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Pharm exam 5 chapters > ch 87 highlights > Flashcards

ch 87 highlights Flashcards

1
Q

1st line treatment in glaucoma

A

B Blockers

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2
Q

Who cannot use B Blockers

A 
Asthma
COPD
Diabetics
AV heart block
cardiogenic shock
hear failure (use with caution)
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3
Q

What glaucoma treatment can you use for asthma and copd patients

A

Betaxolol

B1 selective

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4
Q

What drugs can you use for angle closure glaucoma

A

B Blockers as adjunct

Pilocarpine

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5
Q

B blockers approved for glaucoma

A 
Betaxolol
carteolol
levobunolol
metipranolol
timolol
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6
Q 
latanoprost
travoprost
bimatoprost
latanoprostene bunod
tafluprost
A

Prostaglandin analogs for Glaucoma

considered 1st line

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7
Q

what prostaglandin was more effective in the African American population

A

Travoprost

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8
Q

what medication can cause a gradual increase in brown pigmentation of the iris, which may be irreversible. It can also increase pigmentation of the eyelid and growth to the eyelashes

A

Prostaglandin analogs for glaucoma

-prost

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9
Q

Apraclonidine

Brimonidine

A

Alpha 2 adrenergic agonists approved for Glaucoma

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10
Q

Which alpha 2 adrenergic agonist crosses the blood brain barrier and which does not

A

Brimonidine crosses the BBB

Apraclonidine does not

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11
Q

which Alpha 2 adrenergic agonist is sold OTC

A

brimonidine is sold as Lumify OTC

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12
Q

What Alpha 2 Adrenergic agonist is approved for short term use and which is approved for long term use

A

Apraclonidine is approved for short term use

Brimonidine is approved for long term use

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13
Q

Which Alpha 2 adrenergic agonist has special considerations with contacts and what are those instructions

A

Brimonidine

Wait 15 min before inserting contacts

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14
Q

Which Alpha 2 adrenergic agonist can promote hypotension

A

Brimonidine

it crosses the BBB so it can cause drowsiness, fatigue and hypotension

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15
Q

Combigan

A

Brimonidine + timolol

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16
Q

Simbrinza

A

Brimonidine + Brinzolamide

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17
Q

2nd line treatment for open angle glaucoma

A

Pilocarpine

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18
Q

Can Pilocarpine be used long term?

A

no, it can cause retinal detachment

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19
Q

What pt population cannot use Pilocarpine

A

Asthma and COPD
bradycardic patients
hypotensive

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20
Q

What is the reversal agent for Pilocarpine

A

Atropine

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21
Q

What drug class is Pilocarpine

A

Direct-acting muscarinic agent

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22
Q

what systemic effects can Pilocarpine cause

A 
due to stimulation of muscarinic receptors
Bradycardia
bronchospasm
hypotension
urinary urgency
diarrhea
hypersalivation
sweating
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23
Q

what type of drug is Echothiophate

A

cholinesterase inhibitor that is approved for glaucoma

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24
Q

when would you use Echothiophate

A

Due to the adverse effects this drug is reserved for patients who have not responded well to the preferred treatments (b blockers, alpha 2 agonists and prostaglandins)

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25
Q

what side effects for Echothiophate

A 
stimulation of muscarinic receptors 
Bradycardia
bronchospasm
hypotension
urinary urgency
diarrhea
hypersalivation
sweating

development of cataracts

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26
Q

Dorzolamide

Brinzolamide

A

Carbonic anhydrase inhibitors: topical

used in glaucoma and ocular hypertension

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27
Q

which carbonic anhydrase inhibitor is generally better tolerated

A

Brinzolamide - causes less ocular stinking and burning than dorzolamide

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28
Q

Are there any contact precautions with the Carbonic anhydrase inhibitors

A

yes, for both dorzolamide and brinzolamide

wait 15 min after administering before wearing contacts

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29
Q

most common side effects for the Carbonic Anhydrase Inhibitors

A

ocular stinking
bitter taste immediately after dosing
transient blurred vision (Brinzolamide)

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30
Q

which Carbonic Anhydrase inhibitor do 10-15% of patients experience allergic reactions

A

Dorzolamide -
Conjunctivitis
lid reactions
stop med and contact provider

other reactions for Dorzolamide
blurred vision
tearing
eye dryness
photophobia
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31
Q

t/f

If I miss a dose of my glaucoma medication, it is okay. Try not to miss again

A

False - It is important to take the medication according to the schedule. If days are skipped or if prescriptions are not filled, loss of vision may occur

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32
Q

symptoms of angle closure glaucoma

A

vision loss
severe eye pain
headache
n/v

33
Q

what should you do for photophobia in

A

use sunglasses, wide-brimmed hats, visors or baseball hats

34
Q

what is the drug that you need to allow at least 15 min to elapse between administration and insertion of contacts

A

Benzalkonium

35
Q

To improve topical absorption and minimize systemic absorption for topical eye meds

A

close eyes for 3 min after drops and lightly press a thumb over medial canthus (inner corner of eye)

36
Q 
eye
itching
burning
thin, watery discharge
red and congested conjunctiva
A

allergic conjunctivitis

37
Q

pattern of symptoms for allergic conjunctivitis

A

symptoms appear 20 min after exposure and stop 20 min later and come back 6+ hours later due to recruitment off immune cells

38
Q

cromolyn

lodoxamide

A

mast cell stabilizers

takes days to develop and 2 weeks to become maximally effective

39
Q

treatment for allergic conjunctivitis

A

mast cell inhibitors (cromolyn, lodoxamine) - these take 2+ weeks to be effective

for immediate relief - H1 receptor antagonists (antihistamines)

If you use Azelastine and olopatadine - they do both

Toradol (NSAID) - inhibits prostaglandins

Glucocorticoids (ie) Loteprednol) -if having severe symptoms- may increase IOP if prescribed long term - also inhibits prostaglandins

ocular decongestants (naphazoline and phenylephrine) - decrease redness and edema - these are for no more than 2 weeks and are used just while the mast cell inhibitors take effect (more than 2 weeks may cause rebound congestion)

40
Q

when are ocular decongestants contraindicated

A

history of angle closure glaucoma

41
Q

if multiple topical drugs are being used, how do you apply

A

wait at least 5 min in between drugs so the second drug doesnt flush out the first drug

42
Q

antiviral topical drugs

A

trifluridine

gancyclovir

43
Q

bacterial eye infections will remain contagious

A

until they have been treated for 24-48 hours

44
Q

viral eye infections remain contagious

A

until they are completely gone

45
Q

mild allergic conjunctivitis

A

mild intermittent pruritus

46
Q

moderate allergic conjunctivitis

A

mild to severe pruritis lasts a few days to 2 weeks with no eye redness

47
Q

severe allergic conjunctivitis

A

moderate to severe pruritis that is chronic with eye redness

48
Q

open angle glaucoma is more common in

A

African American Population where angle closure is not

49
Q

effects of dilation with anticholinergic agent

A

tachycardia may indicate toxicity

mydriasis is an effect causing eye unable to focus. Blurred vision until wears off

50
Q 
taking Dorzolamide with the following symptoms
ocular stinging
bitter taste
photophobia
eye dryness
blurred vision
A

normal

51
Q

Taking Dorzolamide with

redness in eyes or eyelids

A

Allergic conjunctivitis

stop med

52
Q

which med was marketed specific purpose of increasing eyelash length, darkness and thickness

A

Latisse (bimatoprost)

53
Q

adverse effects of B Blocker drops for glaucoma

A

ocular stinging

occasionally
conjunctivitis
blurred vision
photophobia
dry eyes
54
Q

B1 Blockade effects

A

bradycardia

AV heart block

55
Q

B2 blockade effects

A

bronchospasm

56
Q

prostaglandin analogues side effects

A 
iris color change
eyelashes - longer, thicker, darker
blurred vision
burning
stinging
conjunctival
hyperemia
conjunctival edema
punctate keratopathy
macular edema (rare)
57
Q

Apraclonidine side effects

A 
headache
dry mouth
dry nose
altered taste
conjunctivitis
lid reactions
pruritus
tearing 
blurred vision

does not cross BBB

58
Q

second line drug for open angle glaucoma and used for emergency treatment

A

Pilocarpine

59
Q

pilocarpine side effects

A

decrease visual acuity
local irritation
eye pain
brow ache

bc its a direct acting muscarinic agonist
bradycardia
bronchospasm
hypotension
urinary urgency
diarrhea
hypersalivation
sweating
60
Q

what cholinesterase inhibitor for glaucoma

A

echothiophate

61
Q

pilocarpine for children

A

may cause paradoxical increases in intraocular pressure

62
Q

glaucoma in pregnancy

A

brimonidine

63
Q

meds for glaucoma for older adults - what drugs contraindicated and why

A

B Blockers can worsen heart failure even topical

A2 agonists can cause orthostatic hypotension

if marked renal impairment, no carbonic anhydrase inhibitors

cholinesterase inhibitors may cause bradycardia and hypotension

64
Q

side effect of Dorzolamide (Trusopt) for glaucoma

carbonic anhydrase inhibitor (topical)

A

ocular stinging
bitter taste after dosing
allergic reactions - conjunctivitis and lid reactions

blurred vision
tearing
eye dryness
photophobia

65
Q

Brinzolamide (Azopt) for topical treatment of elevated IOP in open angle glaucoma or ocular HTN

Carbonic anhydrase inhibitor
adverse effect

A

bitter aftertaste
transient blurred vision

less ocular stinging and burning than dorzolamide

66
Q

contact lens and brinzolamide

A

wait 15 min after drops to put contacts in

67
Q

glaucoma pt teach

A

take according to schedule - you can lose vision if days are skipped

call if vision loss, severe eye pain, headache n/v - s/s of angle closure glaucomA

photophobia outdoors- wear sunglasses, wide brimmed hats, visors or baseball caps

check labels to see if they contain benzalkonium as a preservative. if so wait 15 min after drops to put in contacts

dont touch dropper to eyes and do not touch tip with finger. eye infection

to improve absorption, close eyes for 3 min after drops and lightly press a thumb or finger over the medial canthus (inner corner of eye)

68
Q

iop in glaucoma pt should be checked how often

A

every 1-3 months

69
Q

what can help reduce severity of symptoms for allergic conjunctivitis

A

avoid allergen

for example if allergic to pollen….avoid being outside on a windy day during pollen season

70
Q

if oral antihistamines are taken for allergy symptoms what is a common side effect and what can you do (with eyes)

A

eye dryness
artificial tears or other eye lubricants

apply cold compresses 5-10 min

avoid rubbing eyes and wearing contacts if symptoms are bad to avoid worsening

71
Q

when should you notify provider when being treated for allergic conjunctivitis

A

if no relief after 2 weeks - could indicate underlying issue

72
Q

if using multiple topical drugs in eyes, how do you give

A

wait at least 5 min in between drugs

73
Q

what prescription can be given for dry eyes due to inflammation

A

topical cyclosporine opthalmic emulsion (Restasis)

74
Q

ocular decongestants for allergic conjunctivitis

A 
phenylephrine
naphazoline
oxymetazoline
brimonidine
tetrahydrozoline

only local reactions (stingin, burning, reactive hyperemia with overuse

75
Q

what do you need to ensure prior to giving a ocular glucocorticoid for inflammation of the eye (uveitis, iritis, conjuntivitis)

A

ensure there is no underlying viral or fungal infection or glucocorticoids can cause permanent vision loss

76
Q

antiviral topical for eye infections

A

trifluridine

ganciclovir

77
Q

what is applied to eye to look for lesions on the corneal epithelium

A

fluorescein

makes defects bright green

78
Q

adverse effect of fluorescein

A

n/v
paresthesias
pruritus

anaphylaxis
pulmonary edema
cardiac arrest

79
Q

what is rose bengal used

and lissamine green for

A

visualize abrasions of corneal and conjunctival epithelium

Pharm exam 5 chapters (15 decks)

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