Mertz pharm final 2010

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Acetaminophen (Tylenol)

Class: NSAID/aniline analgesic. Mode of action: Inhibition COX2 enzyme (inhibition prostaglandin synthesis). Therapeutic use: mild to moderate pain, esp good for patients with gastric complaints (no irritation like aspririn); anti-pyretic (fever reducer). Note some classify this as an NSAID but it has weak anti-inflammatory action!*

Acetaminophen/paracetamol - codeine (Tylenol 3)

Class : NSAID/aniline analgesic-opioid blend. Mode of action: NSAID = inhibition COX 2 enzyme (prevention prostaglandin synthesis); opioid = opioid receptor agonist. Therapeutic use: moderate to severe pain relief, anti-pyretic (fever reducer) . Some classify this drug as an NSAID but note that it has weak anti-inflammatory action!*

Albuterol (Ventolin)

Class: Adrenergic agonist (noncatecholamine. ) Mode of action: B2 agonist. Therapeutic use: asthma (short-acting bronchospasms)

Alprazolam (Xanax)

Class: Anxiolytic (benzodiazepine)Mode of action: allosteric GABA receptor agonist; short-acting. Therapeutic use: moderate to severe anxiety, adjunctive for anxiety + moderate depression

Amiodarone (Cordarone)

Class: Anti-arrhythmic (Class III). Mode of action: K+-channel blocker that increases refractory periods & depresses SA node automaticity. Therapeutic use: hypertension, angina, & arrhythmia*Ocular side effects include photosensitivity, corneal microdeposits; also severe GI effects

Amitriptyline (Elavil)

Class: Tricyclic antidepressant (TCA). Mode of action: inhibit NE & serotonin reuptake; A-adrenergic & muscarinic receptor blocker. Therapeutic use: major depression, ADHD, chronic pain (idiopathic), severe anxiety. Ocular side effects: blurred vision, diplopia

Amoxicillin (Principen) (Mertz has "augmentin" as trade)

Class: Antibacterial (penicillin family). Mode of action: interferes with last step of peptidoglycan cell wall synthesis (cross-linkage) = cell lysis can occur via osmotic pressure or through activation autolysins. Therapeutic use: gram + and gram (-); extended-spectrum penicillin; often used for respiratory infections

Atenolol (Tenormin)

Class: Adrenergic antagonist. Mode of action: B1-blocker. Therapeutic use: Hypertension

Atorvastatin (Lipitor)

Class: Statin (HMG-CoA reductase inhibitor). Mode of action: HMG analog (precursor to cholesterol) that competes to inhibit HMG-CoA reductase and thus cholesterol formation; low intracellular [cholesterol] = LDL receptor synthesis = LDL taken up from bloodstream. Therapeutic use: hypercholesterolemia, combined hyperlipidemia *Note that statins exhibit severe GI side effects

Bupropion (Wellbutrin)

Class: Atypical antidepressant & stop-smoking aid. Mode of action: norepinephrine reuptake inhibitor and nicotinic acetylcholine receptor antagonist. Therapeutic use: clinical depression, anxiety w/ depression, smoking cessation. (Note also shown to be effective at treating ADHD and obesity but not FDA-approved for these. No sexual dysfunction side effects like other anti-depressants).

Captopril (Capoten)

Class: ACE inhibitor. Mode of action: Decrease circulating angiotensin II by antagonizing conversion of angiotensin 1; arteriolar & venous dilation, increased cardiac output, natriuresis. Therapeutic uses: Hypertension

Carbidopa - levodopa (Sinemet)

Class: Anti-Parkinson's. Mode of action: L-DOPA is dopamine agonist - actively transported into CNS (unlike dopamine itself); carbidopa enhances effects of L-DOPA by inhibiting its metabolism in the GI by catechol-O-methyltransferase (reduces dose requirement). Therapeutic use: Parkinson's disease

Cimetidine (Tagament)

Class: Histamine H2-receptor antagonist (GI drug). Mode of action: competitively & selectively blocks histamine binding H2 receptor. Therapeutic uses: peptic ulcers, acute stress ulcers, gastroesophageal reflux disease

Ciprofloxacin (Ciloxan/Cipro)

Class: Antibacterial (Quinolone). MOA: DNA-binding agent that inhibits supercoiling of bacterial DNA .Use: broad-spectrum antibiotic; *note that this is a second-generation fluroquinolone that inhibits both DNA gyrase and topoisomerase and hasbroader spectrum activity against gram-positive bacteria

Clindamycin (Cleocin, BenzaClin)

Class: Antibiotic (Lincosamide). MOA: Binds irreversibly to 50S subunit. Use: anaerobic bacterial infections; some protozoals, malaria; BenzaClin is a gel used to treat acne (clindamycin + benzoyl peroxide)

Clonidine (Catapres)

Class: Adrenergic agonist. Mode of action: A2 agonist. Therapeutic use: hypertension that doesn't respond to two or more drugs; note does not decrease renal blood flow/glomerular filtration = good for patients w/ kidney disease.

Clopidogrel (Clopilet or Ceruvin)

Class: Anticoagulant/anti-thrombotic (platelet-aggregation inhibitor). Mode of action: Coronary vasodilator that also inhibits thromboxane A2 synthesis. Therapeutic use: anti-thrombosis in coronary artery disease, peripheral & cerebrovascular disease

Diazepam (Valium)

Class: Anxiolytic & hypnotic (benzodiazepine). Mode of action: allosteric GABA receptor agonist. Therapeutric use: anxiety (low dose), hypnotic (high dose), anticonvulsant, muscle relaxant

Diphenylhydramine (Benadryl)

Class: Antihistamine. MOA: H1 receptor antagonist (first-generation). Use: allergies

Fexofenadine (Allegra)

Class: Antihistamine. MOA: H1 receptor antagonist (second-generation). Use: allergies

Fluconazole (Diflucan)

Class: Antifungal. MOA: inhibits the fungal cytochrome P450 enzyme = cell wall disrupton. Use: superficial & systemic fungal infections

Fluoxetine (Prozac)

Class: Selective serotonin reuptake inhibitor (SSRI). Mode of action: inhibit serotonin reuptake. Therapeutic use: generalized depression & anxiety; bulimia nervosaless side effects than TCAs

Glipizide (Glucotrol)

Class: Sulfonylurea Mode of action: promotes insulin release from pancreatic B-cells by (1) blocking ATP-sensitive K+ channels = depolarization, Ca2+ influx; (2) reducing hepatic glucose production; (3) increasing peripheral insulin resistance. Therapeutic use: Type-2 diabetes*Note that sulfonylureas are dependent on insulin for action

Glyburide (Diabeta or Micronase)

Class: Sulfonylurea. Mode of action: promotes insulin release from pancreatic B-cells by (1) blocking ATP-sensitive K+ channels = depolarization, Ca2+ influx; (2) reducing hepatic glucose production; (3) increasing peripheral insulin resistance Therapeutic use: Type-2 diabetes*Note that sulfonylureas are dependent on insulin for action

Hydralazine (Apresoline)

Class: Direct-acting vasodilator. Mode of action: Relaxes tone of smooth muscle in arterioles/arteries = decreased resistance & BP; may promote angina or myocardial infarction due to reflex stimulation of heart. Therapeutic use: hypertension

Hydrochlorothiazide (Hydrodiuril)

Class: Thiazide diuretic. Mode of action: Prevents Na+/H2O & Cl- resorption in distal tubules by blocking thiazide-sensitive Na+/Cl-symporter; significant loss of K+ over time. Therapeutic uses: Hypertension

Hydrocodone-acetaminophen (Lortab, Vicodin)

Class: NSAID/aniline analgesic-opioid blend. MOA: NSAID = inhibits COX2 to prevent prostaglandin synthesis; opioid = opioid receptor agonist. Therapeutic use: moderate to severe pain. Acetaminophen is labeled as an NSAID but actually has weak anti-inflammatory action. **Hydrocodone is a semi-synthetic opioid derived from either codeine or thebaine.

Hydroxychloroquine (Plaquenil)

Class: Antiprotozoal. MOA: targets erythrocitic stage of protozoal life cycle; leads to cell lysis due to heme buildup. Use: treatment and prevention of malaria, also for RA and lupus (member of "DMAD" class = disease-altering antimalarial drug)

Ibuprofen (Advil, Motrin)

Class: NSAID Mode of action: inhibition COX1 & 2 enzymes. Therapeutic use: anti-inflammation

Imipramine (Tofranil)

Class: Tricyclic antidepressant (TCA). Mode of action: inhibit NE & serotonin reuptake; A-adrenergic & muscarinic receptor blocker. Therapeutic use: major depression, ADHD, chronic pain, severe anxiety. Ocular side effects: blurred vision, diplopia

Indomethacin (Indocin)

Class: NSAID Mode of action: inhibition COX1 & 2 enzymes. Therapeutic use: anti-inflammation, especially in gout

Ketoconazole (Nizoral)

Class: Antifungal & anti-adrenocorticoidMode of action: Strongly inhibits all gonadal & adrenal steroid hormone synthesis (inhibits CYP450 enzymes necessary for synthesis)Therapeutic uses: Cushing's syndrome, sex-change therapy

Labetalol (Trandate)

Class: Adrenergic antagonistMode of action: B1-, B2-, A1-blocker Therapeutic use: hypertension (w/o increased peripheral resistance since A1 counteracts B)

Levothyroxine (Synthroid, Levothroid)

Class: Thyroid hormone drug. Mode of action: T4 agonist. Therapeutic use: hypothyroidism*Note that levothyroxine is a natural component of the mixture that makes up T4 (thyroxine) in the body - synthesized for clinical use

Lisinopril (Prinivil or Zestril)

Class: ACE inhibitor. Mode of action: Decrease circulating angiotensin II by antagonizing conversion of angiotensin 1; arteriolar & venous dilation, increased cardiac output, natriuresis. Therapeutic uses: Hypertension

Lorazepam (Ativan)

Class: Anti-anxiety (benzodiazepine). MOA: GABA receptor agonist (CNS depressant). Use: anxiety (long-term)

Lovastatin (Mevacor)

Class: Statin (HMG-CoA reductase inhibitor). Mode of action: HMG analog (precursor to cholesterol) that competes to inhibit HMG-CoA reductase and thus cholesterol formation; low intracellular [cholesterol] = LDL receptor synthesis = LDL taken up from bloodstream. Therapeutic use: hypercholesterolemia, combined hyperlipidemia*Note that statins exhibit severe GI side effects

Medroxyprogesterone (Provera)

Class: Progestin. MOA: progersterone agonist = promotion of endometrium and inhibition gonadotropin = inhibition ovulation. Therapeutic use: contraception, oral & IV

Metformin (Glucophage)

Class: Biguanidine ("insulin sensitizer"). Mode of action: decreases hepatic output of glucose by inhibiting gluconeogenesis (also increases peripheral uptake & utilization). Therapeutic use: Type-2 diabetes

Methotrexate (Rheumatrex)

Class: Anticancer drug. MOA: folic acid antagonist that interferes with purine/pyrimidine availability (folic acid necessary for nucleotide synthesis); Use: multiple cancers

Methylphenidate (Ritalin)

Class: CNS psychomotor stimulant. Mode of action: blocks dopamine re-uptake. Therapeutic use: ADHDderived from amphetamine

Naproxen (Aleve, Naprosyn)

Class: NSAID Mode of action: inhibition COX1 & 2 enzymes. Therapeutic use: anti-inflammation

Nitroglycerin (Nitro-bid)

Class: Anti-angina. MOA: decrease coronary vasoconstriction/spasm & increase myocardial perfusion by relaxing coronary arteries; also relax veins = decrease preload (smooth muscle relaxation by conversion to NO which leads to cGMP increase) & myocardial O2 demand. Therapeutic use: angina pectoris

Nystatin (Mycostatin)

Class: Antifungal. MOA: inhibits the fungal cytochrome P450 enzyme = cell wall disrupton. Use: cutaneous fungal infections, esp Candida

Omeprazole (Prilosec)

Class: Proton pump inhibitor (GI drug). Mode of action: Blocks parietal cell H+/K+-ATPase = supression of H+ release into gastric lumen. Therapeutic uses: preferred drug for healing peptic ulcers; erosive esophagitis & hypersecretory disorders, gastroesophageal reflux disease

Paroxetine (Paxil)

Class: SSRI antidepressant. MOA: blocks reuptake of serotonin = serotonin stays in synaptic cleft longer = enhanced serotonin activity. Use: Depression

Phenytoin (Dilantin)

Class: Antiepileptic. Mode of action: Na+ & Ca2+ channel blocker (slows rate of recovery). Therapeutic use: partial seizures, generalized tonic-clonic seizures, status epilepticus Ocular side effects: nystagmus, blurred vision, diplopiaChloramphenical, cimetidine, isoniazid, sulfonamides inhibit metabolism = increase effectsCarbamazepine enhances metabolism

Piroxicam (Feldene)

Class: NSAID. MOA: Inhibition COX1/2 enzymes (inhibition prostaglandin synthesis). Use: RA, osteoarthritis.

Promethazine (Phenergan)

Class: Antihistamine. MOA: H1 receptor antagonist (first-generation). Use: allergies, antiemetic, sedative

Propoxyphene (Darvon)

Class: Opioid. MOA: Opioid receptor agonist (CNS depressant). Use: mild to moderate pain; methadone derivative; not as strong as codeine

Propanolol (Inderol)

Class: Adrenergic antagonist. Mode of action: B-blocker (nonselective). Therapeutic use: Hypertension, glaucoma (chronic), migraine, hyperthyroidism, angina, heart attack

Ranitidine (Zantac)

Class: Histamine H2-receptor antagonist (GI drug). Mode of action: competitively & selectively blocks histamine binding H2 receptor. Therapeutic uses: peptic ulcers, acute stress ulcers, gastroesophageal reflux disease*Note that drug interactions include warfarin, phenytoin, theophylline, amirodarone, metronidazole, loratidine, Ca2+-blockers

Sumatriptan (Imitrex)

Class: Triptan (migraine drug). MOA: Serotonin 5-HT receptor agonist. Use: acute migraine

Tadalafil (Cialis)

Class: Erectile dysfunction drug. MOA: Inhibition PDE enzyme (PDE degrades cGMP, which is responsible for smooth muscle relaxation). Use: ED

Tamsulosin (Flomax)

Class: Adrenergic antagonist. Mode of action: A1-blocker. Therapeutic use: Benign prostatic hyperplasia (BPH)

Terasozin (Hytrin)

Class: Adrenergic antagonist. Mode of action: A1 blocker. Therapeutic uses: Hypertension

Tetracycline (Achromycin)

Class: Antibiotic. MOA: Binds to 30S subunit to prevent protein synthesis. Use: broad-spectrum, incl chlamydia & rock mountain spotted fever

Topiramate (Topamax)

Class: Antiepileptic. Mode of action: GABA receptor agonist (CNS depressant); Na+ & glucose receptor blocker. Therapeutic use: partial seizures, bipolar disorder, PTSD & trigeminal neuralgiaOcular side effects: accommodative spasms, angle closure glaucoma

Tramadol (Ultram)

Class: Opioid. MOA: Opioid receptor agonist (CNS depressant). Use: moderate to moderately-severe pain; note that naloxone can only partially reverse tramadol's action

Atropine

Class: Muscarinic/cholinergic antagonist (Cycloplegic). MOA: Inhibition of acetylcholine signaling at muscarinic receptors of ciliary muscle and iris sphincter. Use: clinical mydriasis, cycloplegia that lasts 7-10 days

Acyclovir (e.g. Zovirax, Cyclovir)

Class: Antiviral (guanosine analog). MOA: inhibits viral DNA polymerase. Use: herpes zoster ophthalmicus, herpes simple conjunctivitis and keratitis; Zovirax is a 3% ophthalmic ointment; also available in oral tablets

Apraclonidine (Iopidine)

Class: Adrenergic agonist. MOA: A2-agonist = decreases aqueous humour production; may have some effect in increasing uveo-scleral outflow p'way. Therapeutic use: short-term adjunctive treatment of glaucoma for pts. taking maximal dose IOP-lowering drugs or those awaiting surgery; pre- and post-op in anterior segment laser procedures

Azelastine (Optivar)

Class: Antihistamine. MOA: 2nd-generation H1 receptor blocker. Use: ocular allergies

Azithromycin (Zithromax)

Class: Antibiotic (Macrolide). MOA: i) Bind irreversibly to 50S subunit (either identical or in close proximity to same binding site as chloramphenicol). Use: bacterial infection; *note high distribution- 95% is distributed to body tissues

Betaxolol (Betoptic)

Class: Adrenergic antagonist. Mode of action: B1-blocker = decreases aqueous humor production; Ca2+-channel blocking activity. Therapeutic use: Glaucoma; safer in asthmatic patients (no B2-blocking)

Bimatoprost (Lumigan)

Class: Prostaglandin analog. MOA: increases aqueous outflow via uveoscleral p'way and also via TM. Use: glaucoma, ocular hypertension; good adjunctive therapy with B-blockers; NOTE side effects include darkening of iris pigment, elongation of eyelashes

Brimonidine (Alphagan P)

Class: Adrenergic agonist. MOA: A2-agonist = decreases aqueous humour production. Use: glaucoma

Brimonidine-timolol (Combigan)

Class: Adrenergic antagonist/agonist mix. MOA: nonselective B-blocker + A2-agonist to decrease aqueous humor production. Use: glaucoma

Brinzolamide (Azopt)

Class: Carbonic anhydrase inhibitor. MOA: inhibits carb anhydrase in ciliary body to prevent aqueous humor production. Use: glaucoma

Bromfenac (Xibrom)

Class: NSAID (ophthalmic). MOA: inhibition COX1 & 2 enzymes. Use: pain for post-op cataract surgery

Carboxymethylcellulose (Celluvisc), Refresh Plus)

Class: Cellulose derivative. MOA: lubrication of the ocular surface. Use: dry eye

Ciprofloxacin (Ciloxan)

Class: Antibacterial (Fluoroquinolone, 2nd generation). MOA: DNA-binding agent that inhibits supercoiling of bacterial DNA (inhibition DNA gyrase & topoisomerase) .Use: broad-spectrum antibiotic; o All indicated for bacterial conjunctivitis, though later generations should prob be reserved for more serious infections due to lower resistance (e.g. bacterial keratitis)

Cromolyn sodium (Crolom)

Class: Mast-cell stabilizer. Mode of action: anti-inflammation; prevents degranulation of mast cells and thus release of histamine. Use: seasonal allergic conjunctivitis, GPC, maintenance of treatment of vernal keratoconjunctivitis.

Cyclopentolate (Cyclogyl)

Class: Anticholinergic (antimuscarinic). MOA: blocks M-receptors. Use: clinical mydriasis that lasts 24 hrs

Cyclosporin ophthalmic (Restasis)

Class: Immunosuppressant. MOA: prevents cytokine production & subsequent increase in T lymphocytes; anti-inflammation for enhancement of tear production. Use: dry eye

Dexamethasone (Maxidex)

Class: Corticosteroid anaglog. MOA: anti-inflammation via glucocorticoid actions (e.g. inhibition of transcription of inflammatory cytokines, TCR signalling). Therapeutic uses: rheumatoid arthritis, present in some eye drops, effective as anti-emetic in chemo patients

Dorzolamide (Trusopt)

Class: Carbonic anhydrase inhibitor. MOA: inhibits carb anhydrase in ciliary body to prevent aqueous humor production. Use: glaucoma

Emadastine (Emedine)

Class: Antihistamine. MOA: H1 receptor blocker. Use: ocular allergies

Erythromycin (Ilotycin)

Class: Antibiotic (Macrolide). MOA: Bind irreversibly to 50S subunit (either identical or in close proximity to same binding site as chloramphenicol). Use: Staph blepharitis, chlamydia trachomatis in kids (oral), adult Chlamydia; *note high distribution- 95% is distributed to body tissues

Eye vitamin supplement (Ocuvite PreserVision)

Class: Vitamin supplement. MOA: supplies 100% of the US Daily Values for vitamins C, E, and A, along with high levels of zinc; also contains selenium, copper, lutein. Use: promotion/maintenance of general eye health; note there are also formulations designed for those at risk for ARMD and for elderly people

Fluorometholone (FML)

Class: Corticosteroid analog. MOA: anti-inflammation via glucocorticoid actions (e.g. inhibition of transcription of inflammatory cytokines, TCR signalling). Use: episcleritis, pingueculitis, chronic adenoviral keratitis, Thygeson's keratitis

Gatifloxacin (Zymar)

Class: Antibiotic (fluoroquinolone, 4th generation). MOA: DNA-binding agent that inhibits supercoiling of bacterial DNA (inhibition DNA gyrase & topoisomerase. Use: all indicated for bacterial conjunctivitis, though later generations should prob be reserved for more serious infections due to lower resistance (e.g. bacterial keratitis)

Ketorolac (Acular)

Class: NSAID (ophthalmic). MOA: inhibition COX1 & 2 enzymes. Therapeutic use: management of pain after refractive surgery, allergic conjunctivitis, chronic post-cataract surgery cystoid macular edema, pre-op prophylactic for cataract surgery. NOTE this has weak anti-inflammatory action.

Ketotifen (Zaditor)

Class: Antihistamine-mast cell stabilizer combo. MOA: 2nd generation H1-blocker + prevention degranulation of mast cells. Use: seasonal allergic conjunctivitis. NOTE this drug is also a PDE inhibitor and leukotriene antagonist (both further enhance anti-inflammatory effects)

Latanoprost (Xalatan)

Class: Prostaglandin analog. MOA: increases aqueous outflow via uveoscleral p'way. Use: glaucoma, ocular hypertension; good adjunctive therapy with B-blockers; NOTE side effects include darkening of iris pigment, elongation of eyelashes

Levobunolol (Betagen)

Class: Adrenergic antagonist. Mode of action: B-blocker (nonselective) = decreases aqueous humor production . Therapeutic use: Glaucoma

Levofloxacin (Quixin)

Class: Antibiotic (fluoroquinolone, 3rd generation). MOA: DNA-binding agent that inhibits supercoiling of bacterial DNA (inhibition DNA gyrase & topoisomerase. Use: indicated for bacterial conjunctivitis, though later generations should prob be reserved for more serious infections due to lower resistance (e.g. bacterial keratitis)

Lodoxamide (Alomide)

Class: Mast-cell stabilizer. Mode of action: anti-inflammation; prevents degranulation of mast cells and thus release of histamine. Use: seasonal allergic conjunctivitis, GPC, maintenance of treatment of vernal keratoconjunctivitis.

Loteprednol-tobramycin (Zylet)

Class: Corticosteroid analog + antibiotic mix. MOA: anti-inflammation via glucocorticoid action + aminoglycoside antibacterial action. Use: steroid-responsive inflammatory conditions where corticosteroid is indicated and where superficial bacterial infection exists (or risk exists), e.g ocular injury, foreign body penetration, allergic conjunctivitis, chronic anterior uveitis, acne rosacea

Loteprednol (0.2% Alrex, 0.5% Lotemax)

Class: Corticosteroid analog. MOA: anti-inflammation via glucocorticoid actions (e.g. inhibition of transcription of inflammatory cytokines, TCR signalling). Use: episcleritis, pingueculitis, chronic adenoviral keratitis, Thygeson's keratitis, ocular allergies

Moxifloxacin (Vigamox)

Class: Antibiotic (fluoroquinolone). MOA: 4th-generation DNA-binding agent that inhibits supercoiling of bacterial DNA by inhibiting DNA gyrase and topoisomerase. Use: bacterial conjunctivitis

Naphazoline (Naphcon-A)

Class: Adrenergic agonist. MOA: acts on alpha-receptors in the arterioles of the conjunctiva to produce constriction. Use: ocular allergies

Natamycin (Natacyn)

Class: Antifungal. MOA: inhibits the fungal cytochrome P450 enzyme = cell wall disrupton. Use: Aspergillus and Fusarium corneal infections

Nepafenac (Nevanac)

Class: NSAID (ophthalmic). MOA: inhibition COX1 & 2 enzymes. Use: pain for post-op cataract surgery

Ofloxacin (Ocuflox)

Class: Antibiotic (fluoroquinolone, 2nd generation). MOA: DNA-binding agent that inhibits supercoiling of bacterial DNA (inhibition DNA gyrase & topoisomerase. Use: all indicated for bacterial conjunctivitis, though later generations should prob be reserved for more serious infections due to lower resistance (e.g. bacterial keratitis)

Olopatadine (Pataday, Patanol)

Class: Antihistamine-mast cell stabilizer combo. MOA: 2nd generation H1-blocker + prevention degranulation of mast cells. Use: seasonal allergic conjunctivitis.

Phenylephrine

Class: Adrenergic agonist. MOA: alpha1 receptor agonist that stimulates smooth muscle contraction of the iris dilator. Use: clinical mydriasis, often with tropicamide

Pilocarpine

Class: Cholinergic agonist. MOA: direct-acting parasympathomimetic that acts at muscarinic receptors of sphincter & ciliary muscles; also increases aqueous outflow from TM. Use: miosis, glaucoma

Polymyxin B-bacitracin (Polysporin ointment)

Class: Antibiotic (mixture). MOA: polymyxin - Disruption cell membrane (surfactant that disrupts phospholipid arrangement); bacitracin - disruption cell wall (prevention movement of peptidoglycan precursor across membrane to wall). Use: lid, conjunvtival infection (often choice for staph bleph)

Polymyxin B-bacitracin-neomycin (Neosporin ointment)

Class: Antibiotic (mixture). MOA: polymyxin - Disruption cell membrane (surfactant that disrupts phospholipid arrangement); bacitracin - disruption cell wall (prevention movement of peptidoglycan precursor across membrane to wall); neomycin - aminoglycoside antibiotic = inhibits protein synthesis (30S binding) Use: lid, conjunvtival bacterial infections

Polymyxin B-neomycin-gramicidin (Neosporin suspension)

Class: Antibiotic (mixture). MOA: polymyxin - Disruption cell membrane (surfactant that disrupts phospholipid arrangement); neomycin -aminoglycoside antibiotic = inhibits protein synthesis (30S binding) gramicidin - Disruption cell wall (increases permeability). Use: lid, conjunvtival bacterial infections

Povidone-iodine (Betadine)

Class: Iodine antiseptic. MOA: kills eukaryotic or prokaryotic cells through iodination of lipids and oxidation of cytoplasmic and membrane compounds; effective against bacteria, viruses, fungi, protozoa. Use: EKC (adenovirus) is off-label ophthalmic use; also used in pre-op, treatment of body wounds

Prednisolone acetate ( 1% Pred Forte, 0.125% Pred Mild)

Class: Corticosteroid analog. MOA: anti-inflammation via glucocorticoid actions (e.g. inhibition of transcription of inflammatory cytokines, TCR signalling). Use: anterior uveitis, post-op cataract surgery, adenoviral keratitis, sterile ulcer.

Ranibizumab (Lucentis)

Class: Anti-VEGF drug. MOA: Monoclonal antibody fragment that binds VEGF to inhibit growth of blood vessels (angiogenesis). Use: wet ARMD

Rimexolone (Vexol)

Class: Corticosteroid analog. MOA: anti-inflammation via glucocorticoid actions (e.g. inhibition of transcription of inflammatory cytokines, TCR signalling). Use: anterior uveitis, post-op cataract surgery, adenoviral keratitis, sterile ulcer. NOTE rimexolone does not increase IOP like prednisolone

Sodium chloride (Muro-128)

Class: Hypertonic agent. MOA: reduces corneal edema by drawing water from the cornea. Use: temporary relief of corneal edema and associated symptoms, e.g. blurry vision

Tetrahydrazoline (Visine)

Class: Adrenergic agonist. MOA: Alpha agonist that constricts vessels of the conjunctiva. Use: reduce eye redness associated with mild irritation

Timolol (Timoptic, Betimol, Cosopt)

Class: Adrenergic antagonist. Mode of action: B-blocker (nonselective) = decreases aqueous humor production . Therapeutic use: Glaucoma

Tobramycin (Tobrex)

Class: Antibacterial (aminoglycoside). MOA: Drugs diffuse through gram-negative porin channels in outer membrane & bind to 30S ribosomal subunit Use: broad-spectrum for skin/mucous membrane infections

Tobramycin-dexamethasone (TobraDex)

Class: Antibacterial-steroid combination. MOA: binds 30S ribosome to prevent protein translation + anti-inflammation via glucocorticoid action. Use: broad-spectrum antibiotic, treatment of styes, sometimes pink eye; NOTE this is strongly contraindicated in herpes due to steroid action

Travanoprost (Travatan)

Class: Prostaglandin analog. MOA: increases aqueous outflow via uveoscleral p'way. Use: glaucoma, ocular hypertension; good adjunctive therapy with B-blockers; NOTE side effects include darkening of iris pigment, elongation of eyelashes

Trifluridine (Viroptic)

Class: Antiviral (thymidine analog). MOA: inhibits thymidine synthase in viral & host cells; incorporates into viral DNA chain. Use: drug-of-choice for stage 1 herpes simplex keratitis.

Trifluridine - polymyxin B (Polytrim)

Class: Antiviral + antibiotic mix. MOA: inhibition thymidine synthase (antiviral) + disruption bacterial cell membrane. Use: acute bacterial conjunctivitis, blepharoconjunctivitis

Tropicamide

Class: Muscarinic/cholinergic antagonist (Cycloplegic). MOA: Inhibition of acetylcholine signaling at muscarinic receptors of ciliary muscle and iris sphincter. Use: clinical mydriasis, cycloplegia that lasts ~6 hours; note that mydriasis >>cycloplegia; often used with phenylephrine

Tropicamide-hydroxyamphetamine (Paremyd)

Class: Cycloplegic/adrenergic agonist mixture. MOA: tropicamide - inhibition of acetylcholine signaling at muscarinic receptors of ciliary muscle & iris sphincter; hydroxyamphetamine - catecholamine release/re-uptake inhibition; A- & B-agonist. Use: clinical mydriasis with minimal accommodative effects

Unoprostone (Rescula)

Class: Prostaglandin analog. MOA: increases aqueous outflow via uveoscleral p'way. Use: glaucoma, ocular hypertension

Valacyclovir (Valtrex)

Class: Antiviral (prodrug of acyclovir). MOA: inhibits viral DNA polymerase. Use: herpes zoster ophthalmicus, herpes simple conjunctivitis and keratitis; 500 mg tablets

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