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Therapeutics > Mydriatics > Flashcards

Mydriatics Flashcards

1
Q

name 3 reasons WHY you will use mydriatics on a patient

A
  • enables more thorough examination of the eye e.g. peripheral crystalline lens, vitreous, fundus
  • stereo fundus examination
  • for treatment e.g. uveitis (mostly my ophthalmologists)
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2
Q

name 4 reasons/times WHEN you will use mydriatics on a patient

A
  • on patients at risk of a retinal detachment
  • patients with symptoms
  • for screening
  • inadequate fundus view
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3
Q

which 3 types of patients may be at risk of a retinal detachment

A
  • high myopia
  • family history
  • trauma
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4
Q

list what types of symptoms a patient may have that you will need to use mydriatics on

A
  • unexplained vision loss/visual field loss
  • visual disturbance
  • floaters
  • flashes
  • veils
  • shadows
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5
Q

which 3 types of patients will you need to do screening on with mydriatics

A
  • diabetics (neovascular vessels and tortuosity)
  • high myopia
  • prior to ocular surgery
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6
Q

which 2 reasons may you want to use mydriatics on when experiencing inadequate fundus view

A
  • lens/media opacities

- miotic pupils (especially elderly patients, who also more likely to have cataracts and diabetes)

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7
Q

what are the 6 ideal properties of a mydriatic

A
  • rapid onset
  • adequate duration (lasts long enough to see back of eye)
  • fast recovery
  • no associated cycloplegia and adverse effects
  • light reflex is abolished
  • no rise in intraocular pressure (easily reversed in an emergency)
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8
Q

what 7 things must you do/check prior to dilation

A
  • have a good reason to use the drug
  • explain the procedure (px can’t drive after etc)
  • px consent
  • issue written information
  • advise about the effects - glare, loss of stereo vision, driving, operating machinery
  • check for contraindications (incase of an allergic reaction, check BNF)
  • minimise the risk of adverse reactions (check IOPs before insertion)
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9
Q

list the 4 D test

A
  • Drug
  • Dosage
  • Date
  • Disposal

and time

all should be checked/written/done

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10
Q

where should the drugs be disposed

A

in the yellow bin

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11
Q

why should you note down the time that the drug was instilled

A

to know when the maximum effect is

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12
Q

list 6 general contraindications of using mydriatics

A
  • hypersensitivity to drug
  • iris clip IOLs
  • narrow angles (do slit lamp examination before instilling)
  • patient with symptoms suggestive (e.g. high hyperope) of sub acute or chronic closed angle glaucoma (CAG)
  • patient with diagnosed CAG
  • px using pilocarpine for glaucoma treatment
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13
Q

what happens within the eye during closed angle glaucoma

A

the iris is bowed forward and can touch the back of the cornea which blocks the outflow of aqueous

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14
Q

list the signs and symptoms of closed angle glaucoma

A
  • blurred vision from cloudy cornea
  • haloes
  • headache
  • painful
  • vomiting/nausea
  • photophobia
  • sudden increase in IOP (usually >40mmHg)
  • conjunctival hyperaemia
  • cloudy cornea
  • fixed mid-dilated pupil
  • closed angle
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15
Q

list 4 things you will do/check to minimise the risk of a CAG

A
  • IOP, pre and post dilation
  • anterior angles
  • existing symptoms?
  • use of biotic drug
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16
Q

what will you do and how when checking IOP pre and post dilation in order to minimise risk of CAG

A
  • check if theres a significant rise in IOP or an asymmetric rise (as CAG is most likely to happen in one eye)
  • monitor rises in IOP (post dilation)
  • refer to eye casualty if continues to rise
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17
Q

how will you check anterior angles in order to minimise risk of CAG

A
  • gonioscopy
  • van herrick

if you see narrow angles without symptoms, still refer for further checks

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18
Q

list 2 other names for antimuscarinic mydriatics

A
  • muscarinic antagonists

- anticholinergic

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19
Q

list the three types of anti muscarinic mydriatics

A
  • tropicamide
  • cyclopentolate
  • atropine
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20
Q

which anti muscarinic is rarely used as a mydriatic

A

cyclopentolate

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21
Q

which anti muscarinic is very unlikely to be used as a mydriatic

A

atropine

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22
Q

which anti muscarinic is most likely to be used as a mydriatic

A

tropicamide

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23
Q

which anti muscarinic mydriatic is only available to independent prescribers

A

atropine

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24
Q

how do anti muscarinic drugs work

A

by blocking Ach effects on muscarinic receptors

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25
Q

list another name for a sympathomimetic mydriatic

A

alpha agonist

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26
Q

name the type of sympathomimetic mydriatic

A

phenylephrine

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27
Q

how do sympathomimetic mydriatic drugs work

A

enhancing noradrenaline effects on alpha 1 adrenoceptors

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28
Q

what 2 other things does phenylephrine do to the eye

A
  • makes the eyes look whiter, as it constricts the blood vessels
  • widens the interpalpebral aperture, as it contracts mullers muscle
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29
Q

which ANS branch do antimuscarinic mydriatics work on

A

parasympathetic

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30
Q

which mydriatic is involved in affecting accommodation and why

A

antimascurinics as it affects the ciliary muscle as well as the sphincter

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31
Q

which branch of the ANS won’t affect accommodation or light reflex

A

sympathetic

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32
Q

which muscle does the sympathetic branch of the ANS affect

A

dilator

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33
Q

which ANS branch does the iris sphincter muscle innervate

A

parasympathetic

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34
Q

what do antimuscarinic drugs cause paralysis of

A

the parasympathetic nervous system

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35
Q

what do antimuscarinic drugs inhibit the action of

A

Ach at the end of postganglionic nerves

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36
Q

what three things does antimuscarinic drugs produce

A
  • mydriasis
  • cycloplegia
  • reduced tear secretion
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37
Q

which type of drug is a alpha agonist

A

sympathomimetic/phenylephrine

38
Q

which transmitter do sympathomimetic drugs work on

A

neurohumoral transmitter at most sympathetic postganglionic neuro-effector junctions

39
Q

what 2 things in the body do sympathomimetic drugs have exceptions on

A
  • sweat glands

- vasodilator fibres on skeletal muscle

40
Q

list the alpha and beta receptors that sympathomimetic drugs bind with

A
  • mainly alpha 1 receptors in dilator papillae muscle
  • alpha 1 excitatory, alpha 2 inhibitory
  • beta 1 excitatory, beta 2 inhibitory
41
Q

in how long does tropicamide cause mydriasis within

A

15 minutes

42
Q

after how long is recovery from tropicamide

A

8-9 hours

43
Q

with which drug is light reflect absent

A

tropicamide

44
Q

which drug induces a mild cycloplegic effect

A

tropicamide

45
Q

what may tropicamide cause

A

a rise in IOP but likely to be transitory

46
Q

which drug has fewer contraindications

A

tropicamide

47
Q

how long does phenylephrine cause mydriasis within

A

30 minutes

48
Q

how long does phenylephrine cause mydriasis for

A

12-24 hours

49
Q

with which drug is light reflex retained

A

phenylephrine

50
Q

what is phenylephrine less likely to produce

A

a rise in IOP as sector mydriasis

51
Q

which drug is associated with numerous contraindications with other medications

A

phenylephrine

52
Q

which category of medicine is tropicamide

A

a POM for use and supply by all optometrists

53
Q

which two forms/packaging is tropicamide available in

A
  • single use, minims by bausch and lomb

- multi-dose containers, mydriacyl by alcon

54
Q

what single use doses is tropicamide available in

A

0.5% and 1.0%

55
Q

at what temperature should tropicamide single use minims be stored below

A

25 degrees celsius

56
Q

what dose of tropicamide will you use if you want to paralyse some accommodation

A

1.0%

57
Q

what multi use doses is tropicamide available in

A

0.5% and 1.0%

58
Q

at what temperature should tropicamide multi dose containers be stored below

A

2-8 degrees celsius and protect from light

59
Q

what % of tropicamide is used on darker irides

A

1%

60
Q

which mydriatic is better to use during pregnancy

A

Tropicamide is better to use than phenylephrine

61
Q

what must women who are using tropicamide not do

A

breast feed

62
Q

list the 4 immediate side effects or using tropicamide

A
  • transient stinging
  • transient blurring
  • photophobia
  • raised IOP?
63
Q

list 4 side effects of tropicamide as a result of prolonged administration

A
  • irritation
  • hyperaemia
  • oedema
  • conjunctivitis
64
Q

what is the general body side effect of tropicamide

which type of patient does it mainly affect

A
  • CNS which effects dry mouth

- mainly affects children, with blue eyes and blonde hair

65
Q

which category of medicine is phenylephrine

A

P medicine - such as lemsip etc

66
Q

which forms/packaging is phenylephrine available in

A

single use, minims by Bausch & Lomb

67
Q

what doses is phenylephrine available in

A
  • 2.5%

- 10%

68
Q

at what temperature should phenylephrine single use minims be stored below

A

25 degrees celsius and protect from light

69
Q

which type of patients is 10% phenylephrine contraindicated in and why

A

children and the elderly (>65 years)

because of its increased risk of systemic toxicity

70
Q

which type of eyes may phenylephrine be less effective on

A

highly pigmented

71
Q

what does phenylephrine cause vasoconstriction of

A

conjunctival blood vessels

72
Q

list 7 things that phenylephrine is contraindicated with

A
  • medication for cardiovascular problems
  • medication for depression
  • thyrotoxicosis
  • insulin dependent diabetes
  • asthma
  • pregnancy/lactation
  • use of pilocarpine
73
Q

list the 2 medications for cardiovascular problems that phenylephrine is contraindicated with

A
  • anti hypertensives

- tachycardia

74
Q

list the 2 medications for depression that phenylephrine is contraindicated with

A
  • monoamine oxidase inhibitors

- tricyclic antidepressants

75
Q

which type of mydriatic will you use on a insulin dependent diabetic

A

tropicamide

76
Q

how is phenylephrine contraindicated with pregnancy/lactation

A

it may cause transient fatal hypoxia

77
Q

how is phenylephrine is contraindicated with pilocarpine and on which type of patients

A
  • older px = pupil block

- young px = accommodative spasm, causing contraction of the ciliary muscle

78
Q

list the 6 immediate side effects of phenylephrine

A
  • transient stinging
  • transient blurring
  • photophobia
  • lid retraction
  • conjunctival allergic reaction
  • punctate keratitis
79
Q

list the 5 general body side effects of phenylephrine

A
  • palpitations
  • tachycardia
  • cardiac arrhythmias
  • hypertension
  • headaches
80
Q

how does phenylephrine cause all these general body side effects

A

the drug gains access to systemic blood supply via the puncta, blood vessels or mucous

81
Q

name the two drugs which can be used as synergistic combinations and for what purpose they’re used for

A

combinations of antimuscarinics and sympathomimetics
e.g. tropicamide 0.5% and phenylephrine 2.5%

this allows for lower concentrations of antimuscarinic to be used which results in less cyclo effect

82
Q

what category of medicine is mydriasert

A

prescription only medicine POM

83
Q

in what form does mydriasert come in

A

insoluble ophthalmic insert

84
Q

what does mydriasert contain

A

phenylephrine and tropicamide

85
Q

how fast is mydriasert released

A

gradually

86
Q

when is mydriasert used

A

pre-operatively and diagnostically

87
Q

how is mydriasert instructed for use

A

in adults insert up to max. 2 hours before procedure

remove within 30 mins of mydriasis and within 2 hours of application

88
Q

name 2 other mydriatic drugs other than tropicamide, phenylephrine and mydriasert

A
  • cyclopentolate
  • homatropine

both antimuscarinics

89
Q

when does the mydriatic effect of homatropine commence in

A

10-20 mins

90
Q

when does maximal mydriasis occur with homatropine

A

30-40 mins

91
Q

what 2 things are absent with homatropine

A
  • light reflex

- accommodation

92
Q

after how long is recovery achieved with homatropine

A

up to 3 days (so its rarely used)

Therapeutics (19 decks)

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