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NRS 271A: optho, pulm, GU, Renal, Heme/onc > Ophthalmology Medications > Flashcards

Ophthalmology Medications Flashcards

1
Q

tx and prevention of opthalmia neonatorum

A
  • form of neonatal conjunctivitis
  • prevention: erythromycin ointment
    • thin ribbon on each eye within 1 hour of birth
  • tx: cefotaxime IM/IV BID x 7 days
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2
Q

tx of allergic conjunctivitis

A

slow or stop release of cytokine

1st line = topical antihistamine + decongestant

topical decongestants : alleviate erythema (redness, burning, stinging)

Keep Allergens Near Other People

  • ketotifen (H1 receptor antagonist/ mast cell stabilizer/ eosinphil inhib.)
  • azelastine (H1 receptor antagonist/ mast cell stabilizer)
  • nedocromil (H1 receptor antagonist/ mast cell stabilizer)
  • olopatadine (H1 receptor antagonist/ mast cell stabilizer)
  • pemirolast (Mast cell stabilizer)
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3
Q

Red Flag Symptoms of the Eye

A
  • reduction of visual acuity
  • ciliary flush (redness at the cornea and sclera, and limbus)
  • photophobia
  • severe foreign body sensatiion
  • corneal opacity
  • fixed pupil
  • severe headache with nausea
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4
Q

General Treatment for acute bacterial conjunctivitis

(List 1-5)

A
  1. Macrolides(erythromycin) (first line)
  2. Combo (TMP-Polymyxin B, polymyxin B with Bacitracin) (first line)
  3. Quinolones (Ciprofloxacin, moxifloxacin, ofloxacin, gatifloxacin) Expensive (reserved for recurrent infections
  4. Sulfa (TMP, sulfacetamide)
  5. Aminoglycosides (gentamicin, tobramycin, neomycin)
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5
Q

tx of hyperacute bacterial conjunctivitis

A

ceftriaxone 1g IM x1 + topical abx

refer to ophthalmologist

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6
Q

tx of viral conjunctivitis

A
  • artificial tears
    • the “Refresh” eye drops
      • no preservatives and active ingredients are CMV, Glycerin, Mineral Oil, and PVA
  • Topical decongestants
    • phenylephrine (alpha-agonists)
    • tetrahydrozoline (Visine)
    • **Be careful with long term use ⇒ rebound congestion
      • NO longer than 10 days
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7
Q

Bacterial keratitis

A

bacterial infection of the cornea

  • common pathogens: pseudomonas, gram - rods; strep; staph
  • if left untreated can lead to corneal scarring and loss of vision
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8
Q

tx of bacterial keratitis

A

start with broad spectrum abx empirically

  • start with: cefazolin & tobramycin or fluoroquinolones
  • gram + cocci:
    • cefazoline or vancomycin or bacitracin or moxifloxacin
  • gram - rods:
    • tobramycin, gentamycin, ceftazidime or fluoroquinolones
  • gram - cocci:
    • ceftriaxone or ceftazidime (3rd gen ceph) or fluoroquinolones
  • Nontubercuolosis mycobacteria:
    • amikacin or clarithromycin
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9
Q

Risk factors for Dry Eye

A
  • older age
  • female
  • connective tissue disease
  • vitamin A deficiency
  • Androgen deficiency
  • estrogen replacement therapy
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10
Q

Tx for Severe Dry Eye

A
  • Systemic Treatments:
    • stimulat muscarinic receptors:
      • pilocarpine or cevimeline
  • Topical:
    • immunomodulator that increases tear production
      • cyclosporine ophthalmic emulsion
    • xiidra (lifitegrast)
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11
Q

Drainage of Aqueous Humor

A
  • 8% through the trabecular meshwork and the Canal of Schlemm
  • 20% through the ciliary muscle
    • modulated by:
      1. adrenoreceptors
      2. prostanoid receptors
      3. prostamide (porstaglandin ethenolamide) receptors
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12
Q

What is the name of the angle that determines whether is is open angle glaucoma or closed angle glaucoma

A

irido-corneal angle

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13
Q

Intraocular Pressure

A
  • Normal: 10-21 mmHg
  • Optic nerve Damage over Several Years: 21-30mmHg
  • Rapid Optic Nerve Damage: 40-50mmHg
    • Emergency!
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14
Q

Open Angle Glaucoma

A
  • Asymptomatic
  • slow, insidious loss of vision
    • may take 13-16 years
  • 4-8% progress to legal blindless
  • peripheral vision is most susceptible
    • central vision preserved until advanced disease
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15
Q

What IOPs to refer primary open angle glaucoma?

A

IOP> 40mmHg = EMERGENT REFERRAL

IOP = 30-40mmHG: urgent referral (within 24 hours)

IOP = 25-29mmHg: referral within 1 week

IOP =23-24mmHg: repeat measurement to confirm

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16
Q

Aqueous Humor Inflow is controlled by:

A
  • Alpha-2 adrenergic receptor agonists
  • Beta-blockers
  • Carbonoic anhydrase inhibitors
17
Q

Aqueous humor outflow is controlled by:

A
  • Trabecular Outflow
    • muscarinic agonists
  • Uveoscelral outflow
    • prostaglandin agonists
18
Q

1st line glaucoma treatment

A
  • beta blockers
    • reduce aqueous humor production
    • Timoptic
  • Monotx = tachyphylaxis in 20-50%
  • SEs:
    • systemic absorption via nasolacrimal duct = bronchospasm, bradycardia, hypotension, CHF exacerbation
    • Local: stinging, conjuctivitis, keratitis, dry eyes, uveitis,
      • due to preservatives
19
Q

1st line glaucoma treatment (not beta-blockers)

A
  • Prostaglandin analogs (ocular hypotensive lipids) once daily
    • end in “prost”
      • latanoprost
        • keep in fridge until open, 6weeks at RT
      • travoprost
      • tafluprost
      • bimaprost
    • increase aqueous humor outflow
  • Contraindications:
    • macular edema
    • history of herpetic keratitis
  • SEs:
    • HA, stinging
    • hyperpigmentation of iris, hypertrichosis (increased eyelash growth), darkening of eyelashes
    • conjunctival hyperemia (enlargement of blood vessels in the conjunctiva)
20
Q

Alpha-2 Agonists and Glaucoma

A
  • decrease aqueous humor production (inflow)
  • “idine”
  • Brimonidine
  • Apraclonidine
    • long term = tachyphylaxis
    • SEs:
      • HA, dry mouth, fatigue
      • eyelid retraction
      • foreign body sensation
    • ​used to prevent increased IOP after surgery
21
Q

Carbonic Anhydrase Inhibitors and Glaucoma

A
  • carbonic anhydrase is an important step in aqueous humor production
  • “zolamide”
  • Dorzolamide
  • Brinzolamide
  • Acetazolamide
    • ​CI:
      • significant liver impairment, cirrhosis
  • methazolamide
  • SEs:
    • burning, stinging, itching, foreign body sensation, dry eyes, conjuctivitis
    • AVOID USE if Crcl <30
  • ​Contraindication:
    • do NOT use if pt has sulfonamide allergy
22
Q

Direct Acting Cholinergic Agents and Glaucoma

A
  • pilocarpine 3rd line
    • stimulates M3 receptors
      • ciliary muscle contraction = widening of spaces in trabecular network
    • Se:
      • pupillary spasm, myopia, increased risk of retinal detachment
      • N/V/D and bradycardia
  • Carbachol
    • stimulates M3 and inhibits AchE
    • more potent than pilocarpine but more SEs
23
Q

Indirect Acting Cholinergic Agents and Glaucoma

A
  • echothiophate iodine
  • SE:
    • similar to pilocarpine
    • can deplete systemic cholinesterases and pseudocholinesterases → cataracts
    • should d/c 1 week before general surgical procedures
      • DDI: toxic accumulation of echothiophate because succinulcholine is metabolized by pseudocholinesterases
24
Q

Hyperosmotics and Glaucoma

A
  • Glycerin
  • isosorbide
  • mannitol 20%
    • SE:
      • HA, thirst
        • Caution: CNS dehydration can lead to coma; renal & CV diseases
25
Q

Non-selective adrenergic agonists and glaucoma

A
  • rarely used
  • epinephrine
  • dipivefrin (prodrug that is metabolized to epinephrine)
  • stimulation of alpha and beta receptors leads ot increased outflow through trabecular meshwork and uveoscleral pathway
    • also reduces the production of aqueous humor
  • SEs:
    • mydriasis, conjunctival hyperemia
    • palpitation, HTN, arrhythmias
    • Cautions: CV disease, hyperthyroidism
    • CIs: narrow angles can lead to acute angle closure
26
Q

loteprednol

A

used for allergic conjunctivits

  • Steroid
  • not very popular due to SEs:
    • increased risk of IOP/risk of cataracts
      • reserved for very severe cases
27
Q

Allergic conjunctivitis and Mast Cell Stabilizers

A

typically used for chronic allergic conjunctivitis because it takes 4-6 weeks to reach maximal effect

**not helpful for acute AC**

  • cromolyn
  • lodoxamine
  • nedocromil
28
Q

Ketorolac

A
  • allergic conjuctivitis
  • only NSAID used for itching but may take up to 2 weeks for full efffects and short duration of therapy
    • 5 days on, 5 days off
  • SEs:
    • GI Side effects

NRS 271A: optho, pulm, GU, Renal, Heme/onc (10 decks)

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