1
Q
ANTIBIOTIC TREATMENT FOR DACRYOCYSTITIS
A
- augmentin
- clindamycin
- vancomycin + ceftriaxone
2
Q
ANTIBIOTICS TREATMENT FOR BLEPHARITIS
A
- anterior blepharitis = can use azithromycin solution or erythromycin ointment (on top of eyelid hygiene / warm compresses)
- posterior blepharitis = more systemic antibiotics if eyelid hygiene / Meibomian gland massage doesn’t work = Tetracyclines or Azithromycin
3
Q
ANTIBIOTICS TREATMENT FOR BLEPHARITIS
A
- anterior blepharitis = can use azithromycin solution or erythromycin ointment (on top of eyelid hygiene / warm compresses)
- posterior blepharitis = more systemic antibiotics if eyelid hygiene / Meibomian gland massage doesn’t work = Tetracyclines or Azithromycin
4
Q
ANTIBIOTICS TO TREAT HORDEOLUM
A
- MC caused by staph aureus
- mainstay of treatment = warm compresses
- ABX = azithromycin or Bactroban ointment
5
Q
UNASYN
A
ampicillin + sulbactam (beta lactamase inhibitor)
6
Q
beta lactamase inhibitors
A
clavulanate (augmentin)
sulbactam (unasyn)
tazobactam (Zosyn)
7
Q
antibiotics used to treat blowout fracture if infection develops/needed
A
Unasyn (ampicillin + sulbactam)
or clindamycin
8
Q
treatment for lyme disease
A
doxycycline = adults
amoxicillin in children < 8 & pregnancy
if doxy is CI or if allergic to PCN = give azithro or erythro
9
Q
treatment for RSMF
A
doxycycline, even in kids < 8
2nd line = Chloramphenicol - if pregnant….however chloramphenicol in 3rd trimester = associated with Grey Baby Syndrome
10
Q
AUGMENTIN
A
amoxicillin + clavulanate
11
Q
Treatment for WILSON’S DISEASE
A
D-Penicillinase = chelates copper
Zinc = increases fecal excretion of copper, and decreases intestinal absorption of copper
12
Q
TREATMENT FOR H.PYLORI
A
CAP
Clarithromycin + Amoxicillin + PPI (omeprazole)
if allergic to PCN = give metronidazole instead (with clarithromycin + PPI)
13
Q
TREATMENT FOR WET MACULAR DEGENERATION
dry = drusen; gradual vision loss, more common wet = neovascularization; less common, more rapid loss
A
BEVACIZUMAB = intra-vitreal anti-angiogenic = inhibits VEGF (vascular endothelial growth factor) to reduce neovascularization
14
Q
TREATMENT FOR PROLIFERATIVE DIABETIC RETINOPATHY
A
VEGF INHIBITOR = BEVACIZUMAB
15
Q
ACETAZOLAMIDE (diuretic) IS USED FOR
A
- altitude sickness
- papilledema
- glaucoma (1st line for acute angle closure glaucoma, but not 1st line for chronic (open angle) glaucoma - latanoprost/prostaglandin analogs = 1st line)
- epilepsy
16
Q
eye drops for contact lens wearers
A
CIPROFLOXACIN (protects against pseudomonas)
17
Q
antibiotics to avoid with corneal abrasions
A
AMINOGLYCOSIDES = toxic to corneal epithelium
STEROIDS = slows epithelial healing & predisposed to further infection
never prescribe topical anesthetics for the eyes
- can prescribe cycloplegics though
18
Q
GONORRHEA
A
CEFTRIAXONE (ROCEPHIN)
19
Q
CHLAMYDIA
A
AZITHROMYCIN OR DOXYCYCLINE
20
Q
AMINOGLYCOSIDE DRUGS
A
streptomycin gentamycin tobramycin amikacin neomycin
21
Q
medication for bacterial conjunctivitis
A
erythromycin
can also use azithromycin, fluoroquinolones (moxifloxacin), sulfonamides, aminoglycosides (can be toxic to cornea).
if contact lens wearer = fluoroquinolones (cipro)
22
Q
medication for viral conjunctivitis
A
supportive therapy - cool compresses, artificial tears
can give topical antihistamines for itching / redness
- H1 blocker topical antihistamine = Olopatadine (Patanol = antihistamine / mast cell stabilizer)
23
Q
medication for allergic conjunctivitis
A
- topical antihistamines: H1 blockers = Olopatadine (Patanol), Pheniramine/Naphazoline (Naphcon A)
- can give topical NSAID - ketorolac
- topical steroids
- (se of long term steroid use on eyes = glaucoma, cataracts, and HSV keratitis)
24
Q
medication that can cause optic neuritis
A
ETHAMBUTOL
also chloramphenicol
25
treatment for orbital cellulitis
- IV abx: Vancomycin, Clindamycin, Cefotaxime, Ampicillin/sulbactam (unasyn)
26
HSV keratitis treatment
- treat with topical antivirals = trifluridine, vidarabine, ganciclovir ointment, PO acyclovir
27
Bacterial keratitis treatment
Treat with fluoroquinolone drops (moxifloxacin) - do NOT patch!
28
cataracts are a SE of
steroids
29
TREATMENT FOR ACUTE ANGLE CLOSURE GLAUCOMA
- 1st line = ACETAZOLAMIDE - decreases aqueous humor production --> decreases IOP
- BB - Timolol - reduces IOP pressure without affecting visual acuity
- Miotics (constricts) / cholinergics = Pilocarpine, Carbachol = acetylcholine induced papillary constriction --> reduces IOP by increasing aqueous humor drainage through pupil constriction
- Alpha 2 agonists - apraclonidine , brimonidine - suppresses aqueous humor production, and increases outflow
30
TREATMENT FOR CHRONIC OPEN ANGLE GLAUCOMA
1st line = prostaglandin analogs = Latanoprost --> reduces IOP
- Timolol (BB)
- Brimonidine (alpha-2 agonist) - decreases production and increases outflow
- acetazolamide (carbonic anhydrase inhibitor - reduces IOP by decreases production of aqueous humor)
31
TREATMENT FOR PAPILLEDEMA
ACETAZOLAMIDE = decreases production of aqueous humor
32
optic neuritis treatment
- IV methylprednisolone followed by oral steroids
| - vision usually returns with treatment
33
EPIDIDYMITIS TREATMENT
- in younger men < 35 = consider GC & Chlamydia = give Ceftriaxone 250mg IM + Doxy 100mg BID x 10 days (if septic = hospitalize for IV hydration & IV antibiotics)
- in older men or hx of BPH, urethral stricture, or chronic UTI = consider enteric gram negative bacteria = fluoroquinolones!
- Levaquin 500mg qday x 10 days: outpatient management
SYMPTOMATIC TREATMENT
⦁ NSAIDS
⦁ Scrotal elevation
⦁ Ice
lot of symptomatic relief while waiting for ABX to work
34
MEDS THAT CAN CAUSE PRIAPISM
PDE-5 inhibitors
antidepressants (especially Trazodone)
antipsychotics
anticonvulsants
alpha blockers
35
PHENYLEPHRINE
alpha agonist used for PRIAPISM (1st line!)
causes vasoconstriction - will increase venous outflow of blood / contract smooth muscle
CONTRAINDICATIONS = cardiac or CV history
36
TREATMENT FOR PRIAPISM
TREATMENT FOR LOW FLOW (ISCHEMIC PRIAPISM)
1st line = PHENYLEPHRINE = alpha agonist intracavernous injection - causes contraction of smooth muscle - will increase venous outflow
TERBUTALINE = PO or SQ - constricts cavernosal artery - decreases arterial inflow; may be used if < 4 hrs
Needle Aspiration of corpora to remove blood; especially if > 4 hours duration - can also give phenylephrine in addition to aspiration
surgery if not responsive to medication / aspiration
TREATMENT FOR HIGH FLOW (NON-ISCHEMIC)
- observation
- can do arterial embolization or surgical ligation if refractory
37
reversal of methotrexate
Leucovorin
38
medication to treat EPS (extrapyramidal symptoms)
Cogentin (Benztropine)
39
BBW of anti-depressants
suicidal thinking / behavior
40
SNRI indicated for DPN & Fibromyalgia
Duloxetine (Cymbalta)
41
SNRI DRUGS
VENLAFAXINNE (EFFEXOR)
DESVENLAFAXINE (PRISTIQ)
DULOXETINE (CYMBALTA)
LEOMILNACIPRAN (FETZIMA)
42
URINARY RETENTION MEDICATION
ALPHA-1 BLOCKERS
- Prazosin (Minipress)
- Tamsulosin (Flomax)
- Doxazosin (Cardura)
43
PYELONEPHRITIS MEDICATION
FLUOROQUINOLONES**** if resistance is low
cipro or Levaquin
if resistance is high = give Bactrim or augmentin
if in hospital = give IV ceftriaxone, then discharge on fluoroquinolones
44
TREATMENT FOR GOUT
ALLOPURINOL
45
PHENOZOPYRIDINE
anesthetic agent (pill) in urogenital tract - can give for symptoms of dysuria. Turns urine dark orange. Will stain clothes permanently
46
CYSTITIS TREATMENT
```
WOMEN
nitrofurantoin (Macrobid)
Bactrim
can give phenozopyridine (pyridium)
reserve fluoroquinolones (for pyelonephritis and more severe cases due to resistance)
```
MEN
Bactrim
fluoroquinolone
47
PDE-5 INHIBITORS
SILDENAFIL (VIAGRA)
TADALAFIL (CIALIS)
VARDENAFIL (LEVITRA)
MOA = increases nitric oxide levels and increases cGMP -->
48
BPH TREATMENT
⦁ Alpha-1 blockers
⦁ 5 alpha-reductase inhibitors
⦁ Combo = Dutasteride-Tamsulosin (Jalyn)
⦁ Tadalafil (Cialis) = 5PDE-inhibitor
49
ALPHA-1 BLOCKERS
```
⦁ Tamsulosin (Flomax)
⦁ Terazosin (Hytrin)
⦁ Doxazosin (Cardura)
⦁ Alfuzosin (Uroxatrol)
⦁ Silodosin (Rapaflo)
```
Alpha-1 blockers = more effective than 5-alpha reductase inhibitors for short & long term symptom management
MOA = relaxes smooth muscle in bladder neck, prostatic capsule, and prostatic urethra
Alpha-1 receptors = located in the base of the bladder and in the prostate
SE OF ALPHA-1 BLOCKERS
***MOST COMMON SE = DIZZINESS & ORTHOSTATIC HYPOTENSION
OTHER SE
⦁ problems with ejaculation - found primarily with Tamsulosin (flomax) - this is a problem with all alpha blockers, but more so with Tamsulosin
- retrograde ejaculation in Silodosin (Rapaflo)
⦁ Doxazosin (Cardura) & Terazosin (Hytrin) = cause more BP lowering than others
⦁ Tamsulosin (Flomax), Alfuzosin (Uroxatrol) & Silodosin (Rapaflo) = less BP effects
⦁ ***Alpha-1 blockers = can cause severe hypotension if used with PDE-5 inhibitors
50
5 ALPHA REDUCTASE INHIBITORS
⦁ Finasteride (Proscar)
⦁ Dutasteride (Avodart)
Combo: 5-ARI + alpha-1 blocker
⦁ Dutasteride (Avodart) + Tamsulosin (Flomax) = Jalyn
The only agents that provide LONG TERM DECREASE IN PROSTATE SIZE and decreased need for prostatic surgery
MOA
- 5- alpha reductase converts testosterone to dihydrotestosterone
- by inhibiting 5-alpha-reductase = blocks conversion of testosterone to dihydrotestosterone = suppresses serum dihydrotestosterone levels
- This decreases prostate size
- may take up to a year to notice reduction in symptoms
- decreased need for surgery
- decreased development of acute urinary retention
- the larger the prostate volume, the more effective the medication**
- Dutasteride (Avodart) may be more potent than Finasteride (Proscar)
SE
⦁ decreased libido
⦁ ejaculatory or erectile problems (ED)
- may only have these SE for the first year of therapy
⦁ ***********decreases serum PSA by 50%*************
- in the first 24 months of therapy = multiply PSA by 2 when interpreting results
- after 24 months of therapy = multiply PSA by 2.5 when interpreting results
- There is decreased development of prostate cancer, but concern of possible increased incidence of high grade lesions
51
5-PDE INHIBITORS
⦁ Tadalafil (Cialis)
⦁ Vardenafil (Levitra)
⦁ Sildenafil (Viagra)
⦁ Avanafil (Stendra)
MOA
- For an erection to occur, nitric oxide (NO) is released in the corpus cavernosum during sexual stimulation
- Nitric Oxide (NO) then activates the enzyme guanylate cyclase --> results in increased levels of cGMP (cyclic guanosine monophosphate) --> produces smooth muscle relaxation and inflow of blood to the corpus cavernosum
- PDE-5 degrades cGMP (erection goes away) in the corpus cavernosum, so PDE-5 inhibitors enhance the effect of NO by inhibiting PDE-5 from degrading cGMP = leads to maintained erection
- PDE-5 inhibitors do not directly cause penile erections...they enhance erections (still need arousal)
CONTRAINDICATIONS TO PDE-5 INHIBITORS
⦁ men taking nitrates
⦁ caution with alpha-1 blockers due to risk for severe hypotension
ADVERSE REACTIONS
⦁ severe hypotension (with nitrates or alpha-1 blockers)
⦁ common = flushing, headaches, dyspepsia
⦁ visual effects = transient blue vision with sildenafil (viagra), may increase risk for nonarteritic ischemic optic neuropathy
⦁ Hearing loss
⦁ Priapism
52
FLUOROQUINOLONES
MOA = inhibits DNA topoisomerase
Pregnancy category = C
Black box warnings (2) = tendon rupture; may exacerbate myasthenia gravis
Adjust dose based on renal function
Urologic indications
⦁ Cystitis
⦁ UTI (pyelonephritis)*
⦁ Prostatitis
53
BACTRIM
Class = Sulfonamides
MOA = inhibits folic acid synthesis - avoid in pregnancy!
- effective against gram negative and staph; not active against group A strep
Pregnancy category = X
- 2nd best coverage for MRSA after Vanco
- oral tx for MRSA
can be used for UTIs - cystitis / pyelonephritis
54
drug given to terminate ectopic pregnancy fetus prior to rupture
METHOTREXATE
55
drug given to allow quick passage of spontaneous abortion/miscarriage rather than expectant and surgery
MISOPROSTOL (CYTOTEC)
56
drug given to stop contractions with pre-term labor
magnesium sulfate
57
drug given in preterm labor to help fetal baby's lungs mature
betamethasone or dexamethasone
58
drug given for hypercalcemia oncologic emergency
IV PAMIDRONATE
59
drug given for spinal cord compression due to malignancy
decadron (dexamethasone)
CUMULATIVE
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