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Pharmacology Drugs 5

Ocular Therapeutics-SA Antimicrobials

QuestionAnswer
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,
Created by: clcxrf