Een Pharmacology

Front 1

Mydriatic vs. Anticholinergic vs. Parasympatholytic

Back 1

They all mean the same thing

Front 2

*Pharmacology of beta blockers for glaucoma

Back 2

Decrease ocular pressure by decreasing formation of aqueous humor. End with "-olol". Very commonly used. SE: ocular irritation and dry eyes. Don't with with cardiac problems.

Front 3

*Pharmacology of prostaglandins for glaucoma

Back 3

Decrease ocular pressure by increasing clearance of aqueous humor. End with "-ost". Most commonly used to treat glaucoma. SE: darkening of eyelashes.

Front 4

*Pharmacology of cholinergics for glaucoma

Back 4

Stimulates M3 receptor on eye, causing contraction and allowing fluid to flow out into anterior chamber and then out of the canal of schlemm. Less used now because of SE profile.

Front 5

Pharmacology of adrenergic agonists for glaucoma

Back 5

End with "-idine". Not commonly used d/t to SE. Red eye and ocular irritation.

Front 6

Basics of antibiotics in the eyes

Back 6

Antibiotics are rarely indicated, but when so, treatment is empiric (because we don't typically culture the eye). Erythromycin, Trimethoprim-Polymyxin B, Ofloxacin, Ciprofloxacin.

Front 7

*What is a common mydriatic agent and what are its common side effects?

Back 7

Mydriatic = pupil dilation. Tropicamide (pupillary dilator). SE: Increased intraocular pressure especially in elderly, psychotic rxns, belladonna toxicity, increased systemic absorption in inflammation, discolors contacts

Front 8

*How does cyclosporin A treat dry eye?

Back 8

Turn off calcineurin (shuts off T cells) --> reduces inflammation in lacrimal glands --> increased fluid in eye

Front 9

*What are the pathophysiologic effects of histamine?

Back 9

Mast cells degranulate (release histamines) as a response to antigens --> Directly cause nerve stimulation (itching) and vasodilation (redness). Indirectly via mediators (prostaglandin, heparin, tryptase) cause fluid leakage out of blood vessels = swelling.

Front 10

*How do antihistamines work?

Back 10

Block to histamine H1 receptors as a full antagonist, blocking their actions.

Front 11

*What are the differences between 1st, 2nd, and 3rd gen. antihistamines?

Back 11

1st Gen are lipophilic (cross BBB) and cause sedation, urinary retention (anti-cholinergic effect), liver cleared. 2nd Gen are not lipophilic and do not cross BBB. 3rd Gen. are metabolites of 2nd gen.

Front 12

*What are the various MOAs of antihistamines beyond the histamine receptor? (Including anti-cholinergic SEs)

Front 13

*What are some topical antihistamine/vasoconstrictor combinations? What happens if you use a vasoconstrictor for too long and then stop it?

Back 13

Naphcon-A, Opcon-A, Visine-A. Rebound hyperemia --> Blood vessels overreact and become very dilated. Beefy red eyes.

Front 14

*What is cromolyn sodium and what does it do in the eye?

Back 14

It is a mast cell stabilizer. Prevents histamines from being release. Slow onset, may take up to 6 weeks to start being effective.

Front 15

*What are the cautions and concerns for using ophthalmic steroid eye drops?

Back 15

They can cause cataracts in the eye, glaucoma. Immune suppression can allow many diseases to quickly take over (herpes) --> Dendritic lesions are a major concern.

Front 16

*What are the various antibiotics available for ophthalmic use and their indications?

Back 16

Blephamide (sulfacetamide+prednisolone) although most staph is not sensitive. Pred-G, Tobradex, Zylet (aminoglycosides+steroids). Azasite (azithromycin) fairly useful with few SE.

Front 17

Topical Pain management in the eye

Back 17

NSAIDs and Voltaren Ophthalmic, but are contraindicated in corneal abrasion (eye surgery).

Front 18

Topical anesthetics in the eye

Back 18

Tetracaine (drops) and Lidocaine gel)

Front 19

*1st and 2nd line treatments for OM?

Back 19

1st: Amoxicillin (Active against S. pneumoniae, H. influenzae, M. catarrhalis). Augmentin for severe otalgia or elevated temperature to cover B-lactamase producing H. influenzae. Failing that: another 10 day course of a broader spectrum - Augmentin, 2nd Gen. Ceph. oral (Cefuroxime), 3rd Gen. Ceph. (Cefdinir oral, Ceftriaxone IM). B-lactam allergy --> azith or clarith or TMP.

Front 20

*Calculate a pediatric dose of amoxicillin and write its prescription

Front 21

Medication for seborrheic dermatitis

Back 21

Selenium sulfide shampoo, steroid ear drops (for itching).

Front 22

*What is a topical ear analgesic and how do you use it?

Back 22

Auralgan OTC.

Front 23

Ear antibiotics

Back 23

Cortisporin Ear Drops: Be aware, it contains polymyxin which has ototoxicity. No more than 10 days.

Front 24

Application of ear drops to middle ear of someone with ear tubes

Back 24

Turn affected ear up. Drop 5 drops into the ear canal. "Pump" it in by pushing on the tragus.

Front 25

*What is the 1st line anti-inflammatory agent used in early OE? What antibiotics are used for more advanced infections?

Back 25

Vosol (acetic acid) or Cortisporin (aminoglycoside + steroid). Ciprofloxacin +/- dexamethasone, otofloxacin.

Front 26

Nasal antihistamines

Back 26

Olopatadine (2nd Gen. Mast cell stabilizer). May take 3 weeks to have full effect, and not every effective anyway. (Better off with oral)

Front 27

Nasal steroids

Back 27

Flonase, Nasocort (<2% systemic absorption)

Front 28

Antihistamines and tolerance

Back 28

There is no evidence of tolerance in antihistamines.

Front 29

*What class does meclizine belong to? And how is it used in vertigo and motion sickness?

Back 29

Meclizine is a 1st Gen. antihistamine. MOA: related to lipophilicity, possibly calcium channel blocker, and blocking of vestibular signaling to vomiting center. SE: Drowsiness, avoid alcohol, caution with renal impairment especially in elderly.

Front 30

*What are leukotrienes? What is their role as an inhibitor in this pathway? Where can this class be used? What is its potency compared to other choices?

Back 30

Leukotrienes are similar to prostaglandins in causing inflammation. Montelukast inhibits the pathway that causes inflammation. Not as potent as other antiinflammatories but very few SE.

Front 31

*What is rhinitis medicamentosa? How does it occur?

Back 31

Application of nasal vasoconstrictors too long followed by sudden d/c. Your blood vessels react by vasodilating and becoming leaky --> Massive rhinitis.

Front 32

*What is the MOA of topical anesthetic benzocaine? What is methemoglobinemia and how is it related? What is the antidote?

Back 32

Inhibits sodium channels in neurons. Spray can of anesthetic - works quickly and for a while. Rare reaction (Methemoglobinemia) causes inability to dissociate oxygen from blood. Antidote is methyl blue IV.

Front 33

*What is thrombin gel used to treat and what is it's MOA?

Back 33

Used to treat epistaxis. Acts to help platelet activation, and helps form a clot.