Pharmacology Gout + Glaucoma Flashcards
mechanism of action of beta blockers
decrease the synthesis of aqueous humor AND allow increased drainage bc of unopposed parasympathetic input to the eye
name a b1 selective beta blocker for glaucoma
betaxolol
mechanism of alpha2 agonists
reduce aqueous humor production and stimulate outflow through uveoscleral pathway
mechanism of prostaglandin analogs
increase uveoscleral outflow
side effects + dosing of prostaglandin analogs
may darken iris
thickening of eyelashes
QD dosing (usually at night)
latanoprostene is what 2 drugs
vesneo and vyzulta
latanoprostene is a _____ analog
PGF2alpha
TRUE OR FALSE
latanoprost is an NO donator
FALSE
latanoprostene
mechanism of rho kinase inhibitors
increase aqueous humor outflow
increase blood flow to optic nerve
what glaucoma drug is cytoprotective on ganglion cells?
rho kinase inhibitors
what glaucoma drugs increase blood flow to optic nerve
rho kinase inhibitors
explain the MOA of colchicine for gout
inhibits leukocytes (polymorphonuclear leukocytes)
-suppresses release of prostaglandins AND leukotrienes
-suppresses proinflammatory mediators
-inhibits tubulin, which interferes with cytoskeleton. this impairs ability of macrophages to phagocytise and release mediators
name side effects of colchicine
diarrhea - often a limiting side effect
vomiting
fluid/electrolyte loss
allopurinol:
brand name?
MOA?
what’s the active metabolite?
zyloprim
XOI
oxipurinol
febuxostat
brand name?
MOA?
ulroric
XOI of both reduced AND oxidized forms
______ is a recombinant uricase
pegloticase
pegloticase brand name
Krystexxa
pegloticase MOA
converts uric acid into allantoin (more water soluble)
DEGRADES URIC ACID
lesinurad brand name
zurampic
lesinurad MOA
URAT1 inhibitor
prevents the reabsorption of UA back into the body
BLACK BOX WARNING OF LESINURAD
renal failure
differentiate between vision loss in macular degeneration vs open angle glaucoma
macular degeneration - lose central vision
glaucoma - lose peripheral vision.. gives “tunnel vision”
closed angle (Narrow) glaucoma is usually in 1 eye or both?
usually just 1
true or false
aqueous humor is CSF-like
truw
differentiate between the turnover of aqueous humor vs vitreous humor
aqueous humor has RAPID turnover (sev times a day) and vitreous has very slow turnover (sev times a decade)
“gold standard” drugs for glaucoma
prostaglandin analogs
name some possible side effects associated with betaxolol
bc B1 selective - possible to get side effect slike hypotension and bradycardia
name 2 topical CAIS
dorzolamide
brinzolamide
MOA of CAIS for glaucoma
what else can they be used to treat?
decrease CSF synthesis (dc aqueous humor production)
can be used to treat intracranial hypertension (elevated intracranial pressure)
-therefore, can help in acute motion sickness
which glaucoma drugs are known to potentially cause SJS
carbonic anhydrase inhibitors (oral)
name 2 oral CAIS
acetazolamide and methazolamide
side effects topical CAIS
discomfort
depression, anorexia, and dementia (even as drops!!)
not really used - so many side effects with no benefit over other treatments
cholinergic agonsits and CAIS are considered ___ line for glaucoma
3rd
major disadvantage of cholinergic agonists
require frequent dosing — BID-QID
cosopt is combination of…
timolol/dorzolamide
combigan combination of….
brimonidine/timolol
simbrinza combination of…
brinzolamide/brimonidine
how should prostaglandin analogs be stored
before opening - refrigerate
after opening - room temp
discard after 6 weeks
omidenepag isopropyl MOA
prostaglandin E2 analog
increased outflow aqueous humor via trabecular and uveoscleral
3 classes that decrease aqueous humor production
beta blockers
alpha2 agonists
CAIS
nonselective alpha agonists MOA
(epinephrine/dipivefrine/cholinergic agonists)
increase trabecular outflow
side effects are HTN, tachycardia, dizziness
name something that a little can be given (shot glass worth) to decrease UA levels
apple cider vinegar
name 2 uricosurics
probenicid and sulfinpyrazone
how do uricosurices like probenecid and sulfinpyrazone work
increase elimination of uric acid by competing for its reuptake into the body
what drug for gout is in the top 10 for causing SJS
allopurinol
before giving allopurinol, it’s important to consider what?
renal function
allopurinol, when first started, can exacerbate acute gouty attacks. what is done to prevent this?
coadminister colchicine
disadvantage of uloric vs allopurinol
has more drug-drug interactions
ADRS of lesinurad
increased creatinine bc causes muscle breakdown
influenza-like response
