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Pharm 2 - Ocular 2

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drraythe's version from 2015-04-13 21:57

(corneal) ulcers

Question Answer
what is the pathogenesis of a corneal ulcer? (what two things happen?)happens when there is an amplification of biochemical degradation of (1) stromal collagen (2) extracellular matrix glycosaminoglycans (what holds the cornea together)
what are the two main causative agents of a corneal ulcer?(1) host-derived proteinases (zinc metalloproteinases (MMPs), neutrophil serine proteinases) (2) exogenous microbial hydrolases
what are the two HOST proteinases which contribute to corneal ulcers?zinc metalloproteinases (MMPs), neutrophil serine proteinases
plasma alpha2-macroglobulin--> spectrum? works on what?(proteinase inhibitor), broad spectrum means it works on host AND microbial proteinases (alpha and macro= the big #1 does everything!)
why would you use a chelating agent to tx a corneal ulcer?Chelation= a particular way that ions and molecules bind metal ions.. My guess is that this means you're binding up the proteinase and rendering it useless
what are the three chelating agents used to inhibit proteinases?EDTA, acetylcysteine, tetracyclines(doxy)
EDTA is a what? side effects?chelating agent. it impairs epithelization (healing)
acetylcysteine is a what? what else does it do?chelating agent. it also has mucolytic action (lyses tear film mucins so film is more watery)
tetracyclines (doxycycline) is used as/for what?chelating agent to inhibit proteinases
what is a systemic proteinase inhibitor used to tx corneal ulcers? how do you apply it? what can you combine it with?homologous(self) plasma or serum which is applied topically; combo with EDTA or acetylcysteine
explain why we use heparin to tx corneal ulcersheparin has an indirect action impedes extravasation of leukocytes(which produce proteinases)
explain ilomastat (how does it work?)inhibits endogenous and Pseudomonas proteinases ( IL ma stat(fast) anti proteases, esp if theyre from pseudomonas)
polysulphated glycosaminoglycans--> used for what? how are they applied?5% solution in artificial tears. (remember that glycosaminoglycans are what the extracellular matrix of the eye is made of. if you have them polysulphated, not incorporatedback into eye matrix-- provide antiinflammatory action instead)
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glaucoma

Question Answer
what are the 4 main choices in how to dec intraocular pressure in glaucoma?(1) decreasing the production of aqueous humor (2) inc outflow (3) do some neuroprotection: prevent damage by increased glutamate(NMDA receptor) signalling (pressure on optic n-->inc glutamatic signaling--> can lead to neurodegeneration) (4) decide if sx is needed
trabecular outflow is mediated by what drugs?muscarinic agonists
(trabecular outflow is mediated by?)muscarinic agonists
(uvealsclearal outflow is mediated by?)prostaglandin agonists
(aqueous humor inflow is mediated by?)beta blockers, alpha2 AR agonists, CAIs
what are the three topical prostaglandine analogs?latanoprost; bimatoprost; travoprost (PROST= PROSTAGLANDIN)
what do topical prostaglandine analogs do (how do they work?)facilitates outflow through uveoscleral pathway (mechanism unknown-- works on Gq) (prostate has stuff flow OUT,and for U(uveo), Quick!) (outflow is prostate carps. awesome.)
what are the beta-adrenoceptor antagonists?timolol; metipranolol, betaxolol (BETA BLOCKERS END IN LOL!!!)
what receptor does the beta-antagonist most prominantly work on? what should be noted about these drugs?beta2-receptor most prominent(wanna open shit up); non-selective drugs, used in clinic
how to beta antagonists work?regulate aqueous humor production (B stoppin the pool from fillin up)
why do we use carbonic anhydrase inhibitors to tx glaucoma?reduced formation of bicarb leads to a reduction in fluid transport (pumps not pumping to exchange fluid or sthing)
what are the local carbonic anhydrase ihibitors? what are the oral carbonic anhydrase inhibitors?LOCAL= dorsolamide and brinzolamide. ORAL= methazolamide, dichlorphenamide, acetazolamide (bicarb-lamide. except dichlor) (MAD oral skills. local is BadDay when you gotta put crap in your eye)
what is the topical miotic used? what does it do?pilocarpine, increase aqueous outflow via trabecular outflow. (muscarinic) (carp swimming on the outflow of the river, avoiding the TReachery)
what are the two neuroprotection drugs used, and why are they used?used to prevent excitotoxicity of the optic nerve. (1) amlodipine; calcium channel blocker (2) memantine; NMDA channel blocker (both end in ine, calcified pines and sniffing NMDA off fork tines)
what are two surgeries used to help tx glaucoma?(1) cilio destruction (2) creation of alternative outflow tracts (Cullen frontal sinus shunt; gonioimplants)
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Anti-inflammatories

Question Answer
what are the 4 groups of antiinflammatories used on the eye?NSAIDs, antihistamines and mast-cell stabilizers, glucocorticoids, cyclosporin A (highly lipophilic immunosuppressant drug)
what is the absorption of NSAIDs like? how is it administered?rapid absorption, can be admin topically or subconjunctival injections-- can consider systemic tx
what are antihistamines/mast cell stabalizers used for?allergic conjunctivitis
how strong are glucocorticoids as antiinflmmatory agents? what side effects should you know? when should you not use?STRONG antiinflammatory effects, but they are IMMUNOSUPPRESSIVE And SHOULD NEVER BE USED ON DAMAGED CORNEA(impede healing i think)
cyclosporin A-- hydro or lipophilic? what side effect should you know? what is it used to tx?highly lipophilic. can be immunosuppressive. Is used to tx ERU- equine recurrent uveitis (trying to treat a recurrently dzed horse is a vicious CYCLE)
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diagnostic aids

Question Answer
what are the main autonomic agents used in the eye in vetmed?mainly muscarinic antagonists in veterinary medicine
sympatholytic drugs--> what pupillary response? what is the drug? what is the dz this is used to tx?constriction(miosis), timolol acetate, glaucoma (remember tim is constricting out of sympathy)
timolol acetate is a what used to tx what, with what effect on the eye?sympatholytic, used to tx glaucoma, causes constriction of the pupil (lol= beta blocker, so know it's adrenergic. Think that Tim is under a lot of pressure and so he is constricting inwards in sympathy)
para-sympatholytic drugs--> what pupillary response? what are the drugs? what is the dz this is used to tx?dilation (mydriasis). The drugs are atropine, tropicamide, scopolamine. Used to treat uveitis in the horse, and also used as a diagnostic agent (PS- atropine makes you all dewey eyed)
atropine is a what used to tx what, with what effect on the eye?para-sympatholytic drug, Used to treat uveitis in the horse, and also used as a diagnostic agent. dilation (mydriasis) (atropine would kill a horse, but not its uvea apparently)
tropicamide is a what used to tx what, with what effect on the eye?para-sympatholytic drug, Used to treat uveitis in the horse, and also used as a diagnostic agent. dilation (mydriasis) (a horses pupils get big when it looks at the tropics, and it's uveas are healed!)
scopolamine is a what used to tx what, with what effect on the eye?para-sympatholytic drug, Used to treat uveitis in the horse, and also used as a diagnostic agent. dilation (mydriasis)
sympathomimetic drugs--> what pupillary response? what are the drugs? what is the dz this is used to tx?dilation (mydriasis). phenylephrine, epinephrine. Used to treat anterior uveitis
phenylephrine is a what used to tx what, with what effect on the eye?sympathomimetic, Used to treat anterior uveitis. dilation (mydriasis). (looks like epinepherine. same thing)
epinephrine is a what used to tx what, with what effect on the eye?sympathomimetic, Used to treat anterior uveitis. dilation (mydriasis).
what are the topical local anesthetics?proparacaine and tetracaine (TP just stays on the eye surface)
what are the infiltrative local anesthetics?lidocaine and bupivacaine (LB infiltrates!)
what is a disinfectant that can be used on the eye?povidone iodine (iodine scrub on the eye)
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