IP exam Flashcards
What are the types of Trauma?
Chemical - Nail polish, acid
Physical - Blunt, sharp, perforating
Electrical - Shock, burn
Thermal- Heat, Cold
Radiation - Ionizin, UV, laser
Mechanisms of ocular trauma
Self inflicted
Accidental
Environmental
Occupational
How do you classify eye trauma?
Using the Birmingham eye trauma terminology system.
Which classifies into
Closed glove or Open globe.
What is the Glasgow coma scale?
This checks the eye responses: From NT– Not testable to +4 Spontaneously.(Normal)
What to check for visual function with Ocular Trauma?
VA
RAPD
Colour vision
Confrontation
Motility
IOP
Investigation for Ocular trauma?
Blood work- to check tents status & immunisation
BScan
CT scan
MRI
Facial X rays
Systemic drugs- IP
AH
AB
NSAIDS
CAI- Azetozolamide
What is pharmacodynamic?
Describes what the drug does to the body, . It refers to the relationship between the drug concentration at the site of action and the resulting effect, including the time course and intensity of therapeutic and adverse effects.
Biochemical & physiological effects
Receptors
Dose response
What is pharmacokinetics?
Describes what the body does to the drug
Absorption
Distribution
Biotransformation (Metabolism)
Excretion
Why is pharmacokinetics important to understand?
To ensure the appropriate drug is being administered, pharmacokinetics factors takes into account inter individual variability in therapeutic response meaning the way the drugs metabolised & is excreted.
How do drugs work?
Drugs are chemical which altering cell functions specific ways
How do drugs achieve there effects?
By binding to specific target protein molecules, targets include
Receptors
Enzymes
Transporters
ION channels
Discuss the different drug targets.
Drug achieve there effects by binding to specific target including,
Enzymes- CAI, NSAIDS
ION channels- TA
Receptors- BB, AA, Histamines
Transporters
What are antagonist?
Drugs that bind to receptors WITHOUT stimulating them. They block receptors preventing natural binding ligand.
They can be competitive meaning bind to same site as the natural agonise OR
Non competitive bind to alternative site and affect binding of agonist indirectly.
What are agonist?
Drugs that STIMULATE receptors, agonists perform the same function as naturally occurring receptors, they can produce partial or maximal response.
What is drug specificity?
Ideally a drug should have a high specificity meaning only able to bind to one site, but this is rare& drugs can bind to multiple sites. Increasing drug dosage can lead to affect on other target sites meaning increased side effects.
The lower the drug potency= higher dose needed & greater likelihood of wanted effects.
What is TI?
The ratio between the toxic dose and the therapeutic dose of a drug, used as a measure of the relative safety of the drug for a particular treatment. Drugs with a narrow TI= high side effects eg: Digoxin, Warfarin
What are the 4 parts of Pharmacokinetics
1) Absorption
2) Distribution
3) Biotransformation & Excretion
Describe the absorption of a drug?
This is pharmokinetics- What the body does to the drug
Absorption: Administered through site of entry eg, intravenous, topical, oral.
The degree of absorption is dependent on the degree of Ionisation.
High polar molecules are poorly absorbed where is non polar meaning unionised readily penetrate cell membranes.
The absorption of drugs is determined by the surrounding PH, this determines degree of ionisation of a drug,
Low ph: Absorbed across stomach
High ph Absorbed across Small intestine
Factors affecting absorption
Gut mobility
Blood flow
Drug formulation- drugs can be formulated for slow release, eg resistant coating
discuss the distribution of a a drug
This is pharmokinetics- What the body does to the drug
After absorption, drug taken into blood stream is distributed to the site of action, distribution is affected by a number of factors including,
1) plasma proteins
2) melanin/fat of tissue
3) Physiochemical properties of the drug
4) Bloodflow between tissues
5) Degree of leakiness of BV
What is excretion in pharm-kinetics?
This is pharmokinetics- What the body does to the drug , after absorption & distribution there is elimination.
This occurs by metabolism (biotransformation) & excretion- Most drugs eliminated by the kidney.
Some by the liver.
When monitoring AS diseases what factors to think about?
Assess the risks and benefits
Select the most appropriate drug, dose & formulation
Monitor effectiveness of treatment & side effects
Modify the treatment plan
Identify endpoint of treatment
Repeat prescribing
What is supplementary prescribing?
‘A voluntary partnership between the responsible prescriber
and a supplementary prescriber, to implement an agreed
patient-specific clinical management plan with the patient’s
agreement, particularly but not only in relation to prescribing
for a specific non-acute medical condition or health need
affecting the patient.’
3-way partnership between a medical practitioner (independent prescriber) who establishes the diagnosis and initiates treatment an optometrist (supplementary prescriber) who monitors the patient and prescribes further supplies of medication and the patient who agrees to the supplementary prescribing arrangement
What is good prescribing practice?
Prescription writing
Record keeping
Review practice- audit, identify errors
CPDS- develop
At risk groups?
Neonate – child
■ Pregnant / Breast feeding
■ Kidney/ liver impairment
■ Hereditary disorders
■ Pre-existing condition(s)
Risks from medications include?
■ Drugs with cumulative effects
■ Drugs requiring dose adjustments
■ Polypharmacy
■ ADRs
■ Errors
■ High risk drugs
■ Interactions
What are competency frameworks?
A competency framework is a collection of competencies thought to be central to effective performance. There is something called Optometrists Competency Framework published jointly by the National Prescribing Centre (NPC) and General Optical Council in 2004. The competencies within the framework 2 domains, consultation & prescribing governance. There are 10 diff competencies between these 2.
Competency frameworks can be used to:
Inform development of curricula for basic or specialist training
Provide a framework for assessment
Support continuing professional development (CPD
What does COO management guidelines state about IP?
CHM’s recommendation was that suitably qualified optometrists should be able to prescribe any licensed medicines (except for controlled drugs or medicines for parenteral (injected) administration) for ocular conditions affecting the eye, and the tissues surrounding the eye, within their recognised area of expertise and competence
What is a clinical management plan?
A clinical management plan is a plan of care that relates to a named patient and the specific condition(s) to be managed by the SP made by the IP
What should a clinical management plan include?
1) Name of px;
2) The illness or conditions which may be treated by the supplementary prescriber
3) The date on which the plan is to take effect, and when it is to be reviewed by the doctor (independent prescriber) who is party to the plan
4)Reference to the class or description of medicines which may be prescribed or administered under the plan
5) Any restrictions or limitations as to the strength or dose of any medicine
6) Relevant warnings about known sensitivities of the patient to
7) Relevant suspected or known adverse reactions to any other medicine
8) The circumstances in which the SP should refer to, or seek the advice of, the doctor (independent prescriber) who is party to the plan
What is an ADR?
An adverse drug reaction (ADR) is defined as an unwanted or harmful reaction experienced following the administration of a drug (or combination of drugs)
What are the types of ADR?
ADRs can be classified as Type A (pharmacological) or Type B (idiosyncratic)
Type A reactions represent an exaggeration of the normal pharmacological reaction of the drug
Type B reactions are uncommon and unrelated to the known action of the drug
What is a type A drug reaction known as?
pharmacological- exaggeration of the normal pharmacological reaction of the drug
