Ophthalmic Diseases - Block 4 Flashcards
1
Q
What are the types of available optic formulations?
A
- Solution
- Suspension (shake well)
- Ointment: applied to conjunctival sac or over lid margins -> blurred vision -> no contacts
- Gels: With cap on, invert and shake once to get medication to tip before instilling in the eye
2
Q
How man mL are in 1 gtt?
A
0.05 mL
3
Q
Are ear and eye drops interchangeable?
A
Eye drops for ear, but not ear drops for eyes
4
Q
How should you instill eye drops?
A
- Clean hands
- Remove contacts
- Look up and form pocket in lower eyelid
- Release drop between eye and lower eyelid (don’t touch tip of bottle to eye)
- Close eye
- Nasolacrimal/punctal occlusion (NLO) x 1-3 minutes
5
Q
What do you do if you are need to instill multiple dropps of the same med? Differnt med?
A
Same: Wait 5-10 minutees between drops
Differnet: Apply drops 5-10 minutes apart
6
Q
What is the order of instilling solution and suspension?
A
Instill solution first then suspension
7
Q
How can you insert contacts after drops?
A
15 minutes after
8
Q
Right eye sig?
A
OD
9
Q
Left eye sig?
A
OS
10
Q
Both eyes sig?
A
OU
11
Q
Drop sig?
A
gtt
12
Q
What is glaucoma?
A
Optic neuropathy characterized by changes in the optic nerve head that is associated with loss of visual sensitivity and field
13
Q
What are types primary glaucoma?
A
- Open angle
- ANgle closure:
* with pupillary block
* W/o pupillary block
14
Q
What is secondary glaucoma?
A
- Open angle” pretrabecular, trabecular, posttrabecular
- Angle closure:
* w/o pupillary block
* With pupillary block
15
Q
What is the aqueous humor?
A
Clear fluid and ultrafiltrate of the serum that fill the chambers of the eye
16
Q
How is aqueous humor formed?
A
Ciliary body and epithelium through filtration (pressure) and secretion (osmosis)
17
Q
What receptors are involved with ciliary epithelium?
A
Carbonic anahydrate, a- and b adrenergic receptors
18
Q
What are the receptors involved with the ciliary body?
A
Increase inflow: b adrenergic agents
Decrease outflow: a2, b, dopamine blocking, carbonic anhydrase inhibitors, melatonin 1 agonist, adenylate cyclase stimulating agents
19
Q
What is the rate of aqueous humor secretion into the posterior chamber?
A
2-3 µL/min
20
Q
What drugs have the greatest effect in lowering IOP?
A
- Prostaglandin analog (nocturnal IOP)
- Beta blockers
- Carbonic anhydrase inhibitors (nocturnal IOP)
21
Q
What is our normal IOP?
A
15.5 mmHg
22
Q
When is IOP the highest?
A
At night after falling asleep or at awakening
23
Q
What is ocular HTN?
A
Elevated IOP without s/s of glaucoma
24
Q
What an advantegous way in treating glaucoma patients?
A
IOP reduction
25
What is a cup?
Small depression within optic disk
26
What are the alterations of the optic disk and visual fields from glaucoma?
**Optic Disk:**
1. Cup-to-disk ratio >0.5
2. Progressive increase in cup size
**Visual fields:**
1. Peripheral field constriction
2. Blind spots
3. Nasal visual field depression
27
Drugs that cause glaucoma?
**Open angle:** corticosteroids, anticholinergics
**Closed-angle:** anticholinergics, antihistamins, sympathomimetics
28
What is the difference between OAG and ACG sx?
**OAG:** none until substantial visual flied loss occurs
**ACG:** nonsymptomatic or prodromal sx (blurred/hazy vision with halos, HA)
* Acut sx: cloudy, pain, n/v, abdominal pain, diaphoresis
29
What are the presentations of OAG?
Bilateral, denetically determined
30
What are the forms of secondary OAG?
**Pretrabecular:** normal meshwork is covered and doesn't allow aqueous humor outflow
**Trabecular:** alterations of meshwork or accumulation of material in intertrabecular spaces
**Posttrabecular:** Increased episcleral venous BP
31
What is the classification of ocular HTN?
IOP >22 mmHg
32
What are the RF of ocular HTN?
1. IOP >25
2. Cup:disk >0.5
3. Central corneal thickness of < 555 μm
4. family history of glaucoma, black, Latino/Hispanic ethnicity, severe myopia, and patients with only one eye
33
Tx for ocular htn?
First line: Topical PG analog or b-blocker
Alt first line: a2 agonist, CAI, netasudil
34
What is the intial tx for OAB?
First: PG analog or beta-block
Second: CAI or Brimonidine
Last line: Dipivefrin, carbachol, topical cholinesterase inhibitors, PO CAI
CI with first: topical CAIs
Partial response: add second/thrid line or CAI
Intolerance of pharm: laser or surgical trabeculectomy
35
PG analod Types?
1. Latanoprost
2. Bimatoprost
3. Travoprost
4. Tafluprost
5. Latanoprostene
36
PG analog ADRs?
1. Iris pigmentation
2. SUnken eyes
3. Corneal thinning
4. Uveitis (redness, pain, blurred vision)
37
B-blocker types?
1. Timolol
2. Betaxolol
3. Cartelol
4. Levobunolol
5. Metipranolol
38
When would PO CAIs be used?
Severely high IOP that needs to be treated quickly
39
How often is opthalimic therapy initiated?
Started in one eye to evaulate efficacy
Reassess in 2-4 weeks
40
What color are your first line? second line? combo? packaging
**PG:** teal
**Beta-blockers (2nd first line):** yellow
**CAI:** orange
**Combo:** navy
41
Omlonti
| MOA, Dosing, ADR, Caution
**MOA:** selective PG E2 receptor agonist -> reducing IOP
**Dosing:** 1 gtt in affected eye QPM
**ADR:** photophobia, vision blurred, dry eye, conjuctival hyperemia
**Caution:** hyperpigmentation, eyelash changes, ocular inflammation, macular edema
42
What are the non pharm for OAG?
1. Laser trabeculoplasty
2. Surgical trabeculectomy
43
What is the tx for AACC?
1. Miotics (pilocarpine)
2. Secretory inhibitors (B-block, a2-agonist, CAI)
3. PG analog
4. Lack of response from topicals: mannitol or glycerin
5. Ocular inflammation: topical corticosteroids
44
What is the function of a miotic agent?
Pulls the peripheral irus awaw from meshwork however may worsen angle closure trough pupillary block
45
What is the definitive tx for ACG?
Iridectomy -> hole in irus
Long-term drug therapy is only used if IOP remains high -> refer to ocular HTN
46
What is the goal and monitoring paramters of ocular HTN?
**Goal:** lower IOP by 20%, or decrease 25-30% from baseline
**Monitor:** IOP, optic disk, visual fields, drug ADR
Unresponsive tx: switch to alternative agents
Partial: drug combo
47
How often do you monitor OAG therapy?
IOP
**Initial check:** 4-6 weeks
**After target:** Q3-4M
**Prolonged control:** 6-12M
Visual fields and disk changes:
* Q6-12M
48
Describe therapeutic adjustments of OAG?
**No response:** switch to alt agents
**Partial:** add combo (PG analog, b-blocker, brumonidine, CAI, pilocarpine)
49
What is the goal for acute angle closure crisis?
Rapid reduction of IOP to preserve vision and avoid surgery/laser
50
What is AMD?
Age related macular degeneration: neurodegenerative dx that produces irreversible loss of central vision due to damage to the macula
51
What is the macula?
Responsible for all central vision and fine detail images
52
What is the function of photoreceptors cells?
Identify light and then transfer the information to the brain to produce an image
53
What is drusen?
Yellow deposits of lipids between the RPE (retinal pigment epithelium) and Bruch's membrane that can develop with age
54
What is the clinical presentation of AMD?
1. Presence of drusen
2. RPE abnormalities
3. Reticular pseudodrusen
4. RPE geographic atrophy
5. Choroidal neovasc
6. Retinal angiomatous proliferation
55
What increased the risk of developing AMD?
1. UV
2. Tyroid dysfunction
3. Med (Nitroglycerin, beta blockers, chloroquine, phothiazines)
4. Pestacide
56
What is the difference between non-neovascular and neovascular AMD?
Non-NV/atrophic dry: macula thins with age and tiny clumps of protein (drusen) grow
**NV (wet):** New, abnormal blood vessels grow under the retina and may leak blood or other fluids, causing scarring of the macula
57
Sx of dry AMD?
Painless, slow, bilateral
1. subretinal hard and soft drusen deposits
2. THinning of macula
3. RPE atrophy
4. Hyperpigmentation of retina
Sx: visual distortion
58
Sx of wet AMD?
Loss of central vision
* VEGF -> angiogenesis of BV growth
Amsler grid
Sx: dark spots in central vision, wavy lines instead of straight lines
59
Non pharm for AMD?
1. Smoking cessation
2. Antioxidant vitamins and minerals
3. Healthy diet
4. Control cormorbities
60
Tx for wet AMD only?
1. VEGF inhibitors
2. Photodynamic therapy
3. Surgery
61
Vitamins and minerals good for the eyes?
Vitamin E, C, beta-carotine and zinc
62
VEGF inhibitors?
| Types, MOA
**Types:**
* Bevacizumab
* Ranibizumab
* Afibercept
* Pegaptanib
**MOA:** prevents the growth of new BV into the retina from VEGF
63
What is Vabysmo?
Treat neovascular (wet) aged-related macular degeneration and diabetic macular edema
64
What is photodynamic therapy?
IV injection of dye (verteporfin) -> laser activates dye -> formation of thromboembolism -> seals abnormal blood vessels
ADR: light sensitivity and eye pain
65
RF of dry eyes?
1. Age
2. Female
3. Smoking
4. Extensive computer use
5. LASIK
6. Med:
* Anticholinergics
* Hormones
* CS
66
When do you begin tx for dry eyes?
Moderate to severe
Nonpharm: mild
67
Non-pharm for dry eyes?
1. Education/environmental mods
2. Elimination of offending meds
3. Warm compresses, eyelid hygiene
4. Eye drops
68
Anti-inflammatory agents for dry eyes?
1. Cyclosporine
2. Lifitegrast
3. CS
69
Cyclosporine
| MOA, ADR, Counselign
**MOA:** Calcineurin inhibitor -> increases eyes ability to produce tears (0.05% - Restasis)
**ADR:** burning, redness, watery eyes, itching
**Counseling:** can be used with artificial tears and shouldn't be used with active infections or with contacts
70
What are the formulations of Cyclosporine 0.05%?
1. Restasis multi-dose
2. Cequa: NCELL tech (preservative free)
71
Lifitegrast
| Brand, MOA, ADR
Xiidra 5%
**MOA:** Lymphocyte function-associated antigen 1 (LFA-1) antagonist
**ADR:** burning, dysgeusia, blurred vision, watery eyes
72
What eye drops are used to treat the cause of dry eyes? which one treats the sx?
**Cause:** cyclosporine 0.05%
**Sx:** Lifitegrast 5%
73
When can we use CS for dry eyes? ADRs?
Loteprednol (Lotemax): Shrot term basis up to 2 weeks
**ADR:** Increased IOP, cataracts
74
What is blepharitis?
Inflammation of the eyelid margin
75
What are the presentations of blepharitis?
1. Swollen itchy eyelids
2. Crusting or matting eyelashes
3. Blurred vision
4. Pink eye
76
What is the tx for blepheritis?
1. Warm compresses
2. Eyelid cleansing
3. Artificial tears
77
Types of carbonic anhydrase inhibitors (topical>
1. Brinzolamide
2. Dorzolamide
78
Types of Rho kinase inhibitors?
Netarsudil
ADR: cnjunctival hyperemia, hemmorhage
79
Types of adrenergic agonist?
1. Dipivefrin
2. Apraclonidine
3. Brimonidine
80
Types of cholinesterase inhibitors?
Echothiophate
81
Cholinergic agonist-direct acting?
1. Carbachol
2. pilocarpine
82
Combo products?
Timolol/dorzolamide (Cosopt)
Timolol/brimonidine (Combigan)
Brinzolamide/brimonidine (Simbrinza)
Netarsudil/latanoprost (Rocklatan)
