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GLOCKTOMETRY > OD > Flashcards

OD Flashcards

1
Q

Diagnostic Dyes (medical devices)

A

Fluorescein Sodium
Rose Bengal
Lissamine green - unverified legally

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2
Q

Fluorescein - Uses, mode, AR, preparation

A

1) Goldmann, cL, corneal integrity, tear BUT
2) Ph indicator
3) rare
4) Single dose Minims 1mg (1&2%)

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3
Q

Lissamine Green - Uses, mode, AR, preparation

A

1) Dry eye
2) stains devitalized cells
3) Less than Bengal
4) paper strips 1.5mg

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4
Q

Bengal Rose (Uses, Mode, AR, Preparation)

A

1) Keratoconjunctivits sicca
2) stains devitalized cells
3) stings and stains skin
4) paper strip 1.5mg

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5
Q

Paper strips as vehicles (advantages)

A

Economy and storage
not aqueous, sterile
when eye vunerable

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6
Q

Why fluorescein?

A

visible in low conc

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7
Q

Topical Anaesthesia uses, mode of action, onset and recov time, AR, preps

A

1) applanation tonometry, lenses; superficial FB, gonioscopy, ultrasound
2) blocks increase in nerve permeability, to na+ ions, no depolarization
3) 30 seconds: 25/30 mins
4) toxicity & allergy
5) minims -
- proxymetacaine0.5%, - stings signif less and store -in refrigerator
- oxybruprocaine0.4% - stings signif
- tetracaine 0.5% and 1% - minor surgery
- lidocaine 4% +0.25% fluorescein- stings and surgery onset 1 min, recov 20-30mins

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8
Q

Re-usable ophthalmic devices, steps

A

1) rinse in water and saline for irrigation >30 secs
2) clean surfaces with detergent >30 secs
3) immerse in na hypochlorite 1% for 10 mins
4) rinse in 3 changes of water for irrigation >10mins
5) shake, dry, store
6) conventional disinfection

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9
Q

Why topical Anaesthesia?

A

inhibit reflex tearing

facilitate corneal absorption

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10
Q

Dry eye, what do we do?

A

give: povidone, theratears, actimist spray, rohto

refer severe cases and Sjorgens syndrome

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11
Q

Importance of adequate aq production and drainage of aqueous

A

1) maintain tear nutrients
2) moisten the surface
3) mechanical flushing system

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12
Q

Mucin deficiency, effects on tear film and why?

A
  • Unstable tear films, abnormal tbut

- reduction in goblet cells

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13
Q

Importance of lipids

A

bacterial release of lipase to hydrolyse reactions

decreases rate of spreading

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14
Q

Impaired lid function

A

Exposure keratitis

poor mucous distribution

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15
Q

Lubricants

A 
Acetylcysteine
Carbomers
Carmellose sodium
hydroxyethycellulose
hypromellulose
liquid paraffin
macrogols
paraffin, yellow and soft
polyvinyl alcohol
nacl
na hyaluronate
soya bean oil
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16
Q

Tear substitutes, types of Carbomers and properties

A 
most prescribed tear substitute after hypromellulose
Carbomers:
polymer of acrylic acid
reduce natural elimination of tears
retention time 7 x pva
drops 4x a day not 20
protects in sleep
less benzalkonium allergy risk
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17
Q

Contact lens product categories

A 
- Designer Molecule Disinfectants - (biocides)
H2O2, 3%, req neutralisation
Polyhexamide, common constituent
Polyquaternium 1
Alexidine, Amidoamine
  • Surfactant cleaner - poloxamer, removes bacteria,
  • Chelating agent - EDTA removes calcium and protein
  • Demulcents - water soluble polymers
  • Propylene Glycol - enhanced water retention on hydrogel lens surface
  • Tonicity and Buffering agents - phosphates, borates & citrates, resist pH change
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18
Q

Ocular first aid advice

A

WHAT TO HAVE

  • Keep calm
  • Auxiliary staff recognising important sx
  • Record is essential
  • Drugs used - fluorescein, saline, tear subs, anti infective, allergy

BE PREPARED FOR

  • superficial FB - evert, sketch staining pattern and record advice give. If embedded, refer. Check both eyes
  • Harmful chem agents - lime and alkali DANGEROUS AS NOT SELF LIMITING, irrigate, refer if signif damage, but H/S usually protects
  • AR to instillation, Acute ocular pathology
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19
Q

Most likely presentations of FB

A 
Sports - cycling, running, tennis
DIY - drills, sanding, gardening
Everyday tasks - elec toothbrush
Corneal epitheliopathy - finger nails
The Lost Contact Lens...
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20
Q

Optometric Drug Use categories

A 
Extraocular
Intraocular
Cycloplegia, 
mydriatics
miotics
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21
Q

Muscle Pathways: Cillary, Sphincter, Dilator

A

Cillary

  • CILLARY & SPINCTER.
    PARASYMPATHETIC
    acetylcholine - Muscarinic. Via Cholinegic (neuro - effector)

DILATOR AND MULLERS MUSCLE SUPERFICIAL CONJUNCTIVAL VASCULATURE

SYMPATHETIC
Nor adrenalin - Alpha 1. Via Adrenergic (neuro - effector)
alpha 2 receptors on pre synaptic nerve

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22
Q

Which drugs effect which receptors

A
  • Cycloplegia (antagonist) - Block muscarinic (CYCLOPENTOLATE)
  • Mydriasis - Block Muscarinic (TROPICAMIDE) and stimulate Alpha 1 (PHENYLEPHERINE)
  • Miosis - Stimulate Muscarinic (PILOCARPINE) and block Alpha 1 (THYMOXAMINE)
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23
Q

Pharmacological Group

A
  • Parasympathomimetic - Stimulate ACh, accom and miosis, cholinomimetic esterase’s & alkaloids. PILOCARPINE
  • Anticholinesterases - Increase ACh, accom and miosis, indirect muscarinic, reversible (physostigmine) and irreversible (ecothiophate)
  • Antimuscarinics - ACh antagonist,
    Natural - atropine (as), hyoscine
    Synthetics - cyclopentolate & tropicamide(EL), Homatropine (AS)
  • Sympathomimetics - cause adrenergic action. Cause mydriasis (widening)
    Catecholamines (hormones in body)
    Non - catecholamines - phenylephrine, naphazoline, xylometazoline, brimonidine, apraclonidine
  • Adrenergic blockers - block adrenergic receptors
    miosis, ptosis
    Thymoxamine
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24
Q

The aim of cycloplegics? and how does it work? Types?

A

Estimate static refraction by eliminating accommodation as a variable.

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25
Q

When to use Cycloplegics (signs) and sx

A 
Hyperopia, FH
unstable ESOP
anomalies of AC/A
malingering
Refraction surgery

Accom spasm,
asthenopia,
visual conversion reaction

26
Q

Advantages and Disadvantages of Cycloplegia

A

Ad
full static rx, assoc mydriasis useful

DIsad
unnatural, aberrations, glare disability, toxicity

27
Q

Alternatives to cycloplegia and ensure

A

Fogging, Mohindra, Auto-rx

Dosage, 
progression, 
retinoscopy, 
pre and post cyclo - D & N     WHILE CYCLO, JUST D     
prescribing, AR
28
Q

Cyclopentolate, action n recovery times

A

Main cycloplegic 1%, 2 drops of 0.5%
action time - c 40m m 20m
Recovery times - c24hr m 48hr

29
Q

Tropicamide, who, action n recov times, AR?

A 
Mydriatic normally but cycloplegic for olders
and is rapid
0.5 and 1%
Action time - c 20m M 15m  
recovery -   c 3hr M 5hr
peak period 10 -15 mins
toxic reactions rare
30
Q

Atropine and Homatropine

A

Rarely used in GP, sx of poisoning

young child with no BV

31
Q

Application of Mydriatics

A

Anti muscarinic, sympathomimetics

General - unsure about cause, stereo needed, risk of detachment

Specific - diab, cataract, monocular px

Instrumentation - ret camera, mono bin, slit lamp

32
Q

CN of mydriatics, risk and how to minimalize

A

1) consent, measure diameter before, monitor change, glare sensitivity
2) 1/5000 ACG, risk when driving and cycling. Risk of missed pathology outweighs risk of dilation

3)

  • IOP before and after
  • angle
  • sx of sub acute attack of closed angle glaucoma
  • management of acute attack
33
Q

Sympathomimetics and synergistic combinations

A

1)

  • phenylephrine
  • relatively slow action
  • pupil reactions retained

2)

  • can reduce cycloplegic effect
  • rapid action and recovery
  • use of topical anaesthesia
34
Q

Miotic drugs, what do they do, categories

A

Causes constriction of pupil
assists recovery, rarely used in practice

Categories - parasympathomimetic, anticholinesterases, adrenergic blockers

Parasympathomimetic - Pilocarpine, 1% ,2% ,4%

  • POM - AS)
  • CI - phenylephrine
  • limited use for POAG

Anticholinesterase
-Physostigmine, not available in practice, very pronounced miosis
ecothiosulphate

Adrenergic - 
Thymoxamine (AS), alpha 1 adrenergic antagonist.
-refrigerate
-stings a lot
-Conjunctival ptosis
35
Q

What is infection

A

1)Detrimental colonization by foreign species
2)this pathogen uses the bodies resources
main ones - bacteria, fungi, virus. Optoms do bacteria

Mechanisms of action

  • > Antibacterial
  • > Antiviral
  • > Antifungal
36
Q

Anti viral and Antifungals

A

Only SP and IP

  • Antivirals (SP & IP)
    aciclovir (POM)
    ganciclovir (POM)
  • Antifungals (SP & IP)
    Specialist centres
37
Q

Anti bacterial

A

superficial infection, usually staphyloccoci, usually

incorporates a steroid and broad spectrum

EL -
- Chloramphenicol - eye infections. Inhibit protein synthesis, binding to 50s subunit
CI - pregnant, hypersensitivity, bone marrow
disorder
AR - aplastic anemia
Minims.

 - Fusidic acid - protein synthesis inhibitor for eye 
   infection.
   CI - Hypersensitivity
   AR- transient stinging
   Ointment
  • Propamidine isetionate - Modify DNA uptake, minor eye infections
    CI - hypersensitivity
    Ointment - Golden eye

AS -

Amino glycosides - gentamycin, Polymycin B, neomycin, tobramycin

Quinolones - ciprofloxacin, oloxacin, levofloxacin, moxifloxacin

Macrolide antibiotic - Azithromycin

SP AND IP - all current

38
Q

Inflammatory response and allergy mechanism

A

1) Response to threat: infection, allergy or trauma
2) Biological response of vasculature
3) ocular structures susceptible to damage

[antigen-antibody]>allergen>IgE >mast cells >histamine

vasodilation, itching, oedema

39
Q

Mechanisms of action, corticosteroids

A

1) Corticosteroids
- inhibit cyclooxygenase, so decreased prostaglandin
- short term therapy
- eg Hydrocortisone and prednisolone
- AR - raised IOP
- corneal thinning
- betamethazone, dexamethazone, fluromethazone, rimexalone, loteprednol, etabonate, prednisolone
- ONLY SP AND IP AND ALL

2) NSAID
- inhibit prostaglandin synthesis
- diclofenac sodium (AS), the rest all IP AND SP

3) Antihistamines (antagonist),
- Block H-1 histamine receptors
- antazoline EL, Emedastine AS, ALL SP AND IP

Antazoline

  • indic, allergic conjunc
  • CI <5yrs, cl problems
  • AR - transient stinging
  • prep - Otrivine-Antistin: 0.5%

4) Mast cell stabilizers,
- Inhibit CA2+ inflow, no degranulation
- loading does req
- Sodium cromoglycate EL
- lodoxamine EL
- nedocromil AS
- ALL SP AND IP

Sodium cromoglycate

  • acute allergic conjunc/season
  • CI - soft CL, hypersensitivty
  • AR - transient stinging
  • prep - opticrom

Lodoxamine

  • inhibits release of Mast cell mediators
  • allergic conjuc
  • CI - <4 yrs, CL, hypersensitivity
  • AR, burning, itching
  • prep -alomide eyedrops 0.1%

5)Vaso constrictors

40
Q

Anti histamines + MSC

A

No EL

AS
Azelastine Hydrochloride - AS
Ketotifen - AS
Olopatadine - AS

IP AND SP
all available

41
Q

Vasoconstrictors

A

determine cause of redness
- prolonged use can cause reactive hyperaemia
eg - naphazoline, xylometazoline often
combined with antihistamine

-we have access to all

42
Q

Glaucoma

A

1 - Beta blockers, decrease aqueous humor production = lower IOP
prostaglandin first choice
CI - asthma, heart/lung disease
Receptor sensitivity - B1 heart, B2 Bronchioles
- Timolol - 12% of all Rx
dorsolamide (Cosopt ®), brimonidine(Combigan ®)
brinzolamide (Azarga ®), latanoprost (Xalacom ®)
travoprost (DuoTrav ®), bimatoprost (Ganfort ®)
tafluprost (Taptiqom ®), Betaxolol, Carteolol,
Levobunolol

2 - Prostaglandin analogues & prostamides
Latanoprost, tafluprost, travoprost, bimatoprost
- AR - eyelash growth, dark lid skin

3 - Sympathomimetics
brimonidine, a2 agonist
apraclonidine, a2 agonist used after surgery

  • combined products
  • brimonidine & timolol - combigan
  • brimonidine & brinzolamide - simbrinza

5 - Carbonic anhydrase inhibitors
Dorzolamide, 3x daily
Brinzolamide, 2x daily, more comfort
Dorzolamide + timolol =cosopt

6 -Miotics
- pilocarpine, 1,2,4% drops - muscarinic receptor agonist
drops iop by 15-20%, 3x/4x a day
superseded by newer agents
significant AR
43
Q

Role of optom in AR

A

> Monitor - Large sample, wide age range, regular visits
Detect - Base line data, quantify OAR, assess to FIT
Report - Reporting essential, implied criticsm, med continues.

report

  • MHRA.GOV.UK
  • CONSULT GP INDEPENDANTLY
  • MUST INFORM GP
  • Black Triangle drugs
  • Drugs given, vaccines, OCT, herbal remedies
  • areas of interest, children, young and elderly
44
Q

AR - Medical Devices, Sources of information, probability of occurrence

A
  • CL, care products
  • ophthalmic equipment
  • dressing
  • disinfecting, sterilizing equipment

SOURCES OF INFORMATION
> patient - part of GH assessment, name of drug/condition, consult BNF
> local RX - Prescribing profile, cardiovascular/CNS, log book of medicines
> Black triangle drugs
> mims.co.uk
> mhra.gov.uk
> emc.medicines.org.uk

CONDITION - CHRONIC PATHOLOGY METABOLISM - route of administration
PX - AGE, HISTORY, GENETIC - systemic AR
DRUG - NATURE, DOSE, INTERACTIONS

AMIODARONE - anti-arrhythmic
 - corneal microdepositis 
   no stain, clear after 3-7 months, change lens
 - night glare
 - Optic Neuritis, phototoxicity

VIGABATRIN - for epilepsy
VF constriction - dose dependant,
Field deficits in CV, CS, VA

CORTICOSTEROIDS - suppression of inflam/allergy
Cataract - PSC, BILATERAL, IRREVERSIBLE
Raised IOP - glaucomatous change
Corneal Oedema

HYDROXYCHLOROQUINE - for rheumatoid arthritis
corneal deposits, bulls eye macular, check peri-macular field

TAMOXIFEN - Post-surgery breast cancer
Retinopathy, keratopathy, cataract

Vortex corneal deposits - amiodarone, chloroquine, tamoxifen, chlorpromazine, indometacin.

45
Q

Auxiliary topics - ocular peri-operative drugs

A
  • Ocular peri-operative drugs - injected into AC at surgery time to prepare.
    prevent inflam, pain, prophylaxis

Diclofenac, flurbiprofen: prevent miosis in surgery
cefuroxime: after cataract surgery

1) apraclonidine - alpha 2-adrenoreceptor agonist, reduce IOP via reducing AH prod
2) acetylcholine - instilled into AC in surgery, cause rapid Miosis
3) sodium hylauronate - with salt solution in surgery
4) sodium chloride - 0.9% for surgery irrigation
5) povidone-iodine - antisepsis for conjuc, prevent infection

46
Q

Auxillary topic - Sub-foveal choroidal neovascularisation

A
  • Sub-foveal choroidal neovascularisation
    Anti-VEGF

Pegaptanib
Ranibizumab
Aflibercept

  • Verteporfin
    subfoveal choroidal neovascularisation
    activated by local irradiation using non-thermal red light, produces cytotoxins
47
Q

Auxiliary topics - Vitreomacular traction

A

Vitreomacular traction
- Ocriplasmin
including when associated with a macular hole of
diameter less than or equal to 400 microns.

48
Q

Auxiliary topics - Nutritional supplements

A

good and bad
robust evidence req for AMD
carotenoids, balanced diet, healthy weight, no smoking

49
Q

Auxiliary topics - drugs for myopia treatment

A
  • pirenzepine
  • 7-methylxanthine (‘7-mx’)
  • Atropine (CYCLOPLEGIA +MYDRIASIS)
    enters muscarinic receptors (cillary muscle) via M3
    Inhibits myopia in children action on sclera
50
Q

Intro

A

AFLUC

EL, AS, SP, IP

Extraocular drugs - Fluorescein, anaesthesia, anti histamines, anti bac, tear subs

Intraocularagents - cycloplegics, miotics, mydriatics

Drug sources - inorganic, organic, synthesis, proteomics & genomics

Nomenclature

1) full chem name
2) brand
3) shorter generic name

51
Q

Administration

A 
3 points before admin:
1) Clinical data
2) Why this drug?
3) Indirect consequence of it?
CONSENT

Before
Why
What
When
Give leaflet - educating: driving, topical anaesthesia, AR/allergy
Principle concerns
1- Mydriatics - dilation dont drive etc, glare, ACG
2- topical anaesthetic - 15 mins before instillation, 25 mins before CL reinsert
3- AR - ocular/ systemic

Administration - 
Wash hands and short nails
4D's
DRUG
DOSE
DATE
DISPOSAL

Instillation technique order

1) remove CL
2) clear throat
3) head back
4) nose horizontal
5) expose fornix
6) keep looking back
7) instil in fornix
8) release
9) head forward
10) close eyes and wipe

52
Q

Formulation

A

Examples of excipient
-buffers, chelating agent, viscosity agents and electrolytes, antimicrobial preservatives

Sterility -
Minims: (sterile and single dose)
Multidose containers for preservatives

Preservatives (antimicrobials) - Quaternary ammonium compounds, Benzalkonium Chloride (0.01%), Mercurials (20%), Phenylmercuric nitrate (0.002%), Alcohols (20%), Chlorobutanol, Others
Boric acid, Chlorhexidine (0.01%)

Stability -
Store in cool and dark
Ph vs tonicity
- Cornea is semi permeable membrane,
- Isotonicity is 300 milliosmoles/kg and isotonic to tear film, eye drops change this when applied.
- Tonicity also measured as % of NaCl - 0.9%
- Buffer - sodium acetate, sodium borate

Sustained activity -
Viscous enhancing agent: povidone, hydrophilic CL, ointments, cellulose derivatives

53
Q

Drug preps

A 
Minims: 0.5% & 1%
paper strip
multidose container
ointment
gels
lotion
irrigation system
wafer inserts

POSOLOGY: the study of the dosages of drugs,
especially the determination of appropriate doses

BD: twice (two times) a day, stands for ‘bis die’
OD: once a day; stands for ‘quaque die’
OD nocte: once a day at night
TDS: three times a day; stands for ‘ter die sumendum’
QDS: four times a day; q.i.d. stands for ‘quater die
sumendum’

54
Q

Pharmakinetics

A

Action of a drug in your body over a period of time.

Admin + Formulation

  • Dosage & instillation (dosage vs conc)
  • Drug vehicle - usually sol
  • Surface drainage and retention - q of tears
  • Vascular absorption

eye drops - 50ul
palpebral capacity - 30ul
Tear layer - 7-10ul
drop life - 2 mins

Corneal transmission

1) FAT - tear layer, corneal epithelium - Bowmans membrane (squamous tight layers)
2) H2O - stroma
3) FAT - descemets membrane (junctional gaps in endothelium cells), corneal endothelium, anterior chamber

1% of drug reaches ac, conc decided based on this.

Biphasic solubility

  • corneal epith/endo - allow fats through only (non ionised)
  • stroma - allows water soluble and ionised particles through
  • AC- allows everything through

Excretion - Intraocular excretion - diffusing into surrounding vessels and into aqueous for canal of schlemm
- oxidation and reduction and hydrolysis happens in liver and kidney excretion

Additional factors:
Age - kidney and liver less efficient
Body-weight - low higher doses (children), 
             higher BMI can store it for longer
Gender - recommended amount subject 
genetics - AR 
interaction - interact with other meds
pathology - CI, excretion
Time - best with food some
Tolerance - built up
55
Q

Legislation

A

Medicine: is a substance used to
treat or
prevent disease
restoring, correcting or modifying physiological functions
by exerting a pharmacological, immunological or metabolic action; a medicine can also be used to make a medical diagnosis.

Medical Device: diagnosis/prevention/monitoring/treatment of a disease - does not involve pharmacology, immunology, metabolism

56
Q

HMR 2012 enforced & MHRA

A

HMR 2012 - sets legislation req, for admin, supply and prescription

  • Sales and supply through registered pharm
  • Medical devices - CE annotation

POM - doctor, dentist or vet
P - from pharmacy
GSL - supply to public without pharm. supervision
- eye drops and eye ointments not
available under GSL
- Certain drugs can be a combination of GSL, P and POM depending on e.g. pack size, %, presentation and use.
- Contact Lens products/solutions & diagnostic dyes are devices

57
Q

AS

A

non sight threatening conditions
● 2 years post-registration;
● Post-graduate course covering theory and practice of
prescribing;
● Hospital placement under supervision of
ophthalmologist.

58
Q

Signed orders

A

req for EL AND AS, given by optom to pharmacist or by px if given instruction

Content:
optom name address, GOC no
date
px name, address
drug, dose, reason
labelling directions
optom signature
59
Q

SP

A

voluntary relationship with an independent
prescriber (i.e. doctor)
management plan is agreed for an individual patient
SP manage px cond, prescribing and management

60
Q

IP

A

responsibility of assessment, diagnosis and management

61
Q

Comanagement schemes

A
  • Limited special circumstances
  • post surgical
  • drugs outside P, EL, AS
  • under authority of Patient group direction
  • access to responsible medical practitioner
  • must be signed by a senior medical doctor and senior pharmacist
62
Q

Self prescribing and treatment

A

1) Avoid, avoid POM on family/friends, risks litigation due to less objectivity
xexceptions - minor ailments/emergencies

2) no legal restriction on instillation
- but optom still responsible for it, should intervene and be on premises

GLOCKTOMETRY (4 decks)

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