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HEENOT > Pharm - Eye > Flashcards

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
Q

Antibiotic of choice
Blepharitis
Oral (2)
- when use

A
  • Tetracycline
  • Azithromycin

use in refractory or severe cases

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26
Q

Antibiotic of choice
Acute bacterial conjunctivitis
non-contact wearers (2)

A
  1. Erythromycin ophthalmic ointment

2. Trimethroprim-polymyxin B (Polymix) ophthalmic drops

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27
Q

Antibiotic of choice
Acute bacterial conjunctivitis
contact wearers (1)

A

Ocular fluoroquinolones

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28
Q

Acute bacterial conjunctivitis - what type of application for children vs. adults

A

children - ointment (will blur eyes for 20 min)

adults - drops

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29
Q

Antibiotic of choice
Corneal abrasion/foreign body
Not d/t contacts

A

Topical antibiotic to prevent superinfection

Erythromycin oint 0.5%

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30
Q

Antibiotic of choice
Corneal abrasion/foreign body
Not d/t contacts AND can’t tolerate or allergic to erythromycin

A

trimethoprim-polymyxin B

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31
Q

Antibiotic of choice
Corneal abrasion/foreign body
d/t contacts

A

Fluoroquinolones

  • Ofloxacin
  • Ciprofloxacin drop
  • Ciprofloxacin oint

Amino glycosides
- tobramycin drops

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32
Q

Corneal abrasion/foreign body - preferred application children

A

ointment bc drops sting

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33
Q

Antibiotic of choice

Orbital cellulitis will always include which one antibiotic

A

IV Vancomycin

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34
Q

Antibiotic of choice

Orbital cellulitis if not special situation

A

one of the following:

  • Ceftriaxone
  • Cefotaxime
  • Ampicillin-sulbactam
  • Piperacillin-tazobactam
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35
Q

Antibiotic of choice

Orbital cellulitis if serious penicillin/cephalosporin allergy

A

fluoroquinolone

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36
Q

Antibiotic of choice

Orbital cellulitis if MSSA

A

oxacillin

nafcillin instead of vancomycin

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37
Q

Why use IV vans in orbital cellulitis?

A

MRSA

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38
Q

when switch from IV to oral antibiotics in orbital cellulitis

A

when pt is afebrile and the eyelid/orbital findings have improved

usually 3-5 days

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39
Q

Oral antibiotic of choice for orbital cellulitis

A
  • Clindamycin or trimethoprim-sulfamethoxazole (Bactrim)

PLUS One of the following:

  • Amoxicillin
  • Augmentin
  • Cefpodoxime
  • Cefdinir
  • Children with serious pen/ceph allergy: Fluroquinolones
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40
Q

Two types of antibiotic therapy for preseptal cellulitis

A

mono therapy

combo therapy

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41
Q

mono therapy for preseptal cellulitis

A

oral clindamycin

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42
Q

combo therapy for preseptal cellulitis

A
  1. Oral trimethoprim-sulfamethoxazole (Bactrim)

PLUS

  1. Beta-lactamase (penicillin & cephalosporin)
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43
Q

Second line abx for acute bacterial conjunctivitis

A 
Bacitracin ointment
sulfacetamide ointment
bacitracin-polymixin B ointment
fluoroquinolone drops
azithromycin drops
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44
Q

Drug classes to treat Dry Eye (4)

A
  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)
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45
Q

Drug classes to treat hordeolum (2)

A
  1. OTC NSAIDS – pain relief

2. Topical antibiotic – lid margin at bedtime for 1-2 weeks

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46
Q

Drug classes to treat blepharitis (4)

A
  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
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47
Q

Drug classes to treat

Acute bacterial conjunctivitis no contact lens (2)

A 
- Abx ointment:  
Macrolides ointment (erythromycin) OR 
Sulfonamide drops (trimethoprim-polymyxin B)

(Lots of other alternative therapies)

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48
Q

Drug classes to treat

Acute bacterial conjunctivitis yes contact lens (1)

A

fluoroquinolones

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49
Q 
Drug classes to treat 
viral conjunctivitis (2)
A
  • Topical antihistamine/decongestant drops - symptomatic relief
  • Non-medicated ointment/gels – symptomatic relief
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50
Q

Drug class to treat allergic conjunctivitis (5)

A
  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)
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51
Q

List drug class types to treat corneal abrasion/foreign body

A
  1. topical abx

2. pain control - OTC, Rx

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52
Q 
Drug class to treat corneal abrasion/foreign body
no contacts
A

Topical antibiotics

  • Macrolides ointment (erythromycin)
  • Sulfonamide drops (trimethoprim-polymyxin B) if allergic to macrolides
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53
Q 
Drug class to treat corneal abrasion/foreign body
Yes contacts
A

Topical abx

  • Fluorquinolone drops
  • Aminoglycoside drops (tobramycin)
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54
Q

Pain control types for corneal abrasion/foreign body (6)

A
  • 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
Q 
Drug class to treat
Herpes simplex keratitis
A

Topical and oral antivirals

56
Q

Drug class to treat herpes zoster ophthalmicus

A
  • Oral antivirals
  • Corticosteroid therapy – reduce duration of pain, only use WITH antivirals
  • Steroid eye drops can be used with consultation with ophthalmologist
57
Q

Drug class to treat optic neuritis

A

IV corticosteroid - methyprednisolone

58
Q 
Drug class to treat 
orbital cellulitis
A
  • Broad spectrum antibiotics – Vancomycin PLUS

- Beta-lactamase – penicillin or cephalosporin

59
Q

mechanism of action Restates

A
  • Topical immunomodulator

- Cyclosporine is an immunosuppressant that blocks production of cytokines in T cells

60
Q

mechanism of action Xiidra

A

Hinders T-cell activation, inhibits inflammatory pathways in dry eyes

61
Q

mechanism of action

Erythromycin

A

50s ribosome interruption, can’t make proteins

62
Q

mechanism of action

Azithromycin

A
  • Macrolide

- 50s ribosome interruption

63
Q

mechanism of action

Trimethoprim-polymyxin B

A
  • Trimethoprim interrupts DNA replication

- Polymyxin B is bacteriocidal agent that inhibits cell wall synthesis

64
Q

mechanism of action Fluoroquinolones

A

Prevent DNA replication = death

65
Q

mechanism of action

Topical antihistamine

A

blocks histamine receptors in the conjunctiva and eyelids, histamines released during mast cell degranulation cannot exert their actions

66
Q

mechanism of action Decongestant

A

vasoconstriction, adrenergic receptor agonist – decrease blood flow and reduce congestion

67
Q

mechanism of action Mast cell stabilizer

A

Inhibit mast cells from degranulating and releasing inflammatory mediators
Ex: ketotifen fumurate and Olopatadine (Pataday)

68
Q

mechanism of action aminoglycoside

A

Ribosome 30s and 50s, inhibit protein synthesis

69
Q

mechanism of action Antiviral

A

Inhibit replication of virus via inhibition of DNA synthesis

70
Q

mechanism of action corticosteroid

A
  • act in the hypothalamic, pituitary, adrenal axis

- get into cells and inhibit production of proteins that create inflammation

71
Q

mechanism of action

-beta lactimase

A

Bind to penicillin binding proteins to inhibit cell wall synthesis

72
Q

mechanism of action

clindamycin

A

50s ribosomal unit – inhibit protein synth

73
Q

Most common organisms that cause infection in

Hordeolum (1)

A

Staphylococcus aureus

74
Q

Most common organisms that cause infection in

Blepharitis (1)

A

Staphylococcus aureus

75
Q

Most common organisms that cause infection in

acute bacterial conjunctivitis (3)

A
  • Staphylococcus aureus
  • Streptococcus pneumonia
  • Haemophilus aegyptius
76
Q

Most common organisms that cause infection in corneal abrasion/foreign body
1 - contacts
1 - no contacts

A
  • Non contact: Staphylococcus aureus

- Contacts: pseudomonas

77
Q

Most common organisms that cause infection in herpes simplex keratitis (1)

A

Herpes simplex virus

78
Q

Most common organisms that cause infection in herpes zoster ophthalmicus (1)

A

herpes zoster virus

79
Q

Most common organisms that cause infection in orbital cellulitis (4)

A
  • Staph aureus (including MRSA)
  • Strep pneumonia
  • Other streptococci
  • Gram-neg bacilli
80
Q

Most common organisms that cause infection in preseptal cellulitis (4)

A
  • Streptococcus pneumonia
  • H. influenza
  • Moraxella catarrhalis
  • Staph aureus
81
Q

Adverse effects of artificial tear solutions

A

Preservatives can damage conjunctiva and corneal cells

82
Q

Adverse effects of non-medicated ophthalmic ointments and gels

A
  • Blurry eyes – use at bedtime only or reduce amt used

- Preservatives can irritate the eye

83
Q

Adverse effects of Restasis

A

Ocular burning

84
Q

Adverse effects of Xiidra

A
  • Eye irritation or discomfort

- Bad taste in ~25%

85
Q

Adverse effects of Erythromycin

A

GI upset

86
Q

Adverse effects of Azithromycin

A

GI

87
Q

Adverse effects of tetracycline

A
  • Photosensitivity
  • GI upset
  • Gray teeth in children <12
88
Q

Adverse effects of Topical antihistamine/decongestant drops

A

Tolerance and rebound reactive hyperemia

89
Q

Adverse effects of Antihistamines with mast cell-stabilizing properties

A
  • Burning and stinging

- Increased ocular dryness

90
Q

Adverse effects of

Ophthalmic Mast Cell Stabilizers

A

Transient ocular stinging/burning upon administration

91
Q

Adverse effects of Oral antihistamines

A

Dry eyes or worse dry eyes if already present

92
Q

Adverse effects of Topical ophthalmic corticosteroids

A
  • Increase intraocular pressure

- Cause cataracts

93
Q

Adverse effects of Oral and topical antivirals

  • gel
  • drop/oint
  • topical
  • trifluridine
A
  • Gel – blurred vision
  • Drops/Oint – burning sensation
  • Topical: long term use corneal toxicity
  • Trifluridine: epithelial toxicity, esp with prolonged use
94
Q

Adverse effects of IV methylprednisolone

A
  • Hyperglycemia
  • Fluid retention
  • Increased BP
  • Hypokalemia
95
Q

Adverse effects of Beta-lactamase

A
  • Allergy
  • Cross reactivity
  • In generals – lots have specific other ADEs
96
Q

Adverse effects of Clindamycin

A

Diarrhea from c. diff overgrowth

97
Q

Pt with contacts and acute bacterial conjunctivitis

  1. 1st line therapy
  2. counseling
A
  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
Q

Pt with contacts and corneal abrasion/foreign body

  1. 1st line therapy
  2. counseling
A
  1. Fluoroquinolone drops

2. Counseling: refrain from wearing contact lens until fully healed

99
Q

Drug of choice for dry eyes

A

Artificial tears (ocular lubricants)

100
Q

Rx Drug of choice for dry eyes

A

Restasis

101
Q

Drug of choice for Hordeolum

A

Topical bacitracin or erythromycin

102
Q

Drug of choice for Blepharitis

A

Abx oint

103
Q

Drug of choice for Acute bacterial conjunctivitis adult vs. child

A
  • Ointment for children

- Drops for adults

104
Q

Drug of choice for corneal abrasion/foreign body

A
  • Erythromycin ophth. Oint. OR trimethoprim-polymyxin B
  • Ointment for children
  • Drops for adults
105
Q

Drug of choice for Viral conjunctivitis

A
  • Topical antihistamine/decongestant drops

- Non medicated ophth. oint/gels

106
Q

Drug of choice for Corneal abrasion/corneal foreign bodies

A
  • Erythromycin oint
  • Trimethoprim-polymyxin B drops
  • Fluoroquinolone drops: contact wearers
107
Q

Drug of choice for Herpes simplex keratitis

A
  • Oral acyclovir 400 mg
  • Ganciclovir ophthalmic gel
  • Trifluridine drops
108
Q

Drug of choice for herpes zoster ophthalmic

A

Antiviral:

  • Acyclovir (Zovirax)
  • Famciclovir (Famvir)
  • Valacyclovir (Valtrex)

Corticosteroids oral

109
Q

Drug of choice for Optic neuritis

A

IV methylprednisolone for adults and children (NOT oral)

110
Q

Drug of choice for orbital cellulitis

A
  • Vancomycin for broad spectrum coverage PLUS
    One of the following
  • 3rd gen cephalosporin
  • penicillin
111
Q

Effects of ingredients in ophthalmic lubricants:

  • Lubricants
  • what is most common
A
  • lubricate the eye

- methyl cellulose most common

112
Q

Effects of ingredients in ophthalmic lubricants:
Preservatives
- where used
- why

A
  • multi-dose containers to limit/destroy microorgs that grow in the bottle
  • bactericidal
113
Q

Four examples of ophthalmic lubricants preservatives

A
  • 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
Q

Ingredients in ophthalmic lubricants:
Lipids
- effect
- two examples

A
  • Promote a clear refracting surface
  • Prevent evaporation of fluid
  • Mineral oil & drakeo
115
Q

Ingredients in ophthalmic lubricants:
Polymers
- effect
- two examples

A
  • Provide a matrix for aqueous component so it sticks to the eye longer
  • Hydroxypropyl guar, carboner copolymer type A
116
Q

Ingredients in ophthalmic lubricants:
Osmoprotectants
- effect
- two examples

A
  • Blunt effect of high osmolarity, helps when use drugs in high concentrations
  • L-carnitine, erythritol
117
Q 
Ingredients in ophthalmic lubricants:
Preservative Free
- when use
- price
- recommended for whom
A
  • Single dose only
  • More expensive
  • Recommended for people with severe dry eyes OR people who use artificial produce 4+ per day
118
Q

How counsel older adults to place eye drops

A

special devices

119
Q

how counsel babies/children place eye drops

A

lay on back, place drop on medial corner of eye, eyes can be closed. If drop not seeping in, can gently separate lids

120
Q

Role of hot compress in hordeolum

A

speed rupture of the stye, aid in symptom relief

121
Q

Role of topical/oral abx in hordeolum

A

kills staph

122
Q

Role of OTC analgesics in hordeolum

A

pain relief

123
Q

Role of OTC sty ointment in hordeolum

A

nothing :)

124
Q

Blepharitis

ID methods and agents helpful in removing crusted secretions from eyelid margin (3)

A
  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
Q

Rationale for use of antibiotics in blepharitis

A

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
Q

ophthalmic vasoconstrictors

  • duration of use
  • reason for limited duration
A
  • Don’t use more than 2 weeks

- Avoid rebound effect, when stop the symptoms come back worse!

127
Q

topical ophthalmic histamine antagonist and mast cell stabilizer of choice for allergic conjunctivitis and 3 examples

A

Ophthalmic histamine agonist

  • Ketotifen fumurate (OTC). Adults and kids >=3
  • Olopatadine (Pataday). Adults and kids >= 2
  • Cromolyn sodium for mast cell stabilizer only
128
Q

State recommended time to start antiviral agents for HZO and duration of therapy

A

w/in 72 hours

129
Q

Rationale for favoring oral famciclovir or valacyclovir over oral acyclovir

A

Both have simpler dosing regimen (TID vs. 5 times daily)

130
Q

3 benefits of oral corticosteroids

A
  1. Reduce duration of pain during acute phase
  2. Increase skin healing
  3. Do not reduce incidence of post-herpetic neuralgia
131
Q

ADE Prostaglandings (glaucoma treatment)

A
  • Iris pigmentation
  • Hypertrichosis and hyperpigmentation around lids and lashes (grow)
  • Uveitis
  • Can worse herpetic keratitis
132
Q

ADE beta blocker (glaucoma treatment)

A 
- 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
Q

ADE Alpha2 adrenergic agonists (glaucoma treatment)

A
  • Local
    Allergic conjunctivitis, hyperemia, ocular pruritis
  • Systemic
    Dizziness, fatigue, sleepiness, dry mouth, decreased bp and pulse
134
Q

ADE systemic carbonic anhydrase inhibitors (glaucoma treatment)

A

Systemic acidosis (malaise, fatigue, anorexia, etc.)

HEENOT (13 decks)

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