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Pharm - Eye Flashcards

1
Q

Dry Eye
Treatment goals
3

A
  1. Alleviate symptoms
  2. Control dryness of ocular surface
  3. Prevent possible tissue and corneal damage
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2
Q

Dry eye
Monitoring Parameters
3

A
  1. Response to therapy
  2. Alleviation of symptoms
  3. Ability to administer medications – can patient give eye drops?
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3
Q

Hordeolum Treatment goals

1

A

Resolution of inflammation

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4
Q

Hordeolum Monitoring parameters

2

A
  1. Monitor for resolution

2. Monitor for development of chalazion or cellulitis

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5
Q

Blepharitis Treatment goals

2

A
  1. Eradicate the infection

2. Relieve symptoms

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6
Q

Blepharitis
Monitoring parameters
3

A
  1. 1-2 days of treatment should have decrease in discharge, redness, irritiation
  2. Monitor for reduction in visual acuity that may indicate infectious keratitis, iritis, angle closure glaucoma
  3. Photophobia or severe HA with nausea
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7
Q

Allergic conjunctivitis
Treatment Goal
3

A
  1. Remove or avoid the allergen
  2. Limit or reduce the severity of the allergic reaction
  3. Provide systematic relief
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8
Q

Corneal Abrasion/Corneal Foreign Body
Treatment Goal
4

A
  1. Prevent superinfection via abx for most likely org.
  2. Adherence to therapy
  3. Preserve vision
  4. Minimize pain
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9
Q

Corneal Abrasion/Corneal Foreign Body
Monitoring Parameter
5

A
  1. Increase in the size of defect in 24 hours
  2. Purulent discharge
  3. Decrease in vision
  4. Not healing 3-4 days
  5. Children who will not open the affected eye within 24 hrs
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10
Q

Herpes Simplex Keratitis Treatment Goal

3

A
  1. Minimize stromal damage and scarring
  2. Optical therapeutic efficacy without toxicity
  3. Eradication of infection
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11
Q

Herpes Simplex Keratitis
Monitoring Parameter
1

A

Response to therapy

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12
Q

Herpes Zoster Ophthalmicus
Treatment Goal
3

A
  1. Treat the infection
  2. Preserve sight
  3. Relieve symptoms
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13
Q

Herpes Zoster Ophthalmicus Monitoring Parameter

1

A

response to therapy

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14
Q

Glaucoma Treatment Goal

2

A
  1. Lower intraocular pressure (IOP_

2. Reduce risk of visual field loss and or optic disc changes

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15
Q

Glaucoma Monitoring Parameter

4

A
  1. IOP
  2. Optic disc
  3. Visual fields
  4. Medication adherence
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16
Q

Optic Neuritis treatment goal

2

A
  1. Improve vision, hasten recovery

2. Prevent or delay development of MS

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17
Q

Optic neuritis monitoring parameter

2

A
  1. Response to therapy

2. Appearance of AE

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18
Q

Orbital cellulitis treatment goal

1

A

Eradicate infection

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19
Q

Orbital cellulitis monitoring parameter

2

A
  1. Temperature

2. Symptom resolution

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20
Q

Preseptal cellulitis treatment goal

1

A

Eradication of infection

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21
Q

Preseptal cellulitis monitoring parameter

2

A
  1. Response is rapid and complete to appropriate abx

2. Lack of response in 24 hrs – hospitalize pt with broad spectrum abx & evaluation for orbital cellulitis

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22
Q

Antibiotic of choice

Hordeolum (2)

A

Topical abx oint to lid margin hs

  • bacitracin
  • erythromycin
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23
Q

Antibiotic of choice
Blepharitis
Ointments (2)

A
  • bacitracin

- erythromycin

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24
Q

Antibiotic of choice
Blepharitis
Solutions (1)

A

Azithromycin 1% ophthalmic solution (AzaSite)

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25
Antibiotic of choice Blepharitis Oral (2) - when use
- Tetracycline - Azithromycin use in refractory or severe cases
26
Antibiotic of choice Acute bacterial conjunctivitis non-contact wearers (2)
1. Erythromycin ophthalmic ointment | 2. Trimethroprim-polymyxin B (Polymix) ophthalmic drops
27
Antibiotic of choice Acute bacterial conjunctivitis contact wearers (1)
Ocular fluoroquinolones
28
Acute bacterial conjunctivitis - what type of application for children vs. adults
children - ointment (will blur eyes for 20 min) | adults - drops
29
Antibiotic of choice Corneal abrasion/foreign body Not d/t contacts
Topical antibiotic to prevent superinfection | Erythromycin oint 0.5%
30
Antibiotic of choice Corneal abrasion/foreign body Not d/t contacts AND can't tolerate or allergic to erythromycin
trimethoprim-polymyxin B
31
Antibiotic of choice Corneal abrasion/foreign body d/t contacts
Fluoroquinolones - Ofloxacin - Ciprofloxacin drop - Ciprofloxacin oint Amino glycosides - tobramycin drops
32
Corneal abrasion/foreign body - preferred application children
ointment bc drops sting
33
Antibiotic of choice | Orbital cellulitis will always include which one antibiotic
IV Vancomycin
34
Antibiotic of choice | Orbital cellulitis if not special situation
one of the following: - Ceftriaxone - Cefotaxime - Ampicillin-sulbactam - Piperacillin-tazobactam
35
Antibiotic of choice | Orbital cellulitis if serious penicillin/cephalosporin allergy
fluoroquinolone
36
Antibiotic of choice | Orbital cellulitis if MSSA
oxacillin | nafcillin instead of vancomycin
37
Why use IV vans in orbital cellulitis?
MRSA
38
when switch from IV to oral antibiotics in orbital cellulitis
when pt is afebrile and the eyelid/orbital findings have improved usually 3-5 days
39
Oral antibiotic of choice for orbital cellulitis
- Clindamycin or trimethoprim-sulfamethoxazole (Bactrim) PLUS One of the following: - Amoxicillin - Augmentin - Cefpodoxime - Cefdinir - Children with serious pen/ceph allergy: Fluroquinolones
40
Two types of antibiotic therapy for preseptal cellulitis
mono therapy | combo therapy
41
mono therapy for preseptal cellulitis
oral clindamycin
42
combo therapy for preseptal cellulitis
1. Oral trimethoprim-sulfamethoxazole (Bactrim) PLUS 2. Beta-lactamase (penicillin & cephalosporin)
43
Second line abx for acute bacterial conjunctivitis
``` Bacitracin ointment sulfacetamide ointment bacitracin-polymixin B ointment fluoroquinolone drops azithromycin drops ```
44
Drug classes to treat Dry Eye (4)
1. Ophthalmic lubricants – OTC artificial tears or ocular lubricants 2. Nonmedicated ophthalmic ointments and gels 3. Topical immunomodulator (Restasis) 4. Lymphocyte function-associated antigen 1 (LFA-1) Agonist (Xiidra)
45
Drug classes to treat hordeolum (2)
1. OTC NSAIDS – pain relief | 2. Topical antibiotic – lid margin at bedtime for 1-2 weeks
46
Drug classes to treat blepharitis (4)
1. Artificial tear replacement – especially dry eyes 2. Antibiotic ointment – after removal of crusts 3. Antibiotic-corticosteroid combo – more difficult cases, not recommended long term (risk glaucoma or cataract formation) 4. Oral antibiotics – refractory or severe cases
47
Drug classes to treat | Acute bacterial conjunctivitis no contact lens (2)
``` - Abx ointment: Macrolides ointment (erythromycin) OR Sulfonamide drops (trimethoprim-polymyxin B) ``` (Lots of other alternative therapies)
48
Drug classes to treat | Acute bacterial conjunctivitis yes contact lens (1)
fluoroquinolones
49
``` Drug classes to treat viral conjunctivitis (2) ```
- Topical antihistamine/decongestant drops - symptomatic relief - Non-medicated ointment/gels – symptomatic relief
50
Drug class to treat allergic conjunctivitis (5)
1. Topical antihistamine/decongestant drops – short term symptomatic relief 2. Topical antihistamine with mast cell stabilizer – frequent episodes or seasonal/perennial (take longer to go into effect) 3. Ophthalmic Mast Cell stabilizers: seasonal allergies who don’t tolerate other therapies AND can anticipate when symptoms will start 4. Oral antihistamines: helpful when have a systemic reaction (rhinitis, itching, etc.) 5. Topical ophthalmic corticosteroids: when symptoms are refractory to other treatments (have serious side effects)
51
List drug class types to treat corneal abrasion/foreign body
1. topical abx | 2. pain control - OTC, Rx
52
``` Drug class to treat corneal abrasion/foreign body no contacts ```
Topical antibiotics - Macrolides ointment (erythromycin) - Sulfonamide drops (trimethoprim-polymyxin B) if allergic to macrolides
53
``` Drug class to treat corneal abrasion/foreign body Yes contacts ```
Topical abx - Fluorquinolone drops - Aminoglycoside drops (tobramycin)
54
Pain control types for corneal abrasion/foreign body (6)
- Oral NSAIDS - Topical NSAIDS - Oral opioid for further pain relief - Cycloplegic drops for large lesions for pain and photophobia * *AVOID topical anesthetics * *NO topical corticosteroids
55
``` Drug class to treat Herpes simplex keratitis ```
Topical and oral antivirals
56
Drug class to treat herpes zoster ophthalmicus
- Oral antivirals - Corticosteroid therapy – reduce duration of pain, only use WITH antivirals - Steroid eye drops can be used with consultation with ophthalmologist
57
Drug class to treat optic neuritis
IV corticosteroid - methyprednisolone
58
``` Drug class to treat orbital cellulitis ```
- Broad spectrum antibiotics – Vancomycin PLUS | - Beta-lactamase – penicillin or cephalosporin
59
mechanism of action Restates
- Topical immunomodulator | - Cyclosporine is an immunosuppressant that blocks production of cytokines in T cells
60
mechanism of action Xiidra
Hinders T-cell activation, inhibits inflammatory pathways in dry eyes
61
mechanism of action | Erythromycin
50s ribosome interruption, can’t make proteins
62
mechanism of action | Azithromycin
- Macrolide | - 50s ribosome interruption
63
mechanism of action | Trimethoprim-polymyxin B
- Trimethoprim interrupts DNA replication | - Polymyxin B is bacteriocidal agent that inhibits cell wall synthesis
64
mechanism of action Fluoroquinolones
Prevent DNA replication = death
65
mechanism of action | Topical antihistamine
blocks histamine receptors in the conjunctiva and eyelids, histamines released during mast cell degranulation cannot exert their actions
66
mechanism of action Decongestant
vasoconstriction, adrenergic receptor agonist – decrease blood flow and reduce congestion
67
mechanism of action Mast cell stabilizer
Inhibit mast cells from degranulating and releasing inflammatory mediators Ex: ketotifen fumurate and Olopatadine (Pataday)
68
mechanism of action aminoglycoside
Ribosome 30s and 50s, inhibit protein synthesis
69
mechanism of action Antiviral
Inhibit replication of virus via inhibition of DNA synthesis
70
mechanism of action corticosteroid
- act in the hypothalamic, pituitary, adrenal axis | - get into cells and inhibit production of proteins that create inflammation
71
mechanism of action | -beta lactimase
Bind to penicillin binding proteins to inhibit cell wall synthesis
72
mechanism of action | clindamycin
50s ribosomal unit – inhibit protein synth
73
Most common organisms that cause infection in | Hordeolum (1)
Staphylococcus aureus
74
Most common organisms that cause infection in | Blepharitis (1)
Staphylococcus aureus
75
Most common organisms that cause infection in | acute bacterial conjunctivitis (3)
- Staphylococcus aureus - Streptococcus pneumonia - Haemophilus aegyptius
76
Most common organisms that cause infection in corneal abrasion/foreign body 1 - contacts 1 - no contacts
- Non contact: Staphylococcus aureus | - Contacts: pseudomonas
77
Most common organisms that cause infection in herpes simplex keratitis (1)
Herpes simplex virus
78
Most common organisms that cause infection in herpes zoster ophthalmicus (1)
herpes zoster virus
79
Most common organisms that cause infection in orbital cellulitis (4)
- Staph aureus (including MRSA) - Strep pneumonia - Other streptococci - Gram-neg bacilli
80
Most common organisms that cause infection in preseptal cellulitis (4)
- Streptococcus pneumonia - H. influenza - Moraxella catarrhalis - Staph aureus
81
Adverse effects of artificial tear solutions
Preservatives can damage conjunctiva and corneal cells
82
Adverse effects of non-medicated ophthalmic ointments and gels
- Blurry eyes – use at bedtime only or reduce amt used | - Preservatives can irritate the eye
83
Adverse effects of Restasis
Ocular burning
84
Adverse effects of Xiidra
- Eye irritation or discomfort | - Bad taste in ~25%
85
Adverse effects of Erythromycin
GI upset
86
Adverse effects of Azithromycin
GI
87
Adverse effects of tetracycline
- Photosensitivity - GI upset - Gray teeth in children <12
88
Adverse effects of Topical antihistamine/decongestant drops
Tolerance and rebound reactive hyperemia
89
Adverse effects of Antihistamines with mast cell-stabilizing properties
- Burning and stinging | - Increased ocular dryness
90
Adverse effects of | Ophthalmic Mast Cell Stabilizers
Transient ocular stinging/burning upon administration
91
Adverse effects of Oral antihistamines
Dry eyes or worse dry eyes if already present
92
Adverse effects of Topical ophthalmic corticosteroids
- Increase intraocular pressure | - Cause cataracts
93
Adverse effects of Oral and topical antivirals - gel - drop/oint - topical - trifluridine
- Gel – blurred vision - Drops/Oint – burning sensation - Topical: long term use corneal toxicity - Trifluridine: epithelial toxicity, esp with prolonged use
94
Adverse effects of IV methylprednisolone
- Hyperglycemia - Fluid retention - Increased BP - Hypokalemia
95
Adverse effects of Beta-lactamase
- Allergy - Cross reactivity * In generals – lots have specific other ADEs
96
Adverse effects of Clindamycin
Diarrhea from c. diff overgrowth
97
Pt with contacts and acute bacterial conjunctivitis 1. 1st line therapy 2. counseling
1. Ocular fluoroquinolones (High incidence of pseudomonas) 2. Discontinue lens wear until eye is white without discharge for 24 hours after completing abx therapy. Discard lens case, discard lens if disposable
98
Pt with contacts and corneal abrasion/foreign body 1. 1st line therapy 2. counseling
1. Fluoroquinolone drops | 2. Counseling: refrain from wearing contact lens until fully healed
99
Drug of choice for dry eyes
Artificial tears (ocular lubricants)
100
Rx Drug of choice for dry eyes
Restasis
101
Drug of choice for Hordeolum
Topical bacitracin or erythromycin
102
Drug of choice for Blepharitis
Abx oint
103
Drug of choice for Acute bacterial conjunctivitis adult vs. child
- Ointment for children | - Drops for adults
104
Drug of choice for corneal abrasion/foreign body
- Erythromycin ophth. Oint. OR trimethoprim-polymyxin B - Ointment for children - Drops for adults
105
Drug of choice for Viral conjunctivitis
- Topical antihistamine/decongestant drops | - Non medicated ophth. oint/gels
106
Drug of choice for Corneal abrasion/corneal foreign bodies
- Erythromycin oint - Trimethoprim-polymyxin B drops - Fluoroquinolone drops: contact wearers
107
Drug of choice for Herpes simplex keratitis
- Oral acyclovir 400 mg - Ganciclovir ophthalmic gel - Trifluridine drops
108
Drug of choice for herpes zoster ophthalmic
Antiviral: - Acyclovir (Zovirax) - Famciclovir (Famvir) - Valacyclovir (Valtrex) Corticosteroids oral
109
Drug of choice for Optic neuritis
IV methylprednisolone for adults and children (NOT oral)
110
Drug of choice for orbital cellulitis
- Vancomycin for broad spectrum coverage PLUS One of the following - 3rd gen cephalosporin - penicillin
111
Effects of ingredients in ophthalmic lubricants: - Lubricants - what is most common
- lubricate the eye | - methyl cellulose most common
112
Effects of ingredients in ophthalmic lubricants: Preservatives - where used - why
- multi-dose containers to limit/destroy microorgs that grow in the bottle - bactericidal
113
Four examples of ophthalmic lubricants preservatives
- BKA: excellent preservative but long-term frequent use can damage conjunctiva and corneal cells Don’t use more than 4 or more times a day - Chlorhexidine: not toxic, doesn’t alter corneal permeability - Chlorobutanol: not as stable as BKA, no allergic rxns - Vanishing preservatives dissociate when hit the eye and no longer active Expensive, best for people who use frequently (to avoid preservative exposure long term)
114
Ingredients in ophthalmic lubricants: Lipids - effect - two examples
- Promote a clear refracting surface - Prevent evaporation of fluid - Mineral oil & drakeo
115
Ingredients in ophthalmic lubricants: Polymers - effect - two examples
- Provide a matrix for aqueous component so it sticks to the eye longer - Hydroxypropyl guar, carboner copolymer type A
116
Ingredients in ophthalmic lubricants: Osmoprotectants - effect - two examples
- Blunt effect of high osmolarity, helps when use drugs in high concentrations - L-carnitine, erythritol
117
``` Ingredients in ophthalmic lubricants: Preservative Free - when use - price - recommended for whom ```
- Single dose only - More expensive - Recommended for people with severe dry eyes OR people who use artificial produce 4+ per day
118
How counsel older adults to place eye drops
special devices
119
how counsel babies/children place eye drops
lay on back, place drop on medial corner of eye, eyes can be closed. If drop not seeping in, can gently separate lids
120
Role of hot compress in hordeolum
speed rupture of the stye, aid in symptom relief
121
Role of topical/oral abx in hordeolum
kills staph
122
Role of OTC analgesics in hordeolum
pain relief
123
Role of OTC sty ointment in hordeolum
nothing :)
124
Blepharitis | ID methods and agents helpful in removing crusted secretions from eyelid margin (3)
1. Warm-water compresses to losses dried, hardened gland secretions 2. Gentle washing of eyelids with dilute baby shampoo – warm washcloth or cotton tipped applicator (not in eye!!) 3. Selenium shampoos (Selsun blue) with cotton tipped applicator
125
Rationale for use of antibiotics in blepharitis
Not so much from killed staph but instead by reducing irritating lipases the bacteria produce that is part of the inflammatory process of blepharitis
126
ophthalmic vasoconstrictors - duration of use - reason for limited duration
- Don’t use more than 2 weeks | - Avoid rebound effect, when stop the symptoms come back worse!
127
topical ophthalmic histamine antagonist and mast cell stabilizer of choice for allergic conjunctivitis and 3 examples
Ophthalmic histamine agonist - Ketotifen fumurate (OTC). Adults and kids >=3 - Olopatadine (Pataday). Adults and kids >= 2 - Cromolyn sodium for mast cell stabilizer only
128
State recommended time to start antiviral agents for HZO and duration of therapy
w/in 72 hours
129
Rationale for favoring oral famciclovir or valacyclovir over oral acyclovir
Both have simpler dosing regimen (TID vs. 5 times daily)
130
3 benefits of oral corticosteroids
1. Reduce duration of pain during acute phase 2. Increase skin healing 3. Do not reduce incidence of post-herpetic neuralgia
131
ADE Prostaglandings (glaucoma treatment)
- Iris pigmentation - Hypertrichosis and hyperpigmentation around lids and lashes (grow) - Uveitis - Can worse herpetic keratitis
132
ADE beta blocker (glaucoma treatment)
``` - Ophthalmic: Stinging dry eyes corneal anesthesia blepharitis blurred vision conjunctivitis uveitis keratitis ``` ``` - Systemic: Decreased heart rate neg inotropic effects conduction defects bronchospasm CNS effects block symptoms of hypoglycemia ```
133
ADE Alpha2 adrenergic agonists (glaucoma treatment)
- Local Allergic conjunctivitis, hyperemia, ocular pruritis - Systemic Dizziness, fatigue, sleepiness, dry mouth, decreased bp and pulse
134
ADE systemic carbonic anhydrase inhibitors (glaucoma treatment)
Systemic acidosis (malaise, fatigue, anorexia, etc.)

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