NU 578
Unit 5 Study Guide
Key Concepts & Exam Review
University of South Alabama.
This document provides a focused
study guide
It summarizes key concepts, lecture highlights, and
exam-relevant material to support efficient last-
minute review. The guide is structured to help students reinforce
understanding, identify weak areas, and prepare confidently for
the assessment.
, Unit 5 Study Guide
Chapters 70-89
Eye/Ear/Skin
pilocarpine (eye) pg 827 – topical muscarinic (PNS) agonist
o Use: second-line drug for open-angle glaucoma, emergency tx of acute angle-closure
glaucoma
o Causes miosis (constriction of pupil) and contraction of ciliary muscle (focuses lens for near
vision). These two actions indirectly lowers IOP.
o ADRs: constant contraction of ciliary muscle can lead to retinal detachment. Decreased
visual acuity, local irritation, eye pain. Can cause systemic effects (bradycardia,
bronchospasm, HoTN, urinary urgency, diarrhea, increase secretions, sweating) but rarely.
Tx of macular degeneration
o bevacizumab is used off label to treat the neovascular form of age-related macular
degeneration pg 808
Tx of glaucoma—when looking at beta blockers, remember your patient’s comorbid conditions!
o Open-Angle Glaucoma pg 823
Characterized by progressive optic nerve damage with vision loss occurring first in
peripheral field. IOP may be normal or abnormal. Painless.
Tx includes drugs that lower IOP by facilitating aqueous humor outflow or reducing
production.
First line drugs include B blockers (timolol), A2 adrenergic agonists (brimonidine), and
prostaglandin analogs (latanoprost). Second line include cholinergic drugs, carbonic
anhydrase inhibitors.
Table 87.1 pg 823 – Topical drugs for open-angle glaucoma
o Angle-Closure (narrow-angle) Glaucoma pg 823
Precipitated by displacement of iris and IOP increases rapidly to dangerous levels.
Without tx, vision loss can occur in 1-2 days. Extremely painful.
Tx consists of drug therapy to manage acute attack follow by corrective surgery.
Combo of drugs (osmotic agents, short-acting miotics, carbonic anhydrase inhibitors,
and topical β-adrenergic blocking agents) is employed to suppress symptoms.
o B-Blockers in Glaucoma pg 824
Betaxolol, carteolol, levobunolol, metipranolol, and timolol are approved for use in
glaucoma.
Lowers IOP by decreasing production of aqueous humor.
Topical absorption can have similar effects as PO. 1 drop of 0.5% timolol can produce
same effects as 10mg PO.
For this reason, B1 blockers are CI in pts with AVB, bradycardia, and cardiogenic
shock. B2 are CI in asthmatics, COPD. Betaxolol is B1 selective so use for these
patients.
o Prostaglandin Analogs in Glaucoma pg 825
Fewer SE than B-blockers so considered first choice.
Latanoprost pg 825
Topically applied to lower IOP in pts with open-angle glaucoma and ocular HTN
, Unit 5 Study Guide
Chapters 70-89
Works by facilitating aqueous humor outflow by relaxing ciliary muscle
SE: brown pigmentation of iris and eyelid
o A2-Adrenergic Agonists in Glaucoma pg 826
Brimonidine pg 826
Approved for long-term reduction of elevated IOP in open-angle glaucoma and
ocular HTN. Reduces production of aqueous humor. May delay optic nerve
degeneration and protects retinal neurons from death.
ADR: dry mouth, ocular hyperemia, burning, headache, blurred vision, itching. Can
cross BBB so may see drowsiness, fatigue, HoTN.
Treatment of allergic conjunctivitis (Fig 87.3) pg 830
o Goal: Relief of ocular pruritis, watery discharge, and redness. Prevention of associated
complications that occur secondary to eye irritation or vigorous eye rubbing.
o Table 87.7 pg 829 – Topical Drugs for Allergic Conjunctivitis
Topical use of benzoyl peroxide and steroids; use of isotretinoin; hydrogen peroxide; tx of lice
o Benzoyl Peroxide pg 837
First-line tx of mild to moderate acne. It is an abx and keratolytic. Suppresses growth of
P. acnes.
Unlike other topical antimicrobials, benzoyl peroxide does not promote emergence of
resistant P. acnes.
ADR: drying/peeling of skin. If blistering/burning occurs, reduce frequency of
application. A/w serious HST rxns in pts with asthma.
o Topical Glucocorticoids pg 835
Use: insect bites, dermatitis, psoriasis, eczema, pemphigus
Can cause skin atrophy, hypopigmentation, telangiectasias (permanent focal red
lesions), adrenal suppression in high doses
Absorption rate is higher in axilla, face, eyelids, neck, genitalia. Lower through intact
skin and inflamed skin.
Table 88.1 – Potency of Topical Glucocorticoids
o Isotretinoin pg 839 (Accutane)
Use in tx of nodulocystic acne vulgaris
BBW for fetal structural and cognitive defects, spontaneous abortion.
Women must pass monthly pregnancy test before refill can be obtained. 2 methods
of birth control must also be committed to.
ADR: Depression/SI, nosebleeds, lip/eye inflammation, dryness of skin/nose/mouth,
joint stiffness, back pain, pseudotumor cerebri, pancreatitis, hearing impairment,
decreased BMD
o Ivermectin can be used to tx lice.
Unit 5 Study Guide
Key Concepts & Exam Review
University of South Alabama.
This document provides a focused
study guide
It summarizes key concepts, lecture highlights, and
exam-relevant material to support efficient last-
minute review. The guide is structured to help students reinforce
understanding, identify weak areas, and prepare confidently for
the assessment.
, Unit 5 Study Guide
Chapters 70-89
Eye/Ear/Skin
pilocarpine (eye) pg 827 – topical muscarinic (PNS) agonist
o Use: second-line drug for open-angle glaucoma, emergency tx of acute angle-closure
glaucoma
o Causes miosis (constriction of pupil) and contraction of ciliary muscle (focuses lens for near
vision). These two actions indirectly lowers IOP.
o ADRs: constant contraction of ciliary muscle can lead to retinal detachment. Decreased
visual acuity, local irritation, eye pain. Can cause systemic effects (bradycardia,
bronchospasm, HoTN, urinary urgency, diarrhea, increase secretions, sweating) but rarely.
Tx of macular degeneration
o bevacizumab is used off label to treat the neovascular form of age-related macular
degeneration pg 808
Tx of glaucoma—when looking at beta blockers, remember your patient’s comorbid conditions!
o Open-Angle Glaucoma pg 823
Characterized by progressive optic nerve damage with vision loss occurring first in
peripheral field. IOP may be normal or abnormal. Painless.
Tx includes drugs that lower IOP by facilitating aqueous humor outflow or reducing
production.
First line drugs include B blockers (timolol), A2 adrenergic agonists (brimonidine), and
prostaglandin analogs (latanoprost). Second line include cholinergic drugs, carbonic
anhydrase inhibitors.
Table 87.1 pg 823 – Topical drugs for open-angle glaucoma
o Angle-Closure (narrow-angle) Glaucoma pg 823
Precipitated by displacement of iris and IOP increases rapidly to dangerous levels.
Without tx, vision loss can occur in 1-2 days. Extremely painful.
Tx consists of drug therapy to manage acute attack follow by corrective surgery.
Combo of drugs (osmotic agents, short-acting miotics, carbonic anhydrase inhibitors,
and topical β-adrenergic blocking agents) is employed to suppress symptoms.
o B-Blockers in Glaucoma pg 824
Betaxolol, carteolol, levobunolol, metipranolol, and timolol are approved for use in
glaucoma.
Lowers IOP by decreasing production of aqueous humor.
Topical absorption can have similar effects as PO. 1 drop of 0.5% timolol can produce
same effects as 10mg PO.
For this reason, B1 blockers are CI in pts with AVB, bradycardia, and cardiogenic
shock. B2 are CI in asthmatics, COPD. Betaxolol is B1 selective so use for these
patients.
o Prostaglandin Analogs in Glaucoma pg 825
Fewer SE than B-blockers so considered first choice.
Latanoprost pg 825
Topically applied to lower IOP in pts with open-angle glaucoma and ocular HTN
, Unit 5 Study Guide
Chapters 70-89
Works by facilitating aqueous humor outflow by relaxing ciliary muscle
SE: brown pigmentation of iris and eyelid
o A2-Adrenergic Agonists in Glaucoma pg 826
Brimonidine pg 826
Approved for long-term reduction of elevated IOP in open-angle glaucoma and
ocular HTN. Reduces production of aqueous humor. May delay optic nerve
degeneration and protects retinal neurons from death.
ADR: dry mouth, ocular hyperemia, burning, headache, blurred vision, itching. Can
cross BBB so may see drowsiness, fatigue, HoTN.
Treatment of allergic conjunctivitis (Fig 87.3) pg 830
o Goal: Relief of ocular pruritis, watery discharge, and redness. Prevention of associated
complications that occur secondary to eye irritation or vigorous eye rubbing.
o Table 87.7 pg 829 – Topical Drugs for Allergic Conjunctivitis
Topical use of benzoyl peroxide and steroids; use of isotretinoin; hydrogen peroxide; tx of lice
o Benzoyl Peroxide pg 837
First-line tx of mild to moderate acne. It is an abx and keratolytic. Suppresses growth of
P. acnes.
Unlike other topical antimicrobials, benzoyl peroxide does not promote emergence of
resistant P. acnes.
ADR: drying/peeling of skin. If blistering/burning occurs, reduce frequency of
application. A/w serious HST rxns in pts with asthma.
o Topical Glucocorticoids pg 835
Use: insect bites, dermatitis, psoriasis, eczema, pemphigus
Can cause skin atrophy, hypopigmentation, telangiectasias (permanent focal red
lesions), adrenal suppression in high doses
Absorption rate is higher in axilla, face, eyelids, neck, genitalia. Lower through intact
skin and inflamed skin.
Table 88.1 – Potency of Topical Glucocorticoids
o Isotretinoin pg 839 (Accutane)
Use in tx of nodulocystic acne vulgaris
BBW for fetal structural and cognitive defects, spontaneous abortion.
Women must pass monthly pregnancy test before refill can be obtained. 2 methods
of birth control must also be committed to.
ADR: Depression/SI, nosebleeds, lip/eye inflammation, dryness of skin/nose/mouth,
joint stiffness, back pain, pseudotumor cerebri, pancreatitis, hearing impairment,
decreased BMD
o Ivermectin can be used to tx lice.
