Pharmacology Gout + Glaucoma

Question 1

mechanism of action of beta blockers

Answer 1

decrease the synthesis of aqueous humor AND allow increased drainage bc of unopposed parasympathetic input to the eye

Question 2

name a b1 selective beta blocker for glaucoma

Answer 2

betaxolol

Question 3

mechanism of alpha2 agonists

Answer 3

reduce aqueous humor production and stimulate outflow through uveoscleral pathway

Question 4

mechanism of prostaglandin analogs

Answer 4

increase uveoscleral outflow

Question 5

side effects + dosing of prostaglandin analogs

Answer 5

may darken iris
thickening of eyelashes

QD dosing (usually at night)

Question 6

latanoprostene is what 2 drugs

Answer 6

vesneo and vyzulta

Question 7

latanoprostene is a _____ analog

Answer 7

PGF2alpha

Question 8

TRUE OR FALSE

latanoprost is an NO donator

Answer 8

FALSE

latanoprostene

Question 9

mechanism of rho kinase inhibitors

Answer 9

increase aqueous humor outflow
increase blood flow to optic nerve

Question 10

what glaucoma drug is cytoprotective on ganglion cells?

Answer 10

rho kinase inhibitors

Question 11

what glaucoma drugs increase blood flow to optic nerve

Answer 11

rho kinase inhibitors

Question 12

explain the MOA of colchicine for gout

Answer 12

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

Question 13

name side effects of colchicine

Answer 13

diarrhea - often a limiting side effect

vomiting

fluid/electrolyte loss

Question 14

allopurinol:

brand name?
MOA?
what’s the active metabolite?

Answer 14

zyloprim
XOI
oxipurinol

Question 15

febuxostat

brand name?
MOA?

Answer 15

ulroric

XOI of both reduced AND oxidized forms

Question 16

______ is a recombinant uricase

Answer 16

pegloticase

Question 17

pegloticase brand name

Answer 17

Krystexxa

Question 18

pegloticase MOA

Answer 18

converts uric acid into allantoin (more water soluble)

DEGRADES URIC ACID

Question 19

lesinurad brand name

Answer 19

zurampic

Question 20

lesinurad MOA

Answer 20

URAT1 inhibitor

prevents the reabsorption of UA back into the body

Question 21

BLACK BOX WARNING OF LESINURAD

Answer 21

renal failure

Question 22

differentiate between vision loss in macular degeneration vs open angle glaucoma

Answer 22

macular degeneration - lose central vision

glaucoma - lose peripheral vision.. gives “tunnel vision”

Question 23

closed angle (Narrow) glaucoma is usually in 1 eye or both?

Answer 23

usually just 1

Question 24

true or false

aqueous humor is CSF-like

Answer 24

truw

Question 25

differentiate between the turnover of aqueous humor vs vitreous humor

Answer 25

aqueous humor has RAPID turnover (sev times a day) and vitreous has very slow turnover (sev times a decade)

Question 26

“gold standard” drugs for glaucoma

Answer 26

prostaglandin analogs

Question 27

name some possible side effects associated with betaxolol

Answer 27

bc B1 selective - possible to get side effect slike hypotension and bradycardia

Question 28

name 2 topical CAIS

Answer 28

dorzolamide
brinzolamide

Question 29

MOA of CAIS for glaucoma

what else can they be used to treat?

Answer 29

decrease CSF synthesis (dc aqueous humor production)

can be used to treat intracranial hypertension (elevated intracranial pressure)

-therefore, can help in acute motion sickness

Question 30

which glaucoma drugs are known to potentially cause SJS

Answer 30

carbonic anhydrase inhibitors (oral)

Question 31

name 2 oral CAIS

Answer 31

acetazolamide and methazolamide

Question 32

side effects topical CAIS

Answer 32

discomfort
depression, anorexia, and dementia (even as drops!!)

not really used - so many side effects with no benefit over other treatments

Question 33

cholinergic agonsits and CAIS are considered ___ line for glaucoma

Answer 33

3rd

Question 34

major disadvantage of cholinergic agonists

Answer 34

require frequent dosing — BID-QID

Question 35

cosopt is combination of…

Answer 35

timolol/dorzolamide

Question 36

combigan combination of….

Answer 36

brimonidine/timolol

Question 37

simbrinza combination of…

Answer 37

brinzolamide/brimonidine

Question 38

how should prostaglandin analogs be stored

Answer 38

before opening - refrigerate

after opening - room temp

discard after 6 weeks

Question 39

omidenepag isopropyl MOA

Answer 39

prostaglandin E2 analog

increased outflow aqueous humor via trabecular and uveoscleral

Question 40

3 classes that decrease aqueous humor production

Answer 40

beta blockers
alpha2 agonists
CAIS

Question 41

nonselective alpha agonists MOA

Answer 41

(epinephrine/dipivefrine/cholinergic agonists)

increase trabecular outflow

side effects are HTN, tachycardia, dizziness

Question 42

name something that a little can be given (shot glass worth) to decrease UA levels

Answer 42

apple cider vinegar

Question 43

name 2 uricosurics

Answer 43

probenicid and sulfinpyrazone

Question 44

how do uricosurices like probenecid and sulfinpyrazone work

Answer 44

increase elimination of uric acid by competing for its reuptake into the body

Question 45

what drug for gout is in the top 10 for causing SJS

Answer 45

allopurinol

Question 46

before giving allopurinol, it’s important to consider what?

Answer 46

renal function

Question 47

allopurinol, when first started, can exacerbate acute gouty attacks. what is done to prevent this?

Answer 47

coadminister colchicine

Question 48

disadvantage of uloric vs allopurinol

Answer 48

has more drug-drug interactions

Question 49

ADRS of lesinurad

Answer 49

increased creatinine bc causes muscle breakdown

influenza-like response