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Therapeutics > Dry eye preparations > Flashcards

Dry eye preparations Flashcards

1
Q

what is the most general way to improve dry eyes

A

using ocular lubricants

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2
Q

how many % of the total ophthalmic drugs do artificial tears contribute to in the UK

A

33%

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3
Q

why are artificial tears not exactly the same as natural tears

A

because lots of glands contribute to natural tears which artificial tears can’t mimic

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4
Q

other than functioning as lubricants, what do some more recent formulations mimic

A

the electrolyte composition of human tears (e.g.TheraTears®)

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5
Q

what are the 3 forms that ocular lubricants are available as and what are they used to treat

A
  • eyedrops
  • gels
  • ointments

used to treat the discomfort associated with conditions in which the tear film is reduced or unstable

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6
Q

what are lubricant eye ointments also used in the treatment of as well as the discomfort associated with conditions in which the tear film is reduced or unstable

A

the treatment of recurrent corneal erosions

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7
Q

what are the majority of dry eye preparations available as and who can they be sold and supplied by

A

over the counter (P medicines, GSL or CE marked products) and can be sold and supplied by optometrists

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8
Q

what are the most commonly used drugs in optometric practice

A

ocular lubricants

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9
Q

what are the 2 foremost objectives in caring for patients with dry eye disease

A
  • to improve the patient’s ocular comfort and quality of life and
  • to return the ocular surface and tear film to the normal homeostatic state
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10
Q

symptoms can rarely be ____________, they can often be __________ with ocular lubricants

A

symptoms can rarely be eliminated, they can often be improved with ocular lubricant

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11
Q

what did a systematic review conclude about artificial tears

A

that they improved the condition of the exposed ocular surface in patients with dry eye, based on Rose Bengal staining as the primary outcome measure.
However, there was no statistical difference in the efficacy of the various formulations

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12
Q

list 4 limitations that the treatment of dry eye with ocular lubricants has

A
  • Formulation cannot replace complexity of natural tears
  • Administered intermittently rather than continuously as with natural tears. Therefore formulated to increase their contact time e.g. mucoadhesive polymers
  • Choice of therapy is determined by the severity of the condition (taking into account the lifestyle and dexterity of the patient)
  • The presence of preservatives in artificial tears can compromise the ocular surface following prolonged use
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13
Q

what is the recommended treatment of ocular lubricants for mild dry eye disease

A

Artificial tears up to 4x per day

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14
Q

what are the recommended treatments of ocular lubricants for moderate dry eye disease

A
  • Unpreserved artificial tears up to 12x per day with lubricating ointment at night
  • Tear conservation
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15
Q

what are the recommended treatments of ocular lubricants for severe dry eye disease (name 3)

A
  • Immunotherapy e.g. cyclosporin
  • Autologous therapy (serum)
  • Tear conservation
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16
Q

what is the name of the recommended immunotherapy treatment for severe dry eye disease

A

cyclosporin

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17
Q

list the 7 types of formulations that ocular lubricants are available in

A
  • Cellulose esters
  • Carbomers
  • Polyvinyl alcohol
  • Sodium hyaluronate
  • Lubricating ointments
  • Acetyl cysteine
  • Liposomes (liposomal spray)
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18
Q

what type of products are ocular lubricants increasingly available stand what does this stand for

A
  • available as CE–marked products

- These are ‘medical devices’ (similar to contact lens solutions) and therefore not regulated by the Medicines Act

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19
Q

if a product is a medical device which is CE marked, what are they not regulated by

A

the medicines act

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20
Q

because ocular lubricants are increasingly available as medical devices, what is a limit as a consequence

A

their availability on NHS prescriptions

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21
Q

what advantage do mucoadhesive properties in ocular lubricants have, and what are they available as

A
  • Increased contact time with the ocular surface
    as they are more sticky
  • available as mucoadhesive viscous gels
  • most are polymers (artificial molecules)
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22
Q

what are the side affects associated with mucoadhesive viscous gels

A
  • blurring

- sticky lids

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23
Q

what is the most commonly prescribed formulation of ocular lubricants and name 4 examples

A

Cellulose esters

e. g.
- hypromellose
- hydroxyethylcellulose
- methylcellulose
- carboxymethylcellulose

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24
Q

which formulation of drugs are viscoelastic polysaccharides

A

Cellulose esters

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25
Q

what is an advantage of the Cellulose ester formulation of ocular lubricants

A

Good retention time on ocular surface

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26
Q

what is a disadvantage of the Cellulose ester formulation of ocular lubricants

A

Can cause crusting of eyelids mimicking blepharitis

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27
Q

what two forms of packaging are the Cellulose ester formulations of ocular lubricants available as

A
  • unit dose preservative free
    or
  • multi dose
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28
Q

which type of ocular lubricant formulation is the cheapest and thus available on the NHS

A

Cellulose ester

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29
Q

which type of molecule are the ocular lubricant formulation, carbomers

A

Synthetic polymers

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30
Q

name 2 advantages of the carbomer formulation of ocular lubricants

A
  • Good retention time on ocular surface

- Good viscosity when eyes open shear thin during blinking

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31
Q

what is a disadvantage of the carbomer formulation of ocular lubricants

A
  • Tends to blur vision
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32
Q

what causes the viscosity of tears to be decreased

A

if applying a force when blinking

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33
Q

what behaviour does the tear fluid display

A

non-Newtonian behaviour

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34
Q

what are the majority of solutions unaffected by

A

the shear rate

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35
Q

which type of molecule are the ocular lubricant formulation, Polyvinyl alcohol

A

Synthetic polymers

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36
Q

Polyvinyl alcohol formulations have low….

A

viscosity

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37
Q

which type of dry eye is Polyvinyl alcohol ocular lubricant formulations beneficial in

A

mucin and lipid deficiency dry eye

38
Q

what is a disadvantage of Polyvinyl alcohol ocular lubricant formulations

A

Short retention time

therefore need to put in more times

39
Q

which formulation of drugs are Mucopolysaccharides

A

Sodium hyaluronate

40
Q

Sodium hyaluronate is a __________ formulation

A

Sodium hyaluronate is a vicious formulation

41
Q

what is the advantage of Sodium hyaluronate ocular lubricant formulations

A

Good retention time on ocular surface (superior to cellulose esters and PVA)

42
Q

what 2 other formulations is the retention time of Sodium hyaluronat superior to

A
  • cellulose esters
    and
  • Polyvinyl alcohol
43
Q

which ocular lubricant formulation is a natural product, which makes it work well as a ocular lubricant

A

Sodium hyaluronate

44
Q

what is the disadvantage of the ocular lubricant formulation, Sodium hyaluronate

A

Tends to blur vision

45
Q

which ocular lubricant formulation blurs vision less than the Cellulose ester formulation

A

Sodium hyaluronate

46
Q

what form do ophthalmic lubricating ointments come as

A

Liquid paraffin

47
Q

ophthalmic lubricating ointments have high….

A

viscosity

48
Q

what does ophthalmic lubricating ointments contribute to

A

rebuilding the lipid layer

49
Q

what does ophthalmic lubricating ointments melt at

A

the temperature of ocular tissues

50
Q

what is the advantage of ophthalmic lubricating ointments

A

long retention time

51
Q

when is ophthalmic lubricating ointments used at its best

A

when other artificial tears are used during the day and ophthalmic lubricating ointments used at night

52
Q

what is a disadvantage of ophthalmic lubricating ointments

A

Blurred vision

53
Q

what can be a result of tear modification as a result of dry eye

A

Mucolytic in filamentary keratitis

54
Q

which formulation of ocular lubricant needs to be used to treat Mucolytic in filamentary keratitis and at what dose

A

Acetylcysteine 5-10%

55
Q

name an example of Acetylcysteine 5-10% used to treat Mucolytic in filamentary keratitis and which type of medicine is it available as

A
  • Ilube

- available as POM

56
Q

how does the Acetylcysteine 5-10% formulation of ocular lubricant treat Mucolytic in filamentary keratitis

A

it dissolves mucous filaments by breaking disulphide bonds

57
Q

what sensation is felt when instilling Acetylcysteine 5-10% into the eye

A

stinging sensation

the cornea feels rough

58
Q

what is the purpose of preservatives in ocular lubricants

A

to prevent bacterial contamination

59
Q

what is the drawback of preservatives in ocular lubricants

A

they are toxic to the ocular surface

60
Q

when do preservatives cause more harm/toxicity to the ocular surface

A

when they are put into the eye lots of times a day to treat a chronic condition

61
Q

what is the most common type of ocular preservative found in ocular lubricants and solutions

A

Benzylkonium chloride BAK

62
Q

what affect on the eye can 1 drop of Benzylkonium chloride have after 10 minutes

A

an effect/morphology on the microvilli of the corneal epithelium and on the corneal stroma

63
Q

what affect on the eye can 1 drop of Benzylkonium chloride have after 6 hours

A

it strips off microvilli of the corneal epithelium and on the corneal stroma

64
Q

how are preservative free ocular lubricants generally packaged as and what implications does this have

A
  • as single dose minims

- this is more expensive

65
Q

what is Benzylkonium chloride BAK taken up by and what consequences does this have

A
  • by soft contact lenses
  • and then is released slowly
  • exceeding upper safety limits (increases toxicity)
66
Q

what type of contact lenses absorbs greater quantities of Benzylkonium chloride BAK

A

High-water content lenses

greater than low water content lenses

67
Q

which lenses take up a very small amount of Benzylkonium chloride BAK and what implications do they have

A
  • hard contact lenses
  • and then is released slowly
  • approaching upper safety limits (increases toxicity)
68
Q

what can tear film concentrations of benzalkonium, such as after eye drop use in the presence of soft contact lenses could result in

A

adverse effects on the ocular surface

69
Q

what have newer generation ophthalmic preservatives been developed with

A

reduced ocular toxicity

70
Q

name 4 newer generation ophthalmic preservatives

A
  • Purite
  • Sodium perborate
  • SofZia
  • Polyquaternium
71
Q

what can newer generation preservatives be used with and why

A

contact lenses

as they’re less toxic

72
Q

what happens to the newer generation preservative purite after going into the eye

A

dissociates into water, oxygen, sodium, and chlorine free radicals

73
Q

what happens to the newer generation preservative Sodium perborate after going into the eye

A

converts into water and oxygen on instillation

74
Q

what happens to the newer generation preservative SofZia after going into the eye

A

it is modified into harmless elements on instillation

75
Q

which newer generation preservative is more common in multi dose contact lens care products, and is less toxic than BAK

A

Polyquaternium

76
Q

name a brand of ocular lubricant that is a multi dose preservative free system and how does it achieve this

A

Hycosan

by having a valve system in the neck of its bottle

77
Q

what is the advantage to having a multi dose packaging preservative system

A

it is more cos effective than single use minims

78
Q

other than Hycosan, name 3 other multi dose preservative free systems with its available dose

A
  • Hylotear 0.1% hyaluronate
  • Hyloforte 0.2% hyaluronate
  • Hyabak 0.15% hyaluronate
79
Q

what impact does a more concentrated dose (%) preservative free multi dose ocular lubricant have

A

it sticks more to the ocular surface

but then can affect vision

80
Q

what ingredient does the ocular lubricant Systane contain which causes it to increase its viscosity on contact with the ocular surface

A

hydroxypropyl (HP) guar

81
Q

what is the mechanism of the ocular lubricant Systane to increase its viscosity on contact with the ocular surface based on

A

the change in pH
Systane is a liquid in the bottle at a pH of 7.0, but when placed in the eye (which has a pH of ~7.4), a chemical reaction occurs

82
Q

how does the ingredient hydroxypropyl (HP) guar in Systane cause it to increase its viscosity on contact with the ocular surface

A

the HP guar binds to the ocular surface and simultaneously crosslinks with borate ions in the solution, forming a network with a gel-like consistency

83
Q

what is the ocular lubricant liposomal spray and what does it contain

A

An aqueous suspension of phospholipid-containing liposomes containing hydrogenated phosphatidylcholine

i.e. a lipid in an emulsion

84
Q

what type of dry eye has liposomal sprays been beneficial in

A

evaporative dry eye

85
Q

how is the liposomal spray formulation used

A

it is sprayed onto the closed eyelids

86
Q

what is recognised as a key pathogenetic mechanism of dry eye

A

inflammation

87
Q

which anti inflammatory drug was the first commercially available pharmaceutical therapeutic agent for the treatment of dry eye/keratoconjunctivitis sicca

A

Restasis - 0.05% cyclosporine ophthalmic emulsion

available in US but not UK

88
Q

how does autologous serum work as a treatment for dry eye

A

it uses the patients own blood plasma, this is because it is a neutral substance and is very good for the ocular surface

89
Q

why is autologous serum a good dry eye treatment for the ocular surface

A

it contains serum and anti-bodies

90
Q

what other alternative dry eye treatments are there from ocular lubricants

A

ingestion Omega-3 and Omega-6 fatty acids

91
Q

where can Omega-6 fatty acids be found

A

evening primrose oil

92
Q

which fish contains lots of Omega-3 fatty acids

A
  • mackerel
  • tuna
  • cod liver

Therapeutics (19 decks)

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