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123 Cards in this Set
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What is the mechanism of action of plaquenil?
A. DNA polymerase inhibitor B. Blocks phospholipase A-2 C. Inhibits DNA Gyrase D. Interferes with cell wall in RBC's? |
B.
Recall Plaquenil is used in inflammatory conditions as well as for malaria. |
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You prescribe a drug that has a clearance of 1.7325 L/h and a Vd of 20 L. What is the half life?
A) 2 Hours B) 8 Hours C) .02 Hours D) 80 Hours |
B.
Recall that the lower the Vd the safer the drug. Plaquenil, for example, has a Vd of 15,000, while Caumodin has a Vd of 8. |
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Drugs A and B have the same mechanism of action. Drug A in a dose of 2 mg produces the same effect as drug B does in a dose of 200 mg. Which of the following are true:
A)Drug A is more efficacious than drug B B)Drug A is about 100 times more potent than drug B C)Drug A is more toxic than drug B D)Drug A has a higher affinity |
B.
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The largest response a drug can produce regardless of the dose is the:
A)Maximum Potency B)Maximum Affinity C)Toxic Dose D)Maximum Efficacy |
D.
If these concepts confuse you at all, start by always putting the word BINDING in front of affinity. BINDING AFFINITY refers to how well the drug binds to its receptor site. However, just because a drug binds well, doesn't mean it's going to have much of an effect (Efficacy). |
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The sympathetic system promotes all of the following except:
A)Glycogenolysis B)Insulin release from B-cells of pancreas C)Gluconeogenesis D)Lipogenolysis |
B.
INsulin wants to move glucose and amino acids INto cells and STORE them. Answers A,C,D all put nutrients into the bloodstream for immediate use; this should make sense considering the sympathetic system ('Fight or Flight') wants to utilize energy NOT store nutrients (like Parasympathetic System and Insulin). |
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The parasympathic system promotes all of the following except:
A)Bronchoconstriction B)Salivation C)Urination D)Pupil dilation |
D.
Parasympathetic System has 3 main actions: -- Miosis and Bronchoconstriction -- Rest and Digest -- SLUD (Salivation,Lacrimation,Urination, Defecation) |
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Neostigmine is in which of the following categories of drugs?
A) Cholinergic Antagonist B) Cholinergic Agonist C) Adrenergic Antagonist D) Adrenergic Agonist |
B.
Recall that neostigmine is an indirect cholinergic AGONIST. Why is it considered indirect? Because it inhibits acetylcholinesterase (the enzyme that breaks down acetylcholine); obviously, this will lead to an increase in Acetylcholine at the synaptic cleft, increasing cholinergic activity. Recall, whenever we see the word cholinergic, we think parasympathetic; since this drugs is an agonist, it promotes parasympathetic activity. |
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Cocaine can cause:
A)Adrenergic Effects B)Blocks reuptake of norepinephrine C)Bronchodilation D)Mydriasis E)All of the Above |
E.
Cocaine is an adrenergic agonist - all of the effects below are sympathetic actions. |
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Which of the following is an Adrenergic Antagonist?
A)Cocaine B)Methyldopa C)Phenylephrine D)Epinephrine E)Propanolol |
E.
The 'olol' drugs are B-Blockers. Recall how much we stressed the importance of knowing the CNS drugs. Recall that the ANTAGONIST drugs are simply the alpha and beta blockers, as well as the drugs we use commonly in clinic (STop ACH): ADRENERGIC ANTAGONISTS -Alpha Blockers -Beta Blockers CHOLINERGIC ANTAGONISTS (STop ACH) -Scopolamine, Tropicamide, Atropine, Cyclopentalate, and Homatropine. |
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Which of the following is a Cholinergic Agonist?
A) Pilocarpine B) Succinylcholine C) Atropine D) Scoplolamine E) All of the Above |
A.
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Which of the following drugs inhibits cyclooxygenase irreversibly?
A)Histamine B)Ibuprofen C)Corticosteroids D)Acetylsalicylic Acid |
D.
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Leukotrienes are produced from arachidonic acid by:
A) Lipoxygenase B) Cyclooxygenase I C) Prostacyclins D) Thromboxane |
A.
Leukotrienes are involved in ASTHMA and ALLERGIC conditions and sustain the INFLAMMATORY process in the body. |
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The following is true about Cromolyn Sodium.
A) It causes bronchodilation B) It is helpful in acute allergic situations C) It blocks the mediator release from mast cells D) It causes cortisol release |
C.
As a reminder, ALOcril, ALOmide, and ALAmast are all topical Mast Cell Stabilizers. Recall that Cromolyn Sodium is a MAST CELL STABILIZER - so it is not effective in acute allergic conditions (examples - acute allergic conjunctivitis, contact dermatitis). |
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The mechanism of Methotrexate is:
A) Causes intrastrand DNA crosslinking B) Causes DNA fragmenting C) Inhibits dihydrofolate reductase D) Covalently X-links DNA at guanine N-7 |
C.
Methotrexate is commonly prescribed for Lupus, Rheumatoid Arthritis, Leukemia and Lymphomas. |
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The following statements are true regarding 5-Fluorouricil
A) It can cause non-reversible myelosuppression B) It is used topically on Basal Cell Carcinomas C) It is used during glaucoma surgery D) All of the Above |
D.
5-FU inhibits dihydrofolate reductase, which is an enzyme used in DNA SYNTHESIS. |
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Dr. Julio saw a patient at the VA with acute dacrocystitis. When considering his treatment options, he noticed that the patient was allergic to Cephalexin. Which of the following drugs (if prescribed) would be most likely to cause an allergic reaction?
A) Amoxicillin B) Doxycycline C) Trifluridine D) Azithromycin |
A.
Recall that Cephalexin (Keflex) is a FIRST GENERATION Cephalosporin, so it's most effective against Gram (+) organisms (like Staph); this is why we commonly use Keflex for preseptal cellulitis (Staph is the culprit). |
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A patient comes to your office with a corneal ulcer. Which of the following antibiotics is the most inappropriate therapy for the patient?
A) Ocuflox B) Bacitracin C) Gentamycin D) Ciloxan |
B.
Your biggest concern with a corneal ulcer is PSEUDOMONAS (Gram(-)aerobic rod). Bacitracin is highly selective for Gram(+) organisms. |
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A 21 year old male comes to your clinic with large inferior follicles with mucopurulent discharge and explains that he has a red eye that hasn`t gone away in months. What is the most likely diagnosis?
A) Chlamydia B) Gonorrhea C) Herpes Simplex |
A.
Remember, associate.... -Chlamydia with Chronic symptoms -Gonorrhea with Acute symptoms |
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A 30 year old female comes to your office complaining of acute red eye with severe conjunctival inflammation and purulent discharge. There is no corneal involvement noticed on exam. The drug of choice for this patient would be:
A) Bacitracin (topically) B) Ceftrioxone (IM) C) Penicillin (IM) D) Azithromycin (Oral) |
B.
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Which is NOT true regarding Anti Tuberculosis medications?
A. Rifampin can be used alone for prophylaxis of TB B) Rifampin can cause orange-pink tears C) Rifampin, Isoniazid and Pyrazinamide can be used in combination for TB D) Isoniazid can cause peripheral neuritis |
A.
Recall that the anti-TB drugs are RIPE... -Rifampin, ISOniazid, Pyrazinamide, Ethambutol ISOniazid is the only drug that can be used in ISOlation. |
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Which is NOT true concerning Chloramphenicol?
A) It can be used for rickettsial disease and bacterial meningitis B) It can cause an adverse effect of aplastic anemia C) Its MOA is that it blocks protein synthesis at the 30S ribosomal subunit D) It is bacteriostatic |
C.
Tetracyclines and Aminoglycosides work on 30S |
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Which of the following would be used topically in the eye for HSV?
A.Triflouridine B.Acyclovir C.Tetracycline D.Valacyclovir E.Ganciclovir |
A.
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Which is NOT true concerning Gancyclovir?
A.Inhibits DNA polymerase B.Used Orally C.Drug of choice for CMV infections D.Used IV |
B.
Recall that Viroptic, Acyclovir, Valcyclovir, and Gancyclovir all INTERFERE WITH DNA SYNTHESIS by INHIBITING DNA POLYMERASE. |
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Cephalexin's MOA is:
A. Bind to 30 S ribosomal subunits B. Inhibits Cell Wall Synthesis C. Blocks DNA Topoisomerase D. Blocks DNA Precursors |
B.
Remember, associate penicillins and cephalosporins together.... they both interfere with cell wall synthesis! |
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A side effect of Sulfamethoxazole is:
A.Megaplastic Anemia B.Red Man`s Syndrome C.Steven Johnson`s Syndrome D.Grey Baby Syndrome |
C.
Red Man's Syndrome is a side effect of Vancomycin. |
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Which of the following is NOT true regarding hydroxychloroquine...
A. It can be used for Malaria B. It can be used for Rheumatoid Arthritis C. Acts on Phosopholipase A-2 D. Causes a higher incidence of Bull's Eye Maculopathy as compared to chloroquine. E. All are true |
D.
Plaquenil is the generic name for hydroxychloroquine, which has a much lower incidence of bull's eye maculopathy as compared to chloroquine. |
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The following is true regarding levodopa:
A. It can not cross the Blood Brain Barrier B. It cannot be used with other Parkinson meds C. It is contraindicated in patients at risk for Angle Closure Glaucoma D. It is contraindicated in Cataract patients |
C.
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Local Anesthetics:
A. Block Na+ gated channels B. Block Ca 2+ gated channels C. Stop ACh D. Increase GABA |
A.
Pound this in your brain!... Anesthetics work by blocking Na channels! |
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Which of the following describes Metformin's MOA?
A. Increases secretion of insulin by beta cells B. Inhibits Carbohydrate break down C. Binds to PPAR receptors D. Decreases liver glucose production |
D.
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Hydrochlorothiazide....
A.Works on the Late DCT B.Causes Hyperkalemia C.Works on the Early DCT D. Works on the collecting duct |
C.
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Captopril....
A. Increases aldosterone secretion B. Has a side effect of cough C. Can be given in pregnancy |
B.
Remember, the major issue with the PRIL (captoPRIL, lisinoPRIL, etc) drugs is COUGH! |
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Guanethidine MOA includes
A.Increasing nEpi levels B.Decreasing Ca levels C.Increasing CAMP D.Decreasing nEpi levels |
D.
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Whorl Keratopathy is most likely to occur with which of the following classes of antiarrhythmic medications...
A. Class 1b B. Class 1a C. Class III D. Class IV |
C.
Amiodarone is a Class III (blocks K channels) Antiarrhythmic. Recall that amiodarone can also cause a non-arteritic ischemic optic neuropathy (NAION). |
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Your patient has Acute Angle Glaucoma and you give him a dose of Acetazolamide. What side effect should you be aware of...
A. Hypokalemia B. Ototoxicity C. Metabolic Acidosis D. Pulmonary Edema |
C.
Recall that Acetazolamide is a Carbonic Anhydrase Inhibitor; these drugs work by INHIBITING BICARBONATE (base); a decrease in the amount of basic molecules leads to an acidotic state (metabolic acidosis). |
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Hormones synthesized in the hypothalamus include all except...
A.Oxytocin B.TRH C.LH D.ADH |
C.
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Which of the following drugs has the least sedating potential?
A.Diphenhydramine B.Promethazine C.Loratadine D.Azelastine |
C.
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Your patient has a red eye and is reporting severe ocular pain. She mentions that she routinely sleeps in her lenses and recently wore her contacts in a hot tub. What type of infection should be ruled-out?
A. Pseudomonas B. Staphylococcus Aureus C. Acanthamoeba |
C.
Hot-tubs, swimming in contact lenses and utilizing homemade saline solution are buzz phrases you should associate with Acanthamoeba. |
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Which of the following drugs is a viral reverse transcriptase inhibitor?
A.Acyclovir B.Zidovudine C.Amantadine D.Amphotericin B |
B.
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Sulfamethoxazole....
A. Inhibits Dihydropteroate synthesis B. Inhibits Dihydrofolate reductase C. Inhibits ergosterol synthesis D. Disrupts DNA precursors |
A.
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A wide spectrum antibiotic includes...
A. Clindamycin B. Tetracycline C. Bacitracin D. Vancomycin E. Dicloxacillin |
B.
Fluoroquinolones, Aminoglycosides and Tetracyclines = FAT These are the drugs that should first come to mind when thinking about broad-spectrum agents. |
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Acyclovir is used...
A.For active HSV corneal keratitis B.For HSV genitally C.For HSZ in the eye D.B and C E.All of the above |
D.
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Which of the following drugs would mimic parasympathetic symptoms?
A.Acetylcholine B.Atropine C.Succinylcholine D.Methyldopa |
A.
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Which of the following drugs blocks the reuptake of nEpi?
A.Clonidine B.Cocaine C.Prazosin D.Phenylephrine |
B.
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Heparin...
A. Decreases the rate of thrombin and antithrombin III formation B. Causes anticoagulation over several days C. Is contraindicated in pregnancy D. Cannot be given orally |
D.
Heparin is given in a hurry (IV). Caumodin is given chronically (oral). |
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Which diuretic can cause pulmonary edema?
A.Aldosterone B.Acetazolamide C.Mannitol D.Ethcrynic Acid |
C.
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Which of the following activates tyrosine kinase receptors?
A.Doxycycline B.Dicloxacillin C.Insulin D.Chloramphenicol |
C.
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Which of the following is a fungus?
A. Toxoplasmosis B. Histoplasmosis C. Both D. Neither of the above |
B.
Histo = fungus Toxo = parasite, Acanthamoeba = parasite |
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Which of the following is NOT a recognized side effect of pilocarpine?
A. Miosis B. Ciliary Spasm C. Retinal detachment D. Tachycardia |
D.
What class of drugs is pilocarpine in? Cholinergic Agonists This class of drugs promotes parasympathetic (cholinergic) activity, which includes REST (lower heart rate) and DIGEST. |
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Which of the following is not true?
A. Clonidine has greater Alpha 2 than Alpha 1 activity B. Phenylephrine has greater Alpha 1 than Alpha 2 activity C. Dobutamine has greater Beta 1 than Beta 2 activity D. Albuterol has greater Beta 2 than Beta 1 activity E. Norepinephrine has greater Beta 2 than Beta 1 activity |
E.
** Make sure you know each of these drugs and which receptors they have greater effects on. Recall that B1 receptors dominate in the heart, so dobutamine is used for heart failure. Recall that phenylephrine acts on alpha 1 receptors on the dilator muscle. Recall that B2 receptors dominate in the lungs, so albuterol is used for asthma. |
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Which of the following drugs has bone marrow suppression and aplastic anemia as potentially fatal side effects?
A. Acetazolamide B. Hydroxyamphetamine C. Cocaine D. Methyldopa |
A.
Acetazolamide works quite well in reducing IOP; however, because of its severe side effects, it is not used for chronic treatment of glaucoma. |
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Which of the of the following is inversely related to the amount of dosage in a medication?
A. Potency B. Efficacy C. Affinity |
A.
Always think AMOUNT of drug when talking about potency. If you have a drug that produces a huge response at a very low dose, it would be described as potent. |
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Your patient reports diplopia that occurs daily after work. She notices that after waking up from a nap the diplopia recedes. Which of the following is the most likely diagnosis?
A. CN IV palsy B. Optic Neuritis C. Dry Eye Syndrome D. Myasthenia Gravis |
D.
If you get a question talking about ptosis and/or diplopia at the END OF THE DAY - choose Myasthenia Gravis as your answer. |
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Which of the following is considered the treatment of choice for methicillin resistant staph infections (MRSA)?
A. Amphotericin B B. Fluconazole C. Trimethoprim D. Vancomycin |
D.
Vancomycin 'VANQUISHED' MRSA... Recall that AmphoTERicin is a fungal drug that is TERRIBLE on the kidneys. |
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Which of the following drug(s) are bacteriocidal?
A. Bacitracin B. Fluoroquinolones C. Trimethoprim D. Sulfonamides |
A and B
Trimethoprim and Sulfonamides are bacteriostatic. |
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Which of the following drugs is considered safe during pregnancy?
A. Fluoroquinolones B. Sulfonamides C. Tetracycline D. Penicillin |
D.
You might recall the phrase I used during lecture to help you remember which drugs are safe/unsafe during pregnancy: Pregnant women are not FAT, they are just PACking a baby. --FAT drugs are unsafe: Fluoroquinolones, Aminoglycosides and Tetracyclines --PAC drugs are safe: Penicillins, Azithromycin and Cephalosporins Why are the FAT drugs unsafe?.... --FluoroquinoLONES: Hurt the attachment to your bones. --AmiNOglycosides: Cause nephrotoxicity and ototoxicity. --Tetracyclines: Retard bone growth, discolor teeth, etc. |
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Which of the following drug(s) are considered broad-spectrum?
A. Tetracyclines B. Aminoglycosides C. Fluoroquinolones D. Polymixin B |
A, B, C.
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Which of the following is the MOA of Prozac?
A. Enhances GABA B. Inhibits NE reuptake C. Inhibits Seratonin reuptake D. Increases Dopamine |
C.
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Which of the following drugs causes blue-yellow color defects?
A. Phenytoin B. Wellbutrin C. Chlorpromazine D. Digitalis |
D.
Remember, Digitalis is a Na/K channel blocker that can cause B/Y color defects. |
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What is the MOA of Zocor?
A. Decreases platelet aggregation B. Decreases antithrombin III activity C. Vitamin K antagonist D. HMG CoA reductase inhibitor |
D.
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Which of the following is the MOA of Losartan?
A. Inhibits Na/K pump B. Blocks ACE enzyme C. Inhibits Renin D. Angiotensin II Receptor blocker |
D.
Definitely know that the SARTAN drugs are Angiotensin II blockers. |
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What is the MOA of Tamoxifen?
A. Inhibits DNA polymerization B. Inhibits leukotrienes C. Acts on the 30S subunit D. Inhibits estrogen |
D.
You are likely to get a question on TAMOXIFEN because it is very commonly prescribed and it can cause CRYSTALLINE RETINOPATHY. Recall that tamoxiFEN inhibits estroGEN. |
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Esters are ______ acting local anesthetics whose mechanism of action involves blocking ______ channels.
A. long, Na B. short, Na C. long, Ca D. short, Ca |
B.
Recall that proparacaine and benoxinate (anesthetic in Fluress) are ESTERS. |
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Isosorbide decreases IOP by ________ the osmolarity of ________?
A. Increasing, plasma B. Decreasing, aqueous humor C. Decreasing, plasma |
A.
Recall that you should NOT give glycerine to a diabetic. Recall that the 'normal' gradient is one in which the aqueous humor is HYPERTONIC to the plasma (in the ciliary body stroma region). This HYPERTONIC gradient is created because Na and bicarbonate are shuttled from the PLASMA to the AQUEOUS. So.... ISOSORBIDE and GLYCERINE reverse this gradient b/c they are HIGH molecular weight compounds that can NOT cross the tight junctions into the aqueous humor; thus, they SUCK water and solute from the aqueous humor back into the venous system; this is why our patients who drink these meds during an acute angle closure attack will often vomit and/or have diarrhea. Their body is overloaded with extra water and solute. |
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The MOA of cocaine includes....
A. Inhibiting the action of acetylcholinesterase at preganglionic nerve terminals B. Blocking the reuptake of norepinephrine at postganglionic nerve terminals C. Blocking the release of norepinephrine at postganglionic nerve terminals D. Blocking the reuptake of norepinephrine at preganglionic nerve terminals |
B.
Recall that cocaine has multiple mechanism of actions (MOA's), including: Blocks the reuptake of norepinephrine, which obviously increases sympathetic activity (including dilation!) Blocks Na channels (allows use as an anesthetic) Vasoconstrictor (stops nose bleeds) In a Horner's patient, COCAINE will NOT cause DILATION. The next step would be to determine if the lesion is pre or postganglionic, which can be determined by HYDROXYAMPHETAMINE or PHENYLEPHRINE. What percentage do you use of phenylephrine in clinic?.... 2.5percent..... Does 2.5percent give full dilation by itself? NO In a Horner's patient, 1percent gives FULL dilation, providing evidence that the lesion is POSTGANGLIONIC! Make sure you have know this well because this concept is very likely to show up on the exam. |
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Hydroxyamphetamine stimulates the following::
A. The release of acetylcholine from postganglionic nerve terminals B. The release of epinephrine from preganglionic nerve terminals C. The release of epinephrine from postganglionic nerve terminals |
C.
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.125percent pilocarpine is used in the diagnosis of _________, and is effective in constricting the pupil because of a supersensitized sphincter muscle that is a result of a _______ lesion.
A.Adie`s tonic pupil, sphenopalatine B.Horner`s syndrome, lung C.Adie`s tonic pupil, ciliary ganglion |
C.
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Which of the following is the only agonist used for pupil dilation?
A. Phenylephrine B. Succinylcholine C. Atropine D. Tropicamide |
A.
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Which of the following is the drug of choice for routine cycloplegia?
A. Tropicamide B. Cyclopentalate C. Atropine D. Scopolamine |
B.
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Which of the following drug combinations are the best choice for treating anterior uveitis?
A. Predforte Acetate 1percent, Homatropine 5percent B. Predforte Acetate 1percent, Atropine 1percent C. Predforte Phosphate 1percent, Homatropine 5percent |
A.
Predforte acetate, 'a' for better 'a'bsorption |
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One of the following drugs, used for motion sickness, reaches systemic circulation via transdermal delivery and can lead to a dilated pupil on the side of the face that it is applied.
A. Glyburide B. Keflex C. Scopolamine D. Atropine |
C.
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All of the following characteristics increase bioavailability, except:
A. High lipid solubility B. High degree of ionization C. Small molecular size D. Weak base |
B.
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Preganglionic sympathetic cell bodies are located in the __________ regions of the CNS. Sympathetic preganglionic neurons extend from these cell bodies and release the neurotransmitter _______ to act on nicotinic receptors on the postganglionic cell body.
A. Thoracolumbar, Epinephrine B. Thoracolumbar, Acetylcholine C. Craniosacral, Epinephrine D. Craniosacral, Acetylcholine |
B.
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Preganglionic and postganglionic neurons in the parasympathetic nervous system release the following neurotransmitters, respectively.
A. Acetylcholine, Acetylcholine B. Acetylcholine, Epinephrine C. Epinephrine, Acetylcholine |
A.
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A patient is prescribed Neostigmine -- what side effect is not expected?
A. Tachycardia B. Increased lacrimation C. Miosis |
A.
Remember, NEOSTIGMINE an INDIRECT cholinergic agonists... thus, it promotes PARASYMPATHETIC ACTIONS. Remember, on the exam you need to immediately put the drug into its correct category (chol agonist, chol antagonist, etc) and then ask yourself if the drug promotes sympathetic or parasympathetic activity. |
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All of the following are side effects of pilocarpine, except:
A. Ciliary Spasm B. Miosis C. Cataracts D. Dry Eyes |
D.
Recall that PILOCARPINE is a CHOLINERGIC AGONIST. So, you expect PARASYMPATHETIC ACTIONS, including lacrimation - which explains the answer above. |
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Which of the following describes pilocarpine's MOA?
A. Inhibits acetylcholinesterase B. Binds to longitudinal muscle of the ciliary body -- decreases resistance to outflow. C. Binds to radial muscle of the iris -- decreases aqueous production. |
B.
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Edrophonium is used in the diagnosis of ______. Its mechanism of action includes _______ ?
A. Myasthenia Gravis / Inhibition of acetylcholinesterase B. Graves Disease / Binds to longitudinal muscle of the iliary body C. Osteogenesis Imperfecta / Binds to radial muscle of the iris D. Myasthenia Gravis / Inhibits acetylcholine |
A.
Edrophonium = Ed diagnoses Myasthenia Gravis (MG) with the Tensilon Test. If ptosis improves within 1-2 minutes of edrophonium injection, the test is POSITIVE for Myasthenia Gravis. Recall that the two classic signs for MG are PTOSIS and DIPLOPIA that occur AT THE END OF THE DAY. |
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All of the following are examples of cholinergic antagonists, except:
A. Tropicamide B. Scopolamine C. Phenylephrine D. Atropine |
C.
PHENYLEPHRINE is a ADRENERGIC AGONIST. Recall it is the only AGONIST that causes dilation. |
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Toxicity to atropine would include all of the following effects, except:
A. Dry mouth B. Rapid pulse C. Disorientation D. Sweating |
D.
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Botulina Toxin (Botox) is an example of a _______ ?
A. Cholinergic Antagonist B. Adrenergic Antagonist C. Adrenergic Agonist |
A.
Botox, Scopolamine, Tropicamide, Atropine, Cyclopentalate and Homatropine are all CHOLINERGIC ANTAGONISTS. So 6 there are 6 drugs on the NBEO outline that you need to know that are Cholinergic Antagonists. All of these drugs have the same mechanism of action (MOA), they STop ACH. CHOLINERGIC ANTAGONISTS = Botox and STACH. The mechanism of action of these drugs is that they inhibit Acetylcholine (they STop ACH |
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Epinephrine`s MOA differs from Norepinephrine due to its action on _____ receptors.
A. B-1 B. B-2 C. A-1 D. A-2 |
B.
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Brimonidine is a _________ whose well-known side effect includes _______?
A. Alpha 2 antagonist, follicular conjunctivitis B. Alpha 2 agonist, follicular conjunctivitis C. Alpha 1 antagonist, iris darkening |
B.
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All of the following are side effects of B-blockers except:
A. Bradycardia B. Bronchoconstriction C. Euphoria D. Wheezing E. GI distress |
C.
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Which of the following B-Blockers has intrinsic sympathomimetic (ISA) properties?
A. Levobunolol B. Timolol C. Carteolol D. Betaxolol |
C.
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Carbonic Anhydrase Inhibitors (CAI`s) should not be used in patients with allergies to ____?
A. Penicillin B. Sulfonamides C. Tetracyclines D. Cephalosporins |
B.
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All of the following are side effects of Carbonic Anhydrase Inhibitors (CAI`s) except?
A. Bone marrow suppression B. Aplastic anemia C. Metabolic acidosis D. Metabolic alkalosis |
D.
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Which of the following binds best to fluoroscein in solution?
A. Proparacaine B. Tetracaine C. Benoxinate |
C.
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Systemic side effects of oral steroids include all of the following except:
A. Elevation of blood glucose B. Weight loss C. Alteration of body fat D. Mood swings |
B.
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Which of the following is not a side effect of topical corticosteroids:
A. Glaucoma B. Increased risk of secondary infections C. Posterior subcapsular cataracts (PSC's) D. Nuclear Sclerotic (NS) Cataracts |
D.
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The primary drug of choice for epithelial keratitis in Herpes Simplex is ______?
A. Trifluridine B. Acyclovir C. Guanethidine D. 5- Fluorouracil |
A.
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It takes approximately _________ for injected fluoroscein dye to reach the retinal blood vessels.
A. 2 minutes B. 5 minutes C. 30-60 seconds D. 10-20 seconds |
D.
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Which of the following class of glaucoma drugs typically gives the largest decrease in IOP -- how do they work?
A. Prostaglandins -- uveoscleral meshwork B. B-Blockers -- decrease aqueous production C. Alpha Agonists -- decrease aqueous production |
A.
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The MOA of corticosteroids includes:
A. Inhibiting the action of Cox-2 B. Inhibiting Phospholipase A-2 C. Inhibiting Cox-1 |
B.
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Rose Bengal (RB) differs from fluoroscein in that...
A. RB stains epithelial defects B. RB allows more effective analysis of tear film quality C. RB stains dead cells |
C.
Rose bengal stains dead and devitalized cells and mucous strands. Rose Bengal also stains the borders (active viral cells) of a Herpes Simplex dendrite. Rose Bengal (RB) does NOT enter epithelial defects like fluoroscein. Lissamine Green is thought to have similar staining properties (dead and devitalized cells and mucous strands) as Rose Bengal, but Lissamine Green causes LESS STINGING and is more comfortable during instillation. Lissamine Green is more commonly utilized for DRY EYE EVALUATIONS. |
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Patients with cardiac arrhythmias are commonly treated with amiodarone, a drug with what commonly known ocular side effect?
A. PSC cataracts B. Glaucoma C. Whorl keratopathy D. NS cataracts |
C.
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Which of the following preservatives are most toxic to the corneal epithelium?
A. Polyquad B. Thimerosal C. Dymed D. Benzalkonium chloride (BAK) |
D.
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Which of the following drugs causes bulls-eye maculopathy?
A. Tamoxifen B. Chloroquine C. Canthaxanthin D. Corticosteroids |
B.
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Which of the following drugs can cause corneal melting?
A. Predforte Acetate B. Proparacaine C. Diamox D. Chloramphenicol |
B.
The TOPICAL ANESTHETICS (most notably, PROPARACAINE) can melt the cornea with excessive use. I have heard of a few cases of corneal abrasion patients who actually stole their doctor's proparacaine bottle - devastating vision loss can result (if drops used repeatedly), because of the corneal melting side effect. |
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Which of the following drops should be SHAKEN before use?
A. Iopidine B. Timolol C. Proparacaine D. Predforte Acetate |
D.
Remember, we use predforte ACETATE not predforte PHOSPHATE, because ACETATE has better absorption. Don't forget to SHAKE that ASSetate prior to instillation! The major concept to remember is that SUSPENSIONS should be shaken prior to use. AZOPT, FML, PREDFORTE ACETATE are commonly prescribed drugs that are suspensions. |
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Which of the following drug(s) are well-known to cause stinging during instillation?
A. Proparacaine B. Acular C. Restasis D. Patanol E. Two of the above |
E. Acular and Restasis
If you get a question on STINGING, think of the following drugs first: -RESTASIS -COSOPT -ACULAR You will find that several different eye drops can cause stinging. The three listed above are more commonly discussed clinically. |
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Which of the folllowing drugs is most likely to cause corneal toxicity?
A. Patanol B. Alocril C. Timolol D. Acular |
D.
Recall that the topical NSAIDS (ACULAR and VOLTAREN) can cause corneal toxicity, including CORNEAL MELTING with prolonged use. Be sure to associated CORNEAL MELTING with TOPICAL ANESTHETICS and TOPICAL NSAIDS. |
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Which agent for treatment of exudative ARMD is not a VEGF inhibitor?
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Verteporfin (Visudyne)
Macugen and Lucentis are VEGF inhibitors. Visudyne targets low-density lipoprotein receptors (LDL) on neovascularization. All three agents (macugen, lucentis and visudyne) are similar in that they inhibit ANGIOGENESIS (new blood vessel growth). |
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Which treatment agent for exudative ARMD is more commonly associated with photosensitivity reactions?
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VISUDYNE
Patients are advised to avoid sunlight exposure or bright indoor light after treatment. Recall that Visudyne is injected and PHOTODYNAMIC THERAPY (PDT) targets low-density lipoprotein (LDL) receptors of newly forming vessels. |
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What does VEGF stand for?
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VEGF = Vascular Endothelial Growth Factor
VEGF is a group of PROTEINS that promote vascular permeability (leakage) and new blood vessel formation (neovascularization). |
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Which of the following drugs are Mast-Cell Antihistamine Combinations?
A. Optivar B. Elestat C. Zaditor D. Crolom E. Alocril |
A, B and C
Optivar, Elestat, Zaditor, Pataday and Patanol are the FIVE drugs in this (Mast-Cell/Antihistamine) category listed on the NBEO Outline. You are most likely to confuse these drugs with the Mast Cell Stabilizers. These drugs (mast cell stabilizers) are easy to remember because you have the prototype of Cromolyn Sodium (Crolom) and then the rest of the drugs start with Alo or Ala.... The FOUR drugs listed on the NBEO Outline for this category include... MAST CELL STABILIZERS: Crolom, Alomide, Alocril, Alamast |
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Which topical ophthalmic drug can cause systemic side effects of dry mouth and fatigue?
Which topical ophthalmic drug can cause systemic side effects of bradycardia and bronchoconstriction? Which topical ophthalmic drug can worsen the parasympathetic effects of myasthenia gravis? Which topical ophthalmic drug should be used cautiously in diabetics and in patients with hyperthyroidism? Which topical ophthalmic drug is contraindicated in patients taking MAIO's and TCA's? |
DRY MOUTH/FATIGUE = side effect of ALPHAGAN. Dry mouth is the most common adverse effect reported. Fatigue/lethargy effects are more commonly reported in children.
BRADYCARDIA/BRONCHOCONSTRICTION = side effects of B-BLOCKERS. Always ask about heart and lung issues prior to starting a B-Blocker. MYASTHENIA GRAVIS: This condition can be worsened with TIMOLOL or other B-BLOCKERS.... definitely know this concept! DIABETICS/HYPERTHYROIDISM: These conditions can be worsened with TIMOLOL or other B-Blockers. So, in summary, be careful with B-Blockers in 5 major scenarios: -HEART issues -LUNG issues -MYASTHENIA GRAVIS -DIABETICS -HYPERTHYROIDISM You might recall that B-BLOCKERS can also cause depression and impotence. The three that you can NOT afford to miss are heart issues, lung issues, and Myasthenia Gravis. If you can remember the others... GREAT! MAIO's/TCA's: Do NOT use PHENYLEPHRINE 10percent in these patients. |
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How long after instillation does it take for tropicamide to reach its maximum mydriatic effect?
A. 10-15 minutes B. 20-30 minutes C. 30-40 minutes D. 40-60 minutes |
B.
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How long after instillation does it take for cyclopentalate to reach its maximum cycloplegic effect?
A. 10-15 minutes B. 20-40 minutes C. 40-60 minutes D. 60-70 minutes |
C.
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What receptor do B-Blockers act on?
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B-2 receptors in the non-pigmented ciliary body epithelium (NPCE).
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Name three drugs that decrease IOP by increasing outflow.
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If you get a question on the exam about the mechanism of action of glaucoma drugs, remember that glaucoma drugs have to work by either DECREASING PRODUCTION or by INCREASING OUTFLOW or by doing a little of both.
Since there are only three drugs that INCREASE OUTFLOW, its easiest just to learn those and know that any others asked on the exam have to be agents that decrease production. Here are your drugs that INCREASE OUTFLOW: TM OUTFLOW: PILOCARPINE UVEO OUTFLOW: PROSTAGLANDINS and ALPHA 2 AGONISTS (APRACLONIDINE AND BRIMONIDINE) So if they ask you the MOA of Diamox, Osmoglyn, B-Blockers, etc.... they all fall into the category of decreasing production. Its easy for me to just memorize the three above and move on. Recall that the ALPHA 2 AGONISTS have TWO MOA's... they decrease production AND they increase uveoscleral outflow! They are the only class that works both sides (outflow and production). |
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Which of the 4 classes of CNS drugs does NOT have an agent used for glaucoma treatment?
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CHOLINERGIC ANTAGONISTS = recall that this class has all the drugs we commonly use in clinic, including tropicamide, atropine, cyclopentalate. The other three classes all have drugs used for glaucoma management... none of these drugs have that capability.
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What systemic condition is Atropine contraindicated?
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Down's Syndrome
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Why can repeated instillation of visine cause a fixed dilated pupil?
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Visine contains TETRAHYDROZOLINE, an adrenergic agonist.
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Which of the following drugs is well-known for tachyphylaxis?
A. Xalatan B. Lumigan C. Apraclonidine D. Timolol |
C.
Recall that TACHYPHYLAXIS refers to a rapid decline in drug efficacy after a short period of time. Apraclonidine provides a significant reduction in IOP (up to 40percent) in ACUTE situations (angle-closure attacks, IOP spikes). However, it is loses its efficacy quickly when repeated doses are given; so it is NOT prescribed for long-term care. |
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Which two drugs arguably have some neuroprotective capabilities?
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BRIMONIDINE (ALPHAGAN) and BETAXOLOL (BETOPTIC-S)
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Name three contraindications for prostaglandins.
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-cases of ACTIVE INFLAMMATION (UVEITIS, for example)
-patients with active or past history of HERPES SIMPLEX -patients who are at risk for Cystoid Macular Edema (CME); post-op cataract patients, for example. |
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Which prostaglandin has the highest incidence of hyperemia?
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Lumigan
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Which prostaglandin may provide the best IOP control for African Americans?
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Travatan
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Describe the mechanism of action (MOA) of prostaglandins. What receptors do they activate?
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Prostaglandins increase outflow via the UVEOSCLERAL MESHWORK.
They act on PGF2a receptors on the CILIARY MUSCLE, which activates METALLOPROTEINASES, causing a reduction in neighboring COLLAGEN. If the NBEO wants to be really difficult, they could ask what class of enzymes are activated to allow for the increase in eyelash length and growth seen with prostaglandins.... the answer.... PHOSPHOLIPASE C |
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What is the mechanism of action (MOA) of Predforte Acetate?
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Inhibits phospholipase A-2
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Which of the following drugs inhibits prostaglandin formation?
A. Acular B. 5-Fluorouracil C. Viroptic D. Macugen |
A.
Acular is an NSAID. NSAIDS block the action of CYCLOOXYGENASE, thereby stopping the conversion of arachidonic acid into prostaglandins and thromboxanes. Make sure you review the Arachidonic Acid Pathway, which is covered in the Anti-Inflammatory Agent section of the General Pharmacology chapter. |
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What preservative binds to and chelates Calcium?
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EDTA
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What is the mechanism of action of Restasis?
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Inhibits T-CELL activation by stopping the production of IL-2.
Recall that the Helper T-Cell is the orchestrator of the immune system. |
