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Pharmacology Drugs 5
Ocular Therapeutics-SA Antimicrobials
| Question | Answer |
|---|---|
| What are common methods of administering opthalamic drugs? | topical, systemic, subconjunctival, intralesional |
| Which drugs have the longest contact times as far as topicals go? | oinments |
| T/F: suspensions >10um work best in the eye. | False; >10um=irritant |
| Are most preservatives used in topical eye meds bacteriocidal or bacteriostatic? | bacteriostatic |
| When you have to give multiple eye meds, how much time b/t each aministration should you allow and in what order? | 5+min b/t each amin; solutions first, suspensions second, ointments last |
| Where is a sub-palpebral lavage tube placed in equine eyes? | inferomedial placement |
| What type of eye disease do systemic eye drugs cure? | orbital and posterior segment diseases |
| What must you take into consideration when choosing a systemic ocular drug? | it must cross blood-ocular barriers |
| Why would you use subconjunctival injectable drugs? | Topical treatments not possible; Achieve high initial drug levels; Sustained levels (repositol agents) |
| For which problems/diseases would you choose to use a topical antimicrobial? | Corneal ulcers; Conjunctivitis; Blepharitis- inflam of eyelide; Dacryocystitis- inflam of teat duct; Post-op (Adnexal Surgery) |
| for which problems/disease would you choose to use a systemic antimicrobial? | Anterior uveitis; Chorioretinitis; Endophthalmitis; Orbital cellulitis/abscess; post-op (Intraocular Surgery) |
| what aminoglycosides are available for use in ocular medicine? | neomycin, amikacin, gentomycin, tobramycin |
| Why are aminoglycosides commonly used as topicals for opthamology? | broad spectrum and poor penetration |
| which aminoglycoside will cause hypersensitivity reactions in cats? | neomycin |
| what are the polypeptide antibiotics? | polymyxin B, bacitracin, gramicidin, vancomycin |
| polypeptide antibiotics are used commonly as what in reference to ocular pharmaceuticals? | topicals |
| polypeptide antibiotics have a narrow spectrum of usage and which microbes? | gram positive and gram negative |
| which polypeptide antibiotic is used to treat gram negative ocular diseases? | polymyxin B |
| which antibiotics are found in "triple antibiotics?" | neomycin, Polymyxin B, bacitracin, gramicidin |
| this drug is used commonly to treat ulverative keratitis and conjunctivitis in cats. | Chloramphenicol |
| Streptococcus is normally resistant to which antibiotic? | aminoglycosides |
| Pseudomonas is normally resistant to which antibiotic? | chloramphenicol |
| chloramphenicol is used as a topical why? | it penetrates well and has a broad spectrum of action |
| which fluoroquinolones are used as topical ocular meds? | Ciprofloxacin; Ofloxacin; Gatifloxacin; moxifloxacin; Levofloxacin; Norfloxacin |
| which fluoroquinolones are used as systemic ocular meds? | Enrofloxacin**; Ciprofloxacin; Norfloxacin; Orbifloxacin; Marbofloxacin |
| fluoroquinolones are ineffective against what? | anaerobes |
| why are fluoroquinolones not recommended to be used routinely as a topical? | decrease healing speed of eye |
| why are systemic fluoroquinolones not recommended for use in cats? and which one is it specificallY? | cause retinal degeneration; enrofloxacin |
| what are fluoroquinolones commonly used for? | severe corneal infections |
| why are tetracyclines a good choice for use in topical ocular diseases? | broad-spectrum, bacteriostatic |
| what are some common uses of tetracyclines in opthamology? | Infectious bovine keratoconjunctivitis(systemic oxytetracycline); Feline conjunctivitis (topical oxytetracycline); Canine uveitis (systemic doxycycline); Tear staining – cosmetic only (systemic tetracycline) |
| how do macrolides work as ocular meds? | spectrum varies with agent |
| Azithromycin is used to treat? | Borrelia burgdorferi; Bartonella henselae |
| what drug is used as an alternative to oxytetracycline for feline conjunctivitis? | erythromycin |
| Erythromycin treats what spectrum of microbes? | gram positive |
| lincosamides (clindamycin) is used to treat? | anaerobic infections and feline uveitis |
| Azoles work how? | inhibit cytochrome P450 14a-demethylase and prevent synthesis of ergosterol |
| what are some triazoles used in ocular vet med? | Fluconazole; Itraconazole; Voriconazole |
| which of those triazoles are used topically in ocular vet med? | Itraconazole; Voriconazole |
| what are the imidazoles and which one is used topically? | Miconazole; Ketoconazole; mmiconazole used topically |
| how doe polyenes work? | Binds to sterol in the fungal cell membrane disrupting membrane integrity |
| what are the polyene ocular vet med drugs? | Natamycin; Nystatin; Amphotericin B |
| what are the pyrimidine nucleoside analog antiviral agents for ocular med? | Idoxuridine (topical); Trifluridine (topical) |
| whata re the purine nucleoside analog antiviral agents for ocular med? | Famciclovir (oral); Cidofovir (topical); Valacyclovir (systemic) |
| which purine nucleoside analong antiviral is not for use in cats? | valacyclovir |
| which purine nucleoside analog antiviral is to be given only twice per day? | cidofovir |
| interferons are used as antivirals and exert their effects at what level? | cellular level |
| how doe l-lysine work? | decreases arginine available to the replicating virus |
| what are corticosteroids used to treat in ocular med? | Posterior uveitis; Optic neuritis; Blepharitis; Conjunctivitis; Keratitis(Immune-mediated and Non-ulcerative); Anterior uveitis |
| T/F: it's wise to use topical corticosteroids with corneal ulcers | false; never use corticosteroids with corneal ulcers |
| with which ocular diseases would you not use corticosteroids other than corneal ulcers? | Infectious keratitis (toical); Deep mycotic disease (systemic) |
| what forms of corticosteroids are more lipid soluble? | acetate and alcohol forms more so than phosphate form |
| why is solubility of an ocular drug an important consideration? | highly lipid solubile= better penetration through corneal epithelium |
| why is potency of an ocular drug an important consideration? | The extent of the anti-inflammatory effect, irrespective of penetration |
| addition of fluoride or methyl groups to a molecule does what to the corticosteroid? | enhances anti-inflammatory activity |
| which is more potent: dexamethasone or prednisolone? | dexamethasone |
| which pentrates the cornea better: prednisoloneacetate or dexamethasone sodium phosphate? | prednisoloneacetate |
| what is a non-penetrating corticosteroid and what is it used for? | dexamethasone sodium phosphate; superficial problems: immune-mediated non-ulcerative keratitis or allergic/follicular conjunctivitis |
| what is a penetrating corticosteroid and what is it used for? | prednisolone acetate; deep ocular problems: anterior uveitis and nodular granulomatous episcleritis |
| systemic corticosteroids are used to treat? | uveitis, optic neuritis, immune-mediated disorders |
| what is an indication for use of megestrol acetate? | eosinophilic keratitis |
| how is megestrol acetate administered? | orally |
| what is the dosing regimine like for megestrol acetate? | 2.5-5mg daily for 5d; every other day for 5d; every three days for 5d; one dose every 1-2wks |
| what are some contraindications of megestrol acetate? | diabetes mellitus; pyometra; adrenocortical suppression |
| what are two corticosteroids that can be injected intralesionally or subconjunctivally? | depo-medrol; dexamethazone |
| what diseases do the intralesion and subconjunctival injectable corticosteroids treat? | anterior uveitis; nodular granulomatous episcleritis; infectious bovine keratoconjunctivitis |
| which systemic NSAID causes dry eye? | etogesic |
| what are the systemic NSAIDS? | Aspirin; Rimadyl; Etogesic; Phenylbutazone; Flunixin meglumine; Metacam; Previcox; Piroxicam; Zubrin; Deramaxx |
| what are the calcineurin inhibitors? | Cyclosporine A (oral, topical), Tacrolimus (topical) |
| what are calcineurin inhibitors used to treat? | keratoconjunctivitis sicca and immune-mediated diseases |
| why would you choose to use tacrolimus over cyclosporine A to treat dry eye? | b/c patient doesn't respond to cyclosporine therapy |
| A novel bioerodible deep scleral lamellar cyclosporine implant is used to treat? | Equine Recurrent Uveitis |
| what is an indication for use of megestrol acetate? | eosinophilic keratitis |
| how is megestrol acetate administered? | orally |
| what is the dosing regimine like for megestrol acetate? | 2.5-5mg daily for 5d; every other day for 5d; every three days for 5d; one dose every 1-2wks |
| what are some contraindications of megestrol acetate? | diabetes mellitus; pyometra; adrenocortical suppression |
| what are two corticosteroids that can be injected intralesionally or subconjunctivally? | depo-medrol; dexamethazone |
| what diseases do the intralesion and subconjunctival injectable corticosteroids treat? | anterior uveitis; nodular granulomatous episcleritis; infectious bovine keratoconjunctivitis |
| which systemic NSAID causes dry eye? | etogesic |
| what are the systemic NSAIDS? | Aspirin; Rimadyl; Etogesic; Phenylbutazone; Flunixin meglumine; Metacam; Previcox; Piroxicam; Zubrin; Deramaxx |
| what are the calcineurin inhibitors? | Cyclosporine A (oral, topical), Tacrolimus (topical) |
| what are calcineurin inhibitors used to treat? | keratoconjunctivitis sicca and immune-mediated diseases |
| why would you choose to use tacrolimus over cyclosporine A to treat dry eye? | b/c patient doesn't respond to cyclosporine therapy |
| A novel bioerodible deep scleral lamellar cyclosporine implant is used to treat? | Equine Recurrent Uveitis |
| T/F: an antibiotic can still work even if there is no blood flow through an area? | false; no blood= no antibiotic penetration |
| what is an indication for use of megestrol acetate? | eosinophilic keratitis |
| how is megestrol acetate administered? | orally |
| what is the dosing regimine like for megestrol acetate? | 2.5-5mg daily for 5d; every other day for 5d; every three days for 5d; one dose every 1-2wks |
| what are some contraindications of megestrol acetate? | diabetes mellitus; pyometra; adrenocortical suppression |
| what are two corticosteroids that can be injected intralesionally or subconjunctivally? | depo-medrol; dexamethazone |
| what diseases do the intralesion and subconjunctival injectable corticosteroids treat? | anterior uveitis; nodular granulomatous episcleritis; infectious bovine keratoconjunctivitis |
| which systemic NSAID causes dry eye? | etogesic |
| what are the systemic NSAIDS? | Aspirin; Rimadyl; Etogesic; Phenylbutazone; Flunixin meglumine; Metacam; Previcox; Piroxicam; Zubrin; Deramaxx |
| what are the calcineurin inhibitors? | Cyclosporine A (oral, topical), Tacrolimus (topical) |
| what are calcineurin inhibitors used to treat? | keratoconjunctivitis sicca and immune-mediated diseases |
| why would you choose to use tacrolimus over cyclosporine A to treat dry eye? | b/c patient doesn't respond to cyclosporine therapy |
| A novel bioerodible deep scleral lamellar cyclosporine implant is used to treat? | Equine Recurrent Uveitis |
| T/F: an antibiotic can still work even if there is no blood flow through an area? | false; no blood= no antibiotic penetration |
| what is the general flora of the mouth? | gram positive, aerobic, non-motile, cocci bacteria |
| what is the flora of the mouth when periodontal disease sets in? | gram negative, anaerobic, motile, rod bacteria |
| which oral microflora are frequqnetly reported to not be obligately anaerobes? | streptococcus; actinomyces |
| T/F: when you do a culture of the mouth, it is important to do both an aerobic and an anaerobic culture. | True |
| T/F: antimicrobial therapy alone does not eliminate progression of periodontal disease. | True |
| what are clinical signs of periodontal disease? | Halitosis; Decreased appetite; Excessive salivation; Oral discomfort; Accumulation of plaque and tartar (calculous); Inflamed or bleeding gingiva |
| what is the difference b/t calculous and plaque? | plaque can be wiped off of the tooth; calculous must be scraped off with a dental tool |
| what is the number one preventative method in avoiding periodontal disease? | brush teeth |
| what is the general flora of the mouth? | gram positive, aerobic, non-motile, cocci bacteria |
| what is the flora of the mouth when periodontal disease sets in? | gram negative, anaerobic, motile, rod bacteria |
| which oral microflora are frequqnetly reported to not be obligately anaerobes? | streptococcus; actinomyces |
| T/F: when you do a culture of the mouth, it is important to do both an aerobic and an anaerobic culture. | True |
| T/F: antimicrobial therapy alone does not eliminate progression of periodontal disease. | True |
| what are clinical signs of periodontal disease? | Halitosis; Decreased appetite; Excessive salivation; Oral discomfort; Accumulation of plaque and tartar (calculous); Inflamed or bleeding gingiva |
| what is the difference b/t calculous and plaque? | plaque can be wiped off of the tooth; calculous must be scraped off with a dental tool |
| what is the number one preventative method in avoiding periodontal disease? | brush teeth |
| Why are antibiotics not very effective against periodontal disease? | plaque on the teeth protects the bacteria from antibiotics due to the biofilm the plaque produces |
| how do you treat periodontal disease? | educate the owner, train and motivate owner, daily toothbrushing, supra- and sub-gingival scaling and polishing, root planing and extraction of unsalvageable teeth |
| in order from 1st to 4th, what are the top systemic use periodontal antibiotics? | clindamycin, clavomox, metronidazole, doxycycline |
| what is the most commonly used local antibiotic for periodontal disease? | doxirobe gel |
| why is clavamox better than clindamycin? | has a better IN VITRO culture and sensitivity results |
| why is clindamycin better than clavamox | it can get through the biofilm to treat the tooth; clavamox cannot |
| what is the antibiotic of choice for periodontal disease resulting from actinomyces | clindamycin |
| why is doxirobe a good drug of choice? | meadows interpretation: it acts as a physical barrier to slow down the overgrowth of hte long junctional epithelium; is an anti-inflammatory; |
| what does doxirobe do to destroy microbes? | Inhibits collagenase enzymes, which are destructive to the periodontal attachment apparatus |
| clues of a bacterial infection? | Purulent exudate ; Fever +/-; Evidence of sepsis; Localized disease site; Predisposing events; Cytologic evidence (including Gram stain); Culture evidence |
| what should you consider when choosing an antibiotic? | Susceptibility of pathogen ; Antibacterial activity; Drug distribution; Local environmental factors; Safety for the individual; Drug formulation/administration |
| T/F: Fluoroquinolones are good broad spectrum drugs for gram+ and gram- microbes; therefore, they will also cover anaerobic microbes. | False; don't cover anaerobic microbes |
| T/F: azithromycin has good anaerobic and gram- bacteria covereage. | False |
| What gram negative and what anaerobe does azithromycin cover? | Bordetella; Pasturella |
| which antibacterials have "static" effects? | macrolides, tetracyclines, chloramphenicol |
| what antibacterials have "cidal" effects? | aminoglycosides, beta lactams, fluoroqinolones, TMS |
| what barriers to distribution do we have to worry about? | blood-brain, blood-prostate, blood-ocular, blood-bronchus |
| Define pharmaceutic | are related to chemical stability and conformation in drug mixtures |
| define pharmacodynamic | synergy or antagonism of drug |
| define pharmacokinetic | include drugs that change the absorption, distribution, or elimination of others |
| which drugs are time dependent drugs? | the beta lactams, tetracyclines, macrolides, chloramphenicol |
| which drugs are concentration dependent drugs? | aminoglycosides, fluoroquinolones |
| characterisitics of penicillins | covers gram-/+, anaerobes, aerobes, is bacteriocidal and time dependent, |
| what are some toxiciites that can occur with penicillins | GI toxicity and blood dyscrasia |
| characteristics of beta lactamase inhibitors | same as penicillin: covers gram-/+, anaerobes, aerobes, time dependent, bacteriocidal |
| characteristics of first genreation cephalosporins? | time dependent, bacteriocidal, covers gram+ and aerobes |
| what are the first generation cephalosporins | Cefadroxil; Cefazolin; Cephalexin |
| characterisitics of second geneartion cephalosporins? | bacteriocidal, time dependent, covers gram+/-, anaerobes and aerobes |
| what are the second generations cephalosporins? | Cefoxitin; Cefaclor |
| characterisitics of third generation cephalosporins? | covers gram -, aerobes and anaerobes, bacteriocidal, time dependent |
| what are the third generations cephalosporins? | ceftiofur, cefotaxime, ceftazidime |
| what are two new cephalosporins that use atypical methods of curing infections? | simplicef, convenia |
| characterisitics of amnioglycosides? | bacteriocidal, concentration dependent covers gram- and aerobes, toxicities to ear, kidneys and muscles |
| characteristics of fluoroqinolones? | bacteriocidal, concentration dependent, tissue penetration, cover gram+/- and aerobes and intracellular pathogens. toxicities include eye and skeletal |
| characterisitics of sulfonamides? | time dependent, bacteriocidal, covers gram+/- and aerobes and has good tissue penetration. toxicities to eye, bones and causes blood dyscrasia |
| characteristics of tetracyclines? | bacteriostatic, time dependent, cover gram+/-, anaerobes, aerobes, and intracellular pathogens, and has good tissue penetration |
| what can tetracyclines be used to treat? | ricketsial diseases |
| characteristics of macrolides? | bacteriostatic, time dependent, covers gram+ and some gram- (pasturella and bordatella) and anaerobes and aerobes, and intracellular pathogens. causes GI problems |
| characteristics of lyncosamides? | bacteriocidal and bacteriocidal, time dependent, covers gram+, anaerobes, aerobes, and intracellular pathogens also some protozoans |
| characteristics of chloramphenicol? | bacteriostatic, covers gram+/-, aerobes and anaerobes, has good tissue penetration and is time dependent |
| characteristics of carbapenem? | bacteriocidal, time dependent, covers gram+/- and anaerobes and aerobes, |
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