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Pathology And Pharmacy 309 > Unit 5: Ophthalmic Pharmaceuticals > Flashcards

Unit 5: Ophthalmic Pharmaceuticals Flashcards

1
Q

Uses of topical anaesthetic

A

-Assessment of eye trauma
-Measurement of intraocular pressure
-Removal of superficial foreign bodies
-Ophthalmic surgery
-Reduce stinging from dilating drops


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2
Q

Sensory nerve pathway from cornea to brain

A

-Corneal nerves
-Long ciliary nerves
-Nasociliary nerves
-Ophthalmic nerve
-Trigeminal nerve (CNV)

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3
Q

Examples of topical anaesthetic

A

-Alcaine (proparacaine hydrochloride)
-minims tetracaine hydrochloride (preservative free)
-fluress (Benoxinate & fluorescein sodium)
-10% cocaine (For Horner’s syndrome diagnosis)

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4
Q

ADRs to topical anaesthetic

A

Hives, difficulty breathing, swelling of face. Blurred vision, redness of eye, light sensitivity, tearing, throbbing, pain, itching.

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5
Q

Contra indications for anaesthetic drops

A

-Perforating injuries
-Self administration (may cause corneal breakdown)
-Some dry eye testing
-Some culture collections

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6
Q

Adverse effects of long term use of anaesthetic drops

A

-Epithelial defects
-Stroma edema (swelling)
-Endothelium damage
-Corneal thinning
-Corneal ulcers
-Corneal perforation


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7
Q

Mydriasis

A

Dilates pupils

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8
Q

Cycloplegia

A

Temporary Loss of accommodation

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9
Q

Something that’s worth noting

A

All mydriatics don’t have cycloplegic effects, but all cycloplegics have mydriatic effects

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10
Q

Use of mydriatics and cycloplegics

A

-Dilation
-Cycloplegic refraction
-Amblyopia therapy
-Pain management for uveitis

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11
Q

Contraindications for dilating drops

A

-Allergy to preservatives
-Narrow anterior chamber angle
-Iris fixed intraocular lens
-Pupil evaluation

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12
Q

Adverse effects for dilating drops

A

-Blurred vision
-Stinging
-Photophobia
-Glare
-Risk of angle closure glaucoma
-Longer lasting for light coloured eyes

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13
Q

Dilating drops mechanism of action

A

Cholinergic (parasympathetic)
-Antagonist (Leads to dilation)
Adrenergic (sympathetic)
-Agonist (Leads to dilation)

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14
Q

Cholinergic antagonist (anticholinergic)

A

Blocks muscarinic receptors to inhibit pupillary sphincter (dilation)
-Inhibits ciliary body (cycloplegia)

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15
Q

Examples of cholinergic antagonist

A

-Mydriacyl (tropicamide)
-Cyclogyl (cyclopentolate)
-isopto homatropine
-isopto atropine

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16
Q

Mydriacyl (tropicamide)

A

-Routine eye exam dilation
-0.5% or 1%
-Minimal cycloplegic effect
May cause transient IOP increase

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17
Q

Cyclogyl (cyclopentolate)

A

-Routine cycloplegic refractions
-0.5% and 1%
-Must wait 45 minutes for cycloplegic effect
-May cause hallucinations and strange behaviour
-Accommodation recovers before mydriasis

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18
Q

Isopto Homatropine

A

-Manage pain associated with anterior uveitis
-Strong mydriatic effect
-Weak cycloplegic effect

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19
Q

Isopto Atropine

A

-Most potent mydriatic/cycloplegic
-Amblyopia treatment
-Slow myopia progression
-May cause dry mouth and flush skin, rapid pulse, or disorientation.
-Caution with elderly children and down syndrome

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20
Q

Mechanism of action of adrenergic agonist

A

Binds to alpha receptor causing mydriasis

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21
Q

Mydfrin (phenylephrine)

A

Adrenergic agonist
-Used in combination with mydriacyl
-2% & 10% concentrations
-May cause cardiovascular events

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22
Q

Mydfrin Contraindications

A

-MAOIs
-Tricyclic antidepressants
-methyldopa
-respirine
-guanethidine

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23
Q

Other Methods for dilating meds

A

-spray bottle: Mist closed eyes and ask patient to blink. Dose amount is unknown possibly for children.
-pledget: Cotton swab saturated with drug solution and placed in eye to dilate section of iris

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24
Q

Something worth noting

A

Sympathomimetics are mydriatic with no cycloplegic effect

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25
Q

Something else worth knowing

A

Anticholinergics Are mydriatic and cycloplegic

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26
Q

What do carbonic anhydrase inhibitors do?

A

Reduce the production of aqueous to decrease intraocular pressure When topical treatments don’t work

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27
Q

Four antibacterial mechanisms of action

A

Inhibits:
-Folic acid synthesis
-DNA synthesis
-Protein synthesis
-Cell wall synthesis

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28
Q

Sulphonamide mechanism of action

A

-Inhibits folic acid synthesis during nucleotide production
-Broad spectrum
-Bacteriostatic
-Competitive inhibitor of PABA

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29
Q

PABA

A

P-aminobenzoic acid

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30
Q

Sulphonamides examples

A

Bleph-10 (sulphactetamide sodium)
-mostly ointment

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31
Q

Sulphonamides adverse effects

A

-Allergic reactions
-Stevens-Johnson syndrome
-tetrogenic

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32
Q

Flouroquinolones mechanism of action

A

-Inhibits DNA synthesis
-Broad spectrum
-Bactericidal


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33
Q

Flouroquinolones examples

A

-ciloxan (ciprofloxacin)
-vigamox (maxifloxacin)
- moxeza (maxifloxacin)
-same but with xanthan gum
-besivance (besifloxacin)
-zymaxid (gatifloxacin)

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34
Q

Fluoroquinolones adverse effects

A

-Foreign body sensation
-Itching and burning
-Conjunctival hyperaemia

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35
Q

Fusidic acid mechanism of action

A

-Inhibits protein synthesis
-Bactericidal or bacteriostatic

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36
Q

Fusidic acid example

A

Fusithalmic (fusidic acid)

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37
Q

Fusidic acid Adverse effects

A

-Stinging and irritation
-Localized allergic reactions

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38
Q

Aminoglycosides Mechanism of action

A

Inhibits protein synthesis
-Bactericidal

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39
Q

Aminoglycosides ophthalmic use

A

-Bacterial conjunctivitis
-Corneal ulcer

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40
Q

Examples of aminoglycosides

A

-tobrex (tobramycin) (NOT Tobradex)
-garamycin (gentamicin)
-neomycin (neomycin sulfate)

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41
Q

Aminoglycosides adverse effects

A

-type IV delayed hypersensitivity
-Itching, redness, swelling

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42
Q

Macrolides mechanism of action

A

-Inhibits protein synthesis
-Bactericidal or bacteriostatic

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43
Q

Examples of macrolides

A

Odan-erythromycin (Erythromycin)
-ointment
AzaSite (Azithromycin)
-solution

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44
Q

Macrolides adverse effects

A

-Blurred vision
-Allergic reactions

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45
Q

Polypeptide antibiotic mechanism of action

A

Inhibits cell wall synthesis
-Bactericidal for GRAM POSITIVE bacteria ONLY

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46
Q

Polypeptide antibiotic ophthalmic use

A

-Bacterial conjunctivitis
-Blepharitis

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47
Q

Polypeptide antibiotic examples

A

AK-Tracin (bacitracin)

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48
Q

Polypeptide antibiotic adverse effects

A

Allergic reactions

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49
Q

Examples of combination antibacterials

A

Polytrim (trimethoprim and polymyxin B)
Polysporin (bacitracin and polymyxin B)

50
Q

Polymyxin B Mechanism of action

A

Breaks down cell membranes
-Bactericidal for gram negative

51
Q

Trimethoprim mechanism of action

A

Prevents DNA synthesis


52
Q

Bacitracin mechanism of action

A

Interferes with cell wall synthesis

53
Q

Topical Antivirals mechanism of action

A

Inhibits synthesis of viral DNA

54
Q

Examples of topical antivirals

A

Viroptic (trifluridine)
-solution
Zirgan (ganciclovir)
-gel

55
Q

Topical antiviral adverse effects

A

-Eye irritation
-Conjunctival Hyperaemia
-Blurred vision
-Punctate keratitis (Damage to healthy cells on cornea)


56
Q

Types of antibacterial drugs

A

-Sulphonamides
-Fluoroquinolones
-Fusidic acid
-Aminoglycosides
-Macrolides
-Polypeptide antibiotic
-Combination antibacterials

57
Q

Types of antifungal drugs

A

-polyenes
-azoles
-antimetabolites

58
Q

Polyenes: amphotericin B Mechanism of action

A

-Forms pores in cell membrane-Compounded product
-Effective against yeasts and filamentary organisms

59
Q

Polyenes: natacyn (natamycin) Mechanism of action

A

-Inhibits cell membrane function
-Effective against filamentary organisms
-Commercially available
-Poor ocular penetration

60
Q

Azoles Mechanism of action

A

Inhibit cell wall synthesis

61
Q

Examples of azoles

A

-ketoconazole
-fluconazole
-variconazole

62
Q

Antimetabolites mechanism of action

A

Inhibits DNA and RNA synthesis

63
Q

Examples of antimetabolites

A

Flucytosine

64
Q

Treatment for acanthamoeba

A

-Topical neomycin
-Polyhexamethylene biguanide (PHMB)
-Chlorhexidine

65
Q

Treatment for Demodex mites

A

Cliradex (Tea tree oil)
-Alters cell membrane

66
Q

Arachidonic acid pathway

A

Pospholipase stimulates Phospholipid membrane to release AA, cyclooxygenase makes AA into prostaglandins, prostaglandins create inflammation

67
Q

Cyclooxygenase

A

An enzyme that facilitates conversion of AA to prostaglandins

68
Q

Prostaglandin

A

A natural chemical that creates inflammation

69
Q

Cyclooxygenase-1 releases this

A

Prostaglandins and thromboxane

70
Q

Cyclooxygenase-2 Releases this

A

Prostaglandins only

71
Q

Cyclooxygenase-1 inhibitors do this

A

Thin blood by inhibiting the release of thromboxane
-aspirin and naproxen

72
Q

Corticosteroids inhibit the enzyme

A

Phospholipase

73
Q

NSAIDs inhibit this enzyme

A

Cyclooxygenase

74
Q

General characteristics of corticosteroids

A

-Man made
-Mimics the effects of cortisol
-Anti-inflammatory at low doses
-Immunosuppressive at high doses

75
Q

Ophthalmic use of corticosteroids

A

-iritis
-Conjunctivitis
-Ocular allergies
-Inflammatory dry eye disease

76
Q

Strong corticosteroids

A

-pred forte (prednisolone acetate suspension 1%)
-durezol (difluprednate emulsion 0.05%)
-Lotemax (Loteprednol etabonate 0.5%) (susp, gel, ung)

77
Q

Mild corticosteroids

A

Alrex (loteprednol etabonate susp 0.2%)
FML (fluoromethalone acetate gel, ung 0.1%)

78
Q

Corticosteroids adverse effects

A

-elevated IOP
-Cataracts with long-term use
-Delayed wound healing
-Increased risk of infection

79
Q

Ophthalmic use of NSAIDs

A

-Treat pain and inflammation after cataract surgery
-Treat cystoid macular edema (CME)
-Off label use for pain management

80
Q

Examples of NSAIDs

A

-acularLS (ketorolac tromethamine sol 0.4)
-Voltaren (diclofenac sodium gel 1%)
-Ilevro (nepafenac susp 0.3)
-Prolensa (Bromfenac sol 0.07%)

81
Q

General use of NSAIDs

A

Inhibits cyclooxygenase pathway
-Prevents production of prostaglandins
-Anti-inflammatory and analgesic

82
Q

Adverse effects of NSAIDs

A

-Burning and stinging
-Corneal ulceration
-Possible corneal melts

83
Q

Blephamide

A

Sulphonamide antibiotic with corticosteroid
-sodium suphacetamide 10%
-Prednisone acetate 0.2%
-susp or ung

84
Q

Adverse effects of Blephamide

A

-Allergic reaction
-stevens-Johnson
-Elevated IOP
-Cataract formation

85
Q

TobraDex

A

Aminoglycoside antibiotic with corticosteroid
-Tobramycin 0.3% (aminoglycoside)
-Dexamethasone 0.1% (corticosteroid)
-susp, ung, or sol

86
Q

Adverse effects of TobraDex

A

-Allergic reactions
-Elevated IOP
-Cataracts

87
Q

Maxitrol

A

Aminoglycoside antibiotics with corticosteroid
-neomycin (affects both gram-things)
-polymyxin B (affects gram negative)
-dexamethasone (corticosteroid)
-susp or ung

88
Q

Maxitrol adverse effects

A

-Allergic reactions
-Elevated IOP
-Cataracts

89
Q

Zylet

A

Aminoglycoside and corticosteroid
-tobramycin 0.3%
-Loteprednol etabonate 0.5%


90
Q

Adverse effects of Zylet

A

-Less risk of IOP elevation
-allergic reaction w tobramycin

91
Q

Two categories of immunomodulators

A

-Immunostimulators
-Immunosuppressive

92
Q

Sjögren’s syndrome

A

Dry eyes and mouth caused by body attacking saliva and tear glands

93
Q

Restasis Mechanism of action

A

-Inhibits inflammation in tear glands
-Increases tear production

94
Q

Restasis Ophthalmic use

A

-Dry eye
-sjogren’s syndrome 

95
Q

Restasis Adverse effects

A

-Conjunctiva hyperaemia
-stinging, epiphoria, FBsensation
-blurry vision

96
Q

Xiidra (lifitegrast solition 5%)

A

Competitively interferes with inflammatory cycle

97
Q

Xiidra Ophthalmic use

A

-Inflammatory dry eye disease
-sjogrens syndrome

98
Q

Xiidra adverse effects

A

-Metallic aftertaste
-Burning stinging irritation
-Blurry vision

99
Q

What does histamine do in our body

A

-Allergic reactions
-immune Response
-Gastric acid secretion
-Neurotransmitter in brain

100
Q

Types of allergic conjunctivitis

A

-Seasonal
-Perennial
-Giant papillary conjunctivitis
-Vernal keratoconjunctivitis
-Atopic keratoconjunctivitis

101
Q

OTC allergy pharmaceuticals

A

-Artificial tears
-Vasoconstrictors (visine)
-Mast cell stabilizers (opticrom)
-Antihistamines (refresh eye allergy relief)

102
Q

What do mast cell stabilizers do?

A

Prevents release of histamine from mast cells

103
Q

Examples of mast cell stabilizer

A

Alomide (lodoxamide tromethamine solution 0.1%)

104
Q

Examples of combination anti-histamine and mast cell stabilizers

A

-pataday (olapatidine hydrochloride sol)
-zaditor (ketotifen fumarate solution)
-bepreve (bepotasine besilate solution)

105
Q

Classes of glaucoma drugs

A

-Cholinergic
-Parasympathomimetic
-anticholinesterase
-Adrenergic
-Beta blockers
-Alpha adrenergic
-Carbonic anhydrase inhibitors
-Prostaglandin analogues
-rho kinase inhibitors
-combination glaucoma meds

106
Q

Purpose of glaucoma medications

A

-Lower IOP
-Increase drainage through TM and Uveoscleral pathway
-Reduce aqueous production
-neuroprotective

107
Q

Parasympathomimetic drugs

A

-isopto carpine (pilocarpine hydrochloride)

108
Q

Adverse effects of parasympathomimetic drugs

A

-Burning, stinging
-miosis
-Headache
-May worsen angle closure by shallowing anterior chamber

109
Q

Cholinesterase inhibitors example

A

Phospholine iodide (echithiopate iodide)

110
Q

Cholinesterase inhibitors adverse effects

A

-Burning, stinging
-Conjunctival and ciliary redness
-Small pupil, brow ache
-Induced myopia

111
Q

Beta blockers mechanism of action

A

-Block beta adrenergic receptors
-Reduce aqueous humour production

112
Q

Beta blockers examples

A

-Timoptic (timolol maleate sol or gel)
-betoptic (betaxolol)
-betagan (levobunolol hydrochloride sol)

113
Q

Beta blockers adverse effects

A

-Bradycardia
-Shortness of breath

114
Q

Alpha agonists mechanism of action

A

-Reduce aqueous humour production
-Increase Uveoscleral outflow

115
Q

Examples of alpha agonists

A

Alphagan (brimonidine solution 0.1%)

116
Q

Adverse effects of alpha agonists

A

-Redness, itching
-Dry mouth
-Dysgeusia

117
Q

Carbonic anhydrase inhibitor mechanism of action

A

-Inhibits carbonic anhydrase enzyme
-Reduces aqueous production

118
Q

Examples of carbonic anhydrase inhibitor

A

Azopt (brinzolamide sol)
Trusopt (dorzalamide sol)

119
Q

Prostaglandin analogues mechanism of action

A

-nitric oxide increases uveoscleral and TM outflow

120
Q

Examples of prostaglandin analogues

A

-xalatan (latanoprost sol 0.005%)
-lumigan (bimatoprost sol 0.03%)
-travatan (travoprost sol 0.004%)
-vyzulta (latanoprostene bunod sol 0.024%)

121
Q

Mechanism of rho Kinase inhibitor

A

-Inhibit norepinephrine transport to reduce aqueous production
-Increase TM outflow

122
Q

Examples of rho kinase inhibitor

A

Rhopressa (netarsudil solution 0.02%)

Pathology And Pharmacy 309 (7 decks)

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