L23: Pharmacology Exam 1

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mherco
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169651
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L23: Pharmacology Exam 1
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2012-09-08 18:15:14
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Pharmacology
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Pharmacology
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  1. Name 6 ways that visual dysfunction can occur:
    • Abnormal ocular movement
    • Alteration in visual acuity
    • Alteration in accommodation
    • Alteration in refraction
    • Alteration in color vision
  2. What are the 3 subclasses of glaucoma?
    • Primary, Open-Angle Glaucoma (POAG): Usually due to outflow obstruction
    • Angle-Closure (Narrow Angle) Glaucoma: Iris displacement that prevents outflow
    • Congenital Glaucoma: Genetic malformation
  3. What are the risk factors of primary, open-angle glaucoma?
    • Increased IOP
    • Ethnicity
    • Family HX
    • Advancing age
  4. What is the formula for intraocular pressure?
    Rate of Formation/Rate of outflow + Perivascualar venous P
  5. What are the general classes of first line agents for POAG treatment?
    • Non-selective Beta Blockers
    • Selective Beta Blockers
    • A2-Adrenergic Agonists
    • Prostaglandin Analogs
  6. First Line POAG Treatment - non-selective beta blockers: Give examples, mechanism of action and advese effects
    • Example: Timolol, Carteolol, Levobunol, Metipranolol
    • Mechanism: Decrease formation
    • Adverse Effects: Heart block, bradycardia, bronchospasm
  7. First Line POAG Treatment - selective beta blockers: Give examples, mechanism of action and advese effects
    • Example: Betaxolol, levobetaxolol
    • Mechanism: Decrease formation
    • Adverse Effects: Heart block, bradycardia, hypotension
  8. First Line POAG Treatment - A2 adrenergic agonists: Give examples, mechanism of action and advese effects
    • Example: Apraclonidine (short term only), brimonidine
    • Mechanism: Increase outflow
    • Adverse Effect: Headache, dry  mouth/nose, change in taste, conjunctivitis, lid reaction, pruritis
  9. First Line POAG Treatment - prostaglandin analogs: Give examples, mechanism of action and advese effects
    • Example: Latanoprost, Bimatoprost, Travoprost, Unoprostone
    • Mechanism: Increase outflow
    • Adverse Effects: Heightened brown pigmentation of iris/eyelid
  10. What are the general categories of second line agents for POAG treatment?
    • Cholinergic Agonist (direct acting)
    • Acetylcholinesterase Inhibitors
    • Carbonic Anhydrase Inhibitors
    • Non-Selective Adrenergic Agonist
  11. Second Line POAG Treatment - cholinergic agonist: Give examples, mechanism of action and advese effects
    • Example: Pilocarpine
    • Mechanism: Increase outflow
    • Adverse Effects: Miosis, blurred vision
  12. Second Line POAG Treatment - Acetylcholinesterase Inhibitor: Give examples, mechanism of action and advese effects
    • Example: Echothiophate
    • Mechanism: Increase outflow
    • Adverse Effect: Miosis, blurred vision
  13. Second Line POAG Treatment - Carbonic Anhydrase Inhibitors: Give examples, mechanism of action and advese effects
    • Example: Dorzolamide, brinzolamide
    • Mechanism: Decreae formation
    • Adverse Effects: Ocular stinging, bitter taste, conjunctivitis, lid reactions
  14. Second Line POAG Treatment - Non-selective adrenergic agonists: Give examples, mechanism of action and advese effects
    • Example: Dipivefrin (coverted to epinephrine in eye)
    • Mechanism: Incrase outflow
    • Adverse Effects: Mydriasis, tachycardia, hypertension
  15. What drugs are used for the acute treatment of angle closure (narrow angle) glaucoma?
    • Short acting miotics
    • Osmotic agents
    • Carbonic-anhydrase inhibitors
    • Beta-adrenergic blocking agent
  16. Describe: Phenylephrine (mydriasis and cycloplegia action)
    • Mydriasis: Peaks in 10-30 minutes, recovery in .25 days
    • Cycloplegia: NONE :)
  17. Describe: Tropicamide (mydriasis and cycloplegia action)
    • Mydriasis: Peaks in 20-40 minutes, recovery in .25 days
    • Cycloplegia: Peaks in 20-30 minutes, recovery in < .25 days
  18. Describe: Atropine (mydriasis and cycloplegia action)
    • Mydriasis: Peaks in 30-40 minutes, recovery in 7-12 days
    • Cycloplegia: Peaks in 60-180 minutes, recovery in 6-12 days
  19. Describe: Dapiprazole
    • Constricts the pupil
    • Can be used to reverse mydriasis after eye exam
  20. What are some general allergic conjunctivitis treatments?
    • Mast cell stabilizers
    • Hitamine receptor blockers
    • NSAIDs
    • Glucocorticoids
    • Decongestants - Vasoconstrictors
  21. Name the 4 important decongestants used in allergic conjunctivitis that work through a vasoconstriction mechanism?
    • Nephazoline
    • Oxymetazoline
    • Phenylephrine
    • Tetrahydrozoline
  22. Describe Atopic/Dry ARMD - 3 stages and management
    • Stages: Early stage - develop druzens without visual loss
    •             Intermediate stage - minor alterations in visual field
    •             Advanced - progressive blurring in central visual field
    • Management: Antioxidants (Vitamin C, E, beta carotine) and zinc (+copper supplement)
  23. Describe Neovascular/Wet ARMD - cause and management
    • Cause: Growth of new subretinal blood vessels that cause the macula to shift
    • Management: Laster therapy, photodynamic therapy and angiogenesis inhibition (antibodies)
  24. Describe: Cyclosporin
    • Used to treat keratoconjunctivitis sicca (chronic dry eyes)
    • Found in demulcents (artificial tears), along with polyvinyl alcohol and cellulose esters
  25. What are the most common local anesthetics for the eyes?
    • Proparacaine
    • Tetracaine
  26. What anti-infectious agents exist for the eye?
    • Antimicrobial
    • Antifungal
    • Antiviral

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