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Ocular Pharm > Ocular Pharm: L5: Drugs for Posterior Segment Disorders > Flashcards

Ocular Pharm: L5: Drugs for Posterior Segment Disorders Flashcards

1
Q

AREDS Study

  1. Pts given a Placebo, or the following Antioxidants: (5)
  2. What where the results of Antioxidant treatment?
A
  1. a. 15 mg Beta-carotene
    b. 500 mg Vit C
    c. 400 IU Vit E
    d. Zing (80 mg w/2mg copper)
  2. Significantly reduced progression in patients w/MODERATE AMD
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2
Q

AREDS Staging

  1. Early Stage
  2. Intermediate Stage
  3. Advanced Stage
A
  1. AREDS Categories 1 and 2: Few or NO Drugsen, or Only SMALL DRUSEN (125 um or equal to). Large are of intermediate drusen, or non-central GA
  2. Tx for CNVM; Photographic documentation of GA involving center of Macula, Non-drusenoid RPE detachment, Rhegmatogenous RD, Hemorrhage under the retina or RPE, and/or Subretinal Fibrosis
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3
Q

AREDS Results

  1. Data from patients with what stage of AMD?
  2. Risk is for Progress to what?
A
  1. 3 and 4 AMD

2. to advanced AMD (not next stage)

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4
Q

AREDS Recommendations

  1. Pts w/What 2 categories of AMD should take AREDS Vitamins?
  2. Patients with what 2 categories of AMD should NOT take AREDS vitamins?
A
  1. 3 and 4

2. 1 and 2….until they reach the next stage…no benefit in early stages (but had a small “n”)

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5
Q

AREDS 2: Study Goals

  1. Primary: To determine whether or not the addition of what could further Decrease AMD Progression?
  2. Secondary: To determine whether LOWER doses of what could be used
  3. Secondary: To determine if what could be omitted. Why?
A
  1. Adding Lutein (10 mg) plus Zeaxanthene (2 mg), or Omega-3 FA (DHA at 350 mg and EPA at 650 mg), or both, to original AREDS formulation would further decrease AMD Progression
  2. of Zn (25 mg vs. 80 mg) could be used…more physiological levels
  3. if Beta Carotene could be omitted (lower lung cancer risk)
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6
Q

AREDS2 Study Protocol

  1. What had to be seen in the eyes?
A
  1. BILATERAL LARGE Drusen in BOTH eyes, or 1 LARGE drusen in one eye, and Advanced AMD in the other.
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7
Q

AREDS Results Summary

  1. Adding what had no effect on progression?
    a. For Pts in the Lowest quintile of what 2 things in dietary intake, what did help reduce progression
    b. Substituting what for what reduced progression to wet AMD?
  2. Lowering concentration of what and getting rid of what from original AREDS formulation had no effect on progression?
A
  1. supplements w/lutein plus Zeaxanthine, DHA Plus EPA, or both, had no effect.
    a. Pts who had low dietary intakes of lutein and Zeaxanthene in diet, taking them did REDUCE PROGRESSION
    b. Beta carotene for Lutein plus Zeaxanthene
  2. of Zn and getting rid of Beta Carotene
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8
Q

Treatment of AMD: Intermediate (AREDS Staging) “Dry”

  1. What formulation is preferred? Why?
A
  1. AREDS formulation w/Lutein and Zeaxanthine, and lower Zn concentration, with no beta carotene. (decreased lung cancer risk in former smokers, just as effective in preventing AMD progression, more effective in preventing progression to wet AMD…most damaging stage)
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9
Q

What is the New AREDS2 Formulation

A

10 mg lutein

2 mg Zeaxanthine

500 mg Vit C

400 IU Vit E

25 mg Zinc oxide/2 mg cupric oxide

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10
Q

Wet: Photodynamic Therapy

  1. What is injected IV?
    a. How is it Activated?
    b. Activation in presence of Oxygen produces what?
    c. Which tissue is more sensitive, neovascular tissue or normal vascular tissue?
A
  1. Verteporin
    a. Shine RED LASER into eye at desired location (NON-THERMAL)
    b. Single Oxygen..damages vascular endothelium…causing Vessel Occlusion
    c. Neovascular tissue
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11
Q

Wet: VEGF Inhibitors/Trap

  1. Why do we use it?
  2. How do we get them into the EYE?
    a. Administered every (how many weeks)?
    b. What is the VEGF Trap called? When can it be given?
    c. Risk of infection of the eye (Endophthalmitis)?
A
  1. VEGF supports growth of leaky new Blood Vessels into the Macula in WET AMD. So we give them this to Prevent or reverse the process
  2. Intravitreal INJECTIONS
    a. . 4 wks

b. EYLEA; every 4 or 8 wks
c. Low

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12
Q

VEGF Inhibitors/Trap

  1. PEGAOTANIB
    a. Anti what?
    b. Approved for what?
  2. RANIBIZUMAB
    a. Fab fragment of what?
    b. Approved for what?
  3. Bevacizumab
    a. Full Ab used to make what?
    b. Approved for what?
    c. Used “off label” for what?
  4. Aflibercept (Elyea or Eylea…depends on how he decides to write it)
    a. Decoy receptor for what?
    b. Approved for what?
A
  1. Anti-VEGF Aptamer
    b. AMD
  2. a. of Humanized Mouse Anti-VEGF Antibody
    b. AMD
  3. a. Lucentis
    b. Cancer
    c. for AMD, recent study showed virtual equivalence to LUCENTIS (Ranibizumab)
  4. a. for VEGF (trap)
    b. for AMD
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13
Q

PDGF Inhibitors

  1. What do they BLOCK/REVERSE?
    a. Greater effect than what by itself?
    b. May require less what?
    c. Inhibits what?
  2. What is it and is it available yet?
A
  1. Development of CNVM when given with VEGF inhibitors
    a. than VEGF inhibitors alone
    b. Less frequent dosing (intravitreal)
    c. Growth/Survival of Pericytes
  2. FOVISTA; late stage clinical Trials
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14
Q

Advanced Dry: Stem Cells

  1. 1 Pt has been treated for “Dry” AMD thus far.
    a. Her vision improved from 20/500 to 20/300 at 4 months, but vision also improved in fellow, untreated eye

b. Improvement was also seen in what?
c. Available?

A
  1. b. RP

c. No. In clinical Trials

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15
Q

Diabetes: CSME (ETDRS)

  1. What is it?
  2. Hard exudates w/in how far from the Center of the Fovea Associated w/Adjacent areas of Retinal Thickening?
  3. Retinal Edema >what area in size and w/in what area of the Center of the fovea?
A
  1. Any retinal edema w/in 500 um of the center of the fovea
  2. 500 um.
  3. > 1 disc area in size, and w/in 1 DD
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16
Q

Tx of CSME

  1. 2 big things?
  2. Laser Combined with what (off label use)
    a. This is for what?
  3. What is used ALONE or WITH LASER TREATMENT?
    a. It’s more effective in the INCREASE of what from BASELINE?
    b. And also in REDUCING what?
A
  1. Focal or Grid Laser
  2. w/Intravitreal TRIAMCINILONE
    a. For diffuse or Extensive Edema
  3. Intravitreal Lucentis
    a. Increase of VA
    b. Reducing Central Retinal Thickness than laser alone
17
Q

Proliferative Diabetic Retinopathy

  1. High risk PDR is treated with what?
  2. What is used OFF LABEL?
    a. Causes REGRESSION of what?
    b. Is it as durable as the first Tx (1.)?

b. Side effects?

A
  1. PRP (Panretinal Photocoagulation)
  2. Intravitreal Avasin (VEGF Inhibitor)

a. of Neovasculature
b. Effect Not as durable as with PRP

b. Yes. Increased risk of Tractional Retinal Detachment

18
Q

Cystoid Macular Edema (CME)

  1. Presentation Varies w/Cause (RVO, Hypertensive Retinopathy, Uveitis, Post Cataract Surgery, Etc)
    a. Impairment of what?
  2. What do we see on OCT?
A
  1. a. of Central Vision w/POSITIVE SCOTOMA

2. Cystic Spaces in OPL and INL on OCT, Petaloid Filling on FA!

19
Q

Tx of CME

  1. Usually TREATED by controlling INFLAMMATION with 1 of 2 things?
  2. Post Cataract Surgery
    a. What Inhibitors are given?
    b. Topical or Periocular what?
    c. What NSAID?
  3. CME associated w/Uveitis
    a. What May be beneficial?
A
  1. with Corticosteroids or other Immunosuppressants
  2. a. Systemic Carbonic Anhydrase Inhibitors (like Acetazolamide)
    b. Corticosteroids
    c. KETOROLAC 0.5% Drops QID
  3. a. Systemic Carbonic Anhydrase Inhibitors
20
Q

Central Serous Retinopathy (CSR)

  1. Localized Detachment of what?
    a. Due to what?
  2. Symptoms?
  3. Usually resolves how?
A
  1. of Sensory Retina at the MACULA
    a. a focal RPE Defect
  2. Bilateral Scotoma, Micropsia, Metamorphopsia, and sometimes MAcropsia
  3. Spontaneously in 3-12 months
21
Q

Tx of CSR

  1. Monitor for what?
    a. What can be given to improve VA?
  2. What Tx can be done at the LEAKAGE SIGHT and in a Grid Covering the Serous Detachment is used in non-resolving or recurrent cases?
  3. What other Therapy can be done at site of Leakage?
  4. What is used OFF Label?
    a. Is it more/less effective than laser?
  5. AVOID WHAT?!
A
  1. for Spontaneous resolution
    a. SRx
  2. Laser Treatment
  3. Photodynamic Therapy
  4. AVASTIN
    a. LESS
  5. STEROIDS!!
22
Q

Optic Neuritis

  1. Loss of vision over what time?
    a. What symptoms does the patient experience?

b. What signs are there?

  1. May have one or more areas of what on an MRI?
    a. Areas of this increase the risk of developing what disease?
A
  1. hours to day
    a. Orbital pain, esp w/Eye movement, Acquired vision loss

b. RAPD, Decreased Color Vision, may have swollen Disc (1/3 of cases) or not (Retrobulbar)

  1. Demyelination
    a. MS
23
Q

Tx of Optic Neuritis

  1. What MAJOR Steroid? (AMY is being injected with it)
    a. Dosage?
  2. Can also use what other steroid?
    a. Dosage?
  3. What other medication can be given Prophylactically?
    a. What is it called?
    b. Dosage?
A
  1. Methylprednisolone
    a. 1g/d IV, pulsed for 3 Days, Taper over 4 Days
  2. Prednisone
    a. 1 mg/kg/d, po
  3. Antiulcer meds
    a. RANITIDINE
    b. 150 mg po, BID
24
Q

AAION

  1. What is it?
  2. What is seen?
  3. What tests should be ordered?
  4. If GSA is suspected, IMMEDIATELY TREAT WITH WHAT?!
    a. Name? (amy…)
    b. Dosage?
    c. Then switch to what?
A
  1. Sudden painless vision loss, Jaw Claudification, Scalp tenderness, Muscle and joint pains, Weight Loss
  2. APD, Vision loss to CF or worse; Pale, swollen disc w/flame hemes, altitudinal VF defect
  3. ESR, CRP, Temporal Artery Biopsy
  4. IV Steroids
    a. Methylprednisolone
    b. 250 mg, q6h for 3 DAYS
    c. Oral Steroid
25
Q

Branch RVO (BRVO)

  1. Symptoms depend on what?
  2. What do we see on examination?
  3. Treat MACULAR EDEMA with 1 of 2 things?
  4. Treat NEOVASCULARIZATION with what?
A
  1. on extent of compromise in Macular Drainage: Blurred vision, metamorphopsia, VF Defect
  2. Dilated Tortuous vessels, Flame-shaped and Dot-blt hemes, CWS
  3. Grid Laser or Intravitreal Tramcinolone
  4. with Scatter Laser Photocoagulation
26
Q

Central RVO (CRVO)

  1. Non-Ischemic
    a. What is it?
    b. All veins are what?
    c. What else do we see?
    d. Tx: INFUSION of what?
    e. TREAT MACULAR EDEMA with what?!
  2. Ischemic:
    a. TREAT NEOVASCULARIZATION with what?
A
  1. a. Sudden unilateral Blurred Vision
    b. Dilated and Tortuous
    c. Flame-shaped and dot-blot hemes, CWS in all four quadrants, “Blood and Thunder”
    d. of tPA (tissue plasminogen Activator) into vein VIA VITRECTOMY
    e. with INTRAVITREAL TRIAMCINOLONE
  2. a. with PRP
27
Q

Choroidopathies

  1. White Dot Syndromes: What are they?
  2. What 2 are usually NOT TREATED?
  3. Serpiginous, Birdshot, and Multifocal Choroiditis are TREATED with what?
  4. CNV in PIC and Multifocal Choroiditis are treated with WHAT?
A
  1. APMPPE, MEWDS, Serpiginous Choroiditis, Birdshot Choroidopathy, Multifocal Choroiditis, PIC
  2. APMPPE and MEWDS
  3. Systemic Steroids or Immunosuppressants
  4. ANTI-VEGF Drugs or LASER
28
Q

Vitreoretinal Traction

  1. Can cause what 2 things?
    a. Depends on location…
  2. Treatment?
A
  1. Macular Hole or other retinal Tear
    a. Macular, Papillary, Ciliary
  2. a. VITRECTOMY
    b. Ocroplasmin (Jetrea): Proteolytic Enzyme (in clinical trials)
29
Q

summary

  1. Inflammatory conditions and EDEMA are generally treated with what?
    a. But sometimes with what?
  2. NEO is usually treated with?
  3. What can also be used for either of the above issues?
  4. Newer meds are still in what?
A
  1. Corticosteroids
    a. VEGF Inhibitors (CSME)
  2. VEGF Inhibitors
  3. Laser Photocoagulation
  4. Clinical Trials

Ocular Pharm (13 decks)

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