Clinical Administration Of Ocular Therapeutic Medications

Question 1

Agonist

Answer 1

Acts directly on receptor

Question 2

Antagonist

Answer 2

Binds to receptor and inhibits agonist

Question 3

Normal tear film volume, including fluid trapped in conjunctival folds

Answer 3

8-10 uL

Question 4

Tear film volume that can be held after given a drop if lids are not squeezed and cul-de-sac is utilized

Answer 4

30 uL

Question 5

Typical ophthalmic drop volume

Answer 5

50 uL

Question 6

Three different fates of excess drop fluid

Answer 6

Drain through nasolacrimal duct

Absorbed through nasal mucosa or swallowed

Rolls to cheek

Question 7

20 drops =

Answer 7

= 1mL

Question 8

Techniques to Maximize Effect of Each Drop

Answer 8

Fraunfelder pouch

Looking down

Punctal occlusion

Question 9

Hurdles in drop administration (dilution)

Answer 9

Tears

Aqueous humor -> trabecular meshwork

Question 10

Corneal epithelium penetration

Answer 10

Lipophilic drugs

Resists hydrophilic drugs

Question 11

Fluorescein is a __________ drug.

Answer 11

Hydrophilic

Question 12

Corneal stroma penetration

Answer 12

Hydrophilic drugs

Resists lipophilic drugs

Question 13

To penetrate the cornea, there needs to be:

Answer 13

A balance of hydrophilic and lipophilic properties

Question 14

Pro-drug

Answer 14

Inactive compound is activated in thebody to active compound
(biotransformation)

Question 15

Getting the maximum effect from each drop equals the maximum therapeutic effect.

Answer 15

FALSE

Question 16

Ways to get max therapeutic effect

Answer 16

-increased drug concentration
~higher concentration; fortified Abx

• more frequent dose
• loading dose

-residence time
~thicker drop; punctual occlusion

Question 17

The increased dose frequency is typically

Answer 17

QID

Question 18

Corneal ulcer treatment

Answer 18

Ciloxan ophth soln q15min

Question 19

What is punctual plug material?

Answer 19

Collagen

Question 20

For children, where is the drop instilled in closed eyes?

Answer 20

Nasal canthus

Question 21

Green

Answer 21

Miotic

Question 22

Red

Answer 22

Mydriatic/ cycloplegic

Question 23

Brown

Answer 23

Antibiotic

Question 24

Grey

Answer 24

NSAID

Question 25

Yellow

Answer 25

0.5% beta blocker

Question 26

Blue

Answer 26

0.25% beta blocker

Question 27

Purple

Answer 27

Alpha agonist

Question 28

Teal/clear

Answer 28

Prostaglandin analogue

Question 29

Orange

Answer 29

CAI

Question 30

Characteristics of a solution

Answer 30

- solid in a liquid - always transparent - small particles - fully dissolve - homogenous - permanent, does not settle out - NO SHAKING - Tobramycin

Question 31

Characteristics of a suspension

Answer 31

- solid in a liquid - cloudy mixture of two or more substances that settle in standing - large particles - do not dissolve - temporary - SHAKE - Prednisolone acetate

Question 32

Characteristics of a colloid

Answer 32

- liquid in a liquid - hybrid between a solution and a suspension - will not separate out - NO SHAKING - Durezol

Question 33

Where are ophthalmic ointments applied?

Answer 33

Inferior lid; lid margin

Question 34

The therapeutic level reached by an ointment is the same as that reached by a drop.

Answer 34

False. It's less.

Question 35

Ointment disadvantages

Answer 35

Blurred vision for 5 minutes Same therapeutic levels as drops not reached Limited number of concentrations available Use in tx with ophth soln Contact dermatitis

Question 36

Don't use ointments when:

Answer 36

- full thickness corneal laceration - with some topical meds - some corneal ulcers

Question 37

Ophthalmic gels

Answer 37

Ointment/ drop hybrid

Question 38

Which type of ophthalmic agent has a timed-release effect?

Answer 38

Gels

Question 39

When are ophth gels usually applied?

Answer 39

QHS

Question 40

Types of lid scrubs

Answer 40

Detergents Prepared pads and solutions Antibiotic ointment

Question 41

Treatment of MGD

Answer 41

Heat and hot soaks Anti inflammatory tx - doxy - omega 3

Question 42

What is Ocusert?

Answer 42

A Pilocarpine-soaked chunk between 2 polymer membranes -replaced every 7 days

Question 43

How does Lacrisert work?

Answer 43

It's a slow-release artificial tear that is applied to the inferior sac and melts throughout the day

Question 44

What is a Morgan lens?

Answer 44

A continuous irrigation system from a saline bag that flushes out eye quickly

Question 45

Mechanism of action

Answer 45

How a drug interacts with a receptor in the bodyto moderate the rate at which an action takes place.

Question 46

What is the most common injection?

Answer 46

Subconjunctival

Question 47

Conditions that may require subconj injections

Answer 47

Severe keratitis Corneal ulcer Bacterial endophthalmitis

Question 48

Conditions that require an anterior sub-Tenon's injection

Answer 48

Pars planitis | Intermediate uveitis

Question 49

Conditions that require a retrobulbar injection

Answer 49

Application of: anesthetics, corticosteroids, alcohol

Question 50

Possible contraindication of adrenergic drugs

Answer 50

Cardiovascular drugs

Question 51

Things to consider when prescribing meds to diabetic patients

Answer 51

Slow detox -> linger drug activity Corticosteroid-induced hyperglycemia Difficulty in dilation

Question 52

Stevens-Johnson disease associated with

Answer 52

Sulfacetamides

Question 53

Pediatric cycloplegic spray contents

Answer 53

- 3.75 ml of 2.0% Cyclopentolate - 3.75 ml of 10% Phenylephrine - 7.5 ml of 1.0% Tropicamide

Question 54

Pediatric cycloplegic spray yields

Answer 54

15 mL of: - 0.5% Cyclopentolate - 2.5% Phenylephrine - 0.5% Tropicamide

Question 55

One spray of pediatric cycloplegic spray =

Answer 55

= 105uL or 2 drops