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Ophthalmology > Ocular Pharmacology > Flashcards

Ocular Pharmacology Flashcards

0
Q

True or false: physiological barriers prevent the penetration of systemically-administered drugs into the eye at therapeutic concentrations.

A

True.

Although, in an inflamed eye, drug penetration may be greater.

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1
Q

Name the properties of a topical drug which permits penetration of corneal epithelium and stroma into the anterior chamber.

A

A molecule with hydro- and lipophilic properties gives best absorption.

Fat-soluble drugs readily cross the corneal epithelium but not the corneal stroma. Water-soluble drugs cannot penetrate the corneal epithelium but can cross the stroma.
The endothelium presents only a minor barrier.

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2
Q

Which two properties favour ocular absorption of systemically administered drug?i

A

High lipid solubility and low molecular weight.

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3
Q

Give two examples of eye disease where topical treatment may be supplemented by subconjunctival injection.

A
  1. Acute anterior uveitis

2. Bacterial keratitis

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4
Q

True or false: the treatment of intraocular bacterial infection does not frequently involve the injection of ABx directly into the globe.

A

False; it does frequently involve direct injection into the globe.

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5
Q

True or false: the risk of ocular side effects from drugs administered systemically (for non-ocular disease) is rarely great and is usually outweighed by clinical therapeutic necessity.

A

True.

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6
Q

What are the adverse effects of amiodarone on the eye?

A

Corneal deposits (vortex keratopathy) - Tom had these with his AF Rx

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7
Q

What are the adverse effects of antiepileptics on the eye?

A

Ocular motility dysfunction

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8
Q

What are the adverse effects of benzhecol, benztropine and atropine on the eye?

A

Pupillary dilatation (risk of angle closure glaucoma)

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9
Q

What are two adverse effects of systemically-administered corticosteroids on the eye?

A
  1. Cataract

2. Glaucoma

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10
Q

What are the adverse effects of digitalis on the eye?

A

Abnormal colour vision

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11
Q

What are the adverse effects of ethambutol and quinine on the eye?

A

Optic neuropathy

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12
Q

What are two adverse effects of hydroxychloroquine and chloroquine on the eye?

A
  1. Retinal degenerative change (“bull’s eye macula)

2. Corneal deposits

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13
Q

What are the adverse effects of opiates on the eye?

A

Pupillary constriction

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14
Q

What are three adverse effects of phenothiazines on the eye?

A
  1. Retinal oedema
  2. Pigmentary retinopathy
  3. Ocular motility dysfunction
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15
Q

What are the adverse effects of sulphonamides and NSAIDs on the eye?

A

Stevens-Johnson syndrome

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16
Q

What are the adverse effects of tamoxifen on the eye?

A

Pigmentary neuropathy

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17
Q

What are 5 types of drugs used in glaucoma treatment (where different types of glaucoma require different therapeutic approaches)?

A
  1. Beta blockers (timolol, carteolol, betaxolol, levobunolol)
  2. Muscarinic (parasympathetic) stimulants (pilocarpine)
  3. Alpha-2 stimulants (brimonidine, apraclonidine)
  4. Latanoprost
  5. Carbonic anhydrase inhibitors (systemic = acetazolamide; topical = dorzolamide).

*all are topical except where indicated

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18
Q

How do beta blockers work to treat glaucoma?

A

Reduce aqueous secretion by inhibitory action on beta-adrenoreceptors in the ciliary body.

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19
Q

How do muscarinic (parasympathetic) stimulants/agonists work to treat glaucoma?

A

Increase aqueous outflow via trabecular meshwork by ciliary muscle contraction.

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20
Q

How do alpha-2 stimulants/agonists work to treat glaucoma?

A

Reduce aqueous secretion by selective stimulation of alpha-2 adrenoceptors in the ciliary body and increase outflow vis uveoscleral route.

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21
Q

How does latanoprost work to treat glaucoma?

A

A prostaglandin analogue; increases aqueous outflow by uveoscleral route.

22
Q

How do carbonic anhydrase inhibitors work to treat glaucoma?

A

Reduce aqueous secretion by the ciliary body.

23
Q

In treating glaucoma with beta blockers, what are some of the ocular and systemic side effects of this drug?

A

Ocular: irritation

Systemic: bronchospasm, bradycardia, exacerbation of heart failure, nightmares.

24
Q

In treating glaucoma with muscarinic (parasympathetic) stimulants, what are some of the ocular and systemic side effects of this drug?

A

Ocular: miosis (reduced vision in presence of cataract, retinal examination impaired); spasm of accommodation, brow ache.

Systemic: sweating, bradycardia, gastro-intestinal disturbance.

25
Q

In treating glaucoma with alpha-2 stimulants, what are some of the ocular and systemic side effects of this drug?

A

Ocular: allergy, mydriasis, eyelid retraction.

Systemic: dry mouth, hypotension, drowsiness, headache.

26
Q

In treating glaucoma with latanoprost, what are some of the ocular and systemic side effects of this drug?

A

Ocular: iris colour change, conjunctival hyperaemia

Systemic: bitter taste

27
Q

In treating glaucoma with carbonic anhydrase inhibitors, what are some of the ocular and systemic side effects of this drug?

A

Ocular (topical drug): irritation, allergy.

Systemic (& generally with systemic version of drug): malaise, paraesthesia, urea and electrolyte disturbance, aplastic anaemia.

28
Q

Name two types of drugs which act as mydriatics and cycloplegics [for retinal examination and objective refraction (retinoscopy)].

A
  1. Antimuscarinics (tropicamide, cyclopentolate, atropine).
  2. Alpha-stimulant (phenylephrine)

*all topically applied

29
Q

By what mechanism do antimuscarinics work as a mydriatic/cycloplegic to enable retinal examination and objective refraction (retinoscopy)?

A

Anti-muscarinics inhibit muscarinic receptors of parasympathetic nervous system to paralyse pupillary sphincter and ciliary muscle.

30
Q

By what mechanism do alpha-agonists work as a mydriatic/cycloplegic to enable retinal examination and objective refraction (retinoscopy)?

A

Alpha agonists work as a mydriatic to stimulate dilator muscle of the pupil; no cycloplegic affect.

31
Q

What are some of the ocular and systemic effects of antimuscarinics, which act as mydriatics and cycloplegics for retinal examination and objective refraction (retinoscopy)?

A

Ocular: blurred vision (especially for near), glare, angle closure glaucoma.

Systemic: tachycardia, dry mouth, confusion, tremor.

32
Q

What are some of the ocular and systemic effects of alpha-stimulants, which act as a mydriatics for retinal examination and objective refraction (retinoscopy)?

A

Ocular: blurred vision, glare, angle closure glaucoma.

Systemic: hypertension.

33
Q

Name 4 types of lubricants which can be used for the treatment of dry eye?

A
  1. Carbomers
  2. Hypromellose
  3. Polyvinyl alcohol
  4. Liquid paraffin

*all topical; exact mechanism depends on agent.

34
Q

Name some of the ocular and systemic side effects of eye lubricating agents?

A

Ocular: preservative allergy/toxicity, blurred vision (especially ointments).

Systemic: nil.

35
Q

Name 5 categories of anti-inflammatory agents used for treating ocular disease.

A
  1. Corticosteroids (prednisolone, betamethasone, dexamethaxone)
    * corticosteroids most important
  2. Systemic immunosuppressants
  3. Topical mast cell stabilisers (cromoglycate, nedocromil, alomide)
  4. Antihistamines (topical = levocabastine; systemic = chlorpheniramine, terfenadine, cetirizine).
  5. NSAIDs (systemic = help to control ocular pain and inflammation; topical = increasingly used for pain of corneal abrasion, for inflammation after cataract surgery, and to maintain pupil dilation during cataract surgery).
36
Q

By which three methods can corticosteroids be administered to treat eye disease?

A

Topical, periocular injection, systemic.

37
Q

How do corticosteroids act to treat eye disease?

A

Suppression of a broad spectrum of inflammatory processes.

38
Q

Name some of the ocular and systemic side effects of corticosteroids.

A

Ocular: glaucoma (especially with local administration), cataract (especially prolonged systemic use), exacerbation of some infections (eg. herpes simplex).

Systemic: negligible with topical use; common and varied with systemic administration.

39
Q

Name some ocular and systemic side effects of topical mast cell stabilisers.

A

Ocular: irritation.

Systemic: nil.

40
Q

By which mechanism do NSAIDs work?

A

They modulate prostaglandin production.

41
Q

Name some ocular and systemic side effects of topical and systemic NSAIDs.

A

Ocular (topical): nil

Systemic (systemic): peptic ulcerstion, asthma.

42
Q

Name 5 commonly used antibacterials in ophthalmology.

A
  1. Chloramphenicol
  2. Gentamicin
  3. Ciprofloxacin
  4. Neomycin
  5. Fusidic acid

Topically applied antibacterial and antiviral agents are very commonly prescribed; the use of antifungal and antiparasitic agents is much less frequent.

43
Q

Name three methods by which antibacterials can be administered to treat eye disease.

A
  1. Topical
  2. Intra-ocular (occasional)
  3. Systemic
44
Q

Name some ocular and systemic side effects arising from antibacterial treatment of eye disease.

A

Vary with agent.
Ocular: allergy, corneal toxicity common with intensive use.

Systemic: generally only with systemic use.

45
Q

Name one common antiviral used in ophthalmology.

A

Acyclovir.

Inhibits herpes virus DNA synthesis.

46
Q

Name three methods by which acyclovir can be given in ophthalmology?

A
  1. Topical
  2. Systemic
  3. Intravitreal
47
Q

Name some ocular and systemic side effects of acyclovir.

A

Ocular: blurred vision, corneal toxicity.

Systemic: rashes, kidney, liver and other effects may occur with systemic use.

48
Q

Name three local anaesthetics commonly used in ophthalmology.

A
  1. Oxybuprocaine
  2. Amethocaine
  3. Lignocaine

Major uses are to relieve pain and thereby assist with clinical examination, and the facilitation of surgical anaesthesia. They block conduction along nerve fibres.

49
Q

Name two methods by which local anaesthetics can be administered in ophthalmology.

A
  1. Topical

2. Periocular injection

50
Q

Name some ocular and systemic side effects associated with local anaesthetics in ophthalmology.

A

Ocular: irritation, corneal toxicity.

Systemic: generally accidental intravascular or intrathecal injection during surgical anaesthesia; cardiac arrhythmias; respiratory depression.

51
Q

Name a compound/drug which is used for management of certain ocular motility disorders, blepharospasm, and to induce ptosis for corneal protection.

A

Botulinum toxin.

Always injected into the site of action.

52
Q

What are three indications for the use of botulinum toxin in ophthalmology?

A
  1. Management of certain ocular motility disorders
  2. Blepharospasm
  3. To induce ptosis for corneal protection.
53
Q

What is the mechanism of action of botulinum toxin, as well as side effects?

A

Prevents release of the neurotransmitter acetylcholine at neuromuscular junctions.
Side effects depend on the treatment site (eg. unwanted ptosis or double vision).

Ophthalmology (25 decks)

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