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Theory Fall 2020 > DPA Part 2 > Flashcards

DPA Part 2 Flashcards

1
Q

1 cause for malpractice in optometry

A

Failure to properly diagnose intraocular disease-majority involved OD’s who failed to use diagnostic drops. Not approved in all states until 1980s-90s

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2
Q

BEFORE dilating the pt, always do the following:

A

Check visual acuities (distance)
Check pupils
Check IOP
Check angles- Van Herick/Shadow test

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3
Q

If gonio shows ___ or less of the trabecular meshwork visible in all 4 quadrants, pt is at risk of angle closure

A

Half or less!

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4
Q

Less than grade __ van heroic angle= risk of angle closure. Do gonio. If you only see ____ of the trabecular meshwork, pt is at risk of an angle closure

A

Grade II

Half or less of the trabecular meshwork in all 4 quadrants.

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5
Q

5 Signs and symptoms of a closed angle attack

A
  1. Does pt see halos around light?
  2. Intermittent eye pain especially going from dim to bright illumination
  3. Intermittent blur
  4. Intermittent ocular redness due to inflammation
  5. Nausea- affects vagus nerve
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6
Q

If your patient is at risk for angle closure and you choose to dilate, what should you do?

A

Check IOP following dilation. If IOP increases more than 5mmHg, it should be monitored and/or treated until the IOP is normal. Use drops to bring pressure down- don’t let them leave until pressure decreases.

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7
Q

What you should ask your patients before dilating?

A

Have you dilated safely before?
Have you been told you are at risk for angle closure?
Any complications from previous dilations?

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8
Q

How do you know what drops to use? 2 goals

A

Agent producing least possible adverse affects

Lowest concentration that will allow you to attain sufficient pupil mydriasis

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9
Q

What to tell pt before instilling drops?

A

They will sting
How long they will last
Light sensitivity, near blur
Answer any questions pt has

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10
Q

Cycloplegia

A

Paralysis of the ciliary muscle- Reduction of accommodation

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11
Q

Mydriasis

A

Dilation of the pupil. Contract dilator muscle.

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12
Q

Function of pharmaceutical agents on iris dilator, sphincter, and ciliary body

A

Iris dilator muscle contracts
Iris sphincter muscle paralyzed
Ciliary body- partial or total paralysis

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13
Q

Phenylephrine hydrochloride is what type of pharmacological agent and how does it work

A

Direct acting sympathomimetic. Alpha 1 Agonist. Causes dilation.
Works by contraction of the radial dilator muscle of the iris.
Pupil will constrict when you shine light in it!

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14
Q

Phenylephrine dosages

A
  1. 12% OTC vasoconstrictor for allergies. Gets red out by shrinking conj blood vessels.
  2. 5% Routine pupil dilation. Mydriasis only, no cycloplegia. Widening of palpebral aperture

10% Break synechia. Serious side effects, but rare.

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15
Q

Does phenylephrine have any cycloplegia

A

No. No affect on accommodation. Only mydriasis.

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16
Q

10% phenylephrine systemic side effects

Be caution in pts with conditions such as:

A

Serious, but rare.
Sympathetic side effect: Dizzy, achy, increased sweating, increased BP, pale.

Use with caution in pts with: Cardiac, HTN, diabetes, aneurysms and arteriosclerosis.

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17
Q

More common side effects of phenylephrine

A

More common: burning, stinging, brow ache, HA, increased tears, photophobia.

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18
Q

Tropicamde Hydrochloride. How does it work?

A

Muscarinic antag/cholinergic antag.

Blocks muscarinic receptor in iris sphincter muscle

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19
Q

How does tropicamide work?

A

Causes mydriasis- strong
and cycloplegia- weak

Affects receptors on the iris sphincter and ciliary body muscles. Eye will not constrict when you shine light into it!

20
Q

Tropicamide side effects for uncorrected hyperope

A

Blurry distance vision.

21
Q

When should you be cautious about eye drops and pregnancy

A

Earlier in pregnancy- when baby is developing the most.

22
Q

iris color and eye drops

A

Darker irides have more pigment
Melanin competes with receptor sites for active ingredient in eye drop. Takes longer to dilate and undulate.
Reduces the overall affect of some drops.

23
Q

Dilating drops in pts with senile meiosis

A

May need more drops since their pupils are much smaller to begin with. Especially if they have dark iris.

24
Q

Systemic conditions that may mess with dilation drops

A

Diabetic pts may need more drops due to denervated pupil.
Low birth weight/premature. Benefits outweigh risk because need to make sure they don’t have detachments.
Down syndrome could be aggravated by drops.

25
Q

Paremyd

  • Combo of what?
  • Benefits
  • Down sides
  • May not work as well on:
A

Combo of 0.25% tropicamide and 1% hydroxyamphetamine. (sympathomimetic)
Works on both muscles in iris. Provides good dilation with minimal affect on accommodation!

more expensive.

may not work well on pts with:

  • Dark brown iris
  • Older pts
  • Diabetic pts
26
Q

Tropicamide and cyclo MOA

A

Compete with each at the affected receptor sites of the iris sphincter and ciliary muscle

Paralyzes iris sphincter and ciliary body muscle.

27
Q

Doses of cyclo

A

0.5%, 1%, 2%

28
Q

Why is cyclo good for uveitis tx

A

Prevents posterior synechiae- iris attached to anterior lens.
Immobilizes iris and reduces pain.

29
Q

Systemic side effects of cyclo

A

*Anti-cholinergic= anti parasympathetic= sympathetic side effects

adults: Clumsiness, confusion, constipatieon, full feeling, passing gas, stomach cramps, achy, skin rash, hallucination, thirst, dry mouth.
Kids: Swollen stomach, restlessness, drowsy, weak

30
Q

What eye drop could be used for myopia progression?

A

Atropine

31
Q

Why would you use atropine?

A

Myopia progression, uveitis

32
Q

Atropine 1% ointment when to use:

A

Uveitis
Adults- 1 to 2 times
Children- 1 to 3 times

Dilated eye exams

33
Q

Atropine action duration of
Mydriasis
Cyclo

A

Mydriasis: weeks
Cyclo: 120 mins

34
Q

Cyclo action duration of
Mydriasis
Cyclo

A

Mydriasis: 1 day
Cyclo: 20-45 mins

35
Q

Phenylephrine action duration of

Mydriasis

A

Mydriasis only 4-6 hours

36
Q

Tropicamide action duration of
Mydriasis
Cyclo

A

Mydriasis 4-5 hours

Cyclo 15 mins

37
Q

What happens if you close your patients anterior chamber angle?

Patient symptoms

A 
Pain
Blurred vision
Colored halos around lights 
Frontal HA 
Nausea/vomitting
38
Q

Critical signs of anterior chamber angle closure

A 
Acute increase in IOP
Corneal edema 
Shallow anterior chamber between iris and cornea
Conj injection due to inflam 
Fixed, mid-dilated pupil. **********
39
Q

How to tx a closed angle

A

Topical glaucoma meds- faster acting. BB, CAI’s, adrenergic agonist (Sympathetic)

IV/oral glaucoma meds if urgent- can only see hand movement

Topical steroids

Topical miotics- pilocarpine. Constricts pupil, but IOP must be lower than 40.

40
Q

If pt has closed angle attack, when you you use topical miotics

A

if their IOP is less than 40

41
Q

Miotics have what color cap

A

Dark green

42
Q

Beta blocker combo has what color cap

A

Dark blue

43
Q

Red caps

A

Mydriatics and cyclo

44
Q

Pink caps

A

Steroids and anti inflam

45
Q

Dark blue

A

BB combo

46
Q

Dark green cap

A

Miotics

47
Q

Duresta implant

A

Implant that lasts 12 weeks and then lowers IOP by 30%

Inserted into anterior chamber

Theory Fall 2020 (13 decks)

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