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PHRM 844 Module #2 > Eye Lecture Part 1 > Flashcards

Eye Lecture Part 1 Flashcards

1
Q

Identify the different anatomical parts of the eye

A

iris
lens
pupil
cornea
retina
sclera
optive nerve

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2
Q

Iris

A

colored part; contains muscles to help change shape of pupils

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3
Q

Lens

A

what we see with; helps us focus

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4
Q

Pupil

A

tunnel for light to see

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5
Q

Cornea

A

clear film on outside of eye, protective layer; bends light so we can see it; has nerve fibers, are sensitive

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6
Q

Retina

A

processes the light

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7
Q

Sclera

A

helps keep the shape of the eye

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8
Q

Optic nerve

A

what transmits everything we are seeing and sends it to the brain

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9
Q

Outline steps for proper administration of ocular medications

A

local drug delivery: eye drops, ointments, gels
systemic drug delivery: injections, oral medications

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10
Q

Topical drug delivery - eye drop considerations

A

limited volume capacity: tear volume = 7-9 microliters, volume delivered by eyedroppers = 35-36 microliters
built in defense mechanisms: sudden increase in tear volume, rapid reflex blinking; corneal protection barrier
residence time: drugs reside in the conjunctiva ~ 3-5min to actually have an affect

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11
Q

Topical drug delivery - eye ointment considerations

A

drug depot: serves as a drug depot in the conjunctival sac resulting in enhanced/sustained absorption
blurry vision: blurred vision reported after administration and can last up to 30 min
challenging to apply: difficult to apply exact dose

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12
Q

Eye drop administration

A
  1. wash hands with soap and water; remove contacts if applicable
  2. while tilting head back, pull down lower lid of eye with index finger to form a pocket
  3. hold the dropper with the other hand, as close to the eye as possible without touching it
  4. while looking up, squeeze the dropper so that a single drop falls into the pocket made by the lower eye lid
  5. remove your index finger from the lower eyelid; close your eyes for 2-3min and tip your head down towards the floor
  6. place a finger on the tear duct and apply gentle pressure
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13
Q

Eye ointment administration

A
  1. wash hands with soap and water; remove contacts if applicable
  2. holding the tube between your thumb and forefinger, place it as near to your eyelid as possible without touching it
  3. while tilting your head back, pull down the lower lid of your eye with your index finger to form a pocket
  4. squeeze ribbon of ointment or gel into pocket made by the lower eyelid
  5. remove your index finger from the lower eyelid; blink your eye gently, then close your eye for 1-2 min
  6. wipe excess ointment or gel from the eyelids and lashes; with another clean tissue, wipe the tip of the tube clean
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14
Q

Administration tips

A

take out contact lenses prior to eye drops/ointments; wait 15 min after eye drops to reinsert contacts, eye ointments generally not recommended with contacts

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15
Q

Timing of administration

A

2 drops same med: wait 5 min b/w drops
2 drops diff meds: wait 5-10 min b/w drops
2 ointments: wait 30 min b/w ointments
1 ointment + 1 drop: use the drop FIRST, wait 5-10 min b/w

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16
Q

Prescription SIG

A

o = eye
a = ear
s = left
d = right
u = both

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17
Q

Classify conjunctivitis as bacterial, viral, or allergic based on patient specific characteristics and provide treatment options for each type

A

conjunctivitis - inflammation of the conjunctiva

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18
Q

Bacterial conjunctivitis

A

presentation: redness, discharge; eye stuck shut in morning; discharge from eye is yellow, white, or green; typically effects only one eye
common causes: bacteria
highly contagious

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19
Q

Bacterial conjunctivitis treatment

A

non-pharmacologic: avoid sharing tissues, towel, cosmetics, linens; remove contact lenses - don’t wear again until eye is white with no discharge for 24 hrs after antibiotics
pharmacologic: often self-limited, topical antibiotics shorten clinical course; antibiotic treatment required in contact wearers; ointment preferred over drops in children and risk of poor compliance

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20
Q

Bacterial conjunctivitis antibiotics (RX)

A

erythromycin ointment; moxifloxacin solution, ofloxacin solution, trimethoprim-polymyxin B solution
treat for 5-7 days

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21
Q

Viral conjunctivitis

A

presentation: water eyes, burning, sandy, gritty feeling; pus in morning crusting followed by watery discharge throughout the day; often involves both eyes; part of viral upper respiratory infection
common causes: adenovirus
highly contagious

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22
Q

Viral conjunctivitis treatment

A

NO role for antibiotics or antivirals
non-pharmacologic: avoid sharing tissues, towels, cosmetics, linens, utensils; remove contact lenses- don’t wear again until eye is white with no discharge for 24 hrs
symptomatic relief only: warm/cool compress; topical decongestant (no more than 72 hr use, rebound congestion)

23
Q

Viral conjunctivitis decongestants (OTC)

A

naphazoline solution
tetrahydrozoline solution
acute use only - no more than 72hrs

24
Q

Allergic conjunctivitis

A

presentation: redness, watery discharge, itching; morning crusting; both eyes involved; accompanied by other allergic symptoms, nasal congestion, sneezing, wheezing; eye rubbing worsens symptoms
common causes: airborne allergens

25
Q

Allergic conjunctivitis treatment

A

non-pharmacologic: do not rub eye, COOL compresses, avoidance or reduction of contact with known allergen
pharmacologic: antihistamines, mast cell stabilizers, multiple acting agents

26
Q

Allergic conjunctivitis - antihistamines

A

olopatadine solution (RX and OTC)
azelastine solution (RX)
epinastine solution (RX)
patients may also take oral antihistamines if other sx present

27
Q

Allergic conjunctivitis - mast cell stabilizers (RX)

A

cromolyn sodium solution
lodoxamide solution
nedocromil solution

28
Q

Allergic conjunctivitis - mutli-acting agents (OTC)

A

ketotifen solution
alcaftadine solution
work on both histamine and mast cells

29
Q

Anterior uveitis

A

intraocular inflammation
presentation: patterned (wagon wheel) redness associated with iritis; dilated pupil; complains of discomfort and sensitivity to light
treatment: topical glucocorticoids; mydriatic/cycloplegic (nothing OTC)

30
Q

Uveitis treatment considerations

A

referral to ophthalmologist or optometrist for treatment
treatment for 4-6 weeks (no more than, can cause glaucoma)
opthalmic steroid toxicity: secondary infections, secondary open-angle glaucoma
increase in intraocular pressure
risk factors: primary open-angle glaucoma, ocular hypertension, elderly, children, connective tissue disease, T1D with myopia

31
Q

Differentiate between dry and wet macular degeneration and their respective treatment options

A

macular degeneration: neovascularization, overgrowth of blood vessels in eye, cause fluid to build up leading to vision loss
top risk factors: age + smoking
dry: common > 50 yrs, 90% of MD cases, usually both eye affected, gradual loss of vision
wet: advanced MD, vision loss rapid, loss of central vision due to abnormal growth of new blood vessels
macular degeneration is the leading cause of blindness

32
Q

Macular degeneration treatment goals

A

slow progression & prevent severe visual impairment or blindness

33
Q

Macular degeneration - choosing a safe supplement

A

AREDS
AREDS 2 - contains beta carotene; beta carotene has an increased risk of lung cancer in smokers

34
Q

Macular degeneration RX treatment

A

vascular endothelial growth factor inhibitors: prevent formation of new blood vessels and vascularization of tissues
shown to slow disease progression and may cause moderate gains in vision
SEs: increased BP, retinal detachment, increased IOP, eye infection, vitreous floaters
injected directly into eye

35
Q

VEGF inhibitors/photodynamic therapy

A

bevacizumab
ranibizumab
aflibercept
pegaptanib
verteporfin
used for wet/severe pts
given at intervals
all intravitreal injections

36
Q

Causes of dry eyes

A

decreased tear production - Sjogren’s syndrome (autoimmune disease characterized by lymphocytic infiltration of exocrine glands resulting in xerostomia and dry eyes) vs non Sjogren’s syndrome
increased evaporative loss

37
Q

Dry eyes risk factors and presentation

A

risk factors: advanced age, female, contact lens wearers, low humidity environments, meds (anticholinergics, SSRIs, antihistamines)
presentation: dryness, red eyes, general irritation, gritty sensation, blurred vision, light sensitivity

38
Q

Recommend both pharmacologic and nonpharamcologic treatment for dry eyes

A

step 1: tear supplementaion, WARM compress, address environmental factors, discontinue meds worsening dryness
step 2: topical treatment: secretagogues - liftegrast, cyclosporine; in office procedures
step 3: oral drug therapy - antioxidants, omega-3 FAs; sclera contact lenses; surgery; investigation drugs

39
Q

Tear supplementation

A

aqueous supplementing (always start with 1st): carboxymethylcellulose
hydroxypopylcellulose
polyethylene glycol, propylene glycol, lipid supplementing: DMPG, propylene glycol, mineral oil

40
Q

Tear supplementation clinical pearls

A

Try to avoid benzalkonium chloride – check inactive ingredients

Preservative-free (PF) is often more-expensive, but is it BETTER?
PF less likely to cause adverse effects or further exacerbate dry/red eyes
-
PF often packaged in individual vials, only 24-hour shelf life

Meibomian gland dysfunction (MGD) or evaporative should be treated with lipid-supplementing artificial tears

Hard to tell the cause of dry eyes in an outpatient pharmacy setting, consider lipid-containing if patient fails aqueous

41
Q

Recognize medications that may cause drug-induced opthalmic disorders

A

cataracts
intraoperative floppy iris syndrome
optic neuropathy
retinopathy

42
Q

Drug-induced cataracts

A

corticosteroids, phenothiazine, alkylating agents, and statins
surgical removal of lens may be necessary to restore vision

43
Q

Drug-induced intraoperative floppy iris syndrome

A

alpha-1 antagonists
irreversible

44
Q

Drug induced optic neuropathy

A

amiodarone, ethambutol, linezolid, and PDE-5 inhibitors
discontinuation of agent generally leads to reversal of symptoms

45
Q

Drug induced retinopathy

A

aminoquinolines, antiestrogen agents, phenothiazines, and retinoids
nonreversible

46
Q

Drug induced dry eyes treatment/management

A

nonpharmacologic therapy: warm compress, increased fluid intake, use humidifier
increase tear volume: aritifical tears or other ocular lubricants
decrease inflammation: restasis or xiidra eye drops
medication changes: discontinue causative agent if possible, switch to preservative free eye drops

47
Q

Amiodarone

A

corneal deposits; optic neuropathy

48
Q

Digoxin

A

yellow tinted vision/halos (toxicity)

49
Q

Anticholinergic agents

A

blurred vision; dry eyes

50
Q

Antidepressants

A

blurred vision; dry eyes

51
Q

PDE-5 inhibitors

A

color changes (blue tint)

52
Q

Bisphosphonates

A

inflammation/redness

53
Q

Topiramate

A

angle closure glaucoma

54
Q

SSRIs

A

eye tics

PHRM 844 Module #2 (23 decks)

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