Ophthalmic Flashcards
Fluorescein is used to
detect dendritic figures is herpes keratitis
diminished tear production or anatomical abnormalities in delivery of tears to the surface of the eye
keratoconjunctivitis sicca
aka xerophthalmia
MC cause of keratoconjunctivitis sicca
contact lens wear
complications of untreated keratoconjunctivitis sicca
cornea ulceration or ocular infx
What is recommended when prescribing artificial tears
use preservative free!
Topical cyclosporine 0.05% sol’n (Restasis) is used to tx
keratoconjunctivitis sicca
doesn’t get absorbed systemically so minimal s/e, which included stinging and redness
non-pharmacologic interventions for keratoconjunctivitis sicca
1) avoid anticholinergics
2) smoking cessation
3) warm compress
4) take breaks from reading/looking at electronic devices
5) oral omega-6 FA (EPO), esp. in females with contacts
Viral conjunctivitis is usually associated with _________, whereas bacterial conjunctivitis is usually associated with _________
1) URI (i.e. adenovirus)
2) Staphylococcus
Allergic conjunctivitis mild tx
cool compress + antihistamine/decongestant + lubricant
Allergic conjunctivitis moderate tx
cool compress + antihistamine/decongestant + lubricant + mast cell stabilizer
Allergic conjunctivitis severe tx
cool compress + antihistamine/decongestant + lubricant + mast cell stabilizer + steroid + NSAID
Ocular decongestants include
1) Tetrahydrozoline (Visine)
2) Naphazoline (Clear Eyes, Vasocon, Naphcon, Naphcon Forte (Rx))
Ocular decongestant MOA
constricts dilated arterioles of conjunctiva
Ocular decongestant/antihistamine combos
1) Antazoline/Naphazoline (Vasocon A)
2) Pheniramine/Naphazoline (Naphcon A, Opcon A)
Ocular Antihistamines include
1) Azelastine hydrocholride (Optivar)
2) Emedastine (Emadine)
3) Olopatadine (Patanol (Rx), Pataday (Rx))
Ocular Antihistamine MOA
blocks H1 receptor sites
Ocular Mast Cell Stabilizers include
1) Ketotifen (Zaditor, Alaway (also an antihistamine))
2) Cromolyn Sodium (Crolom, Opticrom)
3) Nedocromil Sodium (Alocril)
Which mast cell stabilizer is also an antihistamine?
Alaway
Ketotifen
Ocular NSAIDs include
1) Ketorolac (Acular and Acular LS)
2) Diclofenac Sodium (Voltaren)
3) Flurbiprofin (Ocufen)
4) Suprafen (Profenal)
Which microorganisms are associated with mucopurulent ocular d/c?
the bacteria S. aureus, S. epidermidis, and Strep. pneumoniae
Which microorganisms are associated with purulent ocular d/c?
the bacteria N. gonorrhoeae
Drug(s) of choice for tx bacterial conjunctivitis
1) 0.3% Tobramycin (Tobrex)
2) Polymyxin B/Trimethoprim (Polytrim)
Drug(s) used to tx more severe bacterial conjunctivitis infx
1) 0.3% Ofloxacin (Ocuflox)
2) 0.3% Ciprofloxacin (Ciloxan)
If you don’t see improvement in ________ days after starting to tx bacterial conjunctivitis
2-3 days
What are the ocular aminoglycosides?
topical antibiotics
1) Gentamicin
2) Neomycin
3) Tobramycin
What are the ocular fluoroquinolones?
broad-spectrum topical antibiotics
1) Ciprofloxacin
2) Ofloxacin
3) Gatifloxacin
4) Moxifloxacin
____________ are indicated for confirmed ocular gonococcal or chlamydial disease
IV antibiotics b/c these are systemic infx
Erythromycin ointment is reserved primarily for ____________
prophylaxis of neonatal gonococcal and chlamydial infx
problems with Strep. pneumonia and H. influenzae resistance
Drug(s) of choice for HSV keratitis?
Trifluridine (VIROPTIC) topical sol’n
*tx should not exceed 21 days
Drug(s) used to tx CMV keratoconjunctivitis (aka CMV retinitis)
1) Ganciclovir (CYTOVENE)
2) Cidofovir (VISTIDE)
3) Foscarnet (FOSCAVIR)
*if retinal lesions are life-threatening use intravitreal injection of ganciclovir or foscarnet
First line tx for primary open-angle glaucoma
1) Beta blockers to decrease aqueous production
2) Prostaglandin analogs to increase aqueous outflow
Adjunctive agents for tx of primary open-angle glaucoma
1) Brimonidine (alpha-adrenergic agonist)
2) Topical carbonic anhydrase inhibitors (CAIs)
*Both of these agents decrease aqueous production
Second line tx for primary open-angle glaucoma
1) Pilocarpine (parasympathomimetic)
2) Dipivefrin or epinephrine (sympathomimetic)
3) Apraclonidine (sympathomimetic)
*All of these agents decrease aqueous production
What is the MC BB used in tx of primary open-angle glaucoma?
Timolol
nonspecific
Which nonspecific BB is/are used to tx primary open-angle glaucoma?
1) Timolol (MC)
2) Levobunolol
3) Metipranolol
nonspecific are more effective b/c we have both alpha and beta receptors in eye
Which specific BB is/are used to tx primary open-angle glaucoma?
1) Betaxolol (B1)
2) Carteolol (B1 and B2)
(less effective than nonspecific BB)
Which ocular BB have lower risk of systemic s/e
1) Betaxolol
2) Carteolol
With most topical ocular drugs we are not very concerned w/ s/e. However, with _________ we do see systemic s/e.
Beta blockers
can see CV effects (decr. HR, decr. BP, conduction defects) and pulmonary effects (bronchospasm)
Topical timolol caution
can potentially worsen CHF
What is the #1 prescribed prostaglandin analog for primary open-angle glaucoma?
Latanoprost (Xalatan)
BB local s/e
stinging
prostaglandin analog local s/e
iris pigmentation
ocular irritation
Alpha-2 Adrenergic Agonist local s/e
allergic type reaction
Alpha-2 Adrenergic Agonist systemic effects
dizziness, somnolence, dry mouth, decreased BP, decreased pulse
Alpha-2 Adrenergic Agonist cautions
CV disease, renal compromise, cerebrovascular dz, diabetes
Pt. taking: antihypertensives, CAD drugs, MAO inhibitors, tricyclic antidepressants
What are the topical carbonic anhydrase inhibitors (CAIS) commonly used to tx primary open-angle glaucoma
1) Dorzolamide (Trusopt)
2) Brinzolamide (Azopt)
*Acetazolamide (Diamox) can also be used, however it is a systemic formulation
T/F: Topical carbonic anhydrase inhibitors (CAIS) are a first-line tx for primary open-angle glaucoma
FALSE
they are rarely used as an initial therapy
Topical carbonic anhydrase inhibitors (CAIS) MOA
reduces IOP by decreasing bicarbonate production (by inhibiting carbonic anhydrase) resulting in 40-60% decrease in aqueous humor secretion
Topical carbonic anhydrase inhibitors (CAIS) local s/e
ocular burning, stinging, discomfort, and allergic rxn, bitter taste
*generally well-tolerated
