Opthalmic/Thyroid/Smoking Flashcards
What is the difference between closed and open angle glaucoma?
Closed- emergency, sudden blockage , painful
Open - (chronic glaucoma) - partial blockage of the drainage canal “silent thief of sight”
What is treatment for closed angle glaucoma?
Acetazolamide 500mg IV single dose then 250mg PO
Once IOP is decreasing, give pilocarpin 4% topical QID
If IOP is not decreasing - give mannitol 1-2 g/kg IV
Does timolol eye drops have systemic effects?
Yes , so don’t use in asthma
What are first line agents for open angle glaucoma?
Prostaglandin analogues
What are the 5 prostaglandin analogs for open angle glaucoma and their brand names
How often to give?
Travoprost - travatan
Bimatoprost - lumigan (also know as LATISSEE for eyelash growth)
Latanoprost - xalatan
Latanoprostene - vyzulta
Tafluprost - Zioptan (can darken eye color)
Once daily
What beta blockers (4) are used for glaucoma + brand name?
How often to give?
Betaxolol - Betoptic
Carteolol - Ocupress
Levobunolol - Betagan
Timolol - timoptic
BID
What CAI’s are used for glaucoma + brand name?
Can you leave contacts in ?
How often to give?
Acetazolamide - Diamox
Brinzolamide - Azopt
Dorzolamide - Trusopt
NO, remove them and wait 10 minutes.
TID
Brimonidine
Brand / dosage form
MOA
Alphagan-P
Lumify OTC
Mirvaso - gel
Alpha 2 agonist
Generics for :
- Cosopt
- Simbrinza
- Combigan
- Dorzolamide + timolol
- Brinzolamide + brimonidine
- Brimonidine + timolol
Netasurdil
Brand
MOA
Indication
Rhopressa
Rho Kinase Inhibitor
Glaucoma - increase aqueous outflow
How is allergic conjunctivitis described?
Eyes itching
Eyes tearing with stringy discharge
What to recommend for acute allergic conjunctivitis?
Topical antihistamine + mast cell stabilizer OR vasoconstrictor
What are three pure mast cell stabilizers? When would you never use it?
Cromolyn
Nedocromil ( Alocril)
Lodoxamide (alomide _
Acute allergic conjunctivitis
What are two pure antihistamine for allergic conjunctivitis?
Emedastine 0.05% (emadine)
Cetirizine (Zerviate) 0.24% solution
What are 6 antihistamine + mast cell stabilizers options for allergic conjunctivitis?
- Azelastine
- Epinastine (elestat)
- Alcaftadine ) lastacaft)
- Bepotastine (bepreve)
- Olopatadine (pataday or patanol)
- Ketotifen (alaway, zaditor)
What is one decongestant + antihistamine option for short term acute allergic conjunctivitis?
What is the max duration?
What preservative does it have?
Pheniramine + naphazoline (naphcon, opcon)
3 days
Benzalkonium chloride
What NSAID options are there for allergic conjunctivitis?
Ketorolac 0.5% (acular, acuvail)
Diclofenac 0.1% (voltaren ) drops
Nepafenac (ilevro, nevanac)
What nasal spray is FDA-approved to treat allergic conjunctivitis?
Flonase
What are 4 opthalmic steroid options ?
Prednisolone
Loteprednol
Fluorometholone
Difluprednate
What treatments are there for viral conjunctivitis?
None
can only treat symptoms
What are 6 options for bacterial conjunctivitis? (not FQ’s)
Erythromycin ointment
Trimethoprim-polymyxin B drops/ointment
Bacitracin ointment
Sulfacetamide ointment
Bacitracin - polymyxin B ointment
Fluoroquinolone drops
Azithromycin drops
What are your 4 quinolone options for bacterial conjunctivitis?
Can you give to kids?
- Levofloxain
- Gatifloxacin - Zymaxid
- Moxifloxacin - viagmos (TID) moxeza (BID)
- Besifloxacin (Besivance) suspension
Yes
Azasite
Indication
Dose
Storage
Bacterial conjunctivitis
1 drop BID for >1y.o
In the fridge (Room temp x 14 days after opened)
How to treat stye?
Warm compress
DOC for dry eyes?
Restasis - cyclosporine emulsion 0.05%
Cequa - cyclosporine 0.09% solution
Verkazia - cyclosporine 0.1% emulsion
Vevye - cyclosporine 0.1% solution
Lifitegrast
Brand
Indication
Xiidra
Dry eyes
Perfluorohexyloctane
Brand
Indication
Miebo
Dry eyes
What levels would you expect in hyperthyroidism?
What is the goal levels?
DECREASED TSH
INCREASED t3/t4
TSH 0.4 - 4.0 mU/L
How long is the onset of hyperthyroid treatment ?
6-8 weeks
What are two drug options for hyperthyroidism + brand name?
What are their ADE’s?
Methimazole (Tapazole)
Propylthiuracil (PTU)
Agranulocytosis, rash, hepatitis, weight gain
propylthiouracil
MOA
BBW
Indication
Inhibits T4 to T3 conversion
Severe liver injury
Fail other treatments for hyperthyroidismW
What are two adjunct treatments for hyperthyroidism?
Beta blockers to help with symptoms
Cholestyramine to increase fecal excretion of T4
What are some causes of hypothyroidism?
Symptoms?
hashimoto’s
Drugs - amiodarone, interferons/interleukins, lithium
Cold, weight gain, puffy face, large tongue
Can you use thyroid replacement in pregnancy?
Yes and their dose would increase to protect the child
Dessiccated thyroid
Brand
MOA
Consideration
Armour thyroid
Provides both T4 and T3
Dried PIG thyroid powder
Levothyroxine
MOA
PK
Counseling
Synthetic pure T4
Slow onset, long duration
Take 30-60minutes before breakfast on empty stomach and wait 4 hours before taking antacids, cholestyramine, or orlistat
Liothyronine
Brand
MOA
Disadvantage
Cytomel, triostat
Synthetic T3
Short half life so need multiple doses
Convert IV levothyroixine to oral
IV is 50-75% of oral dose
How to give levothyroxine in pregnancy?
Increase dose by 25-30%
TSH goals:
1st trimester - 0.1-2.5
2nd - 0.2 -3
3rd - 0.3-3
Test TSH every month
If a patient smokes 10cigs/day for 24 years, what is there pack-year smoking history?
12
When would you start with 2mg nictoine gum/lozenge vs 4mg?
What are the max’s?
<25cig/day or 1st cig >30 min after waking up = 2mg
> 25cigs/day 1st cig <30 min after waking up = 4mg
Max 24 gum/day
Max 20 lozenges/day
How do you dose nicotine patches?
> 10cigs/day = 10 week plan
* 21mg x 6 weeks
14mg x 2 weeks
7mg x 2 weeks
<10cigs/day = 8 week plan
*14mg x 6 weeks
*7mg x 2 weeks
Nictotine inhaler
Brand
Rx or OTC?
Dose / max
Pregnancy?
Nicotrol
RX
Frequent continuous puffing with max 16 cartridges / day up to 6 months
Category D
Nicotine nasal spray
Brand
Rx or OTC?
Dose / max
Nicotrol NS
RX
1 dose = 2 sprays
MAX 40 doses (80 sprays ) per day
Zyban
Generic
Indication
Dose
ADE
Bupropion SR
Smoking cessation
150mg AM x 3 days then 150mg BID
Insomnia, dry mouth
Varenicline
Brand
MOA
Indication
Dose
ADE
Chantix
Partial neuronal A4,B2 nicotonic receptor agonist
Start 1 week prior to quit date
Days 1-3: 0.5mg QD
4-7 - 0.5mg BID
Then 1mg BID for 12 weeks total
Nausea, sleep disturbances, depressed mood, seizures
What are the 5 A’s to smoking cessation?
Ask
Advise
Assess
Assist
Arrange
Cigarette smoke induces…
CYP1A2
