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Ocular Pharm > Ocular Pharm: L10: Drugs Used in Ocular Examinations > Flashcards

Ocular Pharm: L10: Drugs Used in Ocular Examinations Flashcards

1
Q

IOP Check (1)

  1. Fluress
    a. % Fluorescein
    b. % Benoxinate Hydrochloride
    c. % Chlorbutanol (Preservative)
  2. Flurasafe
    a. % Fluorexon Disodium
    b. % Benoxinate Hydrochloride
    c. % Chlorbutanol
  3. Fluorocaine
    a. % Fluorescein
    b. % Proparacaine
    c. % Thimerosal
  4. Flucaine
    a. % Fluorescein
    b. % Proparacaine
    c. % Thimerosal
  5. Which one is good for CL Wearers and why?
A
  1. a. 0.25%
    b. 0.4%
    c. 1% (preservative)
  2. a. 0.35% (NOT ABSORBED by SCL’s)
    b. 0.4%
    c. 0.5% (Preservative)
  3. a. 0.25%
    b. 0.1%
    c. 0.01% (Preservative)
  4. a. 0.25%
    b. 0.5%
    c. 0.01% (preservative)
  5. FLURASAFE! (because Fluorexon Disodium is NOT ABSORBED by SCLs, so CLs can be put back in immediately after IOP Measurement!)
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2
Q

IOP Check (2)

  1. What may be Superior to PROPARACAINE?
    a. Number of Side Effects?
    b. Has what kind of properties?
  2. What drugs May ALTER CORNEAL THICKNESS (increase of decrease) by 10uM?
    a. Wait for AT LEAST 5 Minutes after Instilling Anesthetic BEFORE performing what?
    b. Consider Non-Contact Measurement of CORNEAL THICKNESS when what is REQUIRED?
A
  1. BENOXINATE
    a. Fewer (Redness, Burning, Stinging, Eye Pain, Eye Swelling, Vision Changes, Allergic Symptoms)
    b. Antibacterial Properties
  2. Benoxinate AND Proparacaine
    a. Ultrasound Pachymetry
    b. when HIGH RELIABILITY is REQUIRED
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3
Q

Corneal Epithelium/Tear Evaluation

  1. Examination of what?
  2. Diagnosis of Viral Disease (what 2 things)?
  3. Evaluation for Dry Eye (2)?
A
  1. of Abrasion, Erosion, Ulcer, etc.
  2. a. Herpetic Dendrite
    b. SEI’s in EKC (Infiltrate with minimal Staining)
  3. a. TBUT
    b. SPK (aka Punctate Erosions; PE)
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4
Q

Evaluation with Fluorescein

  1. Characteristics of Fluorescein
    a. Visualizes what type of Defects?

b. Stains for what?
c. DOESNT STAIN for what Cells?
d. Is it an Ocular Irritant?
2. DONT USE FLURESS for evaluation of what 2 things?
a. Why?
3. Fluorescein is available in what?
a. Which are better?

A
  1. a. Epithelial Defects
    b. for MUCIN (for TBUT)
    c. for Devitalized Cells
    d. Minor Ocular Irritant.
  2. of SPK or TBUT
    a. It’s viscous and will not give an accurate result
  3. in drops or on strips
    a. STRIPS have better storage characteristic and more uniform dose delivery
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5
Q

SPK (PEE)

  1. Unspecified SPK
    a. Can be what?
    b. Often more Pronounced where?
  2. Thygeson SPK
    a. what do the Epithelial lesions look like?
    b. What haze is seen?
A
  1. a. Fine or Coalesced
    b. Inferiorly
  2. a. Coarse, Distinct, Granular Greyish, Elevated Epithelial Lesions
    b. Mild, Subepithelial Haze
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6
Q

Tear Meniscus

  1. height of a Normal Tear Meniscus = ?
A
  1. 1 mm
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7
Q

Eroded vs. Elevated Lesions

  1. Erosion (e.g. Ulcer)
    a. Does the Stain fill the lesion?
    b. Usually has what kind of Edge?
  2. Elevation (e.g. Phlyctenule)
    a. Stain Gathers where?
    b. Center MAY BE STAINED if what is disrupted?
A
  1. a. YES
    b. a SHARP EDGE
  2. a. at the Edge and may “wick up” the Side
    b. if Epithelium is DISRUPTED
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8
Q

Evaluation with Other Dyes

  1. Rose Bengal
    a. Stains what 2 things?
    b. DOESNT VISUALIZE what?
    c. May produce what?
    d. Ocular Irritant?
  2. Lissamine Green
    a. Stains what 2 things?
    b. Doesn’t Visualize what?
    c. Ocular Irritant?
  3. Rose Bengal is available as what?
  4. Lissamine Green is available in what?
  5. Fluramene: It’s a Combination DROP of what 2 things?
A
  1. a. Devitalized Cells (?) and Mucin
    b. Epithelial Defects
    c. Cytotoxicity
    d. HIGH LEVEL
  2. a. Devitalized Cells and Mucin
    b. Epithelial Defects
    c. MINOR
  3. as a Solution or on Strips
  4. ONLY on STRIPS
  5. with Fluorescein and Lissamine Green
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9
Q

Dilation

  1. What agents are Effective?
    a. What PARALYZES the Sphincter Pupillae?
    b. What STIMULATES the Dilator Pupillae?
  2. What’s a More Efficacious Dilator and be used ALONE: Anticholinergics or Adrenergics?
  3. Which does not cause CYCLOPLEGIA, but may require Multiple Drops for a Usable Dilation: Anticholinergics or Adrenergics?
A
  1. Parasympatholytic (Anticholinergic) and Sympathomimetic (Adrenergic) Agents are Both Effective
    a. Anticholinergics
    b. Adrenergic Drugs
  2. Anticholinergics
  3. Adrenergics
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10
Q

Cholinergic Antagonists (1)

  1. Atropine 1.0%
    a. Max Dilation at what time?
    b. Duration?
    c. Classical Anticholinergic Side Effects?
    d. What other side effects are there?
    e. Who may have Enhanced CV Response?
  2. Scopolamine 0.25%
    a. Max Dilation?
    b. Duration?
    c. Side Effects similar to what?
    d. But more toxicity to what?
A
  1. a. 30-40 min
    b. 7-10 days
    c. (Dry as a bone, Blind as a Bat, Red as a Beet, Hot as an oven, and Mad as a Hatter) (CNS: Psychotic rxns, behavioral disturbances): Ataxia, Incoherent Speech, Restlessness, Hallucinations, Hyperactivity Seizures, Disorientation as to time and place, and failure to recognize people

d. side effects, including mortality, have been reported in young children, but appear to be RARE.
e. White Males with DOWN’s SYNDROME

  1. a. 20-30 minutes
    b. 3-7 days
    c. to Atropine
    d. But more CNS Toxicity (Confusion, Hallucinations, Restlessness, etc)
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11
Q

Cholinergic Antagonists (2)

  1. Homatropine 2.0%/5.0% Drops
    a. Max Dilation?
    b. Duration?
    c. Same Side Effects as what?
  2. Cyclopentolate 0.5%/1.0% Drops
    a. Max Dilation?
    b. Duration?
    c. Side effects similar to what?
    d. Side effects usually seen in whom?
  3. TROPICAMIDE 0.5%/1.0% Drops
    a. Max Dilation?
    b. Duration?
    c. Side Effects?
A
  1. a. 40-60 minutes
    b. 24-72h/36-72h
    c. as Atropine
  2. a. 30-60 minutes
    b. 12-24h/12-36h
    c. to Atropine, but more CNS Effects
    d. in Pediatric Patients; Especially with a 2% Concentration
  3. a. 20-40 minutes
    b. 4-6h/6-8h
    c. Minor Side Effects, Including Minor CV Effects
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12
Q

Adrenergic Agonists

  1. Phenylephrine 2.5%/10% Drops
    a. Max Dilation?
    b. Duration?
    c. May cause what? (when?)
  2. Hydroxyamphetamine 1% drops
    a. Max Dilation?
    b. Duration?
    c. Can produce what side effects?
A
  1. a. 20-30 minutes
    b. 4-6h
    c. Hypertension if using Multiple drops, or if using on Neonates or Infants
  2. a. 25-35 minutes
    b. 4-6h
    c. Various Cardiovascular Side Effects including Hypertension and Tachycardia
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13
Q

General Procedure

  1. 1 Drop each of what drops?
  2. Have patient do what b/w Drops?
  3. Use Additional drops in patients with what?
    a. A Pupil Dilation of what is usually adequate?
  4. To Induce Cycloplegia, use what?
A
  1. of 2.5% Phenylephrine and 1% Tropicamide
  2. close eye b/w drops
  3. in patients with Dark Irides
    a. of 7mm is usually Adequate
  4. Use Cyclopentylate (after anesthetic)
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14
Q

CIs to Dilation

  1. What are they? (5)
A
  1. Iris-Supported/Anterior Chamber Intra-Ocular Lens
  2. Subluxated Crystalline Lens or IOL
  3. Extremely Narrow or Closed Angles
  4. History suggesting Angle-Closure Glaucoma, w/o Surgical or Laser (e.g. LPI) Intervention
  5. Pregnant Patients
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15
Q

Special Procedures

  1. Borderline Narrow Angles
    a. use what?
    b. re-check what after Dilation?
    c. Have what on hand?
  2. Elderly Patients
    a. Use what?
  3. Patients with CV Disease
    a. Use what?
  4. Down’s Syndrome
    a. Avoid what?
    b. What can be used?
  5. Infants and Young children?
A
  1. a. Use Low-Dose Tropicamide
    b. IOP
    c. Apraclonidine or Similar Agents on Hand
  2. a. Low Dose Tropicamide
  3. a. Use Tropicamide
  4. a. Avoid Strong Anticholinergics
    b. Tropicamide can be used
  5. covered in later lecture
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16
Q

Mydriolytics

  1. Dapiprazole (Rev-Eyes)
    a. BLOCKS what?
    b. What 2 things does it Produce?
    c. Partially Restores what?
  2. Pilocarpine
    a. What is it?
    b. What does it cause?
A
  1. a. Blocks ALPHA Receptors on the Iris Dilator Muscle
    b. Produces Miosis and a Decrease in IOP
    c. Partially Restores Accommodation
  2. a. Cholinergic Agonist (Muscarinic)
    b. Accommodative Spasm or Pupillary Block may occur as a result of stimulating the Pupil Sphincter and Dilator Muscles as the same time.
17
Q

Special Diagnostic Testing (3)

A
  1. Adie’s Pupil
  2. Horner’s Syndrome
  3. Myasthenia Gravis
18
Q

Receptor Supersensitivity

  1. What happens when a NT Receptor is chronically unstimulated?
  2. What can Stimulate Supersensitivity Receptors?
  3. Most common Natural Cause of Loss of Receptor Stimulation?
A
  1. their sensitivity to the NT may increase greatly
  2. an Amt of NT, or Agonist, that has no effect on normally sensitive receptors
  3. Loss of Presynaptic Terminals
19
Q

Horner’s Syndrome

  1. Sympathetic Denervation
    a. Uni/Bilateral?
    b. 3 symptoms?
    c. If Congenital, what will you see?
  2. May be Preganglionic or Postganglionic
    a. Determining level of lesion can guide what?
    b. Some causes can be what?
A
  1. a. UNILATERAL
    b. Miosis, Ptosis, Anhydrosis
    c. Pupil heterochromia if Congenital
  2. a. can guide diagnosis of cause
    b. can be life threatening, while others are benign
20
Q

Sympathetic Innervation of the Eye

  1. First neuron is in what?
    a. Lesion leaves what?
  2. Second Neuron is in what?
    a. Can be disrupted by what?
    b. Lesion leaves what?
  3. Third Neuron is in what?
    a. Can be Affected by what?
    b. Lesion Destroys what?
A
  1. Hypothalamus and Axon Projects to the Ciliospinal Center of Budge (Preganglionic)
    a. Leaves Adrenergic Terminals in Eye Intact but Inactive
  2. in Spinal cord and Projects to Superior Cervical Ganglion (Preganglionic, Cholinergic)
    a. by Lung Cancer (Pancoast Tumor)
    b. Leaves Adrenergic Terminals in Eye Intact but Inactive
  3. is in Superior Cervical Ganglion and Projects to the Eye (Postganglionic, Adrenergic)
    a. by ICA Aneurism or dissection
    b. destroys Adrenergic Terminals in Eye
21
Q

Horner’s Syndrome

  1. Cocaine: 4%
    a. Put into which eye?
    b. What does it Block?
    c. Which pupil will not dilate?
    d. What does this confirm?
  2. Hydroxyamphetamine: 1% into both eyes
    a. What does this do?
    b. Preganglionic?
    c. Postganglionic?
  3. Adrenaline: 1:1000 into both eyes
    a. Directly stimulates what?
    b. Preganglionic?
    c. Postganglionic?
A
  1. a. both eyes
    b. reuptake of Norepi
    c. Horner’s Pupil
    d. Diagnosis of Horner’s
  2. a. Increases release of Norepi, even non-stimulated, and Blocks reuptake
    b. Both Pupils will dilate
    c. Horner pupil will not dilate
  3. a. Noradrengergic Receptors
    b. Neither pupil will dilate because dose is too low
    c. Horner pupil will dilate because the receptors are supersensitive but normal pupil will not dilate.
22
Q

Adie’s Pupil

  1. Dilated Pupil due to what?
    a. Direct Light Response?
    b. Consensual Light response?
    c. What about near?
  2. May follow what?
  3. Pupil may become what?
A
  1. due to Denervation of the Pupil Sphincter
    a. absent or Sluggish, associated with Vermiform movements at border
    b. Slow or Absent
    c. Sluggish Response to Near
  2. May follow viral Illness
  3. small in longstanding Cases
23
Q

Testing for Adie’s Pupil

  1. What cholinergic Agonists?
  2. Adie pupil will do what?
    a. What about normal Pupil?
    b. Dose is TOO LOW to cause what?
    c. Cholinergic receptors in Adie Pupil are what?
A
  1. 2.5% Methacholine or 0.125% Pilocarpine
  2. will Constrict, but normal pupil will not
    a. Normal pupil will not constrict
    b. to cause constriction of normal pupil
    c. are supersensitive due to chronic inactivity
24
Q

Managing Adie’s Pupil

  1. Pilocarpine Drops
    a. Dosage for Constricting pupil?
  2. Bromonidine Drops
    a. Selective for what?
  3. Reading Glasses for what?
    a. Pupil may become what?
A
  1. a. Low dose (0.125%) for constricting pupil
  2. a. Selective for Alpha 2 Receptors (agonist) but also has some Alpha 1 Activity
  3. for Accommodation Problems
    a. tonically constricted after prolonged accommodation
25
Q

Myasthenia Gravis

  1. Autoimmunity to what receptors?
    a. Effects what?
  2. Patient commonly presents with what?
  3. Usually uni/bi?
  4. Most commonly present in what decade?
  5. More common in whom?
A
  1. to Cholinergic Receptors
    a. Effects EOMs and Eyelid Muscles
  2. with Ptosis or Diplopia
  3. Bilateral, but may be Unequal
  4. in Third Decade
  5. in Females
26
Q

Tensilon (ENDROPHONIUM) Test

  1. Short-Acting AChE Inhibitor: Does what?
  2. Given after Atropine (0.3mg iv) to MINIMIZE what?
    a. How much do you give to look for improvement?
    b. If no improvement, give what?
    c. Effect only lasts for how long?
A
  1. Makes ACh available for a longer time, increasing receptor stimulation
  2. to minimize Muscarinic Side Effects
    a. 1 mg/ml: Give 0.2ml iv and look for improvement
    b. give remaining 0.8 ml and re-check
    c. for 5 minutes
27
Q

ICE Test

  1. What do you do?
  2. Look for what?
  3. What test produces similar result?
A
  1. Hold ice over closed eyelids for 2 minutes. Lower Temperature prolongs Activity of ACh
  2. for reduction of Ptosis
  3. Tensilon
28
Q

Emergency Situations

  1. Eye Pressure spike during IOP Measurement
    a. Can happen after dilation with what?

b. TREAT Spike with what?
c. If IOP Doesn’t return to normal, try using what?

  1. Acute Angle Closure
    a. TREAT with what?
    b. If no response, treat with what?
    c. Refer for what?
    d. Consider what other Treatment?
  2. Eye Injury: Seidel Sign
    a. use what to detect leakage?
A
  1. a. with “borderline” Angles (Always re-measure IOP)
    b. with APRACLONIDINE (Iodipine)
    c. try additional drops of Apraclonidine or other Acutely-Acting Glaucoma meds (i.e. NOT PROSTAGLANDINS!)
  2. a. with acutely-acting glaucoma meds
    b. treat with Oral Acetazolamide (Diamox Sequels, Glauctabs, Neptazane)
    c. Refer for LPI
    d. Pilocarpine Treatment if LPI is not immediate
  3. a. use Fluorescein to detect leakage.
29
Q

Seidel Sign

  1. Visualize leakage of what?
  2. Indicates what?
A
  1. of Aqueous from AC by washing away Flourescein Dye

2. Indicates Puncture of Globe

30
Q

Emergency Situations

  1. Anaphylactic Reactions
    a. Treat with what?
    b. There may be a LEGAL Requirement to also do what?
  2. Vasovagal Syncope
    a. Due to what?
    b. Causes?

c. What do you do to help it?

A
  1. a. with Intramuscular Epinephrine Injection (EpiPen)
    b. have Oxygen Administering Equipment Available (e.g. in Arizona)
  2. a. touching eyes or eyelids
    b. Contact tonometry; First time CL trial; Slit-lamp Biomicroscopy; Insertion of Punctal Plugs
    c. Recline Patient, use smelling salts as needed.

Ocular Pharm (13 decks)

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