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Ocular Pharmacology > 1692 Final Material > Flashcards

1692 Final Material Flashcards

1
Q

What is in the AREDS2 vitamin formulation?

A

10mg lutein, 2mg zeaxanthine, 500mg vitamin C, 400IU vitamin E, zinc 80mg with 2mg of copper

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2
Q

What is the original AREDS formulation?

A

15mg beta-carotene, 500mg vitamin C, 400IU vitamin E, 80mg zinc (requiring 2mg copper)

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3
Q

What appearance puts someone in the Early Stage AMD (AREDS Categories 1&2)

A

-few or no drusen to non-extensive area of small (<63microns) or intermediate (63-125 microns) drusen

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4
Q

What appearance puts someone in the Intermediate Stage AMD (AREDS Categories 3&4)?

A
  • at least 1 large druse (>125 microns)
  • extensive area of intermediate drusen, or non-central GA
  • vision loss due to AMD (poorer than 20/32)
  • any stage of AMD pathology accompanied by advanced AMD in the fellow eye
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5
Q

What puts someone in Advanced Stage AMD?

A
  • needing tx for CNVM
  • GA involving center of macula
  • non-drusenoid RPE detachment, rhegmatogenous RD, hemorrhage under the retina or RPE, and/or subretinal fibrosis
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6
Q

What is Aflibercept (Eylea) and what conditions can it be used for?

A

decoy receptor for VEGF (trap) IVT injection, approved for wet AMD, also can treat CSME, PDR, CRVO, BRVO

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7
Q

What is Pegaptanib (Macugen) and what does it treat?

A

anti-VEGF aptamer IVT injection, approved for treating wet AMD

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8
Q

What is Ranibizumab (Lucentis) and what can it treat?

A

fab fragment of humanized mouse anti-VEGF antibody in IVT injections, approved for wet AMD but can also be used for CSME, CRVO, BRVO, and myopic retinal degeneration

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9
Q

What is Bevacizumab (Avastin) and what is it approved for and not approved for but can be used to treat?

A

a full antibody used to make Lucentis, approved for cancers in the body, used off-label for wet AMD, and also often used to treat PDR, CSR, CRVO, and BRVO

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10
Q

What is PDT laser and what can it treat?

A

Photodynamic therapy, used with a dye to visualize retina (verteporfin/visudyne), treats CSR and wet AMD

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11
Q

What is PRP laser and what can it treat?

A

pan-retinal photocoagulation laser, treats high risk PDR, and CRVO (ischemic)

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12
Q

What can focal/grid lasers treat? Scatter photocoagulation?

A

focal - CSME, targeting individual microaneurysms
grid - CSR, BRVO
scatter laser photocoagulation - BRVO

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13
Q

What is Brolucizumab (Beovu) and what is it approved to treat?

A

IVT injection that neutralizes VEGF-A, approved for wet AMD

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14
Q

What is a possible therapy for advanced Dry AMD?

A

Stem cell therapy for RPE cells

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15
Q

What is the Lucentis port delivery system and its advantage?

A

contains 100mg/mL of the medication, refilled every 15months and releases slowly over time, equivalent to monthly injections but last longer and more convenient for doctor and patient

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16
Q

What is the best recommendation for prevention of AMD in a patient with currently no AMD?

A

Highest levels of lutein and zeaxanthine and other carotenoids

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17
Q

What is the treatment for early AMD?

A

no proven treatment :(

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18
Q

What is the treatment for intermediate dry AMD?

A

AREDS vitamins

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19
Q

What is the treatment for advanced wet AMD?

A

VEGF inhibitor injections or PDT

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20
Q

What are the treatment options for CSME?

A

focal/grid laser with IVT triamcinolone if diffuse/extensive edema, or Lucentis/Eylea injections

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21
Q

What are the treatment options for PDR?

A

PRP laser, avastin/eylea

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22
Q

What are the treatment options for CME?

A

corticosteroids, acetazolamide, triamcinolone if associated with uveitis

23
Q

What are the treatment options for CSR?

A

AVOID steroids, PDT laser, avastin, grid laser, or nothing if condition is self-resolving (tx more for chronic cases)

24
Q

What are the treatment options for Optic Neuritis?

A

IV methylprednisolone 250mg q6hx3d followed by oral prednisone 1mg/kg/d x11d and taper over 3d

25
Q

What are the treatment options for CRVO?

A

for non-ischemic –> tPA, IVT triamcinolone for macular edema
for ischemic –> IVT VEGF inhibitor to tx neo, or PRP laser

26
Q

What are the treatment options for BRVO?

A

treat macular edema with grid laser or IVT triamcinolone, treat the neo with VEGF inhibitor or scatter laser

27
Q

How do you treat Sympathetic ophthalmia?

A

1 - 1.5 mg/kg/d QD of prednisone po or IV for at least a year
immunosuppressives may be required

28
Q

How do you treat Vogt-Koyanagi-Harada Syndrome?

A

high dose (1-2mg/kg/d) oral steroid (such a prednisone) for 6mo-1yr
if no response try other immunosuppressives (in escalating order):
-IV steroids before oral (methylpred up to 1g/d)
-cyclosporin po
-cytotoxic agents po (cyclophosphamide, chlorambucil, azathioprine)
-infliximab (TNFa inhibitor), methotrexate

29
Q

How do you treat vitreoretinal traction?

A

vitrectomy or ocroplasmin (Jetrea) injection

30
Q

What are the treatments for choroidopathies?

A

Systemic steroids or immunosuppressants, CNV in PIC and multifocal choroiditis tx w/antiVEGF or laser

31
Q

What are the ocular side effects of systemic drug: alendronate?

A

episcleritis, scleritis, uveitis (incidence <1%)

32
Q

What are the ocular side effects of systemic drug: amantadine?

A

microcystic edema, folds in descemet’s membrane, resolves with discontinuation of the drug

33
Q

What are the ocular side effects of systemic drug: amiodarone?

A

corneal deposits (whorl keratopathy), optic neuritis, optic neuropathy

34
Q

What are the ocular side effects of systemic drug: anticoagulants (aspirin, coumadin, clopidogrel, dabigatran)?

A

subconjunctival hemorrhage

35
Q

What are the ocular side effects of systemic drug: antipsychotics (chlorpromazine, thioridazine)

A

cataracts, whorl keratopathy, RP, pigmentary retinopathy

36
Q

What are the ocular side effects of systemic drug: isoniazid?

A

optic neuropathy, accommodation impairment

37
Q

What are the ocular side effects of systemic drug: rifabutin?

A

acute anterior uveitis (unilateral, associated with hypopion)

38
Q

What are the ocular side effects of systemic drug: ethambutol?

A

toxic optic neuropathy (1-5%), decreased central vision, visual field defects, decreased colour vision, progresses 1-2mo after discontinuation of drug

39
Q

What are the ocular side effects of systemic drug: corticosteroids?

A

cataracts, increased IOP, opportunistic infections

-recommended eye exam f/u 3-4x per year

40
Q

What are the ocular side effects of systemic drug: hydroxychloroquine?

A

bullseye maculopathy

monitor w/VF 10-2, OCT, mfERG, FAF

41
Q

What are the ocular side effects of systemic drug: digoxin?

A

blurred vision, yellowed vision, decreased R-G and B-Y colour discrimination

42
Q

What are the ocular side effects of systemic drug: interferons?

A

cotton wool spots and retinal hemes around the ONH, CME

monitor on eye exam f/u q3mo

43
Q

What are the ocular side effects of systemic drug: isotrentinoin

A

blepharitis, conjunctivitis, dry eyes, irritation

44
Q

What are the ocular side effects of systemic drug: sildenafil?

A

colour vision changes (cyanopsia), blurred vision, peripheral vision loss, photophobia, increased IOP, NAAION, 2-11% incidence

45
Q

What are the ocular side effects of systemic drug: tamoxifen?

A

dry eye, cataracts, keratopathy, retinal deposits (can lead to macular edema)

46
Q

What are the ocular side effects of systemic drug: tamsulosin?

A

intraoperative floppy iris syndrome <1%, blurred vision <2%

47
Q

What are the ocular side effects of systemic drug: tetracyclines?

A

pseudotumor cerebri, papilledema

48
Q

What are the ocular side effects of systemic drug: topirimate?

A

acute myopia, secondary angle closure, blurred vision, diplopia, visual disturbance
discontinue in patients with decreased VAs and pain

49
Q

What are the ocular side effects of systemic drug: vigabatrin?

A

VF constriction >30%, nystagmus (13-15%), blurred vision (11-13%), diplopia (3-7%)
get baseline field and perimetry q3mo, VEP in young children

50
Q

What are the side effects of tetracycline antibiotics in kids?

A

tooth discolouration under the age of 8 years old

51
Q

What are the side effects of fluoroquinolone antibiotics in kids?

A

tendinous arthropathy

52
Q

What are the side effects of aminoglycoside antibiotics in kids?

A

renal toxicity

53
Q

What are the side effects of IV ceftriaxone/rocephin antibiotic in kids?

A

biliary sludging (infants)

Ocular Pharmacology (10 decks)

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