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Therapeutics II > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Cornea

A

-primary absorptive site

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2
Q

Conjuctiva

A

-thin mucus membrane over sclera

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3
Q

ciliary body

A

-makes aqueous humor

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4
Q

Routes of drug admin in eye

A

-local: drops, gels, ointments
-systemic//; inj, oral meds

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5
Q

Regions for absorption

A

-cornea (primary)
-sclera: mostly collagen, limited absorption
-conjuctiva (systemic)

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6
Q

Limitations to ocular absorption and delivery

A

-secretions/tears
-volume capacity
-pH and osmolarity
-metabolism

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7
Q

Nasolacrimal duct

A

-drug can drain from eye to nasal cavity

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8
Q

Eye drop considerations

A

-limited volume capacity
-defense mechanisms (tears, blinking, corneal barrier)
-3-5 min residence time

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9
Q

Eye ointment considerations

A

-drug depot in conjunctival sac result in enhanced/sustained absorption
-blurry vision up to 30 min after admin
-difficult to apply correct dose

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10
Q

Eye formulation

A

-sterile
-7.5-8.5 pH
-pH shifts induce lacrimation
-isotonic best
-hypertonic = cry
-hypotonic effects cornea
-perservatives may cause irritation
-buffer salt effects on mucus secretion

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11
Q

Eye drop admin

A

-wash hands
-remove contacts
-tilt head back
-form pocket
-hold dropper close to eye w/o touching it
-squeeze dropper into pocket while looking up
-close eyes 2-3 min
-tip head DOWN
-finger on tear duct and apply pressure

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12
Q

Eye ointment admin

A

-wash hands
-remove contacts
-hold tube near eyeball w/o touching it
-tilt head back, form poackt
-squeeze into pocket
-blink gently and close eye 1-2 min
-wipe excess of ur eyes and tube

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13
Q

contact consideration

A

-take em out
-wait 15 min to reinsert
-ointment not recommended w contacts

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14
Q

Admin of 2 drops

A

-wait 5 min between drops if same
-wait 5-10 if 2 different medications

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15
Q

2 ointment admin

A

-wait 30 min between ointments

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16
Q

1 ointment 1 drop admin

A

-drop FIRST
-ointment 5-10 min later

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17
Q

Sigs

A

-O is eye
-A is ear
-S left
-D right
-U both

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18
Q

3 types of conjunctivitis

A

-bacterial
-viral
-allergic

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19
Q

Bacterial conjunctivitis

A

-redness, yellow, white, green discharge
-eye stuck shut
-unilateral usually

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20
Q

Common causes bacterial conjunctivitis

A

-staph aureus
-strept pneumoniae
-haemophilus influenzar
-moraxella catarrhalis
-pseudomonas aeruginosa (highly contagious)

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21
Q

Bacterial tx nonpharma

A

-avoid sharing
-remove contact lenses until eye is white and no discharge for 24 hours after abx

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22
Q

Bacterial tx pharma

A

-limited
-topical abx might help
-ointment preferred over drops in children and risk of poor compliance

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23
Q

Abx for bacterial

A

-erythromycin
-moxifloxacin
-ofloxacin
-trimethoprim-polymyxin B

-slide 31 not sure what i need to know

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24
Q

First line tx approach for bacterial

A

-polymyxin B/trimethoprim solution
-poly B/ bacitracin ointment
-erythromycin ointment

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25
Alternatives to bacterial tx approaches
-tobramycin or gentamicin solution or ointment -aminoglycosides have less ram-positive coverage
26
Second-line tx bacterial
-Fluroroquinolones (ofla-, cipro-, levo-, moxi- floxacin) (poort strept coverage, expensive, resistance developing) -azithromycin ($$)
27
Viral conjunctivitis
-watery eyes -burning, sandy feeling -morning crust and watery discharge -other eye involved in 24-28h usually -part of viral respiratory tract infection
28
Causes of viral
-adenovirus -highly contagious
29
Viral nonpharma tx
-avoid sharing -remove contact lenses until eye normal for 24 h
30
viral pharma tx
-relief only -warm/cool compress -topical decongestant but limit duration to avoid rebound congestion
31
Viral decongestants (OTC)
-naphazoline -tetrahydrozoline -no more than 72hours
32
Allergic conjunctivitis
-redness, watery, ITCHING -maybe morning crust -both eyes often -paired w other allergy sx (congestion, sneezing) -eye rubbing can worsen sx -acute -seasonal -perennial
33
Common causes of allergic
-airborne allergens
34
Acute allergic
-sudden onset caused by allergen -cat dander
35
Seasonal allergic
-onset days to weeks in repsonse to pollen -also w rhinitis
36
perennial allergic
-mild, chronic related to exposure to allergens -dust mites, mold
37
Pathophysiology of allergic conjunctivitis
-mast cells activated by allergens -release histamine, cyto/chemokines -histamine release causes redness, itching, swelling
38
Allergic conjunctivitis nonpharma tx
-do not rub eyes -cool compress -avoid reduction of contact w known allergen
39
allergic pharma tx
-antihistamines -mast cell stabilizers -multiple acting agents
40
Acute allergic tx
-artificial tears removes allergens and lubes eye -topical anithistamine/decongestant combo (P/n) -topical antihistamine w mast cell stabilizer features (start prior to exposure)
41
pheniramine/naphazoline
-topical antihistamine and decongestant combo -1-2 drops upto QID up to 3 days max! (rebound congestion)
42
Seasonal/perennial tx
-topical antihistamine w mast cell stabilizer -ketotifen 0.025% cheaper and better availability -Olopatadine 0.1% or 0.2% used second line -start tx 2-4 weeks before onset
43
Antihistamines
44
Mast cell stabilizer
45
multi-acting agents for allergic
46
Uveitis
-intraocular inflammation -wagon wheel redness associated w iritis -dilated pupil -light sensitivity
47
Uveitis tx
-topical glucocorticoids -mydratic/cycloplegic
48
Low strength eye steroids
-dexamethasone -Medysone
49
intermediate strength eye steroids
-slide 47
50
high eye steroid strength
-prednisone acetate 1%
51
Uveitis tx considerations
-refer to optometrist -tx 4-6 weeks -opthalmic steroid toxicity -inc in intraocular pressure
52
Ophthalmic steroid toxicity
-secondary infections -secondary open-angle glaucoma
53
Intraocular pressure in uveitis
-increases -6-15+ mmHg -normal 12-10
54
Uveitis risk factors
-primary open-angle glaucoma -ocular HTN -elderly children -connective tissue disease -type 1 DM w myopia
55
Macular degeneration
-dry or wet -leading cause of blindness -risk factors: smoking and age
56
Dry macular degeneration
-common over 50 years old -90% of MD cases -both eyes affected -gradual loss of vision
57
Wet macular degeneration
-advanced MD -vision loss might be rapid -loss of central vision due to abnormal growth of new blood vessels
58
Macular degeneration tx goals
-slow progression -stop visual impairment or blindness
59
Beta-carotene
-slide 53 -inc risk of lung cancer in smokers
60
Macular degeneration Rx tx
-vascular endothelial growth factor (VEGF) inhibitors -all IntraVITREAL injections -procedure 15 min -results last 30 days -Bevacizumab -Aflibercept -Ranibizumab -Pegaptanib -Verteporfin
61
VEGF inhibitors
-for formulation of new blood vessels and vascularization of tissues -antineoplastic agents to treat some cancer and prevent tumors from creating blood vessels -slow progression and maybe little gain in vision in older people
62
VEGF inhibitor side effects
-inc BP (CVD, strokes) -retinal detachment -inc IOP -eye infection -vitreous floaters
63
Dry eyes causes
-dec tear production (Sjorgen or non Sjorgen) -inc evaporative loss
64
Sjorgen dry eyes
-autoimmune disease -lymphocytic infiltration of exocrine glands =xerostomia
65
Dry eyes risk factors
-age -female -contact lens wearers -low humidity environments -medications
66
Dry eyes presentation
-dryness -white/mild red -irritation -sandy/gritty -blurred vision -light sensititivity
67
Dry eyes tx
1. tears, warm compress (outside factors, dc meds) 2. topical tx w secretagogues (liftegrast and cyclosporine) or in office procedures 3. Oral tx? (antioxidants or omega-3 FAs), sclera contact lens, surgery, investigation drugs
68
Non pharma dry eye tx
-blink more -schedule breaks from screens or reading -warm compress -smoking cessation -humidifiers -protective eyewear -minimize exposure to wind or fans -sufficient oral fluid intake
69
Dry eyes tear supplementation
-carboxymethylcellulose -hydroxypopylcellulose -polyehylene glycol -DMPG (lipid) -mineral oil (lipid)
70
Tear supplementation counseling
-avoid bezalkonium chloride -preservative free ($$) less likely to cause adverse effects, packaged individually w 24h self life -meibomian gland dysfunction (MGD) or evaporative should be treated w lipid-supplementing tears -hard to tell cause of dry eyes, consider lipid containing if pt fails aqueous
71
Dry eyes Rx tx
-cyclosporine 0.05% emulsion or 0.09% solution -one drip each eye BID -single use vials, 0.05% available as multi-dose vial
72
Cyclosporine
-partial immunomodulator by suppressing inflammation -onset effect at 4 weeks, full effect 3-6 months -wait 15 min between eye drops and artificial tears -dry eye tx
73
Cyclosporine side effects
-burning/stinging of eye -s/sx of infection
74
Drug-induced dry eyes
-a1 and a2 agonists -anticholinergic -anticonvulsants -antihistamines -antimalarials -antineoplastics -antipsychotics -anxiolytics -B agonsists and antagonists -bisphosphonates -cannbinoids -decongestants -diuretics -retinoids -oral contraceptives -tricyclic antidepressants -benzalkonium chloride preservative
75
Drug0induced dry eye tx
-warm compress -inc fluid intake -humidifier -inc tear volume (artificial tears or other lube) -decrease inflammatoin (restasis or Xiidra) -dc causative agent -switch to preservative free eye drops
76
Other drug induced eye disorders
-cataracts -intraoperative floppy iris syndrom -optic neuropathy -retinopathy
77
Cataracts caused by
-corticosteroids -phenothiazine -alkylating agents -statins
78
cataracts
-cloudiness in specific part of lens -will not reverse once formed -surgical removal of lens maybe necessary to restore vision
79
Intraoperative Floppy Iris Syndrome
-IRREVERSIBLE -a1 antagonists -seen in cataract surgery -floppy iris -progressive constriction of pupul -prolapse of iris through surgical wounds -preop screening for previous/current use of causititive agents
80
Intraoperative floppy iris syndrome causitive agents
-a1 ANTAgonists
81
Optic neuropathy causitive agents
-amiodarone -ethambutol -linezolid -PDE-5 inhibitors
82
Optic neuropathy
-bilateral vision loss -dec visual activity -dec color vision -gradual sx, no pain -dc agent usually reverses sx
83
Retinopathy causitive agents
-aminoquinolines -antiestrogen agents -phenothiazines -retinoids -perform reg eye exams if pt on these
84
Retinopathy
-late stage is virtually nonreversible
85
Meds w eye related effects
-amiodarone =. corneal deposits -Digoxin = yellow tint/halos (toxicity) -Anticholinergics = blurred vision -PDE-5 inhibitors = color changes (blue tint) -bisphosphonates = inflammation and redness -topiramate = angle closure glaucoma -SSRIs = eye tics
86
Prevention of drug-induced disorder
-education -regular examinations -nonpharma tx -prophylatic meds -avoid exceding daily dose or duration of therapy -assess for risk factors -monitor drug levels -stress adherence to follow up and monitoring -encourage communication of meds, OTCs, natural products
87

Therapeutics II (55 decks)

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