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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
Q

Alternatives to bacterial tx approaches

A

-tobramycin or gentamicin solution or ointment
-aminoglycosides have less ram-positive coverage

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26
Q

Second-line tx bacterial

A

-Fluroroquinolones (ofla-, cipro-, levo-, moxi- floxacin) (poort strept coverage, expensive, resistance developing)
-azithromycin ($$)

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27
Q

Viral conjunctivitis

A

-watery eyes
-burning, sandy feeling
-morning crust and watery discharge
-other eye involved in 24-28h usually
-part of viral respiratory tract infection

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28
Q

Causes of viral

A

-adenovirus
-highly contagious

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29
Q

Viral nonpharma tx

A

-avoid sharing
-remove contact lenses until eye normal for 24 h

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30
Q

viral pharma tx

A

-relief only
-warm/cool compress
-topical decongestant but limit duration to avoid rebound congestion

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31
Q

Viral decongestants (OTC)

A

-naphazoline
-tetrahydrozoline
-no more than 72hours

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32
Q

Allergic conjunctivitis

A

-redness, watery, ITCHING
-maybe morning crust
-both eyes often
-paired w other allergy sx (congestion, sneezing)
-eye rubbing can worsen sx
-acute
-seasonal
-perennial

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33
Q

Common causes of allergic

A

-airborne allergens

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34
Q

Acute allergic

A

-sudden onset caused by allergen
-cat dander

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35
Q

Seasonal allergic

A

-onset days to weeks in repsonse to pollen
-also w rhinitis

36
Q

perennial allergic

A

-mild, chronic related to exposure to allergens
-dust mites, mold

37
Q

Pathophysiology of allergic conjunctivitis

A

-mast cells activated by allergens
-release histamine, cyto/chemokines
-histamine release causes redness, itching, swelling

38
Q

Allergic conjunctivitis nonpharma tx

A

-do not rub eyes
-cool compress
-avoid reduction of contact w known allergen

39
Q

allergic pharma tx

A

-antihistamines
-mast cell stabilizers
-multiple acting agents

40
Q

Acute allergic tx

A

-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
Q

pheniramine/naphazoline

A

-topical antihistamine and decongestant combo
-1-2 drops upto QID up to 3 days max! (rebound congestion)

42
Q

Seasonal/perennial tx

A

-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
Q

Antihistamines

A
44
Q

Mast cell stabilizer

A
45
Q

multi-acting agents for allergic

A
46
Q

Uveitis

A

-intraocular inflammation
-wagon wheel redness associated w iritis
-dilated pupil
-light sensitivity

47
Q

Uveitis tx

A

-topical glucocorticoids
-mydratic/cycloplegic

48
Q

Low strength eye steroids

A

-dexamethasone
-Medysone

49
Q

intermediate strength eye steroids

A

-slide 47

50
Q

high eye steroid strength

A

-prednisone acetate 1%

51
Q

Uveitis tx considerations

A

-refer to optometrist
-tx 4-6 weeks
-opthalmic steroid toxicity
-inc in intraocular pressure

52
Q

Ophthalmic steroid toxicity

A

-secondary infections
-secondary open-angle glaucoma

53
Q

Intraocular pressure in uveitis

A

-increases
-6-15+ mmHg
-normal 12-10

54
Q

Uveitis risk factors

A

-primary open-angle glaucoma
-ocular HTN
-elderly children
-connective tissue disease
-type 1 DM w myopia

55
Q

Macular degeneration

A

-dry or wet
-leading cause of blindness
-risk factors: smoking and age

56
Q

Dry macular degeneration

A

-common over 50 years old
-90% of MD cases
-both eyes affected
-gradual loss of vision

57
Q

Wet macular degeneration

A

-advanced MD
-vision loss might be rapid
-loss of central vision due to abnormal growth of new blood vessels

58
Q

Macular degeneration tx goals

A

-slow progression
-stop visual impairment or blindness

59
Q

Beta-carotene

A

-slide 53
-inc risk of lung cancer in smokers

60
Q

Macular degeneration Rx tx

A

-vascular endothelial growth factor (VEGF) inhibitors
-all IntraVITREAL injections
-procedure 15 min
-results last 30 days
-Bevacizumab
-Aflibercept
-Ranibizumab
-Pegaptanib
-Verteporfin

61
Q

VEGF inhibitors

A

-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
Q

VEGF inhibitor side effects

A

-inc BP (CVD, strokes)
-retinal detachment
-inc IOP
-eye infection
-vitreous floaters

63
Q

Dry eyes causes

A

-dec tear production (Sjorgen or non Sjorgen)
-inc evaporative loss

64
Q

Sjorgen dry eyes

A

-autoimmune disease
-lymphocytic infiltration of exocrine glands
=xerostomia

65
Q

Dry eyes risk factors

A

-age
-female
-contact lens wearers
-low humidity environments
-medications

66
Q

Dry eyes presentation

A

-dryness
-white/mild red
-irritation
-sandy/gritty
-blurred vision
-light sensititivity

67
Q

Dry eyes tx

A
  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
Q

Non pharma dry eye tx

A

-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
Q

Dry eyes tear supplementation

A

-carboxymethylcellulose
-hydroxypopylcellulose
-polyehylene glycol
-DMPG (lipid)
-mineral oil (lipid)

70
Q

Tear supplementation counseling

A

-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
Q

Dry eyes Rx tx

A

-cyclosporine 0.05% emulsion or 0.09% solution
-one drip each eye BID
-single use vials, 0.05% available as multi-dose vial

72
Q

Cyclosporine

A

-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
Q

Cyclosporine side effects

A

-burning/stinging of eye
-s/sx of infection

74
Q

Drug-induced dry eyes

A

-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
Q

Drug0induced dry eye tx

A

-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
Q

Other drug induced eye disorders

A

-cataracts
-intraoperative floppy iris syndrom
-optic neuropathy
-retinopathy

77
Q

Cataracts caused by

A

-corticosteroids
-phenothiazine
-alkylating agents
-statins

78
Q

cataracts

A

-cloudiness in specific part of lens
-will not reverse once formed
-surgical removal of lens maybe necessary to restore vision

79
Q

Intraoperative Floppy Iris Syndrome

A

-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
Q

Intraoperative floppy iris syndrome causitive agents

A

-a1 ANTAgonists

81
Q

Optic neuropathy causitive agents

A

-amiodarone
-ethambutol
-linezolid
-PDE-5 inhibitors

82
Q

Optic neuropathy

A

-bilateral vision loss
-dec visual activity
-dec color vision
-gradual sx, no pain
-dc agent usually reverses sx

83
Q

Retinopathy causitive agents

A

-aminoquinolines
-antiestrogen agents
-phenothiazines
-retinoids

-perform reg eye exams if pt on these

84
Q

Retinopathy

A

-late stage is virtually nonreversible

85
Q

Meds w eye related effects

A

-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
Q

Prevention of drug-induced disorder

A

-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
Q
A

Therapeutics II (45 decks)

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