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Block 3 Clinical Skills > Anesthetics and Methods of Drop Delivery > Flashcards

Anesthetics and Methods of Drop Delivery Flashcards

1
Q

KEY: Topical ocular anesthetics are used to prevent eye pain during what 6 things?

A
  1. Diagnostic testing and procedures
  2. Goldman Applanation tonometry
  3. Gonioscopy (used with slit lamp)
  4. Ophthalmic examinations
  5. Removal of foreign bodies or sutures
  6. Surgery

Note:
Goldmann Applanation Tonometry is currently considered to be the most accurate clinical method for measuring the IOP. This method indirectly measures the IOP by gauging how much force it takes to flatten the cornea over a fixed surface area.

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2
Q

What are 4 types of anesthetics?

A
  1. Cocaine
  2. Tetracaine
  3. Benoxinate
  4. Proparacaine
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3
Q

Mechanism of action of a topical ocular anesthetic:
A topical ocular anesthetic blocks nerve conduction to _____ and _____ by disabling the ability of the nerve cells to generate an __________.

A

superficial cornea and conjunctiva

action potential

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4
Q

KEY: A topical ocular anesthetic suppresses corneal and conjunctival ______.

A

SENSITIVITY

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5
Q

KEY: What is the efficacy of topical ocular anesthetics?

A

The efficacy is determined by their ability to suppress corneal sensitivity.

Note: Combing two or more topical anesthetics does NOT produce an additive effect, but it does increase the risk of side effects.

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6
Q

What are side effects of topical ocular anesthetics?

A

Severe local reactions are rare, systemic reactions are even more uncommon.

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7
Q

KEY: What is Ocular Toxicity?

A
  1. Mild stinging and burning
  2. Desquamation of the corneal epithelium
  3. Retards (slows down) epithelial healing

*Self medication increases the risk of adverse side effects.

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8
Q

KEY: What is Systemic Toxicity?

A

It is an overdose from topical administration theoretically possible.

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9
Q

Local Hypersensitivity Reactions are:

A
  1. Allergies can develop due to repeated exposure (glaucoma patients)
  2. Mild transient blepharoconjuctivitis occurring 5-10 minutes following instillation. Treat with cold compresses and topical decongestants.

There is little cross reactivity among topical anesthetics.

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10
Q

Systemic Hypersensitivity reactions:

A

No life threatening reactions reported

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11
Q

What are Contraindications and Precautions of Topical Ocular Anesthetics?

A 
1. Self-Administration
KEY: 2. Hypersensitivity 
3. Cultures
4. Dry Eye Testing
5. Pachymetry
6. Perforating Injuries
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12
Q

Contraindications and Precautions
Self-administration of topical ocular anesthetics can bring a risk of adverse side effects due to _______.
It can cause vision loss secondary to permanent scarring.

A

corneal toxicity

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13
Q

Contraindications and Precautions

KEY: Hypersensitivity to topical ocular anesthetics: Substitute with a different agent; there is little_________.

A

little cross sensitivity

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14
Q

What topical ocular anesthetic is the least toxic?

A

Proparacaine

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15
Q

Topical ocular anesthetics are toxic to microorganisms. It kills the culture. Why do we need to know the culture?

A

We need to know the culture to treat the eye appropriately.

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16
Q

Contraindications and Precautions

Dry eye testing: The top layer of the ______ toxicity can confuse the clinical picture.

A

cornea (epithelial)

17
Q

Contraindications and Precautions
________ is checking the thickness of the cornea. Topical ocular anesthetics cause transient corneal swelling following anesthetic use.

A

Pachymetry

18
Q

Contraindications and Precautions

Perforating injuries effect ______ toxicity.

A

epithelial

19
Q

KEY: Proparacaine is a __% solution.

A

0.5%

20
Q

KEY: How do you slow down degradation (discoloration) of proparacaine?

A

Proparacaine should be stored in a tightly capped, opaque and (ideally) refrigerated container to slow down degradation (discoloration).

21
Q

KEY: When should Proparacaine solution NOT be used?

A

If the solution shows more than a faint yellow color, it should NOT be used.

22
Q

KEY: Proparacaine is an extremely low systemic toxicity, it has poor penetration of the ______ and ____.

A

conjunctiva and cornea.

23
Q

KEY: Proparacaine has low _______. It is greater than Benoxinate and less than Tetracaine

A

corneal toxicity

24
Q

KEY: Proparacaine is the least ________ of the topical anesthetics. It is used prior to obtaining cultures.

A

bacteriocidal

25
Q

Proparacaine Clinical Considerations:
Durection of Action:
Onset: ____
Durection: ____

The corneal instability last about 5 minutes. Also, remember that Proparacaine is a Pregnancy category C.

A

Onset– 10 to 20 seconds

Durection– 10-20 minutes

26
Q

Eye Drop Instillation:
The goal is to deliver a full dose of the drug to the eye while minimizing systemic exposure and maximizing patient safety and comfort.

Preliminaries:

  1. Patient education: explain the purpose of the procedure
    * *Inform the patient that you are going to instill drops that may cause temporary stinging.
  2. Wash hands
  3. Anesthesa: decreases patient discomfort and maximizes drug penetration through the _____.
A

Cornea

27
Q

What is the preferred method for a routine eye drop instillation (solutions and suspensions)?

A

Inferior Fornix Delivery

28
Q

Name the 4 benefits of inferior fornix delivery?

A
  1. Maximizes ocular contact time of drug
  2. Minimizes drug loss
  3. Increases ocular absorption
  4. Decreases systemic absorption
29
Q

What is the purpose of punctal occlusion?

A

Punctal occlusion minimizes drainage of medication into naso-lacrimal apparatus, thereby maximizing ocular contact.

Punctal occlusion decreases systemic absorption of the drug through nasal mucosa, minimizing risk o f systemic adverse effects.

30
Q

KEY: What is the purpose of punctal occlusion?

A

Punctal occlusion minimizes drainage of medication into naso-lacrimal apparatus, thereby maximizing ocular contact.

Punctal occlusion decreases systemic absorption of the drug through nasal mucosa, minimizing risk o f systemic adverse effects.

31
Q

How do you record for eye drop instillation?

A

One drop (1 gt) of 0.5% Proparacaine OD and OS @ 11:35 AM

32
Q

KEY: What are 3 other methods if eye drop delivery?

A
  1. Medical Canthus Delivery
  2. Spray Bottle
  3. Pledgets
33
Q

What is medial canthus delivery?

A

This is a lower anxiety technique for persons unable to cooperate with inferior fornix delivery.

Technique:

  1. Head inclined backwards
  2. Eyelids closed
  3. Eye drops placed on top of medial canthus
  4. Patient instructed to blink repetitively
34
Q

What is the spray bottle delivery?

A

It is another lower anxiety technique:

  1. Mist applied to closed lids with the spray bottle and the patient is instructed to blink
    - -Excess solution should be wiped off
    - -A second spray might be necessary, especially if the eyes were closed too tightly
35
Q

What are advantages of the spray bottle technique?

A
  • Efficacy reported to be equivalent as ophthalmic drops and more tolerable
  • Patients were more compliant and experienced LESS BURNING when the spray was used than when ophthalmic drops were used.
36
Q

What are disadvantage of the spray bottle technique?

A
  • Inability to deliver precise dosing
  • Lack of an established dose -response relationship for this type of administration
  • Potential for drug contamination
  • Most ophthalmic medications are not currently formulated for this type of application
37
Q

What is the pledgets technique?

A

Pledgets is another lower anxiety technique.

  1. A cotton swab is saturated with drug solution then placed in the eye
  2. It permits very long or very short contact time.
  3. Useful for inferior sector dilation, breaking synechia

Block 3 Clinical Skills (6 decks)

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