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Year 2 Ocular Pharmacology > AMD > Flashcards

AMD Flashcards

1
Q

What are the modifiable risk factors for AMD?

A

Smoking
Weight
Lack of exercise
Hypertension
(Sunlight exposure)
(Heavy alcohol consumption)

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2
Q

What are the unmodifiable risk factors for AMD?

A

Age
Family history
(Caucasian race)
(Female gender)

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3
Q

What clinical features are present in early AMD?

A

Drusen
Pigmentary changes

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4
Q

What clinical features are present in late AMD?

A

Geographic Atrophy
Choroidal Neovascularisation

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5
Q

What clinical features are present in dry AMD?

A

Drusen
Pigmentary changes
Geographic Atrophy

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6
Q

What clinical features are present in wet AMD?

A

Choroidal Neovascularisation

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7
Q

What are drusen and where do they form?

A

Lipid/protein extracellular deposits between Bruch’s membrane and the RPE

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8
Q

What size are drusen compared to to determine if they’re hard or soft?

A

63um (width of a blood vessel)
If under: hard AKA drupelets
If over: soft

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9
Q

What is geographic atrophy?

A

Loss of PRs, revealing area of depigmentation so choroid is visible, well-circumscribed

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10
Q

What is choroidal neovascularisation?

A

Neovasc originating from the choroid which breach Bruch’s membrane and invade sub-RPE/retina

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11
Q

What can CNV lead to?

A

Fibrovascular Proliferation (leads to vitreous haem and tractional retinal detachment)

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12
Q

What is Fibrovascular Proliferation?

A

Growth of fibrous elements from new blood vessels which could contract, leading to vitreous haem and RD

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13
Q

What causes VEGF release?

A

Abnormal retinal changes seen in AMD

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14
Q

What happens as a result of VEGF release?

A

Neovascularisation, inflammation and increased vessel permeability

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15
Q

How can AMD be imaged?

A

OCT
Fundus photography
Fluorescein angiography
Indocyanine green angiography

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16
Q

How is Fluorescein angiography helpful to assess AMD?

A

Can visualise CNV more easily as can view blood flow into choroid

17
Q

How is Indocyanine green angiography helpful in assessing AMD?

A

Visualises poorly circumscribed areas more easily due to longer wavelength of green dye (compared to NaFl)

18
Q

What are some previous treatments for AMD?

A

Surgical movement of macular
Photodynamic therapy

19
Q

How does anti-VEGF work?

A

The drug injected binds to receptor sites on VEGF, stopping it from binding - so stopping neovasc, inflammation and increased vessel permeability

20
Q

What is the brand name of Ranibizumab?
What is it licensed for?
What is injected?
How often is it injected?

Core

A

Lucentis
Wet AMD
Antibody fragment
Monthly injection

21
Q

What is the brand name of Bevacizumab?
What is it licensed for?
What is injected?
How often is it injected?

Further

A

Avastin
Oncology but used in AMD
Full length antibody
Monthly injection

22
Q

What is the brand name of Aflibercept?
What is injected?
How often is it injected?

Core

A

Eylea
‘VEGF trap’ fusion protein - decoy receptor
Injected every 8 weeks

23
Q

What is the brand name of Brolucizumab?
What is injected?

Further

A

Beovu
Single chain antibody fragment - small so penetrates and leaves circulation quickly

24
Q

What is the brand name of Faricimab?
What is injected?
How often is it injected?

Further

A

Vabysmo
Bispecific antibody - inhibits angoprotein-2 and VEGF
Injected every 16 weeks

25
Q

What is the brand name of Pegaptanib?
What is injected?
When did NICE stop recommending its use?

A

Macugen
RNA fragment
2015

26
Q

What are the NICE guidelines for treatment of AMD?

A

VA - between 6/12 and 6/96
No permanent structural damage to central fovea
lesions are less than or equal of 12 disc areas
Evidence of recent disease progression (neovasc, VA changes, Amsler distortion)

27
Q

What are possible future treatments?

A

Gene therapy
Anti-inflammatory therapy (corticosteroids)
Combination of anti-VEGF and corticosteroids
Stem cell therapies

28
Q

What nutritional guidance should you give to patients with AMD?

A

Eat lots of dark green leafy veg and orange/yellow foods
Fish 3-4 times per week
Supplements of vitamins/minerals (not specific brands!)

29
Q

What nutrients help to defend against oxidative damage in the retina?

A

Vitamins C and E
Beta-carotene
Zinc
Omega-3 fatty acids
Carotenoids (Lutein and Zeaxanthin)

Year 2 Ocular Pharmacology (20 decks)

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