Competency 1.2.3 Flashcards
Additional Information Required if a Patient is Diabetic/Hypertensive?
- Duration of disease
- Degree of control (well controlled?)
- How it is controlled (medication or diet?)
- Is condition monitored e.g. by GP, if yes then when was last check?
- In DR do they attend screening?
- Any familial links?
How is Type 2 Diabetes Diagnosed?
- Using a Glycated Haemoglobin test
- This indicates the average blood sugar levels over a period of 2 or 3 months
- Below 5.7% is viewed as normal
- Above 6.5% is indicative of diabetes
- Inbetween is termed prediabetic
Management Options for Type 2 Diabetes
- Healthier eating
- Regular exercise
- Blood sugar monitoring
- Diabetes medication
- Insulin therapy
How frequently is Blood Sugar Monitored in Diabetics?
- Frequency will vary between individuals
- Can be once daily with checks either side of periods of exercise
- Can be more often if the patients is taking insulin
How is Blood Sugar Monitored in Diabetics?
- Monitoring usually performed by a small device which monitors the amount of sugar in a drop of blood
- These readings should be recorded for the benefit of the care team
- There can also be continuous readings which are paired with e.g. a mobile phone which can alert the individual when readings are high or low.
Types of Medication for Type 2 Diabetes
- Biguanides (Metformin)
- Sulfonylureas (Gliclazide)
Mechanism of Metformin in Type 2 Diabetes
- Generally first medicine supplied
- Reduces the glucose production in the liver
- Improves bodys sensitivity to insulin which allows more effective use
Metformin Side Effects
- Nausea
- Abdominal pain
- Bloating
- Diarrhoea
- Vitamin-B deficiency (supplementation is common)
Insulin in Type 2 Diabetes
- Was previously used as a last resort but is now prescribed sooner if blood sugar levels aren’t met swiftly enough
- Most types of insulin are taken by injection
- Long acting insulin keeps levels stable through the day or overnight
- Short acting insulin is used around mealtimes
Management of Type 1 Diabetes
- Known as insulin dependent diabetes
- Managed vis insulin injections or insulin pump
- Injections and monitoring throughout duration of life
How is HBP Diagnosed?
- Diagnosed by a doctor by taking blood pressure readings
- Pressure readings of 140/90 mmHg is taken by doctor, less if taken at home
Mechanism of Gliclazide in Type 2 Diabetes
- Increases insulin production in pancreas
Gliclazide Side Effects
- Stomach ache
- Nausea/vomiting
- Diarhoea/constipation
- Visual impairment???
Management Options for HBP
- Eating a heart healthy diet
- More exercise
- Limiting alcohol
- Not smoking
- Medication
Medical Management of HBP
- Medications are used when lifestyle changes are not sufficient
- Choice of medication dependent on patient health and degree of hypertension
- On many occasions multiple drugs are prescribed
Medications used to Treat HBP
- Diuretics (Water Pills)
- Angiotensin-Converting Enzyme (ACE) Inhibitors
- Angiotensin II Receptor Blockers (ARBs)
- Beta Blockers
Diuretics in Management of HBP
- Remove sodium and water from the body
- Often a first line treatment
- Side effect includes increased urination which can reduce potassium levels
- Examples: chlorthalidone and hydrochlorothiazide
Angiotensin-Converting Enzyme (ACE) Inhibitors in Management of HBP
- Relax blood vessels preventing narrowing
- Does this by blocking formation of chemical which narrows the vessels
- Examples: lisinopril, benazepril and captopril
Angiotensin II Receptor Blockers (ARBs) in Management of HBP
- Relax blood vessels preventing narrowing
- Does this by blocking action of chemical rather than preventing its formation
- Examples: candesartan and losartan
Beta Blockers in Management of HBP
- Reduce the workload on the heart and widens blood vessels
- Heart beats with less force
- Examples: atenolol and metoprolol
Importance of DM/HBP Disease Duration on the Eye
- Longer disease has been present, more likely ocular complications are to be present
- Almost all individuals with diabetes for over 30 years likely to have DR
HBP Drugs and the Eye
- Diuretics linked to progressing POAG
- ACE inhibitors preferable as don’t appear to damage eye
Importance of DM/HBP Disease Control on the Eye
- Better control results in less chance of ocular complications
- More elevated HBP is more likely to lead to retinopathy
Types of Diabetes
- Type 1 in which the body produces almost no insulin due to an attack by the immune system on the pancreatic beta cells which produce insulin. This can appear at any age.
- Type 2 the pancreas doesn’t produce enough insulin to keep blood glucose levels down
- Gestational diabetes is associated with pregnancy, it usually disappears after childbirth but can indicate greater susceptibility to type 2 DM at a later age
Diabetes Disease Process
- Insulin is hormone that allows glucose to be transported into body cells to be used for energy
- Diabetics don’t produce enough/any insulin, meaning that insulin stays in the blood and doesn’t reach the cells
- Diabetes can result in damage to many body structures e.g. eyes, kidneys and heart
Effects of Diabetes on the Eye
- Diabetic keratopathy
- Diabetic retinopathy
- Cataract
- Prescription shifts
Corneal Impact of Diabetes
- Reduced corneal sensation due to effect on trigeminal nerve
- Greater susceptibility to infection due to reduced corneal healing
Retinal Impact of Diabetes
- Increase in blood sugar levels can cause retinal vasculature to become blocked
- This can lead to leaks or bleeds, or troublee supplying oxygen
- Loss of pericytes in vessel walls leads to enlarged pouches forming which appears as dot and blot haemorrhages
- When there is hypoxia, new vessels can grow, resulting in proliferative DR
Diabetes Effect on Lens
- High blood sugar levels cause structural changes within the lens which accelerate cataract formation
- Fluid accumulation as a result of osmosis in lens can result in shape change which can cause a myopic shift
HBP Disease Process
- An increase in the pressure within the body’s arteries and results in the cardiovascular system having to work harder
- Is an important factor in many strokes, heart attacks and retinal occlusive events
- Strong relationship between salt intake and hypertension, around half of patients are described as salt sensitive
Systolic and Diastolic Blood Pressure
- Systolic is the pressure as the heart is actively pushing the blood out, 130mmHg indicative of HBP
- Diastolic refers to the period when the heart is moving around the chambers of the heart, 80mmHG indicative of HBP
Effect of HBP on Eye
- Constricted retinal vessels
- Haemorrhages due to breakdown in blood-retinal barrier
- Can be papilloedema in severe cases
Rheumatoid Arthritis Effect on Eyes
- The connective tissue joint covering which is attacked in this disease is made from collagen, which also makes up the sclera and cornea.
- More likely to develop scleritis, episcleritis etc or have an inflammatory component to their dry eye
- If treated with systemic corticosteroids can result in glaucoma or cataract
- If treated with hydroxychloroquine then can result in macular toxicity
Rheumatoid Arthritis Disease Process
- Attack of immune system on joint tissues due to unknown cause but is likely genetic and environmental factors
- May occur years prior to symptoms
- Causes joint pain and stiffness, more prevalent in the morning
Hyperthyroidism Disease Process
- Thyroid is a gland in the neck which produces hormones which regular many of the body’s functions
- Too high a production of T3 and T4 are are associate with a speeding up of the body processes e.g. overactive heartbeat, losing weigh easily, heat intolerance
- Can result in heart failure/stroke, brittle bones and TED
- TED is a result of activation of orbital fibroblasts by autoantibodies which are directed against thyroid receptors
Sarcoidosis Disease Process
- Inflammatory condition which results in the formulation of granulomas
- Can affect almost any organ in the body
Sarcoidosis Affect on Eyes
- Visually threatening uveitis
- Scleritis
- Inflammatory dry eye disease (inflammation of lacrimal gland)
- Masses on eyelids
Diabetes Layman Explanation
Diabetes occurs when there is too much sugar in your blood. Diabetes affects blood vessels everywhere in your body, as blood sugar levels are higher than average, this causes blood vessels to shrink and break. This can occur at the back of your eye called your retina. This part of the eye is very important for sight, so when blood vessels burst and constrict eventually this can lead to sight loss. In early stages of changes to the retina due to diabetes, no sight loss will be apparent, but if the diabetes isn’t controlled then damage can occur to the blood vessels, leading to more serious sight problems.
HBP Layman Explanation
High blood pressure affects blood vessels in your whole body, including the back of your eye called the retina. Your blood vessels strain at the higher pressure and pace your blood is pumped, therefore blood vessels can break and bleed at the retina. Bleeds at the back of your eye are damaging to sight, and if HBP is left untreated, more bleeds or occlusions mean vision can be lost but it is also a major factor in more serious complications involving organs such as the heart and brain.
Rheumatoid Arthritis Layman Explanation
Rheumatoid arthritis is an inflammatory condition which means that it is the result of the body’s own defence mechanisms attacking the bodys own cells. The condition typically affects the tissue surrounding the joints however it also has links with inflammatory conditions which effect the structures of the eye. This can damage structures within the eye and carries potential for loss of vision so patients must be aware of the tell-tale signs.
Hyperthyroidism Layman Explanation
This involves the thyroid gland producing too much thyroid hormone which has many effects across the entire body. One of the effects affects the eyes in a process called Graves orbitopathy. This affects the tissues such as fat and muscle surrounding the eyes, causing inflammation and swelling. This increase in size, with no more space available causes the eyes to bulge forward which can lead to painful, tender eyes which hurt on movement, and through an inability to blink fully can lead to problems at the front of the eye as the lids aren’t able to fully look after the front surface.
Sarcoidosis Layman Explanation
Sarcoidosis is an inflammatory disease in which the immune system overreacts, causing groups of cells to form clusters of inflamed tissue called “granulomas” in one or more organs of the body. This can affect the eyes in the form of inflammatory diseases or via effects on the tissues surrounding the eyes such as lumps/masses upon the lids.
Steroids and their Uses
- Examples: Prednisolone, hydrocortisone
- Prednisolone is used to treat Crohn’s, Rheumatoid Arteritis, myasthenia gratis and giant cell arteritis
Steroids Ocular Side Effects
- Posterior subcapsular cataract
- Raised IOP
- Papilloedema
- Delayed corneal healing
- Corneal oedema in very high doses
- Central serous retinopathy
Beta Blockers and their Uses
- Examples: atenolol, propanolol and bisprolol
- Beta blockers are used to treat hypertension, migraines and cardiac arrhythmia
Beta Blockers Ocular Side Effects
- Dry eyes
- Miotic eyes
- Reduced IOP
Hypothyroid Drugs and their Uses
- Example: levothyroxine
- In a underactive/missing thyroid it replaces the thyroid hormone called thyroxine
Hypothyroid Drugs Ocular Side Effects
- Diplopia
- Ptosis
- Extraocular muscle paralysis
- Hyperaemia
Statins and their Uses
- Examples: Atorvastatin and simvastatin
- Used to treat high cholesterol
Statins Ocular Side Effects
- Dry eye
Anti-Coagulants and their Uses
- Examples: warfarin and aspirin
- Used in conditions such as deep vein thrombosis or when their is risk of stroke due to clots
Anti-Coagulants Ocular Side Effects
- Subconjunctival haemorrhage
- Retinal haemorrhage
Anti-Malarial/Anti-Inflammatory Drugs and their Uses
- Examples; Quinine, chloroquine and hydroxycholorquine
- used to prevent malaria but hydroxychloroquine is also used to treat rheumatoid arthritis or systemic lupus
Anti-Malarial/Anti-Inflammatory Drugs Ocular Side Effects
- Corneal deposits
- Vortex keratopathy
- Bulls eye maculopathy
- VF defects
- Colour vision defects
Anti-Covulsants and their Uses
- Example: vigabatrin
- Is used to treat spasms e.g. epilepsy
Anti-Convulsants Ocular Side Effects
- Binasal constriction of VF
Anti-Anxiety Medications Ocular Side Effects
- Intermittent blurring
- Photophobia
- Mydriasis
Anti-Anxiety Medications and their Uses
- Examples: Diazepam and Lorazepam
Anti-Allergy Medications and their Uses
- Example: Loratadine
- Used to relieve allergic symptoms
Anti-Allergy Medications Ocular Side Effects
- Dry eye
- Intermittent blurring
- Photophobia
- Blepharospasm
Antiarrhythmics and their Uses
- Examples: amiodarone and digoxin
- Both are used to treat irregular heart beats
Amiodarone Ocular Side Effects
- Vortex keratopathy
- Optic neuropathy
- Anterior subcapsular cataract
Digoxin Ocular Side Effects
- Photopsia
- Red-green colour deficiency
- Decrease in IOP
Tamoxifen Uses and Ocular Side Effects
- Hormone replacement therapy in early breast cancer
- Crystalline maculopathy
- Vortex keratopathy
- Optic neuritis
HRT/Contraceptives Ocular Side Effects
- Papilloedema
- Retrobulbar optic neuritis
- Retinal thrombosis
