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Therapeutics > Cyclopegics > Flashcards

Cyclopegics Flashcards

1
Q

what is the primary purpose for using cycloplegics

A

temporary paralysis of accommodation

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2
Q

why can a hyperopic patients vision fluctuate

A

due to accommodation

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3
Q

list 3 optometric reasons why cycloplegics are used

A
  • assessment of refractive error (latent hyperopia), as child can use accommodation to focus during sight test
  • penalisation
  • adaptation to spectacles (rare)
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4
Q

list 3 other ophthalmological uses of cycloplegics in addition to optometric reasons

A
  • anterior uveitis (to prevent posterior synaechiae)
  • corneal abrasion
  • amblyopia - may blur the good eye if could is non-compliant to patching
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5
Q

list the 2 optometric indications for using cycloplegics from H and S, from symptoms

A
  • asthenopia

- reading difficulties

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6
Q

list the optometric indications for using cycloplegics from H and S, from history

A

manifest deviations

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7
Q

list the 2 optometric indications for using cycloplegics from H and S, from family history

A
  • refractive error at an early age

- manifest deviations

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8
Q

list the 2 optometric indications for using cycloplegics from clinical tests, from finding a binocular vision anomaly

A
  • manifest eso deviation

- sometimes if latent deviation

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9
Q

list the 2 optometric indications for using cycloplegics from clinical tests, following a fluctuating ret

A
  • if theres a large different between subjective and objective
  • poor fixation
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10
Q

why will you find your ret results fluctuating on a child

A

because the child is accommodating and looking at something closer i.e. the ret, so the rx becomes more myopic than it is supposed to be

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11
Q

apart from binocular vision analogies and fluctuating ret, when else will you need to use cycloplegics on a px, from findings in your clinical tests

A
  • accommodative anomalies

- if visual acuity is reduced

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12
Q

list the 6 ideal properties of a cycloplegic

A
  • rapid onset
  • adequate depth of cycloplegia (not much residual accommodation)
  • adequate duration
  • no stinging
  • no mydriasis (but it is a side effect)
  • no toxic effects, local or systemic
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13
Q

name an unnatural condition which may occur after cycloplegic installation

A

pupils can change shape

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14
Q

what occurs initially after instillation of cycloplegics, prior to cycloplegia and why

A

mydriasis

because the iris is located anteriorly and close to the ciliary muscle

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15
Q

list the 3 effects of cycloplegics

A
  • initially mydriasis
  • cycloplegia
  • reduced tear secretion
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16
Q

what occurs within the eye in order to cause cycloplegia

A

relaxation of the ciliary muscle, increasing tension on suspensory ligaments

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17
Q

list the 3 things that muscarinic agonists such as cycloplegics affect

A
  • lacrimal gland
  • iris sphincter muscle
  • ciliary body
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18
Q

list the 5 pieces of advice you will give to a parent before instilling cycloplegics into their child’s eye

A
  • explain the need to use
  • onset
  • duration
  • expected side effects
  • caution
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19
Q

what advice will you give to a child before instilling cycloplegics into their eye

A
  • explain that they might feel the drop on the eye

- use one drop of proxymetacaine first?

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20
Q

why may you want to use proxymetacaine before instilling a cycloplegic

A
  • child will not feel the stinging sensation

- it helps the cyclo go through as the cornea is more permeable

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21
Q

what must you do if consent for cycloplegics is denied for the child by the parent/guardian

A
  • explain the advantages and disadvantages
  • note refusal on the record
  • if concern for the child is great then refer to the GP
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22
Q

what must you do is consent or cycloplegics is denied by the child themselves

A
  • Gillick competent (if the child is sure about their decision even though they’re below the age of 16)
  • record all discussions on notes
  • if concern for the child is great, then refer to the GP
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23
Q

what 2 things may be a helpful way of instilling cycloplegic drops

A

the patient lying down or sometimes drop onto the eyelashes

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24
Q

which 2 ways can you check for cycloplegia

A
  • measure accommodation

- check ret reflex

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25
Q

what sign does not indicate that cycloplegia has been achieved and why

A

mydriasis

as the rate that the pupil dilates and the rate of cycloplegia is different

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26
Q

why may you ask the px to fixate upon the ret light during cycloplegic retinoscopy

A

to ensure that retinoscopy is conducted upon axis

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27
Q

what is there no need to do when carrying out cycloplegic retinoscopy (which you will usually do normally)

A

no need to fog the other eye

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28
Q

when will you occlude one eye when carrying out cycloplegic retinoscopy

A

if the child has strabismus, in order to align the other eye

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29
Q

what must you observe whilst doing cycloplegic retinoscopy and what must you ignore

A

observe central movement

ignore movement in the periphery

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30
Q

which types of aberration are more common during cycloplegic retinoscopy and what risks do they cause

A

positive aberrations more common

this makes the peripheral area more myopic and causes a risk of over prescribing minus

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31
Q

which types of aberration is more rare during cycloplegic retinoscopy and what risks do they cause

A

negative aberrations more rare

this makes the peripheral area more hyperopic and causes a risk of over prescribing positive

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32
Q

list the 4 types of cycloplegics and their available doses

A
  • atropine 1%
  • homatropine 1%
  • cyclopentolate 0.5% and 1%
  • tropicamide 1%
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33
Q

which 2 cycloplegic drugs are additional supply or independent prescriber status

A

atropine and homatropine

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34
Q

which cycloplegic is the weakest drug and which group of patients are they only effective in

A

tropicamide 1% only effective in adults

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35
Q

which cycloplegic is the most commonly used

A

cyclopentolate

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36
Q

what type of compound is atropine sulphate and where is it extracted from

A

a naturally occurring compound extracted from “belladonna” deadly nightshade

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37
Q

what type of agent is atropine sulphate

A

toxic

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38
Q

what was atropine sulphate the first of

A

first muscarine antagonist used in medicine

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39
Q

which category of medicine is atropine sulphate

A

POM
for use and supply by additional supply optometrists
used and prescribed by independent prescribing optometrists

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40
Q

what doses is atropine sulphate eye drops available in

A
  • 0.5%

- 1%

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41
Q

what dose is atropine sulphate eye ointment available in

A

1% atropine sulphate (non-proprietary)

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42
Q

how much of atropine sulphate can be enough to kill a child

A

a 3ml tube of ointment

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43
Q

what dose is atropine sulphate minims available in

A

1% atropine sulphate Bausch and Lomb

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44
Q

which 3 forms is atropine sulphate available in

A
  • eye drops
  • eye ointment
  • minims
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45
Q

what degrees must you store atropine sulphate below

A

25 degrees celsius and protect from light

46
Q

what dose of atropine eye drops and for how many days prior to refraction must an adult or child > 3 months take

A

1 drop of 1% twice per day for 1-3 days before refraction

47
Q

what dose of atropine ointment and for how many days prior to refraction must an adult or child > 3 months take

A

2 times a day for 1-3 days before refraction

give this to the parent with a leaflet

48
Q

what must you ask parents who have received atropine sulphate ointment to do on day of refraction examination

A

to return the unused ointment to practice

49
Q

when does mydriasis commence after instilling 1 drop or 1% of atropine

A

in 10-15 mins

50
Q

when is maximal mydriasis achieved after instilling 1 drop or 1% of atropine

A

30-40 mins

51
Q

when does mydriasis recover after instilling 1 drop or 1% of atropine

A

in 3-7 days

52
Q

when does mydriasis recover after instilling 3x of atropine twice daily

A

after 10-14 days

53
Q

when does cycloplegia commence after instilling 1 drop or 1% of atropine

A

in 30 mins

54
Q

when is maximal cycloplegia achieved after instilling 1 drop or 1% of atropine

A

in 1-3 hours, not complete

55
Q

when does cycloplegia recover after instilling 1 drop or 1% of atropine

A

in 3-7 days

56
Q

when does cycloplegia recover after instilling 3x of atropine twice daily

A

after 7-10 days

57
Q

when does adequate near vision recover after instilling 3x of atropine twice daily

A

after 4-5 days

58
Q

what tones does the ciliary muscle have

A

a dependent and an independent tone

59
Q

what needs to be made for the dependent tone after atropine instillation and how

A

an allowance - where the spherical power only needs to be adjusted in the less positive direction

60
Q

what amount of allowance needs to be made for dependent tone following atropine for low myopes and hyperopes (

A

-1.00DS

61
Q

what amount of allowance needs to be made for dependent tone following atropine for moderate and high myopes

A

0.00DS

62
Q

which drugs is allowance for dependent tone not applicable

A

cyclopentolate and tropicamide

63
Q

why has atropine dependent tonus allowance been abolished

A

because theres a risk of over plussing the patient

64
Q

list 3 possible contraindications to atropine

A
  • a known allergy to atropine or component of the preparation
  • narrow angles?
    in children?
65
Q

list the 7 types of people who need to be cautioned when using atropine

A
  • children
66
Q

why must you take caution with a child

A

it can cause amblyopia from stimulus deprivation

67
Q

why must you take caution with atropine on someone who has a intermittent manifest deviation

A

as the accommodation is paralysed for so long, deviation may become permanent

68
Q

list 4 immediate ocular side effects that can occur when taking atropine

A
  • transient stinging
  • blurring
  • photophobia
  • raised IOP?
69
Q

list 4 ocular side effects that can occur when using atropine repeatedly

A
  • hyperaemia
  • oedema
  • itching, irritation
  • follicular conjunctivitis
70
Q

what are the 3 general body side effects of atropine

A
  • toxic effects
  • tachycardia
  • death from respiratory depression
71
Q

list the 4 different toxic effects atropine has on the body

A
  • dry as a bone: dry mouth and skin due to decreased secretion of salivary and sweat glands
  • red as a beetroot: flushing, increased body temperature, as cannot cool body by sweating
  • blind as a bat: cycloplegia
  • mad as a hatter: CNS effects - ataxia, hallucinations, confusion, difficulty in speaking
72
Q

which type of patients is most likely to die from respiratory depression as a side effect of taking atropine

A

children, who take a 3 gram tube of atropine

can be fatal to small children who ingest it

73
Q

what is an additional use of atropine, and how is it used

A

used to treat amblyopia

  • instilled into better eye
  • prevents accommodation
  • used when child will not tolerate patching or used as a first choice
  • excellent results
74
Q

what is the full name for cyclopentolate

A

cyclopentolate hydrochloride

75
Q

what type of compound is cyclopentolate

A

synthetic drug

76
Q

what dose of cyclopentolate is more useful as a mydriatic

A

0.5%

77
Q

what type of medicine is cyclopentolate

A

POM for use and supply by all optometrists

78
Q

what doses is cyclopentolate multi use eye drops available in and what are they called

A
  • 0.5%
  • 1.0%
    called mydrilate (intrapharm)
79
Q

at what temperature must cyclopentolate multi use eye drops be stored

A

between 2-8 degrees celsius

80
Q

what doses is cyclopentolate minims available in

A
  • 0.5%

- 1%

81
Q

at what temperature must cyclopentolate minims be stored

A

below 25 degrees celsius and protect from light

82
Q

what forms is cyclopentolate available in

A
  • eye drops

- minims

83
Q

what dose of cyclopentolate is used on children up to 12 years old

A

1%

84
Q

what dose of cyclopentolate is used if iris pigmentation is light

A

0.5%

85
Q

after how long does cycloplegia commence from cyclopentolate

A

after a few minutes

86
Q

after how long is maximal cycloplegia achieved with cyclopentolate

A

30-60 minutes

87
Q

after how long is maximal mydriasis achieved with cyclopentolate

A

30-60 minutes

88
Q

after how long is recovery from cycloplegia with cyclopentolate

A

24-48 hours

89
Q

how much of residual accommodation is there with cyclopentolate

A

1.50D or less

90
Q

what amount of rx will you give after using cyclopentolate

A

always give full rx found

91
Q

at what 2 exceptions will you not give the full rx following a cycloplegic refraction using cyclopentolate

A
  • hyperopia and exo deviation

- myopia and eso deviation

92
Q

what are the 6 types of people who have to use cyclopentolate with caution

A
  • young children
  • debilitated patients
  • elderly
  • avoid over dosage in darkly pigmented eyes
  • pregnancy and lactation: unknown use only if risk to mother outweighs risk to foetus
  • hallucinations and CNS effects reported with concentrations (a marked risk only with over dose)
93
Q

list the 5 immediate ocular side effects from cyclopentolate

A
  • transient stinging
  • transient blurring
  • photophobia (due to mydriasis)
  • raised IOP - only in older px
  • conjunctival hyperaemia and oedema
94
Q

list 4 ocular side effects of cyclopentolate after prolonged administration

A
  • irritation
  • hyperaemia
  • oedema
  • conjunctivitis
95
Q

list the 7 general body side effects from cyclopentolate

A
  • dose related in children
  • CNS effects
  • dry mouth
  • flushing
  • tachycardia
  • urinary symptoms
  • GI symptoms

similar to atropine but at a much lower scale

96
Q

what is an additional use of cyclopentolate, and how is it used

A

adaptation to spectacles as patient won’t be accommodating through new spectacles

  • children almost always adapt well to hyperopic prescription, so is used on children who have myopic prescriptions
  • use 1% cyclopentolate daily for 2/52 weeks
  • accommodation is abolished
  • clear vision is only obtained via spectacle wear
  • the child then usually accepts the spectacle wear
97
Q

what is another 3 additional uses to cyclopentolate other than adaptation to spectacles

A
  • mydriasis
  • for anterior and posterior uveitis and posterior synechiae breakdown
  • for alleviation of ciliary spasm
98
Q

how is cyclopentolate used to treat anterior and posterior uveitis and posterior synechiae breakdown

A

1-2 drops of 1% cyclopentolate is instilled every 6-8 hours (only used my ophthalmologist in hospital)

99
Q

how is cyclopentolate used for alleviation of ciliary spasm

A

1 drop is 1% cyclopentolate used 2-3 times a day

100
Q

what is the full name for homatropine

A

homatropine hydrobromide

101
Q

what category of medicine is homatropine

A

POM

additional supply or independent prescriber

102
Q

what for is homatropine available in

A

1% multi dose containers (non-proprietary)

103
Q

at what temperature must homatropine be stored at

A

below 25 degrees celsius and protect from light

104
Q

after how long is mydriasis achieved with homatropine

A

30-40 minutes

105
Q

after how long is recovery of mydriasis achieved with homatropine

A

24-48 hours

106
Q

what is the full name for tropicamide

A

tropicamide hydrochloride

107
Q

what 2 things is the degree of cycloplegia dependent upon with tropicamde

A
  • age

- iris pigmentation

108
Q

when is mydriasis used for cycloplegia in relation to age

A

it is only indicated for cycloplegic refraction in older patients

109
Q

after using 2 drops of 1% tropicamide, when does mydriasis occur after

A

15 minutes (quicker than cyclopentolate)

110
Q

after using 2 drops of 1% tropicamide, when does mydriasis recover after

A

8-9 hours

111
Q

after using 2 drops of 1% tropicamide, when does maximal cycloplegia occur after

A

30 minutes

112
Q

after using 2 drops of 1% tropicamide, when does cycloplegia recover after

A

6 hours

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