Ophthalmic

Question 1

Fluorescein is used to

Answer 1

detect dendritic figures is herpes keratitis

Question 2

diminished tear production or anatomical abnormalities in delivery of tears to the surface of the eye

Answer 2

keratoconjunctivitis sicca

aka xerophthalmia

Question 3

MC cause of keratoconjunctivitis sicca

Answer 3

contact lens wear

Question 4

complications of untreated keratoconjunctivitis sicca

Answer 4

cornea ulceration or ocular infx

Question 5

What is recommended when prescribing artificial tears

Answer 5

use preservative free!

Question 6

Topical cyclosporine 0.05% sol’n (Restasis) is used to tx

Answer 6

keratoconjunctivitis sicca

doesn’t get absorbed systemically so minimal s/e, which included stinging and redness

Question 7

non-pharmacologic interventions for keratoconjunctivitis sicca

Answer 7

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

Question 8

Viral conjunctivitis is usually associated with _________, whereas bacterial conjunctivitis is usually associated with _________

Answer 8

1) URI (i.e. adenovirus)

2) Staphylococcus

Question 9

Allergic conjunctivitis mild tx

Answer 9

cool compress + antihistamine/decongestant + lubricant

Question 10

Allergic conjunctivitis moderate tx

Answer 10

cool compress + antihistamine/decongestant + lubricant + mast cell stabilizer

Question 11

Allergic conjunctivitis severe tx

Answer 11

cool compress + antihistamine/decongestant + lubricant + mast cell stabilizer + steroid + NSAID

Question 12

Ocular decongestants include

Answer 12

1) Tetrahydrozoline (Visine)

2) Naphazoline (Clear Eyes, Vasocon, Naphcon, Naphcon Forte (Rx))

Question 13

Ocular decongestant MOA

Answer 13

constricts dilated arterioles of conjunctiva

Question 14

Ocular decongestant/antihistamine combos

Answer 14

1) Antazoline/Naphazoline (Vasocon A)

2) Pheniramine/Naphazoline (Naphcon A, Opcon A)

Question 15

Ocular Antihistamines include

Answer 15

1) Azelastine hydrocholride (Optivar)
2) Emedastine (Emadine)
3) Olopatadine (Patanol (Rx), Pataday (Rx))

Question 16

Ocular Antihistamine MOA

Answer 16

blocks H1 receptor sites

Question 17

Ocular Mast Cell Stabilizers include

Answer 17

1) Ketotifen (Zaditor, Alaway (also an antihistamine))
2) Cromolyn Sodium (Crolom, Opticrom)
3) Nedocromil Sodium (Alocril)

Question 18

Which mast cell stabilizer is also an antihistamine?

Answer 18

Alaway

Ketotifen

Question 19

Ocular NSAIDs include

Answer 19

1) Ketorolac (Acular and Acular LS)
2) Diclofenac Sodium (Voltaren)
3) Flurbiprofin (Ocufen)
4) Suprafen (Profenal)

Question 20

Which microorganisms are associated with mucopurulent ocular d/c?

Answer 20

the bacteria S. aureus, S. epidermidis, and Strep. pneumoniae

Question 21

Which microorganisms are associated with purulent ocular d/c?

Answer 21

the bacteria N. gonorrhoeae

Question 22

Drug(s) of choice for tx bacterial conjunctivitis

Answer 22

1) 0.3% Tobramycin (Tobrex)

2) Polymyxin B/Trimethoprim (Polytrim)

Question 23

Drug(s) used to tx more severe bacterial conjunctivitis infx

Answer 23

1) 0.3% Ofloxacin (Ocuflox)

2) 0.3% Ciprofloxacin (Ciloxan)

Question 24

If you don’t see improvement in ________ days after starting to tx bacterial conjunctivitis

Answer 24

2-3 days

Question 25

What are the ocular aminoglycosides?

Answer 25

topical antibiotics 1) Gentamicin 2) Neomycin 3) Tobramycin

Question 26

What are the ocular fluoroquinolones?

Answer 26

broad-spectrum topical antibiotics 1) Ciprofloxacin 2) Ofloxacin 3) Gatifloxacin 4) Moxifloxacin

Question 27

____________ are indicated for confirmed ocular gonococcal or chlamydial disease

Answer 27

IV antibiotics b/c these are systemic infx

Question 28

Erythromycin ointment is reserved primarily for ____________

Answer 28

prophylaxis of neonatal gonococcal and chlamydial infx | problems with Strep. pneumonia and H. influenzae resistance

Question 29

Drug(s) of choice for HSV keratitis?

Answer 29

Trifluridine (VIROPTIC) topical sol'n *tx should not exceed 21 days

Question 30

Drug(s) used to tx CMV keratoconjunctivitis (aka CMV retinitis)

Answer 30

1) Ganciclovir (CYTOVENE) 2) Cidofovir (VISTIDE) 3) Foscarnet (FOSCAVIR) *if retinal lesions are life-threatening use intravitreal injection of ganciclovir or foscarnet

Question 31

First line tx for primary open-angle glaucoma

Answer 31

1) Beta blockers to decrease aqueous production | 2) Prostaglandin analogs to increase aqueous outflow

Question 32

Adjunctive agents for tx of primary open-angle glaucoma

Answer 32

1) Brimonidine (alpha-adrenergic agonist) 2) Topical carbonic anhydrase inhibitors (CAIs) *Both of these agents decrease aqueous production

Question 33

Second line tx for primary open-angle glaucoma

Answer 33

1) Pilocarpine (parasympathomimetic) 2) Dipivefrin or epinephrine (sympathomimetic) 3) Apraclonidine (sympathomimetic) *All of these agents decrease aqueous production

Question 34

What is the MC BB used in tx of primary open-angle glaucoma?

Answer 34

Timolol | nonspecific

Question 35

Which nonspecific BB is/are used to tx primary open-angle glaucoma?

Answer 35

1) Timolol (MC) 2) Levobunolol 3) Metipranolol nonspecific are more effective b/c we have both alpha and beta receptors in eye

Question 36

Which specific BB is/are used to tx primary open-angle glaucoma?

Answer 36

1) Betaxolol (B1) 2) Carteolol (B1 and B2) (less effective than nonspecific BB)

Question 37

Which ocular BB have lower risk of systemic s/e

Answer 37

1) Betaxolol | 2) Carteolol

Question 38

With most topical ocular drugs we are not very concerned w/ s/e. However, with _________ we do see systemic s/e.

Answer 38

Beta blockers can see CV effects (decr. HR, decr. BP, conduction defects) and pulmonary effects (bronchospasm)

Question 39

Topical timolol caution

Answer 39

can potentially worsen CHF

Question 40

What is the #1 prescribed prostaglandin analog for primary open-angle glaucoma?

Answer 40

Latanoprost (Xalatan)

Question 41

BB local s/e

Answer 41

stinging

Question 42

prostaglandin analog local s/e

Answer 42

iris pigmentation | ocular irritation

Question 43

Alpha-2 Adrenergic Agonist local s/e

Answer 43

allergic type reaction

Question 44

Alpha-2 Adrenergic Agonist systemic effects

Answer 44

dizziness, somnolence, dry mouth, decreased BP, decreased pulse

Question 45

Alpha-2 Adrenergic Agonist cautions

Answer 45

CV disease, renal compromise, cerebrovascular dz, diabetes Pt. taking: antihypertensives, CAD drugs, MAO inhibitors, tricyclic antidepressants

Question 46

What are the topical carbonic anhydrase inhibitors (CAIS) commonly used to tx primary open-angle glaucoma

Answer 46

1) Dorzolamide (Trusopt) 2) Brinzolamide (Azopt) *Acetazolamide (Diamox) can also be used, however it is a systemic formulation

Question 47

T/F: Topical carbonic anhydrase inhibitors (CAIS) are a first-line tx for primary open-angle glaucoma

Answer 47

FALSE they are rarely used as an initial therapy

Question 48

Topical carbonic anhydrase inhibitors (CAIS) MOA

Answer 48

reduces IOP by decreasing bicarbonate production (by inhibiting carbonic anhydrase) resulting in 40-60% decrease in aqueous humor secretion

Question 49

Topical carbonic anhydrase inhibitors (CAIS) local s/e

Answer 49

ocular burning, stinging, discomfort, and allergic rxn, bitter taste *generally well-tolerated