Pharm Test 2 .txt

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  1. What bacteria cause Blepharitis and what are the symptoms/signs of this condition?
    Staphylococcus aureus, Staphylococcus epidermidis

    Seborrhea, dry eye, rosacea
  2. There are two types of Hordeolums, what are they what bacteria causes them?
    External: Staphyloccus aureus

    • Internal:
    • (Meibomian glands can be acute, subacute of chronic):

    Staphyloccus aureus
    , MRSA (CA or HA)
  3. What bacteria cause Bacterial Conjunctivitis?
    Staphylococcus aureus

    N. gonorrheae

    C. trachomatis

    Strephtococcus pneumoniae

    Hemophilus influenzae

    N. meningitidis
  4. What viruses cause Viral Conjunctivitis?
    • Adenovirus
    • (types 3 and 7 in children and types 8, 11,19 in adults)

    Herpes simplex types 1 & 2
  5. What fungi cause Fungal Keratitis?
    Aspergillus, Fusarium, Candida
  6. what protozoa cause Protozoan Keratitis in soft contact lens wearers?
    Acanthamoeba sp.
  7. What bacteria causes Dacryocystitis?
    Pseudomonas aeruginosa

    Staphylococcus aureus

    Streptococcus pneumoniae

    Group A Streptococci (S. pyogenes)

    Hemophilus influenzae
  8. What is the MOA for Penicillin?
    Bacteriocidal: inhibits bacterial cell wall synthesis, inhibit bacterial enzymes which assemble peptidoglycan, activate autolysis
  9. What are the three commonly used Penicillins we need to know and what bacteria are they effective against?
    A) Bicloxacillin -

    some streptococci and staphylococci,

    many have acquired restistance to this limiting usefullness,

    available in oral form
  10. What bacteria is Bicloxacillin effective against, how is it administered, and has there been any resistance acquired?
    some streptococci and staphylococci,

    many have acquired restistance to this limiting usefullness,

    available in oral form
  11. What bacteria is amoxicillin effective against, how is it administered and has there been any resistance acquired?
    Some streptococci, staphylococci, Listeria, some gram-negative rods and cocci

    many bacteria have acquired resistance, limiting usefulness

    available in oral form only

    does not work against pseudomonas
  12. What bacteria is amoxicillin/clavulanate effective against, how is it administered, and why is it a combination drug?
    • Clavulanate added to restore effectiveness of
    • amoxicillin against some bacteria that acquired resistance

    streptococcus, staphylococci, some gram-negative rods and cocci

    used orally

    doesn't work against Pseudomonas
  13. Do Dicloxacillin, Amoxicillin, and Amoxicillin/clavulanate need to be dose-adjusted in patients with renal impairment?
    Amoxicillin and Amoxicillin/clavulanate= yes

    Dicloxacillin = maybe not
  14. What allergic reactions can result from taking penicillin drugs?
    Ranges from rashes to anaphylaxis

    GI effects with oral use: N/V/D

    CNS (rare, more common in high doses & in infants & children): seizures, confusion, ecephalopathy

    Blood dyscrasias: eosinophilia, thrombocytopenia, rarely leukopenia, neutropenia
  15. Cephalosporins MOA?
    Bacteriocidal: inhibit bacterial cell wall synthesis, inhibit bacterial enzymes which assemble peptidoglycan
  16. Are Cephalosporins under optometry scope of practice in California?
  17. What is Cephalexin and Cefadroxil effective against? Resistance? Administered form?
    Gram positive bacteria

    NOT good for Gram negative in general, will not cover anaerobic bacteria, Pseudomonas or Enterococci

    Many have acquired resistance to these agents

    Available in oral form only
  18. What is Cefaclor effective against? Resistance? Administered form?
    many Gram positive bacteria

    not good for Gram negative bacteria in general

    Does not cover Enterococci or Pseudomonas

    Available in oral form ONLY
  19. Cefotetan has been re-approved in generic form in the USA. Should we prescribe this drug?
    No, we should avoid Rxing this drug because it has an increased risk of bleeding interactions in patients taking anticoagulants/blood thinners.
  20. Do cephalosporins need to be adjusted in patients who have renal impairment?
    Yes in some of the cephalosporins
  21. It is estimated that 2-10% of patients who are allergic to penicillin will also be allergic to ______.
  22. Allergies to cephalosporins may occus in _____% patients. Reactions may range from _______to _______.

    rash to anaphylaxis
  23. Cephalosporins can cause anything from rash to anapylaxis. Other adverse effects include....
    CNS: fatigue, dizziness, vertigo, HA

    Dermatologic effects: rash and other manifestations of allergic responses are common. Exfoliative dermatitis is rare.

    GI effects: N/V/D are common, hepatic and renal effects rarely occur

    Blood dyscrasias: including eosinophilia, thrombocytopenia, neutropenia, and leukopenia occur but are infrequent
  24. Fluroquinolones MOA?
    inhibition of bacterial DNA gyrase which interferes with bacterial reproduction. Effects are often bacteriocidal. Most are broad spectrum
  25. Fluoroquinolones are effective against what bacteria? Resistance?
    Good = Some Gram +, many Gram -, most cover Chlamydia

    No Good = MRSA, Enterococci (not recommended), Bacteroides (doesn't adequately cover)

    bacterial resistances increasing
  26. Name 7 fluroquinolones used in California.
    • 1) Ciprofloxacin
    • 2) Gatifloxacin
    • 3) Levofloxacin
    • 4) Moxifloxacin
    • 5) Norfloxacin
    • 6) Ofloxacin
    • 7) Bestifloxacin
  27. How long will most fluroquinolones be used to treat bacterial conjunctivitis? Corneal ulcers/keratitis?
    7 days

    5-14 days
  28. T/F patients who are allergic to one fluoroquinolone will be allergic to all of the fluoroquinolones.
  29. We should avoid over-use of fluoroquinolones for conjunctivitis, what is a common side effect of over-use of this drug?
    white precipitates of active drug at the site of epithelial defect that may be confused with a worsening infection
  30. T/F there are numerous potential drug interactions, adverse effects, and cautions with oral use of fluoroquinolones.
  31. T/F we do not need renal dose adjustments for patients with renal impairment or renal disease when using fluroquinolones.
  32. What are the 5 cautions for ophthalmic preparations of fluroquinolones we should be aware of?
    1) Be cautions with patients with seizure history

    2) Can increase photosensitivity and cause photophobia

    3) Potential adverse reactions: burning/stinging in eye, blurred vision, redness/irritation in the eye, eye ain, foreign body sensation, tearing, and/or dry eye.

    4) Rare but potentially serious side effects: severe exfoliative dermatitis, severe allergic reactions like anaphylaxis, periocular or facial edema, dizziness etc.
  33. Sulfonamides MOA?
    They are structural analogs of PABA (Paraamino benzoic acid)

    They competively inhibit the bacterial enzyme necessary for incorporating PABA into dihydrofolic acid, the folic acid precursor.

    Inhibiting folic acid formation results in the bacteria not being able to synthesize amino acids and DNA.
  34. Uses of sulfonamides? Bacterial resistance effect upon use?
    Broad spectrum bacteriostatic antibiotics with specific antibacterial and antiprotozoal activities.

    Acquired bacterial resistances have limited use of this class although for some uses this class of drugs is still someowhat medically important
  35. ODs can Rx Sulfamethoxicin/Trimethoprim (SMX/TMP) which is used orally to treat _______________.
  36. The Sulfonamides: Sulfacetamide sodium ophthalmic solution (10%, 15%, 30%) and 10% opthalmic ointment in addition to Sulfisoxazole 4% ophthalmic ointmentand 4% ophthalmic solution are used occassionally for treating what conditions? Is it good for CA-MRSA?
    bacterial conjunctivitis and trachoma/chlamydial infections

    not good for CA-MRSA
  37. What are some potential adverse effects of sulfonamides?
    Stinging and burning upon application

    Allergic reactions possible

    Cross-reactivity with other sulfa drugs

    Dermatologic reactions range from swelling to hives and rash

    Severe exfoliative dermatitis is potentially possible

    Products are incompatible with silver-containing preparations
  38. Polymyxin and Bacitracin MOA?
    Polymyxin = bactericidal agent works by binding to cytoplasmic membranes, disrupting structure and altering membrane permeability

    Most effects are against sensitive Gram-negative bacteria.

    Bacitracin= bactericidal agent works by binding to bacterial cell membranes and interfereing with cell wall synthesis.

    Most effects are against sensitive Gram positive bacteria.
  39. Uses for Polymyxin and Bacitracin both singly and in combination with other anti-infectives include...

    Also what about bacterial resistance?
    short-tern treatment of external ocular infections caused by susceptible bacteria

    NOT for long term treatment

    Acquired bacterial resistance has impacted former widespread usage
  40. Adverse Effects of Polymyxin and Bacitracin?
    Local adverse effects are possible, should check previous patient sensitivity reactions before usage.
  41. Tetracyclines MOA?
    Inhibits bacterial protein synthesis by binding to the 30S subunit (remember by: Thirty Tetracyclines.)
  42. What types of bacteria are Tetracyclines effective against?
    • Variable effects against some Gram-positive
    • bacteria

    Systemic Listeria infections

    Some Gram negative bacteria including Neisseria meningitidis and Legionella

    Mycoplasma, Chlamydia, Rickettsia

    Some anti-clostridial activity but not C. difficile
  43. O.D.s Rxing for oral use should be rare and considered for very specific conditions only like...
    chlamydial inclusion conjunctivits, trachoma
  44. Oral tetracyclines includes __________ and _________
    doxycycline and tetracycline
  45. There are many potential adverse effects and drug interactions possible with the use of tetracyclines antibiotics. Tetracyclines should be used by ODs
    sparingly and with caution. What are some specific Adverse Effects of Tetracyclines?
    a) Many drug-to-drug and drug-to-food interactions exist

    b) Photosensitivity

    c) GI effects: antibiotic-associated pseudomembranous colitis, N/V, abdominal pain, potential pancreatitis, hepatic effects

    d) Allergic reactions possible. Cross-sensitivity exists between agents in the same class.
  46. Avoid use of tetracyclines in pregnancy and with children. How often should they be prescribed in optometry practice?
  47. Macrolides MOA?
    Inhibits protein synthesis by binding to the 50S ribosomal subunit.
  48. What bacteria are Macrolides effective against?
    a) some Gram positive (Group A,B,C,G Streptococcus, Streptococcus pneumoniae, MSSA, Listeria)

    b) some Gram negative bacteria (N. meningitidis, M. catarrhalis, H. influenzae, Legionella)

    c) NOT good for Mycoplasma, Chlamydia, Rickettsia and some Clostridia (not C. difficile)
  49. Of the Macrolides, __________ is used to treat eyelid infections and chlamydial disease manifesting in the eyes and __________ ophthalmic ointment is still available for superficial ocular infections and neonatal conjunctivitis.

    erythromycin 0.5%
  50. which of the following macrolides need to be adjusted for renal impairment?
    erythromycin, clarithromycin = need to be dose adjusted

    azithromycin = does not need to be need to be
  51. Macrolides are either taken orally or parenterally, what are 5 adverse effects that can occur from taking these drugs?
    a) Hepatic complications (hepatitis, jaundice)

    b) Renal complications

    c) GI effects (GI irritation, N/V/D)

    d) ototoxicity may occur

    e) allergic reactions (cross reactivity between agents in this class possible. Allergic reactions can range from rash to anaphylaxis.)
  52. When prescribing Macrolides, what are two cautions we should be aware of?
    1) patients taking blood-thinning medications

    2) monitor for appearance for a super infection
  53. Aminoglycosides MOA?
    Inhibition of bacterial protein synthesis by binding to 30S and 50S ribosomal subunits (remember Aminoglycosides, All subunits)

    • MOA is specifically bacteriocidal
    • Can cause cell death through cytoplasmic membrane disruption
  54. What bacteria are aminoglycosides effective against?
    • Gram + and - bacteria
    • MSSA (sometimes)

    NOT against atypical bacteria, no anaerobic effects
  55. Three aminoglycosides ophthalmic products are commonly used what are they?
    • a) gentamicin 0.3% ointment and solution
    • b) tobramycin 0.3% ointment and solution
    • c) neomycin (in combo with other anti-infectives like polymyxin, bacitracin etc.)
  56. Adverse Effects of aminoglycosides?
    Local irritation with ophthalmic use

    • Caution in myasthenia gravis patients
    • (potential for neuromuscular junction blockade effects can worsen/exacerbate symptoms)

    Allergic reactions = swelling eyelids, face, appearance of rash, dermatologic reactions rare
  57. What are the four Antiviral Agents we need to know ?
    Trifluridine 1% ophthalmic solution

    Vidarabine 3% ophthalmic ointment

    Oral acyclovir

  58. Trifluridine 1% ophthalmic solution and Vidarabine 3% ophthalmic ointment are both indicated for use in what cases?

    What's their MOA? (they're different from each other)
    Herpes simplex-related keratitis and keratoconjunctivitis.

    Trifluridine 1% ophthalmic solution: incorporates in place of thymidine into viral DNA weakening viral ability to infect tissue (don't use prophylatically)

    Vidarabine 3% ophthalmic ointment: inhibits viral DNA polymerase, prevents lengthening or building of DNA viral chains (don't use to treat infections caused by adenoviruses)
  59. What are some of the adverse side effects that Vidarabine 3% ophthalmic oitment can cause? Also, what kind of agent is this drug?
    a) local hypersensitivity reactions: itiching, redness, foreign body sensation, swelling, pain, burning, other irritation on application

    b) increase flow of tears

    c) sensitivity of eyes to light (recommend sunglasses, don't stay in sun for long periods of time)

    d) punctate defects in cornea with too-frequent use
  60. Oral acyclovir treats what disease? What should you take with oral acyclovir for maximum effectiveness?
    Herpes zoster

    a full glass of water
  61. Acyclovir MOA?
    inhibiting DNA replication
  62. Acyclovir shouldn't be taken by patients sensitive to valacyclovir. What are potential adverse effects of Acyclovir?
    a) Renal failure, complicate worsen renal function in renal impaired patients

    b) CNS: Ecephalopathy/neurotoxicity

    c) blood dyscrasias and coagulation problems

    e) hepatic complications

    f) severe skin reactions

    g) visual changes

    h) GI disturbances

    i) agitation, dizziness, myalgia, parethesias
  63. T/F Patients with renal impairment do not need dose adjustments with Acyclovir.
  64. T/F there are many drug-to-drug interactions with acyclovir.
  65. __________ is a prodrug for cyclovir
  66. Trifluridine 1% ophthalmic solution can cause what adverse effects?

    Epithelial keratopathy

    Increased IOP

    Dry eye and irritation

    Burning/stinging upon installation
  67. Which of the antivirals need to be refrigerated?
    Trifluridine 1% ophthalmic solution
  68. Corticosteroids can accelerate the spread of viral infections and are usually contraindicated in treatment of ______________ however, steroids may be used concurrently with trifluridine in treatment of _______________ infections and trifluridine should be continued for a few days after the steroid has been discontinued
    superficial Herpes simplex virus keratitis

    Herpes simplex stromal infections
  69. Coritcosteroids and anti-infective combinations are sometimes prescribed for what conditions?
    Steroid-responsive inflammatory conditions with bacterial infections or risk of bacterial infections
  70. Some anti-infective components that may be used with corticosteroids are...
    Sulfacetamide sodium, neomycin/polymyxin, gentamicin, or tobramycin
  71. Possible corticosteroid components of corticosteroid and anti-infective combinations include...
    prednisone, hydrocortisone, dexamethasone, prednisolone
  72. T/F Combination solutions should be shaken vigorously well prior to use
    F: they should be shaken but rolling between palms of hands is sufficient otherwise air bubbles can result
  73. T/F steroid containing products may increase IOP
  74. Ampicillin**
    aka: Principen, others

    Possible regimen: 250-500 mg PO q 6 hr

    Comments: Renal dose adjustment needed
  75. Clindamycin**
    aka: Cleocin

    Possible regimen: 150-450 mg PO q 6 hr

    Comments: Hard to tolerate, high potential for serious GI ADEs. Hepatic caution as well
  76. Azithromycin**
    • aka: Z-Pack, Zithromax, Zmax
    • - other strength products and preparations available

    Possible regimen: For Z-Pack: 2 x 500 mg tabs PO on day 1, then 1 x 250 mg tab PO on days 2-5

    • Comments: Dose varies by indication.
    • - Hepatic drug clearance*
  77. Doxyclycline**
    aka: Vibramycin, Vibra-tabs, Doryx, others

    Possible Regimen: 100 mg PO q 12 hr

    Comments: mostly hepatic clearance*
  78. Levofloxacin**
    aka: Levaquin

    Possible Regimen: 250-750 mg PO q 24 hr

    Comments: Renal dose adjustment needed
  79. Moxifloxacin**
    aka: Avelox

    Possible Regimen: 400 mg PO q 24 hr

    Comments: no renal adjustment needed*
  80. Trimethoprim/sulfamethoxazole**
    (not specifically on MT2, but on NBEO)
    • aka: Bactrim DS, Septra DS
    • - 800 mg SMX/160 mg TMP = "double strength"

    • Possible Regimen: For CA-MRSA: 2 DS tablets PO B.I.D.
    • (DS = double strength)

    • Comments: Renal dose adjustment needed
    • - Dose varies depending on whether double strength preparation is used
  81. Acyclovir**
    aka: Zovirax

    Possible Regimen: 800 mg PO 5x per day

    Comments: Renal dose adjustment needed
  82. Valacyclovir**********
    aka: Valtrex

    Possible Regimen: 1000 mg PO T.I.D. for VZV keratitis

    Comments: Renal dose adjustment needed
  83. Before prescribing any oral medication, what should you check for?
    1) Check for potential drug-to-drug interactions

    2) Compare the drug that you are considering prescribing with the other meds on the patient's medication history/profile

    3) Seek the assistance of the patients's primary medical doctor and/or a pharmacist if needed to interpret relative risks and for overall patient safety
  84. Class: Centrally acting adrenergic nerve blockers
    • Representative Drugs:
    • Clonidine, Guanabenz, Guanfacine, Methyldopa

    • MOA:
    • α2 agonists, decrease sympathetic outflow from brain to lower blood pressure

    Uses: HTN

    • Other info: orthostatic hypotension, sedation and other possible ADEs possible.
    • Blurred vision, conjunctivitis, and dry eyes are possible
  85. Class: Diuretics
    Representative Drugs: Several in different classes--see diuretics section

    Mechanism of action: see diuretics section in syllabus

    Uses: hypertension, edema, CHF

    Other info: thiazide diuretics currently used as initial meds for HTN
  86. Class: Selective alpha-adrenergic antagonists
    Representative Drugs: Prazosin, Doxazosin, Terazosin, Tamsulosin

    MOA: Competetive blockade of alpha receptors

    Uses: HTN; Doxazosin, Teraxosin, and Tamsulosin are also used for BPH

    • Other Info: Orthostatic hypotension and other ADEs possible.
    • Vision abnormalities (blurry vision, etc) and conjunctivitis can occur
  87. Class: Direct Vasodilators
    Representative drugs: Hydralazine, Minoxidil, Diazoxide, Nitroprusside

    MOA: Relaxes arterioles, peripheral vasculature, and/or smooth muscles independent of sympathetic effects

    Uses: HTN and other specific uses

    • Other info: usually reserved for hypertensive crisis, accelerated HTN, or advanced cases poorly controlled with more than one other class of anti-hypertensive agent.
    • Hydralazine can cause lacrimation
  88. Class: Beta adrenergic blocking agents
    Representative Drugs: Labetalol, Carvedilol, Propanolol, Sotalol, Nadolol, Metoprolol**, Timolol, Atenolol, Acebutolol, Bisoprolol, etc.

    • MOA: Competitive blockade of β adrenergic receptors.
    • - Some agents are specific for β1 receptors at usual doses, while others have actions on both β1 and β2 receptors

    Uses: HTN. Some used also for cardiac arrhythmias, angina pectoris, glaucoma, migraine prophylaxis, MI prevention, CHF maintenance, etc.

    Other Info: Many potential SDRs and D:D interactions. Individual agents need to be reviewed carefully when listed on a medication hx. Use of these agents can cause dryness or soreness of the eyes, orthostatic hypotension, etc. Non-selective agents and high doses can exacerbate bronchospasm in asthma or COPD patients.
  89. Class: Calcium channel antagonists
    Representative Drugs: Nifedipine, Diltiazem, Verapamil, Isradipine, Amlodipine and others

    MOA: Blocks calcium influx during slow channel exchange, dilates peripheral arterioles, some are used for antiarrhythmic properties, also used for angina prophylaxis.

    Uses: Angina prophylaxis, supraventricular tachycardia, HTN

    • Other info: Many potential ADRs and D:D interactions. Individual agents need to be reviewed carefully when listed on a medication hx.
    • Transient blindness has been reported rarely with nifedipine.
  90. Class: Aldosterone Receptor Antagonists
    Representative Drugs: Spironolactone, Eplerenone

    MOA: Blocks aldosterone binding to specific renal receptors

    Uses: HTN, CHF after MI, edema

    Other Info: Can cause hyperkalemia and nephrotoxicity
  91. Class: ACE-Inhibitors
    Representative Drugs: Captopril, Lisinopril**, Enalapril, Ramipril, Quinapril, and others

    MOA: Blocks conversion of angtiotensin I to Angiotensin II (a vasoconstrictor) and suppresses aldosterone, limitng sodium re-uptake in the kidney.

    Uses: HTN, CHF, MI

    • Other info: can cause hypotension, dizziness, tachycardia, headache, cough, bradykinin accumulation.
    • Many potential ADRs and D:D interactions
    • Individual agents need to be reviewed carefully when listed on a med hx
    • Vision changes have been rarely reported
  92. Class: Angiotensin Receptor Blockers ("ARBs")
    Representative Drugs: Losartan, Valsartan**, Irbesartan, Candesartan, Telmisartan and others

    MOA: Blocks angiotensin II receptor site to control vasoconstriction. Also suppresses aldosterone.

    Uses: HTN

    • Other Info: hypotension, dizziness, and other ADEs possible.
    • Conjunctivitis and blurred vision have been reported
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Pharm Test 2 .txt
pharm 70
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