1
Q
What is the proper name of vitamin B2?
A
Riboflavin
2
Q
Why is Riboflavin (B2) important?
A
Metabolism of nutrients
3
Q
What are the ocular complications of a Riboflavin (B2) deficiency?
A
Photophobia
Corneal neo
KCS
4
Q
What are the systemic manifestations of a Riboflavin (B2) deficiency?
A
Dry, cracked lips
Ulcers of the mouth
Sore throat
5
Q
How are large, hydrophilic drugs absorbed ocularly?
A
Transconjunctival route
6
Q
How are small, lipophillic drugs absorbed ocularly?
A
Transcorneal route
7
Q
Which class of glaucoma drugs should not be prescribed when there is active inflammation?
A
Prostaglandins
8
Q
What would be the best glaucoma drug to prescribe to a pt with active inflammation?
A
Brimonadine - often used after trabeculoplasty
9
Q
What are the 2 major complications with Ethambutol therapy?
A
Retrobulbar optic neuritis
Blue/yellow color defects
10
Q
How long after beginning Ethambutol to ocular side effects typically arise?
A
2-5 months
11
Q
What is the proper name of vitamin B1?
A
Thiamine
12
Q
Why is Thiamine (B1) important?
A
Carbohydrate metabolism
13
Q
What disease occurs in Thiamine (B1) deficiency?
A
Beriberi
14
Q
What are the symptoms of Beriberi from Thiamine (B1) deficiency?
A
Difficulty walking Peripheral neuropathy Paralysis Nystagmus Speech difficulty Mental confusion Ophthalmoplegia CHF
15
Q
Beriberi can also arise due to malnutrition from what lifestyle choice?
A
Alcoholism
16
Q
What is the proper name of Vitamin B3?
A
Niacin
17
Q
What is Niacin (B3) responsible for?
A
Carbohydrate metabolism
18
Q
Pellagra is caused by a deficiency of what?
A
Niacin (B3)
19
Q
What are the symptoms of Pellagra?
A
Diarrhea
Dementia
Dermatitis
20
Q
Which vitamin can be used to treat hyperlipoproteninemia?
A
Niacin (B3)
21
Q
What is the proper name of vitamin B6?
A
Pyridoxine
22
Q
What is the purpose of pyridoxine (B6)?
A
Coenzyme for formation of hemoglobin
Amino acid and protein metabolism
23
Q
The aminoglycoside antibiotics are known for corneal toxicity. Which is worse over the same period of time, Tobramycin or Gentamycin?
A
Gentamycin
24
Q
Why were aminoglycosides frequently used in the past?
A
Broad spectrum coverage
25
What class of drug and generation is diphenhydramine?
H1 blocker
| 1st generation
26
What are the side effects of 1st generation H1 blockers?
CNS dysfunction resulting in impairment of cognitive function or performance
27
Which generation of H1 blockers is sedating?
1st generation
28
Name at least 3 2nd generation H1 blockers.
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Loratidine (Claritin)
29
What class of drug is Erythromycin?
Antibiotic - Macrolide
30
What gram does Erythromycin cover?
(+)
31
Name at least 4 opoid analgesics.
Codeine
Hydrocodone
Oxycodone
Morphine
32
Which of the opioid analgesics is most associated with constipation?
Codeine
33
What is the common name of acetylsalicylic acid?
Aspirin
34
Patients with which color irides are most likely to have increased pigmentation with prolonged prostaglandin use?
Light brown
35
Scurvy results from a deficiency of what vitamin?
C
36
Vitamin C facilitates the absorption of what?
Dietary iron
37
What are the symptoms of scurvy?
```
General weakness
Anemia
Brown spots on skin
Spongy gums
Petechial hemorrhage of skin/mucous membranes
Proptosis
Feelings of paralysis
```
38
Name 3 conditions that atropine can be used to treat.
Amblyopia
Anterior uveitis
Posterior synechiae
39
What class of drug is atropine?
Anti-cholinergic
40
What are the 2 ocular alpha-2 agonists?
Apraclonidine
| Brimonidine
41
How do alpha-2 agonists work in glaucoma therapy?
Increases uveoscleral outflow
| Decreases production of aqueous
42
How do alpha-2 agonists reduce production of aqueous?
Constricting ciliary body vessels
43
Which class of antibiotics has a risk of causing idiopathic intracranial hypertension?
Tetracyclines
44
How do tetracyclines function as an antibiotic?
Disrupt bacteria protein synthesis by disrupting the 30s subunit
45
Which of the tetracyclines carries the highest risk of IIH?
Minocycline
46
Why does minocycline have the highest risk of IIH amongst the tetracyclines?
High lipid solubility gives it a higher affinity to pass into the CSF
47
What category of drug is Fluticasone?
Corticosteroid
48
What is the MOA of Salmeterol?
Long acting Beta-2 agonist
49
What is Salmeterol most frequently used for?
Asthma - to relax smooth muscle in/near the bronchioles, allowing for bronchodilation
50
What is the most common OTC decongestant?
Pseudoephedrine
51
What is the MOA of pseudoephedrine?
Adrenergic agonist
52
Pseudoephedrine should be used with caution in persons with what condition?
Cardiovascular disease
53
Which of the topical anti-cholinergics has the shortest duration of mydriatic effect?
Phenylephrine
54
What is the duration of action of phenylephrine?
3 hours
55
What is the duration of action of tropicamide?
6 hours
56
What is the duration of action of cyclopentolate?
24 hours
57
What is the duration of homatropine?
2 days
58
What is the duration of atropine?
2 weeks
59
1st generation cephalosporins have cross-sensitivity with what drug class?
Penicillins
60
Why do penicillins and cephalosporins have cross reactivity?
They both have a beta-lactam ring
61
If an organism is listed as "susceptible" on a sensitivity report, what does that mean?
The organism is sensitive to the standard dose
62
It is important to measure BP and pulse before prescribing which class of glaucoma meds?
Beta-blockers
63
Which drop carries a risk of retinal detachment?
Pilocarpine
64
What are the possible ocular side effects of pilocarpine?
Early cataracts
RD
Brow ache
Myopic shift
65
Why might a drop that is close to physiological pH increase the efficacy of a topical drug?
Less stinging, producing less reflex tearing, keeping more of the drug on the eye
66
Which type of drop is typically more efficacious, suspension or emulsion? Why?
Emulsion
| Pts don't remember to shake the suspension
67
What typically causes talc retinopathy?
IV drug use
68
If talc retinopathy is present, where else in the body may have talc accumulated?
```
Small blood vessels of:
Lungs
Liver
Spleen
Kidneys
Lymph nodes
```
69
What condition may be caused stemming from talc retinopathy?
Ischemia from blocked vessels
70
Which glaucoma med may have a neuroprotective effect?
Brimonidine
71
Acetazolamide should be used with extreme caution in persons with what condition?
Sickle-cell anemia
72
What is drug class does acetazolamide belong to?
CAIs
73
Why is acetazolamide contraindicated in sickle cell anemia?
CAIs can lead to metabolic acidosis, causing additional sickling of RBCs
74
To which class of drug does ketorolac belong?
NSAIDs
75
Percocet is a combination of what 2 drugs?
Oxycodone
| Acetaminophen
76
What may hydroxyurea be used to treat?
Sickle cell - to prevent sickling
77
What class of medications can be used to treat myokmia?
H1 blockers
78
H-1 antihistamines can be used to treat what type of hypersensitivity reaction?
Type I - immediate/anaphylactic
79
What mediates type I hypersensitivity?
IgE
80
What mediates type II hypersensitivity?
IgG/IgM
81
What mediates type III hypersensitivity?
Antibody/antigen complex
82
What mediates type IV hypersensitivity?
T cells
83
Name a disinfectant that is both bactericidal and virucidal.
H2O2
84
How does BAK function as a preservative?
Denatures bacterial cell membranes
85
What solution can be used in intraocular surgical procedures?
Balanced salt solution (BSS)
86
Why can thimerisol be toxic?
Contains mercury
87
Why should BSS be used in intraocular surgical procedures?
To maintain the proper isotonicity of the corneal endothelium
88
How do beta blockers work in hypertension?
Antagonize the beta receptors, allowing for vasodilation and diminished cardiac output
89
How can renin be used to decrease blood pressure?
Reducing renin decreases amounts of angiotensin II, which is a vasoconstrictor
90
How do ACE inhibitors work to lower blood pressure?
ACE converts angiotensin 1 to 2, which is a vasoconstrictor, so by inhibiting the conversion, BP is lowered
91
What is the primary MOA of statins?
Decreasing LDL
92
Why do elevated levels of LDL and triglycerides increase the risk of heart disease?
They can lead to plaque formation, narrowing the lumen of the vessels
93
Name 2 MOAs to reduce cholesterol.
```
Reduce LDL (statins)
Inhibit HMG-CoA reductase, ultimately reducing LDL
```
94
What demographic of patient is most likely to be a steroid responder?
Kids under 10
95
Which type of steroid poses the least risk of causing a steroid response?
Ester based steroids
96
Name a topical ester based steroid.
Loteprednol
97
Which glaucoma drop causes eyelash growth?
Bimatoprost (Lumigan)
98
What are the potential ocular side effects of bimatoprost?
```
Hyperemia
Iris color changes
SPK
CME
Pseudodendrites
Photophobia
Irritation
```
99
Folic acid is required by the body to manufacture what?
RBCs
100
Folic acid can be used to help treat what type of anemia?
Megaloblastic anemia
101
Heparin and Warfarin decrease coagulation by binding to what?
Factor Xa
102
How do aspirin and ibuprofen act as blood thinners?
Inhibiting the synthesis of THA2 (THA2 works with ADP for platelet adhesion)
103
Oral contraceptives carry a risk of what cardiovascular issue?
Blood clot formation
104
What do class I antiarrhythmic agents affect?
Sodium channels
105
What do class II antiarrhythmic agents do?
Decrease sympathetic activity of the heart by blocking beta receptors, and helping prevent recurrent MI
106
How do class III antiarrhythmic agents work?
Prolong repolarization by blocking K channels
107
How do class IV antiarrhythmic agents work?
Block calcium channels, decreasing conduction through the AV node
108
What is the mechanism that might cause topiramate to lead to glaucoma?
Increased choroidal effusion, leading to swelling of the ciliary body, and a subsequent narrowing of the angle (angle closure glaucoma)
109
What may topiramate be used to treat?
```
Seizures
Migraines
Depression
Bipolar disorder
Weight loss promotion
```
110
How long after beginning topiramate therapy do signs of angle closure typically appear?
3-14 days
111
Patients with sulfonamide allergy shouldn't be prescribed which combo antibiotic?
Bactrim (trimethoprim and sulfamethoxazole)
112
What makes up Bactrim?
Trimethoprim
| Sulfamethoxazole
113
Which drop is commonly used to help treat Fuch's dystrophy?
Muro-128
114
What class of drug is Muro-128
Hyperosmotic
115
What do topical anesthetics do the the cornea?
Loosen epithelium
116
Which drug softens the corneal epithelium more, proparacaine or tetracaine?
Tetracaine
117
Which drug is most known to cause crystalline retinopathy?
Tamoxifen
118
What is tamoxifen used to treat?
Breast cancer
119
Where do the crystals in crystalline retinopathy typically accumulate?
Paramacular region
120
What are the potential ocular side effects of tamoxifen?
```
Corneal deposits
CME
Gray lesions of RPE
Retinal hemes
Optic disc edema
```
121
What may Plaquenil be used to treat?
SLE
RA
Malaria
122
What is the most well-known ocular side effect of Chloroquine?
Bull's eye maculopathy
123
Why does chloroquine cause bull's eye maculopathy?
The drug binds to melanin and accumulates in the retina
124
What type of drug is Amiodarone?
Anti-arrhythmic
125
What are the potential ocular side effects amiodarone?
Vortex keratopathy
| NAION
126
What is the major risk with oral fluoroquinolones?
Tendon rupture
127
Name 4 relative contraindications of topical phenylephrine.
Arteriosclerosis
Cardiac disease
Orthostatic hypotension
Hypertension
128
Which oral antibiotic is capable of inhibiting collagenase?
Doxycycline
129
Which class of glaucoma drugs shouldn't be used in a patient with sulfonamide allergy?
CAIs
130
Why shouldn't CAIs be prescribed to pts with sulfa allergy?
CAIs are sulfonamide derivatives
131
Which of the NSAIDs is potentially hepatotoxic?
Acetaminophen
132
Acetaminophen lacks which property that most NSAIDs possess?
Blood thinning
133
Which NSAID is least harmful to the stomach?
Celecoxib
134
What meds make up Vicodin?
Acetaminophen and hydrocodone
135
What trade names are combinations of acetaminophen and hydrocodone?
Vicodin
Percocet
Percodan
Lortab
136
How do tetracyclines help in posterior blepharitis?
Inhibit bacterial lipase production, reducing the concentration of free fatty acids
137
What is the MOA of cyclosporin?
Inhibition of activated T cells
138
Name the 5 things that may cause whorl (vortex) keratopathy.
```
Fabry's disease
Tamoxifen
Chlorpromazine
Chloroquine
Indomethacin
```
139
What are the 2 major routs of drug loss via topical instillation in the eye?
Spillover onto the cheek
| Drainage via nasolacrimal sac
140
About how long does it take for a steroid responder to "respond"?
3-4 weeks
141
Alcohol consumption may lead to what type of nystagmus?
End gaze nystagmus
142
Which drug has potential to cause a serious interaction with amiodarone?
Warfarin - enhanced blood thinning
143
Why do you taper steroids?
To reduce risk of rebound inflammation
144
What is common side effect of oral and topical H1 blockers?
Headache
145
What are the potential side effects of topical steroid use?
```
PSC
IOP increase
Reduced resistance to fungal, viral, and bacterial infections
Delayed would healing
Mydriasis
Ptosis development
```
146
Why might caffeine be added to NSAIDs?
Enhance their effects
| -Typically added to acetaminophen or aspirin
147
Which HTN drug is associated with transient myopia?
Diuretics (thiazides)
148
Which topical steroid is least likely to cause PSC?
Loteprednol (ester=safer)
149
Drugs with which property can cross the BBB?
Lipid solubility
150
Which cycloplegic/mydriatic drugs are contraindicated in trisomy 21?
Atropine
Scopolamine
- may cause hypersensitivity reaction
151
A deficiency of which vitamin causes rickets and osteomalacia?
Vitamin D
152
What is the role of vitamin D in the body?
Regulation of calcium and phosphate levels
153
FA should be performed with caution in people taking which meds?
Beta blockers
154
Why is caution needed in FA when a patient is on beta blockers?
Rare anaphylactic reactions are harder to control when beta blockers are being used
155
Which topical NSAID can be used for seasonal allergic conjunctivitis?
Ketorolac
156
What conditions may ketorlac be used to treat?
Conj inflammation
Post cataract inflammation
CME
Seasonal allergic conjunctivitis
157
What are the 5 drugs that may cause optic neuritis?
```
Chloramphenicol
Ethambutol
Isoniazid
Digitalis
Ribavirin
```
158
What are the 3 drugs that may cause NAION?
(VIA)
Viagra
Immatrex
Amiodarone
159
Why can digitalis be harmful to the eye?
It works on Na/K pumps (for the heart), and there are a ton in the PRs, endo, and NPCE
160
What are the 3 drugs that affect bone marrow?
Chloramphenicol
Trimethoprim
Retrovir
161
What are the 7 causes of whorl keratopathy?
```
(CCHAI-T and Fabry's)
Chloroquin
Chlorpromazine
Hydroxychloroquin
Amiodarone
Indomethacin
Tamoxifen
Fabry's disease
```
162
What are the causes of bull's eye maculopathy?
Chloroquin
| Hydroxychloroquin
163
What drugs cause pigment changes?
Indomethacin
Premoethazine
Thioridazine
Chlorpromazine
164
What 3 drugs may cause SJS?
Amoxicillin
Trimethoprim
Celecoxib
165
What drugs may cause oculogyric crisis?
Cetrizine
Chlorpormazine
Thioridizine
166
What antibiotics shouldn't be used during pregnancy?
(FAT)
Fluoroquinolones
Aminoglycosides
Tetracyclines
167
What antibiotics are OK in pregnancy?
(PAC)
Penicillins
Azithromycin
Cephalosporins
168
What are the common broad spectrum antibiotics?
Aminoglycosides
Tetracyclines
Fluoroquinolones
169
What are the 5 X-linked disease?
Fabry's
Alport
Albinism
Cone dystrophy
170
What are the 3 hormones that will increase blood pressure?
Anti-diuretic hormone (ADH)
Angiotensin II
Aldosterone
171
How does angiotensin II increase BP?
Causes vasoconstriction
172
How does aldosterone increase BP?
Increases blood volume
173
How does ADH increase BP?
Increases blood volume
174
Which hormone is the most potent in terms of increasing BP?
Angiotensin II
175
Where does ADH work?
On the collecting duct
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