Intro to Ophthalmic pt 2 Flashcards
Ophthalmic drug classes
topical anti-infective
topical anti-inflammatory
anti-glaucoma
what types of anti-infective medications are used for the eye?
Antibiotics
Antivirals
Antifungals
What types of antibiotics are used for eye conditions?
Fluoroquinolones
Aminoglycosides
Polymyxin B combo
Others: Erythromycin, azasite
What types of antivirals are used for eye conditions?
Oral: Valacyclovir, Acyclovir
Topical: Zirgan, Viroptic, Gancyclovir, Iodine
What types of anti-inflammatory drugs are used for the eyes?
NSAIDs
Antihistamines
Dry Eye formulations: Restatis + Xiidra
Steroidal
What types of anti-glaucoma drugs are used for the eyes?
Beta-blockers Carbonic Anhydrase inhibitors Adrenergic Agonists Cholinergic Agonists Prostaglandin Agonists New: ROCK Inhibitors: Rho-kinase pathway
What are the clinical warning signs of eye conditions?
- Vision affected?
- Is there pain?
- Is it getting better or worse with the current treatment?
What are the danger signs of the red eye in patients?
- Vision loss
- Corneal cloudiness
- Severe pain
- Circumcorneal injection
- Fix mid-dilated pupil
- Unresponsive to treatment
Which conditions can be managed by primary care providers?
dry eye conjunctivitis blepharitis stye pterygium subconjunctival hemorrhage
Three forms of artificial tears and their benefits:
1) Oil-based: Replace the oils in tears and cause temporary blurry vision
2) Aqueous based: Thinner tears = temporary relief for allergies and dry eyes
3) Mucomimetics: Thicker tears that cause blurred vsion but last a longer time
Jane comes into the pharmacy and asks you to recommend something for her eye issue. She complains of “eye crusties” in the mornings, and oily secretions coming from her eyelid that is very red. Upon closer look, you can see little bumps along her eye lid.
What is the condition and likely cause? Treat or Refer?
Condition: Blepharitis
Cause: Staph/poor lid hygiene
May treat or Refer to PCP:
- Treat: Lid scrubs, massage with heat
- PCP: antibiotics, Demodex kit
Describe the contents of ophthalmic ointments:
Use petrolatum or lanolin base
- Good for night time administration due to stickiness
Which conditions can be managed by primary care providers?
dry eye conjunctivitis blepharitis stye pterygium subconjunctival hemorrhage
Jessie comes to your pharmacy complaining of itchy eyes. She says each morning she has to use a wash cloth to remove these red crusties from her eyes.
What is the condition and likely cause? Treat or Refer?
Condition: Phthirasis Palepebrarum
Causes: exposure to pubic/body lice + poor hygiene
Refer to PCP (& Public health) for “lash lice”
Tx: Avoid commerical preps in eyes
Use removal/bland ointment to smother the louse
Practice good hygiene + Fix source
A truck driver stops in at your pharmacy and complains of a bump in the eye that is red and painful. He is experiencing blurry vision as well.
What is the condition and likely cause? Treat or refer?
Condition:
1) Pinguecula - sclera (white part)
2) Pterygium - cornea
Causes: UV exposure
May treat/Refer to PCP
- Prevention = primary (hat, glasses)
- Artificial tears
- Steroids if inflamed
Lorin comes to your pharmacy complaining about how her eye feels like theres something in it and burns. She wears contacts every day.
What is the condition and likely cause? Treat or Refer?
Condition: Dry Eye Syndrome Cause: Contact lens wearers Other possible causes: - Inflammatory conditions (RA, Graves disease), - EPIPHORA: excessive watering of the eyes - Nocturnal exposure - "Bells Phenomenon" - Bells Palsy, Sjogrens - Post menopausal women - Some Medications
May treat/Refer to PCP:
OTC Products:
#1 = artificial tears
Also, lubricating ointments, Rx drops, tape lids if they open at night
A patient calls you on the phone and states that he has blood in his eye but isn’t touching the color part of his eye. It doesn’t hurt, but looks awful and he would like a recommendation on what to do.
What is the likely condition and how can you help this patient?
Condition: Subconjunctival Hemorrhage
Cause: subtle trauma or vascular disorder
May treat/Refer to PCP:
Use drops to temporarily and state that it may take 1 week to 4 weeks before it clears up.
Be aware of recurrent episodes or large hemorrhages = PCP referral
Patient presents with a red rash on the right side of her forehead around her eye are but not on the left side.
What is the condition?
Condition: Herpes Zoster Ophthalmicus
Refer to Opthalmology
Tx: Antivirals - Acyclovir or valacyclovir
Cool compress for palliative relief
Gage comes to you at the pharmacy for help with where he should go. He’s been experiencing extreme light senstivity and pain. You notice a red ring around his iris and lots of blood vessels in the sclera.
What is the condition and likely cause? Treat or Refer?
Condition: Iritis/Uveitis
Causes: trauma, autoimmune disease or idopathic
Sign: Ciliary flush, pain, light sensitivity
Refer to Opthalmology
Tx: Topical steroids + cycloplegics and artifical tears for palliative relief
Under a microscope, you notice a patient has this tree root-like or a dendritic cell.
This is a classic sign of which infection of the eye?
Can you treat or do you need to refer to a PCP or Opthalmologist?
Herpes Simplex Keratitis
Refer to Opthalmology
Tx: Antivirals + cycloplegics for palliative relief
Patient presents with severally red sclera and eye lids as well as a white spot on the cornea when a light is shined on it.
What is the condition and likely cause? Treat or refer?
Condition: Bacterial Keratitis
Cause: Bacterial infection + contact lense wearers
** Most common = pseudomonas aeruginosa **
Refer to Opthalmology
Info: Culture the ulcers, Risk of corneal perforation
Jessica comes to your pharmacy and asks you to look at her eye. It’s extremely red and has pus and mucous discharge seeping from the area. It looks worse on the upper eye after she hold her lid up.
What is the condition and likely cause? Treat or Refer?
Condition: Bacterial Conjunctivitis
Causes: Staph Aureus, Streptococcus pneumoniae
Refer to PCP
- Empiracal Tx:
a) Polymyxin B/trimethoprim = broad + MRSA coverage
b) Aminoglycosides = toxic to cornea
c) Fluoroquinolones = GNB
Which bacterial infections associated with STIs may cause conjunctivis if the eye is exposed?
Neisseria gonococcus and Chlamydia
What is the leading cause of newborn conjunctivis and how to we decrease prevalence?
Chlamydia
- Treat newborns with erythromycin right away
Alice works in a daycare center and recently has gotten over a URI. She complains that her left eye has become extremely pinkish-red and is concerned she has pink eye.
What is this also known as? Treat or Refer?
Condition: Viral Conjunctivitis
Refer to PCP:
- No use of antivirals = not effective**
- Patient should avoid work while eye is red and weeping secretions
- May take up to 2 weeks to resolve
- Avoid touching or rubbing the affected eye to prevent spreading
T/F: PCP can call in Acyclovir to help treat a patients viral conjunctivitis.
FALSE; proven ineffective unless it is HSV
James comes to your pharmacy looking for a product to help with his itching eyes. He complains about having to wear his glasses more after his trip to Nebraska for a football game. The only medication he current is taking is Allegra.
What is this condition and likely cause? Treat or Refer?
Condition: Allergic Conjunctivitis
Causes: Contact lens wearer + exposure to allergies
Signs: Chemosis + Itching + glassy look to eye
Treat/Refer to PCP:
- Avoid allergen exposure
- Cool compresses
- Use Artificial tears
- Topical antihistamines
- May need vasoconstriction agent (rebound)
- NSAIDs, Mast cell stabiliziers, Steroids, systemic antihistamines
PCP may prescribe prescription eye drops:
- Antihistamines, Mast Cell Stabiliziers or Allergy/Decongestant combo drops
Give two examples of OTC antihistamine eye drops:
Zaditor
Alaway
Give examples of Rx Antihistamine eye drops:
Bepreve, Lastacraft, Patanol
Give examples of Rx Mast Cell stabilizer eye drops:
Alamast, Crolom, Alomide
A patient with Fuch’s dystrophy may present with which symptoms?
What causes this?
What can you use to treat this?
Cause: Corneal Edema
Signs: See starbursts or halos around lights and decreased vision that is worse in the AM and improves throughout the day
Treatment: Hypertonic drops to decrease fluid retention and dehydrate the cornea
Ex: Muro-128, NaCl soln.
SE: may have some stinging
Which patients are at risk for developing exposure keratopathy?
Comatose patients
Cranial Nerve VII = facial nerve impairment
Thyroid dysfunction
Congenical lid abnormalities
Patient presents with thickened secretions from the eyes and you can see red blood vessels on the surface of the skin near the nose and cheeks. She states that she went out last night for dinner at her favorite Indian Restaurant and consumed lots of food and wine.
What is the condition and likely cause? Treat or Refer?
Condition: Ocular Rosacea
Cause: Exacerbated by spicy foods or alcohol
Signs:
Red blood vessels on face = facial telangiectasia
Increased thick secretions from glands
Refer to PCP for treatment
Patient reports having a small stye on the eyelid that is draining.
What is another name for an infectious stye?
Treat or Refer Patient?
AKA Hordeolum (Chalazion = chronic)
Treat if lump is draining
- Tx: Warm compresses
Refer if stye expands to the lid width to PCP or chronic infection
- Tx: Incision/curettage, Oral antibiotics, Steroid injection
Patient complains of a metallic taste and that sometimes her vision gets blurred after she uses some new eye drop the doctor prescribed to help her dry eyes.
What’s the MOA of the drug? :P
It’s Xiidra (lifitigrast)
MOA: T Cell receptor blocker = decreased inflammation
Which eye drop should never be prescribed due to possibility of severe cornea damage if too much is given?
Tetracaine HCl = In office only!
Patient feels like something is stuck in his eye.
Treat or Refer?
Refer to PCP/Ophthamology if severe.
- May suggest pain management medications
AREDS: Who should take it and whats in it?
Macular Degeneration Patients older than 55 y.o. without contraindications (smoking) should take this
- Antioxidant supplement with zinc
Who is at risk for developing Acute Angle Glaucoma? What are the signs? Treat or Refer?
AKA Closed angle glaucoma
- Asians/Eskimos
- Hyperopia = farsighted
- Topical mydriatics
- Anticholinergic medications
- Dim illumination
- Crystalline lens changes
Signs: fixed pupil, Nausea, halo around the iris
Always refer immediately to ophthalmologist.
Macular Degeneration
Affects the central retina and results in decreased central visual acuity and field
- Affects older adults (Age-Related)
