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OD2 S1 > OptoP: Ocular Analgesics - Week 10 > Flashcards

OptoP: Ocular Analgesics - Week 10 Flashcards

1
Q

How many Drug schedules are there? Describe 3 of them

A

9 in total.
Schedule 2: therapeutic use available for supply by pharmacists or appropriately licensed persons
Schedule 3: therapeutic use but are dangerous or liable to abuse so as to restrict supply by pharmacists etc.
Schedule 4: prescription only substances intended for therapeutic use but the safety or efficacy requires further evaluation

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2
Q

For currently listed S2 drugs for optometrists:
- name 2 anti-infectives

A
  • dibromopropamidine
  • propamidine
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3
Q

For currently listed S2 drugs for optometrists:
- name 2 anti-inflammatories

A
  • antazoline
  • azelastine
  • ketotifen
  • levocabastine
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4
Q

For currently listed S2 drugs for optometrists:
- name 2 decongestants/analgesics

A
  • lodoxamide
  • naphazoline
  • pheniramine
  • sodium cromoglycate
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5
Q

For currently listed S2 drugs for optometrists:
- name 1 drug for miotic, mydriatic or cycloplegia
- what schedule of drug do other drugs that have this effect typically fall under?

A

phenylephrine

other drugs fall under S4 generally (prescription only)

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6
Q

What class and schedule of drug does chloramphenicol fall under?

A

S3 drug and is an anti-infective

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7
Q

What schedule of drug for optometry use is the most common for the following?
- anti-infectives, anti-inflammatories, anti-glaucoma, miotic, mydriatic, cycloplegic, local anaesthetics

A

S4

In fact, anti-glaucoma and local anaesthetics for optometrists are all S4 (and have no drugs in S2 or 3)

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8
Q

Name 3 characteristics of a not so serious red eye

A
  • tired, drinking
  • vasodilation of blood vessels
  • usually associated soreness
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9
Q

Name 1 characteristic of a more serious red eye

A
  • persistent red-eye
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10
Q

What actions should you take when you see a more serious red eye (2)

A
  • identify cause
  • decide on best option (understand mediators involved)
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11
Q

What type of drug is usually adequate to treat a not so serious red eye?

A

S2 vasoconstrictors (alpha-adrenoceptor agonists) usually adequate

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12
Q

What 2 drug classes might be used to treat a more serious red eye?

A
  1. Anti-inflammatory: if irritation due to foreign particles or allergic conditions
  2. Anti-infective: if bacterial, viral, or fungal cause
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13
Q

What is the vascular response and cellular response to inflammation? What is the primary defence mechanism in inflammation?

A

Vascular: vasodilation
Cellular: cell migration (WBCs, mast cells)

Primary defence mechanism = pain

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14
Q

Name the 5 mediators of inflammation and rate how much they contribute to the following:
A: dilatation
B: vascular permeability
C: chemotaxis
D: pain

A

A B C D
Histamine ++ +++ - -
Serotonin +/- + - -
Bradykinin +++ + - +++
Prostanoids +++ + +++ +
Leukotrienes - +++ +++ -

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15
Q

Which mediators of inflammation have the largest effect on dilatation? (2)

A

Bradykinin and Prostanoids (closely followed by histamines)

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16
Q

Which mediators of inflammation have the largest effect on vascular permeability? (2)

A

Histamine and Leukotrienes

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17
Q

Which mediators of inflammation have the largest effect on chemotaxis? (2)

A

Prostanoids and Leukotrienes

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18
Q

Which mediator of inflammation has the largest effect on pain? (1) Are there any other mediators that cause pain?

A

Bradykinin. (prostanoids cause slight pain)

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19
Q

How does pain intensity and duration correlate with the use of the following:
A: Prostaglandin (PGE2)
B: Bradykinin
C: PGE2 + Bradykinin

A

A: slight pain
B: slightly more pain
C: a lot more pain

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20
Q

How can we reduce the pain intensity of PGE2 + Bradykinin?

A

By blocking the action of one of this synergistic pair - this may be sufficient to inhibit the overall pain response
e.g. prostaglandin synthesis inhibitors

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21
Q

Describe the Arachidonic Acid (AA) pathway and how it branches out in 2 steps

A
  1. Lipid Membrane produces A.A via phospholipase
  2. A.A differentiates into either prostanoids (via cyclooxygenase) or Leukotrienes (via lipoxygenase)
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22
Q

Name 2 types of prostanoids and describe their effects (4 effects for 1 type and 1 effect for the other)

A
  1. Prostaglandins:
    - hyperalgesia, vasodilation, vasc. permeability (leukocyte trapping)
  2. Thromboxane A2:
    - aggregation of platelets
23
Q

Name 2 prostaglandins

A

Prostaglandins:
- PGE2
- PGI2

24
Q

Name 1 leukotriene and describe its effects (2)

A

LTB4:
- chemoattraction
- neutrophil function (phagocytosis)

25
Q

What class of molecule are prostanoids and leukotrienes?

A

Eicosanoids

26
Q

In regards to NSAIDS, describe the following:
A: What pathways do they inhibit?
B: What treatment are they accepted as an alternative for?

A

A: Inhibits prostanoid pathway only (by reducing amplification of inflammatory signals)
B: Accepted alternative/adjucent to steroid treatment

27
Q

How safe are NSAIDs? List Contraindications (2)

A

Generally considered Safe.
Contraindications:
- aspirin/NSAID anaphylactic reaction
- bisulphate sensitivity (for Indomethacin only)

28
Q

List 4 potential adverse effects of NSAIDs

A
  1. burning, stinging or mild discomfort on application
  2. ocular irritation, itching and redness
  3. delayed epithelial growth and wound healing (Diclofenac only)
  4. Potential bleeding risk (local + systemic)
29
Q

Describe the action of the following classes of drugs on the AA pathway:
A: Steroids
B: NSAIDS

A

A: steroids inhibit phospholipase and cyclooxygenase
B: NSAIDs inhibit cyclooxygenase

30
Q

Describe the mechanism of action of ‘transactivation’ with glucocorticoids (a steroid) (5)

A
  • Glucocorticoids travel through the membrane and bind to the cytosolic GR (glucocorticoid receptor)
  • The newly formed complex then translocates itself into the cell nucleus,
  • where it binds GREs (glucocorticoid response elements) in the promoter region of the target genes
  • resulting in the regulation of gene expression (transactivation) (“these genes turn ON”)
  • result in increase in Lipocortin-1
31
Q

What is the function of Lipocortin-1?

A

it is a phosphoprotein that inhibits PLA-2

32
Q

Describe the mechanism of action of ‘transrepression’ with glucocorticoids (a steroid) (3)

A
  • the activated GR binds to DNA in the same site where the transcription factor would bind (GR binds nGREs)
  • this prevents the transcription of genes that are transcribed via the activity of that factor “these genes turn OFF”
  • results in reduction of cytokines, COX-2 and PLA2
33
Q

What does nGRE stand for?

A

Negative Glucocorticoid Response Element

34
Q

List 12 systemic side effects of steroids (don’t really have to know all of these)

A
  • osteoporosis
  • immunosuppression/risk of infection
  • hypertension
  • fat deposition, abdominal, face, neck
  • thinning skin, arms, legs
  • muscle wasting
  • behavioural disturbances
  • peptic ulceration
  • growth inhibition
  • delay/poor wound healing
  • cataracts
35
Q

List 3 advantages of topical steroids

A
  • minimise systemic effects
  • can place where needed
  • can treat uniocular disease
36
Q

List 1 disadvantage and 2 sub-disadvantages of topical steroids

A
  • specific local reactions: - may leave white residue, may affect vision
37
Q

list 4 common ocular side-effects of topical steroids

A
  • ocular hypertension
  • reduced corneal healing
  • rebound inflammation
  • cataract formation
38
Q

List 6 rare ocular side-effects of topical steroids

A
  • corneal melt
  • refractive changes
  • ptosis
  • lid swelling
  • exophthalmus
  • adrenal insufficiency
39
Q

Name 2 indications for the use of topical steroids

A
  • allergic and selected inflammatory conditions of lids, conjunctiva, cornea, iris and cil. body
  • post-operative inflammation
40
Q

Name 1 contra-indication for the use of topical steroids

A

ocular infection

41
Q

Name 2 specific considerations for the use of topical steroids

A
  • aggravation of glaucoma
  • increase risk of ocular hypertension and cataract
42
Q

Name 5 topical steroids and rate the following features:
A: potency
B: penetration
C: IOP rise

A

A B C
Dexamethasone 4+ 2+ 4+
Fluorometholone 3+ + 3+
Hydrocortisone + + 2+
Medrysone + - +
Prednisolone 3+ 3+ 3+

43
Q

How long should you prescribe topical steroids for? Any exceptions?

A

No longer than 2 weeks unless you are able to monitor corneal epithelium and measure IOP

44
Q

In regards to topical cyclosporin, describe the following:
A: State it’s effect on the immune system
B: What does it inhibit or activate? (2)

A

Cyclosporin is an immunosuppressant that specifically inhibits T-lymphocyte activation and cytokine production

45
Q

List 5 indications for the use of topical cyclosporin

A
  • dry eye
  • vernal keratoconjunctivitis
  • eczema
  • atopic keratoconjunctivitis
  • allergic conjunctivitis
46
Q

Name 3 systemic side effects that are lessened/absent as a consequence of the topical administration of cyclosporin

A
  • IOP increase
  • delay in wound healing
  • cataract formation
47
Q

List 2 contraindications for the use of topical cyclosporin

A
  • known hypersensitivity
  • active ocular infections
48
Q

Name 2 Histamine H1 antagonists and briefly describe them

A
  1. Levocabastine - used for seasonal allergic conjunctivitis; full adverse profile not known
  2. Oloptadine - histamine receptor antagonist and mast cell stabiliser
49
Q

In 2 steps, describe what you should do before removing a foreign particle from the eye

A
  1. ensure no infection
  2. use local anaesthetic
50
Q

Name drugs that can target the following:
A: mediator release (2)
B: cell migration (2)
C: vascular response (1)

A

A: NSAIDs (to inhibit prostaglandin formation) and Oloptadine (to inhibit histamine receptor)
B: suppress WBCs and mast cells with Steroids, Cyclosporin
C: alpha-adrenoceptor agonists

51
Q

List 3 factors to consider when thinking about the quality use of medicine

A
  1. selecting management options wisely
  2. choosing suitable medications
  3. using medicines safely and effectively
52
Q

List 2 factors to consider when thinking about considerations of the patient

A
  1. presentation of signs and symptoms
  2. medical history: other medications, known drug allergies
53
Q

List 6 factors to consider when thinking about the pharmacology of drug use

A
  1. indications/contraindications
  2. normal clinical response expected
  3. suitable dosing regimes
  4. potential side effects (topical and systemic)
  5. interactions with other drugs
  6. how such complications can be managed/avoided
54
Q

Name 4 topical NSAIDs

A
  • Diclofenac
  • Flurbiprofen
  • Indomethacin
  • Ketorolac

OD2 S1 (47 decks)

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