Oc Pharm Antiinflammatory

Front 1

The important anti-inflammatory drugs are

Back 1

corticosteroids
nsaids
antihistamines
decongestants
mast cell stabalizes
cyclosporin

CNADMC

MAD CNN

Front 2

The adrenal medulla secretes __________
while the cortex secretes

Back 2

medulla --> epi and norepi

cortex --> aldosterone, minerlocrotcoids, gucocorticoids --> supresses inflammation

Front 3

Anterior pituitary secretes _ which stimulates adrenal cortex

Back 3

ACTH

Front 4

the action of ________ is responsible for the production of cortisol

Back 4

c-AMP

ACTH effects on adrenal cortex is also mediated by this

Front 5

Hypothalamus secretes __ which stimulates the anterior pit. to produce _____ which stimulates the release of _____ hormones

Back 5

CRF

ACTH
adrenal cortical

Front 6

Effects of glucocorticoids

Back 6

increase production of glucose, glycogen storage increase
redistrubtion of body fat to back of neck and face (moon face)
causes eupohria, insomnia,
response of inflmmation are SUPRESSED

Front 7

the objective of making synthetic steriods has been to

Back 7

enhance anti-inflammatory effects and reduce Na retention effects

Front 8

T/F Prednisolone, dexamthason and fluorometholon significantly inhibit corneal reepithelialization

Back 8

TRUE

also inhibits corneal adenylate cyclase activity

Front 9

Stroids may canse an increase in _______ in aqueous and vitreous humors and reduces _________

Back 9

proteins and glucose increases
ascorbic acid decreases
Aq outflow facility decreases leading to IOP increase!!

Front 10

T/F Steriods case opacities in lens to increase

Back 10

T

Front 11

T/F Steriods are used in ocular infection without worry

Back 11

FALSE

steriods are contraindicated unless used in conjunction with anti-infective agents

Front 12

In general, steriods that are manufactured as _________ are more LIPID soluble and steriods that are manufcated as ____ are more water soluble

Back 12

SUSPENSIONS

SOLUTIONS

Front 13

Which type of steriod is more water soluble?

Back 13

solution

Front 14

T/F ALCOHOL steriod solns are more LIPOHILIC than ACETATES

Back 14

FALSE

Reverse is true

Front 15

T/F is epithelium is intact, acetate steroid form produces significantly higher corneal and aq steriod levels than phosphate derivates

Back 15

TRUE

however, if epithelium is not inact, the drug level is higher for phosphate than acetate!!!

Front 16

Suspension steriods are better at treating _____- eye disease, and solutiosn are better for treating ________ eye diseases

Back 16

INTERNAL

EXTERNAL

Front 17

T/F the naturalyl occuring steriod hydrocortisone has the most anti-inflammatory activity

Back 17

FALSE
has the least

Front 18

6 synthetic steriod drugs

Back 18

Prednisolone
Dexamethasone
Fluromtholone
Medrysone
Loteprednol
Rimexolone

Front 19

T/F Hydrocortisone is not avalable as a single entity drug

Back 19

TRUE

must be mixed with various antbiotics

Front 20

The most effective anti-inflam topical ocular steriod for anterior segment ocular inflammation is

Back 20

1% acetate prednisolone

Front 21

The first drug of choice for treating moderate to severe forms of ocular inflammation

Back 21

prenisolone

Front 22

second drug of choice for treating moderate to severe forms of ocular inflammation

Back 22

dexamethasone

Front 23

This drug is a fluorinated structural analog of progesterone

Back 23

flurometholone

Front 24

The acetate form (suspension) of Flurometholone appears to be _______ effective than the alocohol form and as effective as ___ in its anterior seg anti-inflam properties

Back 24

MORE

Prednisolone

Front 25

The alcohol form of Flurotheolone is the drug of choice for treating

Back 25

LONG TERM chronic external ocular inflammation because it is less likely to elevate IOP than prednisolone and dexamthosone

Front 26

The least likely available topical ocular steriod to cause increase in IOP is

Back 26

medrysone.
It penetrates cornea VERY poorly.

Front 27

Loteprednol has little tendency to elevate IOP because

Back 27

it immediately metabolizes to an inactive form once it reaches target tissue. VERY SAFE!

Front 28

Loteprednol is avaible in

Back 28

.5% and .2% suspension

lower concentration is approved for ocular allergies and higher is approved for anterior segment inflammation, it is just as efficacious as 1% prednisolone.

Front 29

This topical steroid is avalable as a dermatological cream

Back 29

Triamcinolone. Useful in treating lid skin allergic reactions.
NOT to be used directly on eye.

Front 30

T/F long term high doses of ocular steriods should be reduced gradually

Back 30

TRUE

Front 31

These three ocular steriods are safest and shoudl be used whenever possible

Back 31

prenisolone
fluormetholone
medrysone

Front 32

For systemic administration of steriod drugs use

Back 32

predniosne and triamcinolone and use minimal effective dose for shortest time possible

Front 33

for local injections of steroid drugs, use

Back 33

methylprednisolone acetate or triamcinolone

Front 34

2 intraocular steroidal implants

Back 34

dexamethasone mplant
flucinolone acetonide implant

Front 35

T/F Dexamethasone implant has a zero order kinetics with anti-inflam effects lasting days to weeks

Back 35

T
implanted during caract surgery in anterior chamber

Front 36

Fluocinolne acetonide implant is used for

Back 36

noninfectious posterior uveitis, can release drug for up to 3 years

Front 37

Possible contraindications for steriods

Back 37

diabetes mellitus, infections, chronic renal failure, ulcers, glaucoma

Front 38

Drug interactions with steriods

Back 38

rifampin, barbituates, anticoagulant drugs

Front 39

ALTERNATE DAY THERAPY

Back 39

Method not widely accepted
Used only for shorter acting systemic steroid such as prednisolone indicated
Useful when long term therapy indicated

Front 40

ACTIONS OF NSAID
In ascending concentration of dose the following effects occur when these drugs are administered systemically

Back 40

Antiplatelet (reduced blood clotting)
Analgesic (reduction pain sensation)
Antipyretic (reduced fever)
Anti-inflammation

Front 41

Since NSAIDs inhibit cyclo-oxygenase but not lipooxygenase, these agents only inhibit ocular inflammation induced by prostaglandins but not _______________

Back 41

leukotrienes

Front 42

COX-1 produces prostaglandins that have _____________ such as _______ and ____________

Back 42

cytoprotective effects

Mucus production and Mediation of platelet aggregation

Front 43

COX-2 produces prostaglandins that have ____________
In eye effects include the following:

Back 43

pro-inflammatory effects

post-op inflammation, uveitis, allergic conjunctivitis, miosis and cystoid macular edema (CME)

Front 44

T/F Cox-1 is proinflammatory

Back 44

FALSE, that is cox-2

Front 45

The lower the IC50 the ___________ the potency

Back 45

HIGHER!!

Front 46

IC50 FOR COX-1 in order from highest potency to lowest

Back 46

Flurbiprofen
Ketorolac
Nepafenac
Bromfenac
Diclofenac

FKN BD

Front 47

IC50 FOR COX-2 in order of highest potency to lowest

Back 47

Bromfenac
Diclofenac
Flurbiprofen
Ketorolac
Nepafenac

Front 48

Topical NSAIDS include

Back 48

Diclofenac sodium (Voltaren)
Keterolac (Acular)
Flurbiprofen (Ocufen)
Suprofen (Profenal)
Nepafenac (Nevanac)
Bromfenac (Xibrom)

Front 49

T/F DICLOFENAC SODIUM
(Voltaren, 0.1% sol.) is a topical NSAID that effects IOP levels

Back 49

FALSE
An acetic acid derivative that reduces pain and inflammation and has no significant effect on IOP –FDA approved indications: Tx of post op (cataract) ocular inflammation and corneal refractive surgery

Front 50

KETEROLAC
(Acular, 0.5% solution is a topical NSAID that is used for

Back 50

Relief of ocular itching due to seasonal allergy
Post-op cataract surgery inflammation

Front 51

FLURBIPROFEN is a topical NSAID that is used for

Back 51

Blockade of intraoperative miosis, 1qtt q1/2 hr beginning 2 hrs prior to surgery

Front 52

SUPROFEN
is a topical NSAID used for

Back 52

Intraoperative miosis, 2qtts qid day before surgery and 2 qtts 3, 2, and 1 hr before surgery

Front 53

First FDA approved topical ocular non steroidal anti-inflammatory prodrug

Back 53

NEPAFENAC

Front 54

T/F Nepafenac is a topical nsaid that easily penetrates the cornea

Back 54

T

Front 55

Uses of Nepafenac, a topical nsaid

Back 55

Treatment of inflammation and pain associated with cataract surgery –TID dosing starting one day prior to surgery and continuing 2 weeks post operative –As with all ocular suspension, the bottle must be shaken before drug administration

Front 56

BROMFENAC is a _________ that is used to_________

Back 56

topical NSAID

–Inhibits cyclooxygenase •FDA approved use –Treatment of inflammation and pain associated with cataract surgery

Front 57

T/F NSAIDs to not effect time of corneal healing

Back 57

FALSE

they increase the time it takes the cornea to heal

Front 58

Type I (Immediate)hypersensitivity reaction definition

Back 58

involves mast cells, antigens, antibodies and histamine –Allergic and vernal conjunctivitis

Front 59

Type IV (Delayed)hypersensitivity reaction involves

Back 59

involves T lymphocytes antigens and lymphokines –Vernal conjunctivitis, atopic keratoconjunctivitis & preservative induced blepharoconjunctivitis in CL wear

Front 60

histamine is stored in these cells

Back 60

mast

Front 61

H1 receptors are found in

Back 61

Smooth muscle of bronchi, blood vessels & intestines

Front 62

H2 receptors are found in

Back 62

Gastric parietal cells, heart, pulmonary blood vessels, cells of immune system, and other tissues

Front 63

T/F
H1 ANTIHISTAMINES Reversibly bind to H1 receptors blocking histamine and inhibiting Type I reactions

Back 63

T
Also have antimuscarinic, local anesthetic and CNS properties (depression or stimula-tion)

Front 64

H1 ANTIHISTAMINES onset is ____ min, max effect in _____ hours and last _____ hours

Back 64

•Onset 30 min., max. 1-2 hrs., duration 4-8 hrs.

Front 65

H1 ANTIHISTAMINES are metabolized by _____ and excreted by _____

Back 65

Metabolized by liver and excreted in urine

Front 66

SINGLE-DRUG TOPICAL OCULAR ANTIHISTAMINES

Back 66

1.Levocabastine
2.Emadastine difumarate (Emadine)

Front 67

ANTIHISTAMINE-VASOCONSTRICTOR COMBINATIONS

Back 67

•Antazoline-naphazoline (Albalon-A) •Pheniramine-naphazoline (Opcon-A)

•Pyrilamine-phenylephrine (Prefrin-A)
•Pheniramine-phenylephine (AK-Vernacon)

Front 68

Diphenhydramine (Benedryl) is a ____ H1 receptor ______ type

Back 68

Sedating H1 receptor competitive antagonist type

Front 69

•Non-sedating H1 receptor non-competitive antagonist types include

Back 69

Chlorpheniramine (Chlor-trimeton)
Loratadine (Claritin), Desloratadine (Clarinex), Fexofenadine (Allegra) and Cetirizine (Zyrtec)

Front 70

What causes benedryl to be sedating?

Back 70

Lipid solubility allows entrance into brain with resulting sedation

Front 71

T/F DIPHENHYDRAMINE
(Benedryl)Has antimusarinic effects

Back 71

FALSE

anticholinergic

Front 72

Decongestants are _____ agonists that _______ conjunctival vessels

Back 72

Adrenergic agonists

•Constrict conjunctival vessels

Front 73

This warning primarily applies to systemically administered decongestants

Back 73

•Discontinue use prior to use of inhalation type general anesthetics (cyclopropane & halothane) which sensitize myocardium to sympathomimetics

Front 74

MAST CELL STABILIZERS

Back 74

•CROMOLYN SODIUM
•NEDROCROMIL SODIUM (Alocril, Allergan)
•LODOXAMIDE (Alomide, Alcon)
•PERMIROLAST POTASSIUM

CNLP

Front 75

T/F Chromoyln Sodium is a mast cell stabalize that gives immediate relief of ACTUE allergic symptoms

Back 75

FALSE
Does not give immediate relief of acute allergic symptoms but very useful for management of chronic allergies

Type I allergic conjunctivitis: relief of symptoms of acute disease occurs within 7 days •Indicated for relief of chronic allergies –Vernal conjunctivitis: Used with steroids –Giant papillary conjunctivitis

Front 76

H1 receptors are found in

Back 76

Smooth muscle of bronchi, blood vessels & intestines

Front 77

H2 receptors are found in

Back 77

Gastric parietal cells, heart, pulmonary blood vessels, cells of immune system, and other tissues

Front 78

T/F
H1 ANTIHISTAMINES Reversibly bind to H1 receptors blocking histamine and inhibiting Type I reactions

Back 78

T
Also have antimuscarinic, local anesthetic and CNS properties (depression or stimula-tion)

Front 79

H1 ANTIHISTAMINES onset is ____ min, max effect in _____ hours and last _____ hours

Back 79

•Onset 30 min., max. 1-2 hrs., duration 4-8 hrs.

Front 80

H1 ANTIHISTAMINES are metabolized by _____ and excreted by _____

Back 80

Metabolized by liver and excreted in urine

Front 81

SINGLE-DRUG TOPICAL OCULAR ANTIHISTAMINES

Back 81

1.Levocabastine
2.Emadastine difumarate (Emadine)

Front 82

ANTIHISTAMINE-VASOCONSTRICTOR COMBINATIONS

Back 82

•Antazoline-naphazoline (Albalon-A) •Pheniramine-naphazoline (Opcon-A)

•Pyrilamine-phenylephrine (Prefrin-A)
•Pheniramine-phenylephine (AK-Vernacon)

Front 83

Diphenhydramine (Benedryl) is a ____ H1 receptor ______ type

Back 83

Sedating H1 receptor competitive antagonist type

Front 84

•Non-sedating H1 receptor non-competitive antagonist types include

Back 84

Chlorpheniramine (Chlor-trimeton)
Loratadine (Claritin), Desloratadine (Clarinex), Fexofenadine (Allegra) and Cetirizine (Zyrtec)

Front 85

What causes benedryl to be sedating?

Back 85

Lipid solubility allows entrance into brain with resulting sedation

Front 86

T/F DIPHENHYDRAMINE
(Benedryl)Has antimusarinic effects

Back 86

FALSE

anticholinergic

Front 87

Decongestants are _____ agonists that _______ conjunctival vessels

Back 87

Adrenergic agonists

•Constrict conjunctival vessels

Front 88

This warning primarily applies to systemically administered decongestants

Back 88

•Discontinue use prior to use of inhalation type general anesthetics (cyclopropane & halothane) which sensitize myocardium to sympathomimetics

Front 89

MAST CELL STABILIZERS

Back 89

•CROMOLYN SODIUM
•NEDROCROMIL SODIUM (Alocril, Allergan)
•LODOXAMIDE (Alomide, Alcon)
•PERMIROLAST POTASSIUM

CNLP

Front 90

T/F Chromoyln Sodium is a mast cell stabalize that gives immediate relief of ACTUE allergic symptoms

Back 90

FALSE
Does not give immediate relief of acute allergic symptoms but very useful for management of chronic allergies

Type I allergic conjunctivitis: relief of symptoms of acute disease occurs within 7 days •Indicated for relief of chronic allergies –Vernal conjunctivitis: Used with steroids –Giant papillary conjunctivitis

Front 91

This mast cell stabalizer not only inhibits histamine release, but also inhibits chemotaxis of eosinophils and release of pro-inflammatory substances from these cells

Back 91

NEDROCROMIL

Front 92

Clinical uses of nedrocromil (a mast cell stabalizer)

Back 92

Perennial allergic conjunctivitis and GPC

Front 93

COMBINATION ANTIHISTAMINE-MAST CELLS include

Back 93

STABILIZERSOLOPATADINE (Pataday, Alcon)
OLOPATADINE (Patanol, Alcon) KETOTIFEN FUMARATE (Zaditor, Ciba)
AZELASTINE HCL (Optivar, B&L) EPINASTINE HCL (Elastat, Allergan)

A-OK'ES

Front 94

T/F Pataday should not administer while CL in eye since preservative (Benz. Cl) absorbs into Cl

Back 94

T

Front 95

_________ is an immunomodulator with anti-inflammatory effects, but exact mechanism not known

Back 95

CYCLOSPORIN
(Restasis)

Front 96

Restasis is used clinically in patients with

Back 96

keratoconjunctivitis sicca secondary to reduced tear production due to ocular inflammation, Restasis is believed to act as a partial immunomodulator
•Results in increased tear production

Front 97

Dosage and Administration of Restasis includes

Back 97

–1qtt q12h
- Shake bottle
–Can be used concurrently with artificial tears