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112 Cards in this Set

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Production of bicarbonate in the ciliary epi plays a key role in
aqueous humor production
Inhibition of ________ in the ciliary processes decreases bicarbonate, Na, and fluid movement into the posterior chamber
carbonic anhydrase
Contra-indicated in pts with COPD as a glacoma med b/c of excessive CO2 production
carbonic anhydrase inhibitors (CAI)
A systmeic CAI
Acetazolamide
trade name for systemic Acetazolamide
Diamox
Oral dosage for Acetazolamid (Diamox) systemic
250mg tab po QID
500mg cao (sequel) po BID
Side effect of CAI
(1) Paresthesias (lip tingle)
(2) metallic taste
(3) Depression
(4) hypokalemia
(5) acidosis
Topical CAIs
(1) Dorzolamide
(2) Brinzolamide
CAI that has a 20-25% reduction of IOP like systemic B blocker and alpha-2 agonist
TruSopt
CAI effect on blood flow is clinically _________________.
insignificant. Prescribe to reduce IOP
Monotherapy of Dorzolamide RX
TID
Combination Dorzolamide and Timoptic XE
BID
Side effect of dorzolamide in severe corneal tissue toxicity for example_________
Fuch's dystrophy
CAI cap color
pumpkin range
Cosopt contains
timolol 0.5% and dorzolamide
Cospot ocular hypotensive effect equal to
lantanoprost
combo timolol 0.5% and dorzolamide 2% (Cosopt) make it
less expensive
more effective
Brinzolamide is a more or less comfortable that dorzolamide
more
Brinzolamide is formulated as a
suspension
shake once a month
Brinzolamide has equivalent effects on IOP with dosage of
BID or TID
Contraindications for Systemic CAIs
(1) lover disease
(2) Severe COPD
(3) secondary glaucoma
(4) renal disease, kidney stones
(5) pregnancy
(6) hypersensitivity to sulfonamides
Sulfonamide antibiotics do not cross react with other sulfa drugs
T or F
True
1st line of therapy for glaucoma
prostaglandin analogs
Prostaglandin, cannabinoids, and prostamide are part of the _____________family receptors
Lipid
Prostaglandin cap color
teal
Examples of prostaglandins
(1) Latanoprost
(2) Travoprost
Example of prostamides
bimatoprost
The gold standard prostaglandin
Latanoprost (XALATAN)
The tradename for latanoprost
Xalatan
Prostaglandin pro-drugs initially don't work due to
must penetrate and react with esterase to become ACID form
target tissue of prostaglandin
CB
latanoprost activates_____________, increases ______________, and reaches peak effect at ___________.
(1)FP receptors for prostaglandin F2alpha
(2) uveoscleral outflow
(3) 8 hours
lantanoprost is an effective drug for acute angle glaucoma?
T or F
F
peak effect is 8 hours after dose. Reason take at bedtime.
Prostaglandin should not be used for what form of uveitis?
inflammatory glaucoma uveitis due to increase inflammation with prostaglandin
Prostaglandin reduces IOP by _____________ by mechanism of increased _____________
30-25%
uveoscleral outflow
Darken iris color; benign
latanoprost
Reduction of IOP effectively during the night and day
latanoprost
Effective against Primary Open Angle G, Normal Tension Glaucoma, Pigmentary G, and Sturge-Weber syn
latanoprost
Trade name for dorzolamide
Trusopt
Trade name for brimonidine
alphagan
First line therapy glaucoma___________
Second line therapy glaucoma _________________
(1) latanoprost then can add dorzolamide
(2) CAI
Latanoprost require refrigeration. 1 drop daily at ____________.
T or F
False
night due to red eye
latanoprost 0.005% aqueous solution perserved with __________(Xalatan)
BAK
Which of the following has the least hyperemia:
latanoprost
bimatoprost
travoprost
latanoprost
Can cause changes to pigment of iris, periorbital tissue (eye lid) and eyelashes. Also, growth of eyelashes.
Xalatan
Iris darkening with latanoprost occurs as high as ___% and as early as ____wks and only ________irides are affected
70%
4weeks
mixed-colored
Preexisting iris freckles or nevi do change shape or color with use of latanoprost?
T or F
False
Increase number, length, thickness or darkening of eyelashes is called __________; with more obvious with _________ hair.
hypertrichosis
brown/black
Unlikely in eyes with normal blood-ocular barrier. Linkage between prostaglandin and uveitis.
Cystoid Macular Edema
Disruption of blood-aqueous barrier is small and transient and reversible despite cont. therapy with this drug
latanoprost
Lesions that resemble HSV epi. keratitis but disappears with discontinue of prostaglandin.
Corneal Dendritiform Epi.
Treatment of corneal dendritiform epi includes ______________but does NOT include __________.
(1) preservative-free artificial tears and or topical antibodies
(2) anti-viral
Herpes simplex blep can be induced by_________
Steroids
Contraindication of Latanoprost.
(1) history of uveitis or incisional ocular injury
(2) previous HSV keratitis
(3) following cat surgery with risk factors for CME
(4) Active intraocular inflammation
(5) uveitic glaucoma
PGF 2 alpha analog for the treatment of POAG and OHT; 0.004%
Travoprost (Travatan)
Trade name for Travoprost
Travatan
Reduces IOP from 6.8 to 8.3 mmhg over diurnal cycle; morn and eve dose effective
Travoprost
Overdose of a prostaglandin results in
Increase of IOP
Travatain is available in 2.5 ml and 5 ml and ____________ refrigeration.
DOES NOT
Replaces BAK with ionic buffered preservation system
Travatan Z (SofZia)
sofZia contains
(1) borate
(2) sorbitol
(3) zinc
The preseravtion system in sofZia in the eye is inactivated by ________
Na and K
Comparision of Travatan 0.004% and Xalantan 0.0005% showed
NO difference
Per Dr. Bartlett, ______________ works better for Normal Tension Glaucoma
Lumigan
Tradename of Bimatoprost
Lumigan
Side effect of Lumigan
(1) conjunctival hyperemia (make sure tell Pt)
(2)eyelash growth
(3)iris color darken
(4)ocular itch
Lumigan preserved with BAK 0.005%. ____________refrigeration required
No
Pts sensitive to BAK can take this
Treatment should be limited to ____________drugs and be based on efficacy, compliance, cost and few expected side effects.
no more than 3-4
________ change based on one-time sig. elevation of IOP or worsening of visual field.
If change is necessary, consider _______________ rather than ____________medication.
(1)don't
(2)switching
(3) adding
ID noncompliance in pt by:
(1) look at bottles of meds
(2) look at pupils (miotic)
(3) appt day dropper
Systemic hyperosmotic agents for lowering acute elevation of IOP due to acute angle-closure glaucoma; post-op spikes.
(1) IV- mannitol
(2) oral- glycerin
Sensitizes nociceptrs
prostaglandin
Abbrev. for aspirin
ASA
mild to mod pain use
aspirin
Describe drug interaction of NSAID (ASA) with oral hypoglycemic
NSAID bind protein and bump off oral hypoglycemic. Since not attached it is active to bind blood sugar. Result OD and sugar goes way down.
Aspirin hypersensitivity + respiratory
Aspirin triad
(1) rhinitis
(2) asthma
(3) nasal polyps
TYPE 1 rxn
(1) redness
(2) swelling
(3) itching
Hypersensitive to NSAIDS then allergis to all ___________ . Can give __________, __________.
Aspirin
tylenol, acetaminophen
OTC nonacetylated salicylate that illicit less GI distress
Doan's Pills
other salicylate end name
not quite as effective pain relief
Contraindications to NSAIDS
(1) active upper GI disease
(2) history asthma, nasal polyps, aspirin allergy
(3) following cat sx or other sx
(4)chronic renal disease
(5)HTN
(6) pregnancy
Nonsalicylate NSAIDS= Aspirin
T or F
False
Nonsalicylate NSAIDS= Propionic Acid
T or F
True
Examples of propionic acid
(1) ibuprofen
(2) naproxen
(3) naproxen sodium
(4) fenoprofen
(5) ketoprofen
(6) oxaprozin
Excellent alternative for pts allergic to opoids such as codeine
ketoprofen
Ibuprofen dosage over 400mg is better treatment for _________and not for ____________
inflammation
pain; more does not give more releif; ceiling
0 inflammation with hyphema and corneal abrasion can take ibuprofen. Inflammation take _______ and ___________
cyclo
steroid
Ibuprofen has some anti-coag effects when there is a __________ dose in plasma; Aspirin in system for ________
therapeutic
1 week
Can't take ibuprofen(NSAID) then can take_________ and ___________
Tylenol
Acetaminophen
COC that is a good prostaglandin which lines the stomach
COX-1
Examples of COX-2 inhibitors
(1) celecoxib (celebrex)
(2) Rofecoxib (Vioxx)
Treatment of osteoarthirits and adult rheumatoid arthritis
Celebrex
Treatment acute pain in adults
Vioxx
Clinical name for Acetaminophen
APAP
APAP does not:
(1) inhibit platelet aggregation
(2) affect prothrombin time
(3) produce GI discomfort
Dose ibuprofen at least _________min. after taking immedicate release aspirin
30 minutes
Dose ibuprofen more than ________ before aspiring ingestin
8 hours
High dosage of acetaminophen can cause
liver damage
Low dose of acetaminophen can cause damage to liver of ___________
alcholics
Dr. Bartlett: perfect reduce pain
tyelonol xtra strength 2 tabs and 400 mg ibupforen every 4-6 hours
Gold standard opioid
morphine
Agonist receptors for opioid
mu receptor
AL can RX Schedule_________ to ________ but not ________
III - not hydrocodone-lortab
V
Safer for patients with contraindications to NSAIDS
Opioids
1tsp=____ml
5ml
Codeine #1 has 7.5 mg
Codeine #2 has _____
Codeine #3 has _____
#2 7.5x2=15
#3 15x2=30
Hydrocodone trade name
loratab
vicoden
Should you work while you are on opiod?
No
Propoxyphene trade name
Darvocet
Meds instruct to take every 4 hours. What should you do if pain back in 3.
Go ahead and take the pill. More difficult to control too intense pain.
Side effects of opioid analgesics
respiratory depression- not indicated for astham; COPD pts.
Prevent nauseau and vomiting
phenergan
Allergy to an opioid then you can take another different name opioid.
T or F
False!!!!
Contain Mu receptor and similar effect as opioid. Moderate to severe pain. Not a controlled substance. use DEA #
Tramadol (Ultram)