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Pediatric Optometry Final Exam > Pediatric Ocular Pharmacology > Flashcards

Pediatric Ocular Pharmacology Flashcards

1
Q

What are the topical antivirals used in children?

A

Trifluroidine 1% (Viroptic); Gancyclovir (Zirgan)

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2
Q

What ages can trifluoridine be used for?

A

6 and up

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3
Q

What are the oral antiviral agents that can be prescribed for children?

A

acyclovir, valacyclovir

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4
Q

At what age can oral antivirals be prescribed?

A

2 years old

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5
Q

What is the dosage frequency for trifluridine 1% (Viroptic)

A

Q2H, up to 9x/ day

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6
Q

What is the dosage frequency for Gancyclovir (Zirgan)

A

5x/ day until heals then TID x7 days

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7
Q

What is the dosage for oral acyclovir?

A

10-20mg/ kg 4x per day

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8
Q

What is the dosage for oral valacyclovir?

A

20mg/ kg 3x/ day for 5 days

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9
Q

What is a common cause of Viral Conjunctivitis?

A

Upper respiratory infections

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10
Q

What are non-prescription treatments for viral conjunctivitis?

A

cool compresses, artificial tears, hygiene

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11
Q

When do we consider antibiotics in viral conjunctivitis?

A

secondary infection

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12
Q

What steroids are prescribed for children?

A

loteprednol etabonate 0.2% (Alrex); 0.5% lotemax; fluoromethalone 0.1% (FML); 0.25% (FML forte); Prednisolone acetate 1% (pred forte); difluprednate 0.05% (Durezol)

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13
Q

What is the only steroid agent that is established and recommended for children?

A

Fluoromethalone

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14
Q

What formulations are available for fluoromethalone?

A

ung or soln

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15
Q

what ages is fluoromethalone prescribed?

A

2 years old and up

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16
Q

What are the steroid and antibiotic combination drops that are available for children?

A
  • TobraDex (Dexamethasone 0.1% + Tobramycin 0.3%);
  • Zylet (Loteprednol 0.5% + Tobramycin 0.3%);
  • Maxitrol (Dexamathasone 0.1% + Neomycin 0.35% + Polymixin B);
  • Blephamide (Sulfacetamide 10% + Prednisolone 0.2%);
  • pred G (Gentamicin + prednisolone)
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17
Q

What is the dosage frequency for all steroid/ Ab combo drops except for pred G?

A

1 gtt q4-6 hours

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18
Q

What is the dosage for Pred G

A

1 gtt 2-4x/ day

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19
Q

15-67% of uveitis cases in children are secondary to what systemic condition?

A

JIA-U

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20
Q

Which type of uveitis is usually idiopathic in children?

A

intermediate uveitis

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21
Q

JIA-U commonly presents as chronic _____________ uveitis, which is often clinically ____________

A

anterior; silent

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22
Q

Enthesitis-related arthritis (ERA) category of JIA presents as what type of uveitis?

A

Acute anterior uveitis- symptomatic, unilateral and episodic

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23
Q

When is the highest risk of uveitis with JIA?

A

within 4 years of onset

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24
Q

What are risk factors of JIA-U

A

gender, JIA category, age of onset, ANA and HLA-B27 positivity

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25
Q

How does JIA cause uveitis?

A

T and B lymphocytes generate an immune response against native intraocular antigens

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26
Q

JIA patients that are ANA positive have a (higher/ lower) risk of chronic anterior uveitis

A

higher

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27
Q

Which subtype of JIA has the highest risk of uveitis?

A

Oligoarthritis or polyarthritis, ANA +, age of onset at 6 or under; 4 years or less duration of disease

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28
Q

What is the frequency of screening for a high risk JIA patient?

A

q3 months

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29
Q

What is the treatment for children with uveitis secondary to JIA?

A

pred forte qid (or more); cyclopentolate QD (prevent synechiae, pain relief); systemic steroids, NSAIDs, Methotrexate, TNFI (Biologics)

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30
Q

If a child with uveitis secondary to JIA is a steroid responder (IOP > 30 mmHg), what hypotensive should be used?

A

Timoptic 0.25%

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31
Q

What is the only approved NSAID for children?

A

Acular (Ketorolac tromethamine 0.5%) for children older than 2 years old

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32
Q

What are indications for systemic steroids in children?

A

Asthma, allergies, inflammation

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33
Q

Systemic side effects of steroids (systemic)

A

weight gain, stomach ulcers, sleep difficulties, increased blood pressure, increased blood sugar, decreased wound healing

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34
Q

What are steroid Allergy medications for children?

A

Flonase, veramyst, Nasonex, Rhinocort, omnaris

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35
Q

Which two systemic steroids used for allergies are used in children 6 years old or older?

A

Rhinocort (Budesonide) and Omnaris (Ciclesonide)

36
Q

Which two systemic steroids used for allergies are used in children 2 years and older?

A

veramyst (Fluticasone) and Nasonex (Nometasone)

37
Q

At what age is Flonase (fluticasone) used?

A

4 years old and up

38
Q

What are ocular allergy medications used for acute allergies in children?

A
  • Ketotifen 0.025% (zaditor, alway);
  • Olopatadine 0.1% or 0.2% (Patanol/ Pataday);
  • Alcaftadine 0.25% (lastacraft, pazeo) *others non-bold on slide
39
Q

What are agents for chronic ocular allergies?

A
  • Pemirolast Potassium 0.1%,
  • Nedocromil Sodium 2%,
  • Lodoxamine Trimethamine 0.1%,
  • Cromolyn Sodium 4%
40
Q

What are off label therapeutic agents used for chronic ocular allergies?

A

pred forte, durezol, lotemax/ alrex

41
Q

What is the indication and MOA for Verkazia 0.1% (cyclosporine ophthalmic solution)

A

VKC in children 4 and up; calcineurin inhibitor immunosuppressant

42
Q

True or False: Pediatric glaucoma generally does not require surgical intervention?

A

False

43
Q

What is the long-term prognosis for pediatric glaucoma?

A

poor

44
Q

What are commonly prescribed therapeutic agents for pediatric glaucoma?

A

brimonidine 0.2%, dorzolamide, timolol 0.25%, 0.5%; cosopt, prostaglandin analogs

45
Q

What is the most common cause of pediatric hyphema?

A

blunt trauma

46
Q

What is commonly seen with a hyphema?

A

tears in anterior ciliary body and iris vessels; iridodialysis, cyclodialysis

47
Q

How many RBC’s are found in the anterior chamber in a microscopic hyphema?

A

1-4+

48
Q

How is a macroscopic hyphema graded?

A

by percentage of space they occupy; measure height in mm in anterior chamber

49
Q

What are possible complications of hyphema?

A

corneal blood staining (~5%), secondary hemorrhages; Elevated IOPs, Optic atrophy, glaucoma, amblyopia

50
Q

What two medications are used for Hyphema management?

A

Atropine (BID) and Pred Forte (Q1H or Q2H initially)

51
Q

What medications are NOT used for hyphema?

A

aspirin and ibuprofen

52
Q

How often should you see a patient with a hyphema?

A

daily

53
Q

What is important to monitor when a pediatric patient has a hyphema?

A

IOP

54
Q

What is a non-medication management technique for hyphema?

A

bed rest with head elevated 30 degrees

55
Q

What is a masquerader of hyphema?

A

xanthogranuloma

56
Q

What are the FDA subcategories of Pediatrics?

A

neonates: birth to 1 month; infants: 1 month to 2 years; Children: 2 to 12 years; Adolescent: 12-16 years

57
Q

When do cytochrome P450 levels reach adult levels? What about other enzyme systems?

A

1-2 years old; 10 years old

58
Q

How is GI absorption different in children?

A

increased bioavailability of acid labile drugs, decrease bioavailability weakly acidic drugs, gastric emptying time

59
Q

How does the blood brain barrier differ between children and adults?

A

Children: less effective

60
Q

What anesthetics are used for children?

A

0.5% proparacaine, 0.4% benoxinate

61
Q

What are the precautions when using Phenylephrine HCl?

A

cardiovascular disease, premature infants and children in the first 6 months of life

62
Q

What strength of Phenylephrine HCl is used in children?

A

2.5% max dose 2 gtts spaced 5 minutes apart

63
Q

What is in the combo mydriatic spray?

A

0.5% tropic + 2.5% phenyl + 0.5% Cyclo

64
Q

What concentration of atropine is used in light irides? dark irides?

A

0.5% atropine in light irides, 1.0% in dark irides

65
Q

What is the duration of action for atropine?

A

2-3 weeks

66
Q

What is the onset of action for atropine drops?

A

3-6 hours

67
Q

What populations may be hypersensitive to cholinergic antagonists?

A

Down syndrome, spastic paralysis, brain damage and very light pigmentation

68
Q

What is the antidote for atropine toxicity

A

physostigmine salicylate

69
Q

What concentration of cyclopentolate is used in children under 1 year old?

A

0.5%

70
Q

what concentration of cyclopentolate is used in children over 1 year old?

A

1.0%

71
Q

What cycloplegic agent is used in premature or LBW babies?

A

cyclomydril

72
Q

what is the maximum cycloplegia action for cyclopentolate?

A

40 minutes

73
Q

Because of the risk of side effect, what % of cyclopentolate is NOT used in children?

A

2%

74
Q

What are the benefits of tropicamide 1%?

A

less potent, very safe, less adverse effects

75
Q

What are 3 common uses of antibiotics in children?

A

bacterial conjunctivitis, K ulcer, K abrasion

76
Q

Fluroquinolones inhibit bacterial DNA gyrase and are approved in children (older/younger) than 1 year old?

A

older

Moxeza: >/= 4 months

77
Q

What aminoglycosides are used in children?

A

Tobrex (infants 2 months and older); Neomycin (NE); Gentamicin (6 yo and older)

78
Q

Which macrolides are indicated for use in children?

A

erythromycin (infants and newborns), azithromycin 1% (1 yo and up)

79
Q

What are 3 antibiotics commonly used in children?

A

penicillins, cephalosporins, macrolides

80
Q

What is the most common cause of orbital cellulitis?

A

paranasal sinuses

81
Q

What are causes of preseptal cellulitis?

A

breaches in skin barrier: trauma, insect bites; adjacent infections: hordeolum, dacryocystitis

82
Q

What are the two bacteria that cause preseptal or orbital cellulitis?

A

staphylococcus aureus and streptococcus bacteria

83
Q

When is the maxillary sinus fully developed?

A

6 years of age

84
Q

what are the most commonly prescribed antibiotics for preseptal cellulitis in kids?

A

augmentin (250-500 mg po TID or 875 mg po BID); Keflex (250-500 mg po TID)

85
Q

When is hospitalization and IV indicated in preseptal cellulitis?

A

severe cases or children under 5 years old

Pediatric Optometry Final Exam (3 decks)

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