Anti-Inflammatory Agents And Anti-Infectives

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NSAIDS are usually used in ophthalmology following

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intraocular surgery

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Cardinal signs of inflammation

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redness, heat, swelling, pain

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redness

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rubor

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heat

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calor

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swelling

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tumor

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pain

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dolor

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5th sign of inflammation

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loss of function of affected parts

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rubor is when

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blood vessels dilate so more blood is pumped into the injured area

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calor happens when

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tissue temperature increases to speed up the cellular processes and begin repair

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prostaglandins are

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regulatory chemicals of the inflammatory process

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Ocular effects of prostaglandins

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pain, miosis, alter IOP

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Steroids are _______ Than NSAIDS

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stronger

Front 13

three classifications of steroids

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anabolic, adrogenic, corticosteroids

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anabolic steroids

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what athletes use to train harder

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medical uses for anabolic steroids

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treatment of delayed puberty, impotence, body wasting from AIDS

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Large quantities of these supplements increase testosterone

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anabolic steroids

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abuse of anabolic steroids can lead to

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insufficient production of naturally occuring hormones in the body

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androgenic steroids aid in

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growth of male reproductive tract and secondary sex characteristics

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corticosteroids are

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man made

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corticosteroids mimic the action of

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cortisone

Front 21

the workhorses of ophthalmic care when it comes to decreasing ocular inflammation

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corticosteroids

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body produces natural cortisol in the ___ glands

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adrenal

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Triamcinolone (alcon, allergan)

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IV
sympathetic ophthalmia, uveitis, temporal arteritis

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Intravitreal implant

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ozurdex (allergan) for macular edema

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Prednisolone is _________

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the standard

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steroids work by

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decreased dilation of blood vessels, decrease WBC proliferations, decreased mast cell proliferation and release of histamine

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Side effects of corticosteroids

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proliferations of infections, delayed healing, corneal perforation, increased IOP, PSC cataract

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Adrenocortical insufficiency

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steroid withdrawal, we taper therapy to avoid this, rebound inflammation

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Steroid responder

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increased IOP

Front 30

Acetaminophen

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has no anti-inflammatory effect

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NSAIDS are derived from

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ASA

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NSAIDS specifically reduce

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prostaglandin response

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3 approved ocular uses of NSAIDS

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pain, itching, miosis prevention during surgery

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Effects of NSAIDS

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antipyretic, analgesic, inhibits blood clotting

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a major side effect of NSAIDS is

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kidney dysfunction

Front 36

Diclofenac (Voltaren)

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used for post op inflammation, corneal pain, refractive surgery

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ketorolac (acular)

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relieves itching due to allergic conjunctivitis, cornal pain

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nevanac

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treatment of pain and inflammation after cataract surgery, analgesic prodrug

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xibrom

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used for inflammation and pain after cataract surgery

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shotgun therapy isnt recommended because

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it leads to resistant organisms

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infection is

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when our body's defense mechanisms are overcome by microorganisms

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the corneal epithelium is an intact _______

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barrier to resist infection

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Bacteriocidal therapy is the ___________

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drug of choice

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gram positive (blue) microorganisms

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staph, strep

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gram negative (red)

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gonorrhea, flu, pseudomonas

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spectrum of action

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the bateria that a drug is effective in eliminating

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nonbacterial organisms

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protozoa, toxoplasmosis, chlamydia

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antibiotics are often combined with _______

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steroids

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most common anti-infectives to have allergies towards

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sulfa, penicillin

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Bactracin

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ointment, bacteriocidal, blepharitis

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vancomycin

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against gram +, toxic

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polymixin B

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pseudomonas, toxic to kidneys and CNS

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Gramicidin

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little OPH use

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Penicillin

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broad spectrum, Gram +, 10% allergic

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Cephalosporin

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son of penicillin, bacterial corneal ulcers

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Aminoglycosides

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commonly used in OPH, broad spectrum, may cause auditory toxicity

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Neomycin

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"neosporin" most toxic, broadest spectrum, popular with ER

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Gentamicin

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less tendency to allergic reaction

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Tobramycin

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most common for many infections, effective, broad spectrum

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maxitrol

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neomycin + steroid

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zylet, tobradex

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tobramycin+ steroid

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FML-S, blephamide

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sulfa + steroid

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Tetracylcine

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good for neonatal conjunctivitis, chlamydial infection

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contraindicated in pregnancy, young kids, diabetic, those on anticoagulants

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tetracylcine/chlortetracylcine

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azithromycin

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used for bacterial conjunctivitis, chlamydia

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chloramphenical

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extremely effective, but not used in the USA

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trimethoprim

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used in combo with polymyxin B, good for childhood conjunctivitis

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sulfonamides

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"old standby", used for tx of toxoplasmosis

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fluroquinolones

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low corneal toxicity, effective, expensive

Front 70

4 types of Herpes Virus

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Herpes Simplex, Varicella Zoster, Epstein-Barr, Cytomegalovirus

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trifluridine

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choice drug for ocular herpes, corneal toxicity with prolonged useage

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gancyclovir

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implant into eye for cytomegalovirus retinitis in AIDS patients

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Natamycin (natcyn)

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only topical antifungal agent for the eye

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examples of ocular inflammations treated with corticosteroids

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allergic conjunctivitis, optic neuritis, chemical burns, graves ophthalmopathy

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two classes of anti-inflammitory agents

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NSAIDS, Steroids

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ocular complications of topical steroid use

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delayed wound healing, increased IOP, cataract

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NSAIDs have ___ side effects than steroids

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fewer