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Week 130 - Visual Disturbance > Ocular Pharmacology > Flashcards

Ocular Pharmacology Flashcards

0
Q

List 2 disadvantages of ocular treatments applied directly to the eye

A

Any two of the following:

1) technically more difficult than taking a tablet
2) risk of damage to the eye
3) a limited volume can be administered

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1
Q

List 2 advantages of using ocular treatments applied directly to the eye

A

1) allows quick action at sight of the problem

2) minimises systemic effects

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2
Q

For how long should an individual keep their eye closed after administering eye drops?

A

30 seconds

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3
Q

If 2 types of eye drop are required how long should be left between administering the first and the second type of drop?

A

5 mins should be sufficient to allow the first to be absorbed without the second washing it away

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4
Q

When should you advise a patient to use eye ointments and why?

A

At night before bed as a common side effect is blurry vision

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5
Q

What is an adjuvant?

A

A substance which enhances the body’s immune response to an antigen

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6
Q

What is a squint?

A

A squint is defined by a permanent deviation in the direction of the gaze of one eye

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7
Q

What is a sympathomimetic and how does it act?

A

It mimics the effects of the sympathetic nervous system yet acting on alpha-1 receptors, causing mydriasis (pupillary dilation)

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8
Q

What is the most commonly used sympathomimetic?

A

Phenylephrine

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9
Q

Give 3 circumstances or groups of people in which phenylephrine is less effective and explain why

A

1) diabetes mellitus - muscles of the iris become less flexible
2) dark iris - phenylephrine will bind to the melanin rather than the alpha-1 receptors meaning more is required
3) elderly - general wear and tear of the iris sphincter muscles

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10
Q

What are the side effects of phenylephrine and what advice should be given to patients as a result

A

Photophobia (wear hat or sunglasses following the appointment)
Blurred vision (don’t drive/bring a companion)
Stinging on instillation
Acute glaucoma as the drug increases intraocular pressure (rarely)
Hypertension and arrhythmias (rarely)

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11
Q

How long does it take phenylephrine to take effect and how long do the effects last?

A

Achieve mydriasis in 60-90 minutes

Effects last for 5-7 hrs

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12
Q

What is an alternative to (or can be used in conjunction with) with sympathomimetics?

A

Antimuscarinics

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13
Q

Give examples of commonly used antimuscarinics and list them in order of potency (weakest to strongest)

A

Tropicamide 1% - first line and weakest
Cyclopentolate 0.5% - slightly stronger
Atropine - strongest (used least often in this setting)

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14
Q

What part of the nervous system controls accommodation?

A

Parasympathetic

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15
Q

On which structure of the eye do antimuscarinics take effect?

A

Ciliary body

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16
Q

List the differences between the action time and type of actions that Tropicamide and cyclopentolate perform

A

Tropicamide - effect in 15 mins, lasts 4-6 hrs
Cyclopentolate -effect in 30-60 mins, lasts upto 24 hrs (Helen Day suggests this causes cycloplegia - paralysis of ciliary body - and that Tropicamide does not although other sources say Tropicamide 1% does!)

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17
Q

What drops would you administer to a patient suffering from uveitis?

A

Cyclopentolate 0.5%, 1 drop every 6-8hrs.

It relieves the pain by paralysing the ciliary body

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18
Q

What are the side effects of antimuscarinics (Tropicamide, cyclopentolate, atropine)?

A

Same as those for sympathomimetics (stinging on instillation, raised intraocular pressure, photophobia and blurred vision)
Plus - dry mouth, flushing, confusion

19
Q

What are the symptoms of acute-angle closure glaucoma?

A 
Red, painful eye
Blurred vision
Nausea and vomiting
Headache
(Exacerbated by mydriasis, is fairly rare but is a medical emergency)
20
Q

How do parasympathomimetics act?

A

They mimic the effect of ACh on muscarinic receptors (open up drainage channels in trabecular meshwork)

21
Q

What is the physiological effect of parasympathomimetics on the pupil?

A

They reverse mydriasis in around 30 mins and last for around 6hrs

22
Q

What is the principle parasympathomimetic?

A

Pilocarpine

23
Q

Suggest a good ocular drug to treat glaucoma

A

Pilocarpine

24
Q

List 4 possible side effects of pilocarpine

A

Headache / browache
Burning / stinging on instillation
Myopia
Risk of retinal detachment

25
Q

What type of drug will inhibit the production of aqueous humour?

A

Beta-blockers e.g. Timolol

Carbonic anhydrase inhibitors e.g. Acetazolamide (po or IV) or Dorzolamide (topical)

26
Q

How do drugs such as Timolol and Dorzolamide treat glaucoma?

A

By reducing the production of aqueous humour and therefore reducing the intraocular pressure

27
Q

Give 4 functions of the tear film in the eyes

A

Flush away debris
Antimicrobial protection (to an extent)
Optimise visual function
Lubricate eyelid movement

28
Q

What is the first line treatment for dry eyes?

A

Hypromellose 0.3% (May also administer Ilube (acetylcysteine)to break down excess mucus)

29
Q

Give three other possible treatments for dry eyes

A

Carbomers e.g. Viscotears
Polyvinyl alcohol e.g. Liquifilm tears
Lacrilube (ointment)

30
Q

If prescribing Lacrilube when would you advise a patient to use it?

A

At nighttime as it can cause blurred vision, being very viscous

31
Q

What are minims in relation to artificial tears and ocular lubricants?

A

They are single-use bottles which means they can be preservative-free which reduces risk of sensitivity to them

32
Q

If you suspect a foreign body has entered an eye and caused damage what topical drug would you use to examine the eye

A

Fluorescein; yellow / orange dye highlights damage to the conjunctiva or cornea

33
Q

Give 2 examples of anaesthetics you would use before a painful procedure on the eye e.g. Foreign body removal or ocular injection

A

Lidocaine or Proxymetacaine (no significant difference between the 2)

34
Q

What is the first line treatment for superficial eye infections?

A

Chloramphenicol (particularly staph infections)

35
Q

For how long should you continue treatment after infection clears?

A

48hrs (continue the 1drop every 2 hrs)

36
Q

What does Chloramphenicol NOT treat?

A

Pseudomonas

37
Q

What would be a good second line treatment for Staph infections?

A

Fusidic acid

38
Q

Name 4 antibacterial preparations that will treat Staph infections and indicate which one of them will not also treat corneal ulcers

A

Ciprofloxacin
Levofloxacin
Ofloxacin
Gentamicin (only one that doesn’t also treat corneal ulcers)

39
Q

List some common conditions that can cause dry eyes
(Results from a deficiency in any of the 3 tear film layers - outer lipid layer, middle aqueous layer or inner mucin layer)

A

Alterations in hormones e.g. Menopause, pregnancy, contraceptive pill
Rheumatoid arthritis (autoimmune inflammatory conditions)
Blepharitis (Staphylococcal or seborrhoeic)

40
Q

How does blepharitis present?

A

Irritable, red, sticky eyes

Management = lid hygiene, antibiotics and artificial tears

41
Q

List some causes of ptosis

A 
Involutional (ageing) changes
Third nerve palsy
Myasthenia gravis
Trauma to levator muscle
Horner's Syndrome
42
Q

What is the most common cause of visual loss?

A

Compression of the optic nerve (the optic disc may also be swollen or atrophic)

43
Q

What are the most common affects of optic nerve compression?

A

Reduced visual acuity, colour vision loss and peripheral vision loss

44
Q

What commonly causes diplopia (double vision)?

A

Misalignment of the eyes in straight ahead gaze or upon movement

45
Q

A patient presents with a very painful left eye which is looking very red. He is complaining of hazy vision. On examination you notice the pupil of that eye is oval and non-reactive to light, you can detect no red reflex. What is he suffering from?

A

Angle closure glaucoma

Week 130 - Visual Disturbance (3 decks)

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