Day 1- Eyes and Lupus Flashcards
Is the epithelial layer of the cornea hydrophobic or hydrophillic? Stroma?
What makes aqueous humor? Where is it eliminated?
What is the most important anti microbial factor secreted by the eye tears?
Hydrophobic, Hydrophillic.
The cilliary body, Schlemms canal.
IgA
What is a type 1 hypersensitivity reaction?
What is a type 4 hypersensitivity reaction?
What is the pathophysiology of ocular allergy?
Immediate, appears in 2-30 minutes, mediated by IgE mast cell response. Allergy–> Seasonal allergic conjuctivitis is a type 1.
Delayed type, appears in 1-3 days, CD4 and CD8 T cells mediated, macrophages and T cells activated.
sensitization takes place in presence of allergen and prepares the system to launch an antigen specific response(IgE)–> Mast cells release histamine which leads to release of cytokines and prostaglandins–> histamine binds to H1 causing itching–> also binds to H1 and H2 in conjuctival vasculature causing vasodilation.
What are the decongestant’s?
What is the main antihistamine for ocular allergy?
What are the mast cell stabilizers?
Naphazoline, Phenylphrine, Tetrahydrozoline, Vasocon A, Naphcon A, Opcon A.
Patanol, Pataday.
Ketotifen, Cromolyn Sodium, Nedocromil Sodium.
What NSAIDS can you use in ocular allergy?
What steroids can you use in ocular allergy?
What is mild treatment in ocular allergy?
Diclofenac, Flurbiprofin, Ketorolac, Suprofen.
Loteprednol stuff and then prednisolone sometimes.
Cool compresses + antihistamine/decongestant +lubricant(usually one drug)/
What is moderate treatment in ocular allergy?
What is severe treatment?
What are the exudates from the eye in clear to almost opague?
Same as mild but with NSAID and topical mast cell stabilizer(multiple).
Same as moderate but including a steroid.
Serous(viral)–> Mucoid–> Mucopurulent–> Purulent(gonorrhoeae).
How do you normally treat infectious conjuctivitis?
How young can you give a fluoroquinolone?
What is the difference between ciprofloxacin solution and ointment?
Tobrex or Polytrim. If more severe give Ofloxacin or Ciprofloxacin.
Anyone older than 1. If younger than 1 give an gentamicin or tobramycin. Newborn give erythromycin.
Ointment can be given to anyone older than 2, solution is 1.
Do fluoroquinolone’s have good spectrum against stuff? What’s the best against Neisseria(gonococcal)?
How to treat gonococcal infections?
What is Primary Open Angle Glaucoma?
Yes. Erythromycin and Cephalosporin(adults only)
Ceftriaxone and Azithromycin.
Also called chronic, cause unknown, affects both eyes and progresses gradually, trabecular meshwork and canal of schlemm is blocked.
What is closed angle glaucoma?
What are glaucoma risk factors?
What is the hallmark symptom of chronic glaucoma?
Lens becomes larger with aging, angle between iris and cornea narrows causing increase of pressure suddenly in eye.
Family History, Age, Ethnic background(black), Sex(male), Nearsightedness, diabetes, smoking, etc.
Rainbow colored halo around lights.
What are the acute symptoms of glaucoma?
What betablockers are used to treat glaucoma?
What alpha2 adrenergic agonists help with glaucoma?
Severe eye pain and loss of vision, cloudy vision with halos, N&V.
Timolol, Levobunolol, Metipranolol, Carteolol, Betaxolol(Beta 1 selective).
Apraclonidine, Brimonidine.
What CAI’s work to help with glaucoma?
What are the prostaglandin analogues?
What special things to know about Xalatan(Latanoprost)?
Acetazolamide, Dorzolamide, Brinzolamide.
Latanoprost, Travoprost, Bimatoprost.
Take out contacts and wait 15 minutes before putting them in again, can cause change in eye color.
What special things to know about Zioptan(Tafluprost)?
What special things to know about Latisse?
What special things to know about Restasis?
Drop in conjunctival sac in the evening, iris pigmentation is present, increased eyelash length.
Used for eyelash hypotrichosis, may cause brown pigmentation of the iris, DO NOT APPLY to lower lid of eye lid.
Only prescription therapy for patients with KCS. 1 drop 2 times a day, inhibits T-cells.
What is the hallmark symptom of ocular herpes?
How do you treat ocular herpes?
What do you see in CMV infection in the eyes?
Dendritic corneal ulcer
Trifluridine(main option), Idoxuridine, Vidarabine, Ganciclovir opthalmic gel.
Seen in patients with AIDS(late stage), Can take a persons sight within 2-6 months if not treated, high affinity for retina, when CD4 is <100 you see “crumbled cheese” appearance.
What are the CMV infection treatment options?
Can IV medications make it to the eye? What about topical?
How can you characterize Dry AMD?
Ganciclovir(Vitrasert(implant)) causes granulocytopenia, thrombocytopenia, and anemia, renal impairment. Cidofovir(watch for renal impairment, give IV prehydration to help, neutropenia has been observed). Foscarnet watch for renal impairment and seizures.
NO due to Blood Retinal Barrier. Yes, they reach anterior but not posterior.
development of drusen(yellow white deposits underneath the retina)
How can you characterize wet AMD?
What part does nutrition play in MD?
What is the difference between AREDS and AREDS 2?
Straight lines appear wavy, loss of central vision, fast acting.
People with diets high in fruits and vegetables(especially leafy greens) have a lower incidence of AMD. High levels of zinc, vitamin A,C, and E, lutein and zeaxanthin are good.
AREDS has Vitamins E,C and beta carotene and zinc. AREDS 2 has AREDS plus omega 3 fatty acids, lutein and zeaxanthin.
What are the treatment options for wet AMD?
How does Macugen work?
How does Lucentis work?
Pegaptanib, Ranibizumab, Eylea, Bevacizumab(not FDA approved). No proven medical therapy for dry AMD.
Selective VEGF antagonist. VEGF causes blood vessel growth and increases vascular permeability. Administered intravitreally every 6 weeks. Common side effects are due to the injection.
Recombinant humanized IgG1, binds to VEGF-A, interacts with VEGFR1 and 2, one vial each month via eye injection.
What is the difference between the view 1 and 2 trials?
Is lupus multiorgan? Is there a cure?
What comorbidities are associated with lupus?
Randomized trial about Eylea vs Lucentis, Eylea is just as good with less injections
Yes, NO.
Renal involvement, antiphospholipid syndrome, cardiovascular diseases, neurological/psychiatric presentations.
When is lupus most prevalent?
What contributes to lupus?
What are lupus presentations?
Mostly in females(almost 90%), peak age between late teens and early 40’s but can occur at any age.
Genetics, Dietary factors, infection, occupational exposure, estrogen, ultraviolet B light. this disease is HIGHLY unpredictable.
Fatigue, Joint pain, butterfly rash, psychosis, visual disturbances, inflammatory arthritis, CV events at a young age, lupus nephritis.
What drugs exacerbate SLE?
Can drug exacerbated lupus and normal lupus be different and the same?
What drugs cause DILE?
Sulfonamide antibiotics, estrogen, echinacea.
Yes
Hydralazine, Procainamide, Quinidine, Isoniazid, Methyldopa, Minocycline, d-penicillamine.
What non drug therapies help with lupus?
What is the important thing to remember for pharmacotherapy of lupus?
What drugs to we use for pharmacotherapy of lupus?
Balanced routine of rest and exercise, avoid smoking and alfalfa sprouts, avoid sunlight, use sunscreens to minimize flareups.
It is based off of symptoms.
NSAIDS, Anti malarial drugs(hydroxychloroquine), corticosteroids(mainstay of therapy), B cell suppressors(belimumab, rituximab), Cytotoxic drugs(cyclophosamide, mycophenolate, methotrxate).
If the patient has fatigue and lupus what do you want to use?
How do you treat joint pain?
What prevents abnormal thromboembolism?
HCQ and Glucocorticoids.
NSAIDS(ST), HCQ, Glucocorticoids(ST),
HCQ
What treats fever?
What treats rash?
What treats mouth sores?
NSAID
HCQ, Glucocorticoids
HCQ
What treats CNS lungs or heart manifestations?
What treats nephritis?
What treats arthritis?
Steroids(HD)
Steroids, cyclophosamide, Mycophenolic Mofetil, cyclophosphamide with azathioprine with MESNA(neutralizes bladder toxicity).
Methotrexate
Does HCQ have fast or slow onset?
What are the side effects of HCQ?
What does Belimumab target?
SLOW
Generally well tolerated, ocular(corneal deposits, retinopathy).
B lymphocyte stimulator
What does Rituximab target?
Binds to CD20 causes B cell depletion.
