L6 Inflammation and Infection

Question 1

what are the 5 categories of anti-inflammation drugs

Answer 1

 Anti-Histamines
 Mast cell stabilizers
 Vasoconstrictors (decongestants)
 NSAIDs (Non-steroidal Anti-Inflammatory Drugs)
 Corticosteroids

Question 2

5 CARDINAL SIGNS OF ACUTE INFLAMMATION?

Answer 2

Redness
Edema
Pain
Temperature increase (due to increased blood flow)
Loss of function

Question 3

what is the function of prostaglandins and leukotrienes?

Answer 3

In-charge of causing:
 Increase permeability of vessels: edema
 Increase sensitivity to pain caused by prostaglandins

Question 4

4 TYPES OF HYPERSENSITIVITY REACTIONS

Answer 4

Type I: IMMEDIATE
 Eg: Anaphylaxis, allergic rhinoconjunctivitis

 Type II: CYTOTOXIC
 Eg: haemolytic anaemia

 Type III: IMMUNE-COMPLEX
 Systemic Lupus Erythematosus (SLE)

 Type IV: DELAYED
 Eg: Contact Dermatitis

Question 5

DESCRIBE TYPE I: IMMEDIATE HYPERSENSITIVITY

Answer 5

Antigen is reintroduced into an individual who has been exposed to the antigen previously.

 First exposure results in formation of immunoglobin
 IgE binds to mast cells and makes cell rupture (histamine increase) when Antigen is reintroduced

Immunogloblin: an antibody protein that is generated in response to and will bind to a specific antigen

Question 6

what is a hypersensitivity reaction? what is histamine?

Answer 6

When the immune system overreacts, this is known as a
hypersensitivity reaction

 Histamine is a mediator of hypersensitivity
 It is released in large quantities from mast cell in a Type I reaction
 Synthesized and stored in almost all tissues: skin, lungs, nasal mucosa etc
 Ocular: lids, conjunctiva, episclera, limbus

Question 7

4 EFFECTS OF HISTAMINE

Answer 7

 Vasodilation
 Edema
 itching (purely caused by histamine)
 pain

Question 8

what is the use of anti-histamines?

Answer 8

Blocks the action of produced histamine
Used topically for relief of mild to moderate symptoms of
allergic conjunctivitisor irritation (itching), pinguecula, pterygium

Question 9

HOW DOES ANTI-HISTAMINES WORK? give 3 examples of anti-histamines

Answer 9

 They bind to histamine receptors
 Resulting in the prevention of physiologic actions of histamine

 Compound of anti-histamine: pyrilamine, pheniramine, antazoline

Example of Anti-Histamine drugs:
* Ketotifen
* Optivar
* Emedine

Question 10

what are mast cell stabilisers? give 1 e.g

Answer 10

Inhibits the degranulation/rapturing of mast cells, therefore inhibits the
release of histamine.
-prophylactic treatment (preventive)
Long term management of allergies: vernal and seasonal allergic conjunctivitis
- It has NO EFFECT on mediators that has already been released.

e.g Cromolyn sodium (Opticrom 2%)

Question 11

what are VASOCONSTRICTORS (DECONGESTANTS) ? give 2 e.g

Answer 11

 Adrenergic agonists
 Usually combined with anti-histamines
 Compound of vasoconstrictors: phenylephrine, tetrahydrozoline,
oxymetazoline

 Examples: Visine
Opcon-A

Question 12

what are NSAIDs? give 5 e.g

Answer 12

Alternative to steroids
 Inhibit prostaglandin formation
 Conditions: Episcleritis, scleritis, uveitis, cystoid macular edema

Example: Paracetamol (oral)
Aspirin (oral)
Ocufen (ocular)
indocin (ocular)
acular (ocular)

Question 13

what are corticosteroids?

Answer 13

suppress inflammation but underlying cause still remains
suppress inflammatory responses often caused by:
 Allergy
 Infection
 Trauma

Question 14

3 types of topical corticosteroids? give 2 eg for each

Answer 14

Short acting: quick action, short effect
 Hydrocortisone, prednisolone

 Intermediate acting: longer action, longer effect
 Traimcinolone, Fluprednisolone

 Long acting: longer action, longer effect
 Dexamethasone, betamethasone

Question 15

INDICATION FOR CORTICOSTEROIDS

Answer 15

 Topical:
 Allergic conjunctivitis
 Uveitis
 Scleritis
 After intraocular surgeries: IOL implants

 Systemic (disease behind the crystalline lens):
 Posterior uveitis
 Optic neuritis

Question 16

what are the ocular complications of corticosteroids

Answer 16

lens opacities (Posterior subcapsular cataract)
Elevated IOP
mask diseases( do not know about underlying diseases)
lower resistance to infections
retards corneal healing

Question 17

WHAT CAUSES US TO FALL ILL?

Answer 17

1. bacteria
2. fungi
3. virus
4. protozoa

Question 18

WHAT IS THE OCULAR DEFENSE SYSTEM

Answer 18

Tears: Lysozyme, Immunoglobulin A (anti bodies), Lactoferrin, albumin, B-lysin, flush out debris

blinking: constant flow and movement of the tear film to wash away
debris

conjunctiva: lymphoid tissue which has anti-microbial defense

cornea: Langerhans’ cells (antigen presenting cell) from the limbus,
cytokines

Question 19

what is a sign of bacterial infection? give 2 eg what are 3 eggs of anti bacterial drugs?

Answer 19

 Yellowish discharge, usually severe.
 Example: blepharitis, preseptal cellulitis

 Anti-Bacterial drugs:
 Bacitracin – Ointment form
- Bacteriocidal against most gram positive bacteria
- Treatment for: Blepharitis

 Chloramphenicol – broad spectrum
- eye drops/solution or ointment
- Treatment for: Conjunctivitis

Aminoglycosides: most active against gram negative bacteria
 For superficial ocular infections
 Neomycin
 Tobramycin
 Gentamycin

Question 20

what are fungal eye infections? give eg of fungal infection and 3 anti-fungal drugs

Answer 20

most aggressive, hard to resolve. but rare
they tend to come back
eg fungal corneal ulcer

Anti-fungal drugs:
 Nystatin
 Amphotericin
 Natamycin

Question 21

what is a sign of viral infection? give of viral infection and 2 anti-viral drugs

Answer 21

 Watery discharge, ver infectious
 Example: herpetic keratitis, Cytomegalovirus retinitis

Topical drugs
 Trifluridine–costly
 Topical Acyclovir ointment (zovirax)–costly

Question 22

what are the 2 types of anti viral injections? what are they sed for?give 2 eg for each

Answer 22

anti viral injections are used for more severe infections

Intravenous route:
 Ganciclovir
 Foscarnet

Oral:
 Acyclovir
 Famcyclovir