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Pharmacy312 > Eye > Flashcards

Eye Flashcards

1
Q

What is glaucoma?

A

Progressive optic neuropathy involving damage to optic nerve and associated visual field loss.

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2
Q

What are risk factors for glaucoma?

A
  1. High intraocular pressure
  2. Increasing age
  3. Family history
  4. Diabetes
  5. Hypertension
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3
Q

Glaucoma is the…

A

…leading cause of preventable vision loss in NZ

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4
Q

What is aqueous humour?

A

Thin transparent layer of fluid similar to plasma secreted by the ciliary body, filling the anterior and posterior chambers of the eye.

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5
Q

Where is aqueous humour produced?

A

The ciliary epithelium of the ciliary body.

It flows from the posterior to the anterior chamber.

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6
Q

How is aqueous humour drained?

A

90% by the trabecular meshwork, 10% by the uveoscleral pathway

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7
Q

What are the three classifications of glaucoma?

A

Open angle
Closed angle
Congenital

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8
Q

What is the mechanical theory of glaucoma pathophysiology?

A

Increased IOP –> compression of axonal fibres of the optic nerve –> disrupts axoplasmic flow –> loss of cell bodies and nerve fibres

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9
Q

What is the vascular/ischaemic theory of glaucoma pathophysiology?

A

Decreased perfusion at the optic nerve –> disturbs vascular autoregulation –> causing changes to systemic haemodynamics

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10
Q

What is the association of IOP and glaucoma?

A

Increasing IOP does not necessarily correspond with increasing likelihood of glaucoma. IOP fluctuates throughout the day in a normal person; it fluctuates more in a person with glaucoma.

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11
Q

What should be checked when taking history of a patient with suspected glaucoma?

A
  1. Previous ocular history: trauma, surgery, inflammation, eye disease
  2. Systemic disease: current medications etc
  3. Family history of glaucoma
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12
Q

What is tonometry?

A

Measure of IOP, Goldmann is gold standard

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13
Q

What is central corneal thickness and why is it measured?

A

Central corneal thickness is an important risk factor for the development of primary open-angle glaucoma.

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14
Q

What is gonioscopy and why is it measured?

A

Goinioscopy visualises anterior chamber angle structures and is used to differentiate between different glaucoma sub-types

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15
Q

Management of glaucoma should be done…

A

…in a stepwise manner

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16
Q

What are the goals of glaucoma management?

A

Decrease aqueous production

Increase aqueous drainage

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17
Q

What is the first-line treatment of glaucoma?

A

Prostaglandin analogues

  • Bimatoprost
  • Latanoprost
  • Travoprost
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18
Q

Which prostaglandin analogue is most appropriate?

A

Latanoprost

  • subsidised
  • once daily dosing
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19
Q

Prostaglandin analogue MOA?

A

Increase aqueous outflow via uveoscleral pathway

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20
Q

C/Indications to prostaglandin analogues?

A
  1. Allergy
  2. Intraocular inflammation
  3. Macular oedema
  4. Pregnancy
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21
Q

ADR prostaglandin analogues?

A

Increased thickness and length of eyelashes
Changing eye colour
Dilation of conjunctival blood vessels

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22
Q

What are examples of beta blockers (for ocular use)?

A

Timolol
Betaxolol
Levobunolol

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23
Q

Which beta blockers are B1 selective?

A

Betaxolol

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24
Q

C/Indications to beta blockers?

A 
Bradycardia
Heart block
Asthma (for non-beta selective BBs)
Allergy
Hypotension
Pregnancy
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25
Q

ADR beta blockerss?

A

Redness
Bradycardia, heart block
Shortness of breath
Hypotension

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26
Q

Beta blocker MOA?

A

Reduce aqueous production by reducing cAMP levels.

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27
Q

Carbonic anhydrase inhibitor MOA?

A

Reduces aqueous production by inhibiting carbonic anhydrase

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28
Q

When should carbonic anhydrase inhibitors be initiated?

A

When other medications (BB, PA) are contraindicated

29
Q

What are examples of carbonic anhydrase inhibitors?

A

Brinzolamide 1% (Azopt)

Dorzolamide 2% (Trusopt)

30
Q

C/Indications to carbonhic anhydrase inhibitors?

A

Allergy
Moderate renal/hepatic disease
Pregnancy

31
Q

Carbonic anhydrase inhibitor ADR?

A 
Redness
Allergy
Burning and stinging
Metallic taste
Corneal oedema
32
Q

Alpha agonist MOA?

A

Decrease IOP by reducing aqueous production and increasing uveoscleral outflow

33
Q

What are examples of alpha agonists?

A

Brimonidine (alphagan)

Timolol + brimonidine (Combigan)

34
Q

C/Indications to alpha agonists?

A

Allergy
Use of MOAI and TCAs
Severe CV disease
Pregnancy

35
Q

Alpha agonist ADR?

A 
Ocular allergy
Dry mouth and nose
Headache
Fatigue
Redness
36
Q

Muscarinic agonist MOA?

A

Increase aqueous outflow via conventional pathway by directly stimulating muscarinic receptors of the ciliary body and the iris sphincter

37
Q

What is selective laser trabeculoplasty?

A

Laser treatment to trabecular meshwork, increases aqueous outflow facility.

38
Q

What is the association of corticosteroid use and glaucoma?

A

High or moderate responders to corticosteroids may result in an increase in IOP after daily corticosteroid treatment.

39
Q

What is the pharmacist’s role in glaucoma management?

A

Compliance

Inform about side effects and drug interactions

40
Q

What is the 45+5 rule?

A

From age 45 onwards, have an eye check every 5 years.

41
Q

What is blepharitis?

A

Chronic inflammation of the eyelids

42
Q

What are the causative organisms of blepharitis?

A

Staph infection
Demodex infection
Seborrhea

43
Q

What are the symptoms of blepharitis?

A

Irritated red lids, with crusting of eyelashes and capping of meibomian glands.

44
Q

What are the meibomian glands and what happens in meibomian gland dysfunction?

A

Meibomian glands produce oily layer of tear film which prevents tears from evaporating
Dysfunction causes increased evaporation –> dry eye, local infections

45
Q

What are OTC treatment options for blepharitis?

A
  1. Hot compress
  2. Massage to express glands
  3. Lid cleaning products (e.g. Systane lid wipes)
  4. Artificial tear supplements
  5. Tea tree oil if suspected Demodex infection
46
Q

What are prescription treatment options for blepharitis?

A
  1. Topical antibiotics (Fusidic acid)
  2. Systemic antibiotics (doxy, azithro)
  3. Topical steroids (FML)
  4. Topical cyclosporine`
47
Q

What are the two types of dry eye?

A
  1. Poor quantity of tears

2. Poor quality of tears

48
Q

What is the management of poor tear QUANTITY?

A

Add more tears: artificial tear supplements, anti-inflammatory drops

49
Q

What is the management of poor tear QUALITY?

A

Improve tear film:

Hot compress, lid massage, steroids to express Meibomian glands

50
Q

Carmellose

A

Refresh brand

51
Q

Hypromellose + Dextran

A

Poly-tears

52
Q

Wool fat

A

Poly Visc

53
Q

Carbomer

A

Poly Gel

54
Q

Polyvinyl alcohol

A

Refresh Preservative free

55
Q

Sodium hyaluronate

A

Hylo-Fresh

56
Q

Polyethylene Glycol + Hydroxypropyl Guar

A

Systane Ultra

57
Q

Other than eye drops, what other treatments exist for dry eye?

A

Punctal Plus
Topical steroids - FML
Omega 3 supplements

58
Q

What is a punctal plug?

A

Small device that blocks tear duct drainage to relieve chronic dry eye

59
Q

FML MOA?

A

Inhibits inflammatory response to mechanical, chemical or immunological trauma

60
Q

What are the management options for allergic conjunctivitis?

A
  1. Avoid allergen
  2. Ocular decongestants/antihistamines (e.g. Naphcon-A)
  3. Seasonal: mast cell stabiliser (Lomide)
  4. Combination antihistamine + mast cell stabiliser (Patanol)
61
Q

What are the benefits of topical eye drug delivery?

A

Ease of application
Direct application to target site
Small dose of drug required
Rapid onset of action

62
Q

What are the disadvantages of topical eye drug delivery?

A

Potential contamination
Requires preservatives
May cause systemic absorption
Limited penetration, fast elimination

63
Q

What are the benefits of solutions?

A

Good stability
Ease of preparation
Low cost

64
Q

What are the disadvantages of solutions?

A

Fast drainage
Low permeability
Low bioavailability

65
Q

What are the benefits of ointments?

A

High viscosity –> reduced drainage –> better absorption –> higher bioavailability
Less likely to be diluted by tears
Lubricating
No stinging

66
Q

What are the disadvantages of ointments?

A

Blurred vision

Greasy feeling –> reflex tearing

67
Q

What are the benefits of emulsions?

A

Suitable for lipophilic drugs

Lubricating due to oil component

68
Q

What are the disadvantages of emulsions?

A

Contains surfactant –> local toxicity
Low stability
High cost

69
Q

How can we increase ocular bioavailability?

A
  1. Shake bottle before use suspensions)
  2. Apply one drop into lower lid, close eyes and obstruct the duct
  3. Leave 5 mins before using other drops

Pharmacy312 (5 decks)

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