patients need reduced dose on this
What is the mechanism of action of apraclonidine?
alpha-2-adrenergic agonist (partial) –> potent systemic anti-hypertensive –> causes mydriasis
Acts on the presynaptic nerve endings and are inhibitory –> prevent further release of neurotransmitter
Has very little alpha-1 activity
What are the effects of apraclonidine? (3)
- Mydriasis
- Eyelid retraction
- Conjunctival blanching
What are the optic side effects of vigabatrin? (3)
- Optic Nerve Pallor
- RNFL atrophy
- Concentric peripheral field loss (binasal field defect with macula sparing- affects males more than females)
What is the mechanism of action of dorzolamide or brinzolamide?
carbonic anhydrase inhibitor
Which class of IOP lowering agents is most chemically similar to sulphonamides?
Carbonic anhydrase inhibitors
What drugs can cause corneal verticillata / vortex keratopathy? (5 + 1)
- Chloroquine
- Hydroxychloroquine
- Amiodarone
- Indomethacin
- Phenothiazines
- Fabry’s disease
What is the mechanism of action of prostaglandins?
Bimatoprost additionally does what?
Increase uveoscleral outflow –> increased aqueous outflow.
Bimatoprost enhances trabecular outflow.
Which beta blocker will induce less bradycardia and postural hypotension than the others?
Carteolol - has intrinsic sympathetic activity.
What are the main complications of overtreatment with topical antivirals for HSK? (3)
- Follicular conjunctivitis
- Punctate keratitis with photophobia
- Sterile corneal ulceration
What is the main ocular side effects of brimonidine / apraclonidine?
After 1 year - allergic conjunctivitis, follicular conjunctivitis
What are the main side effects of topical prostaglandin analogues? (7)
- Increased iris pigmentation
- Iris cyst formation
- Increased peri-ocular skin pigmentation
- Peri-orbital fat atrophy
- Eyelash hypertrichosis
- Iritis
- CMO
Where are Beta-2 receptors found? (3)
Lungs, GI tract, vascular smooth muscle
Which antibiotics are known to be associated with IIH?
- Tetracyclines
- Fluoroquinolones
What drugs can induce optic neuropathy? (14)
Anti-Tb: Isoniazid, Ethambutol
Antibiotic: erythromycin, streptomycin, quinine, linezolid, dapsone (sulphonamide), chloramphenicol
Anti-retrovirals
Others: Amiodarone, Clioquinol, Infliximab, Pheniprazine, Suramin, Methotrexate
What are the ocular side effects of pilocarpine? (7)
- Miosis
- Induced myopia (myopic shift)
- Conjunctival vascular congestion
- Punctal stenosis
- Cataract formation
- Retinal detachment
- Headaches/brow ache
Which drugs should be avoided in myaesthenia gravis? (9)
- Aminoglycosides (gentamicin)
- Fluoroquinolones (ciprofloxacin, levofloxacin)
- Macrolides (erythromycin, azithromycin)
- Beta blockers
- Chlorpromazine
- Procainamide
- Penicillamine
- Respiratory supplements
Which topical steroid is least likely to induce intraocular pressure elevation?
Loteprednol etabonate
What are the ocular side effects of beta blockers?
(2)
What are the non ocular side effects of beta blockers?
(5)
- Reduced aqueous secretions by inhibition of beta-2 receptors on ciliary epithelium, punctate corneal erosions
- Local allergy, Bradycardia, Bronchospasm, Hypotension, Weakness (sleep disturbance, fatigue, headache, decreased libido)
What are the ocular side effects of topiramate? (8)
- Myopia
- Blurred vision
- Angle-closure glaucoma
- Scleritis
- Suprachoroidal effusion
- Periorbital Oedema
- Oculogyric crisis
- Blepharospasm
What are the side effects of acetazolamide? (7)
Biochemical (3)
Side effects (5)
hyponatraemia, hypokalaemia, metabolic acidosis
Renal calculi, paraesthesia of limbs, fatigue, Steven-Johnson’s syndrome, transient myopia
What is the mechanism of action of rituximab?
What is the mechanism of action of cyclosporin or tacrolimus?
What is the mechanism of action of infliximab and etanercept?
Rituximab - anti-CD20 protein (B cell surface)
Cyclosporin/tacro - calcineurin inhibitor –> anti-IL2
Infliximab/atanercept - anti-TNFdi