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COT > Pharmacology 3% > Flashcards

Pharmacology 3% Flashcards

1
Q

Used to reduce the chance of contamination in meds

A

Preservatives

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2
Q

Common ___________include Sorbonne acid, benzalkonium chloride, benzethonium chloride, benzoyl bromide, EDTA, phenylmercury nitrate, phenylmercury acetate, phenylmercury borate, chlorohexidide, methyl and propyl parabens, phenylethyl alcohol, sodium benzonate, and sodium propionate.

A

Preservatives

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3
Q

Has to do with shelf life

A

Stability and storage

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4
Q

_____________can be accelerated by exposure to air, humidity, light, a higher or lower than normal temperature

A

Degradation

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5
Q

What are steps to take to conserve stability of eye drops?

A

Do not open till needed
Always replace top immediately after use
Keep bottle out of sun

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6
Q

pH value less than 7 is considered to be

A

Acidic

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7
Q

pH value greater than 7 is considered to be

A

Alkaline

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8
Q

pH value of tears is

A

7.1-7.4

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9
Q

A measure of osmotic pressure

A

Tonicity

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10
Q

Osmosis occurs when….

A

Water passes from one side of a semi-permeable membrane to the other in response to the higher concentration of a solute on one side of the membrane compared to the other.

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11
Q

Thickness of a drop

A

Viscosity

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12
Q

Route of drug delivery that includes drops(solution and suspension), ointments, gels, soft CL, and paper strips

A

Topical application

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13
Q

Advantages of topical application

A

A high concentration of the med reaches the anterior segment of the eye.
Effective for treatment of the cornea, conjunctiva, iris, and ciliary body.
The medication is primarily absorbed through the cornea and conjunctiva

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14
Q

Disadvantages of topical application

A

Not as effective when treating the posterior segment of the eye
Poor patient compliance, especially with drops, can limit effectivemess.

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15
Q

Drops are liquid medication with the drug in either _______or _______ form.

A

solution or suspension

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16
Q

Drops: If the drug is dissolved in the liquid, then it is a ________(clear)

A

Solution

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17
Q

If the drug does not dissolve in the liquid, then it is called a _______(cloudy)

A

Suspension

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18
Q

Suspensions must be _______before each use

A

shaken

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19
Q

Advantages of drops:

A

They are easy to use
There is a good local effect with minimal system effects
The possibility of allergic reaction is minimized because of short exposure time.

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20
Q

Disadvantages of drops:

A

They have to be used frequently because of the short exposure time.
The amount of drug that is absorbed is difficult to predict
There is a danger of contamination

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21
Q

Dilating drops lid color

A

Red

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22
Q

Beta blocker lid color

A

yellow .5%
Light blue .25%

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23
Q

alphagan lid top color

A

purple

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24
Q

prostaglandin lid top color

A

teal
ex. Xalatan

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25
Q

The drug is mixed with a substance that melts at body temperature

A

ointment

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26
Q

___________can be applied to the skin of the lids or, if indicated, can be applied to the anterior segment by applying a line of it inside the lower lid

A

ointment

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27
Q

Advantages of ointments:

A

There is prolonged exposure time, decreasing the frequency of application

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28
Q

Disadvantages of ointments:

A

There is an increased possibility of allergic reaction as compared to drops. Ointments blur the vision and are best used at bedtime.

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29
Q

The liquid medium for the drug is thicker than the liquid used for drops

A

gels

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30
Q

Advantages of gels:

A

There is an increased possibility of allergic reaction as compared to regular drops, decreasing the frequency of application needed/

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31
Q

Disadvantages of gels:

A

Vision is blurred somewhat, but not as much as with ointments.

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32
Q

The lens or shield is soaked in the medication solution and then inserted

A

Soft CL and shields

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33
Q

These are sterile strips of dry paper containing a dye (rose bengal or fluorescein)

A

Paper strips

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34
Q

Adavantages to paper strips:

A

They are preservative free and the chances of contamination are minimal

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35
Q

Disadvantages to strips

A

They are only useful for delivering dyes

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36
Q

Used when a larger concentration of a drug is required than can be supplied by topical administration

A

Local injection

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37
Q

A small needle (usually 27-32 gauge, 1/2 inch) is inserted posterior to the lumbus and is aimed toward the vitreous cavity. Used to administer steroids, anti VegF drugs (ex. Lucentis), anti viral drugs (ex. ganciclovir), and abx.

A

Intravitreal Injection

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38
Q

The conjunctiva is lifted up and a small needle is used to inject a medication (antibiotic or steroid) or anesthesia under the conjunctiva.

A

Subconjunctival injection

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39
Q

Tenon’s capsule is a thin membrane that envelopes the eye. The membrane is below the conjunctiva and above the sclera.
The injection site is usually near the equator, aimed toward the back of the eye. A local anesthetic injected here can anaesthetize the globe and paralyze the intraocular muscles. Medication (ex. steroids) can also be injected here.

A

Sub-Tenon’s Injection

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40
Q

This refers to one or more injections in the tissues around the globe, usually for local anesthesia (ex. lidocane) and paralysis of the extraocular muscles. This is also called peribulbar block. medications such as steroid may also be injected.

A

Peribulbar Injection (around)

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41
Q

Along needle (1.5”) is used to inject an anesthetic into the muscle cone behind the globe, for anesthesia of the globe and periocular tissues, and for paralysis of the extraocular muscles. This technique is also called a retrobulbar block. This technique is not used for medication administration. Has fallen into disuse. Of the injection techniques mentioned, this one requires the most skill, and there is a danger of injecting the anesthetic into the globe.

A

Retrobulbar Injection (behind)

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42
Q

_______are injected into the skin of the lids

A

Local anesthetics

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43
Q

Advantages to local injections:

A

Larger doses can be used and absorption is more precise

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44
Q

Disadvantages to local injections:

A

There is a risk of complications such as a hemorrhage or a perforated globe. Some patients don’t tolerate well.

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45
Q

A drug is injected directly into the bloodstream via a vein. An immediae injection of the entire amount (bolus) can be used: for example, diamox can be given IV to lower the intraocular pressure. The drug can be delivered slowly by IV drip; for example, an abx can be given to treat endophthalmitis (bacterial infxn inside the eye)

A

Intravenous Injection

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46
Q

Advantages to Intravenous Injection:

A

Some drugs cannot be administered topically and some eye diseases are treated most effectively by systemic administration of the drug.

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47
Q

Disadvantages to intravenous Injection:

A

Increased risk of side effects because the drug reaches all parts of the body

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48
Q

Pills, capsules, or liquids are taken by mouth and the mediation is absorbed by the digestive system.

A

Oral administration

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49
Q

Advantages to oral adminstration

A

A few eye diseases respond best to the particular concentration of medication in the blood that can be maintained by oral administration. An example would be the treatment of chronic blepharitis Doxycycline.

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50
Q

Disadvantages or oral adminstration

A

Increased risk of side effects because the drug reaches all parts of the body.

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51
Q

Once a day

A

q, qd

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52
Q

qod

A

every other day

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53
Q

q2h

A

every 2 hours

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54
Q

gtt

A

drop

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55
Q

gtt

A

drop

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56
Q

ung

A

ointment

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57
Q

c

A

with

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58
Q

s

A

without

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59
Q

sig

A

instructions

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60
Q

i

A

1

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61
Q

ii

A

2

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62
Q

iii

A

three

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63
Q

sol

A

solution

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64
Q

susp

A

suspenion

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65
Q

ml

A

milliliters

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66
Q

mg

A

milligrams

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67
Q

ophth

A

ophthalmic

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68
Q

wk

A

week

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69
Q

x

A

for

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70
Q

drops that dilate the eyes

A

mydriatic and cycloplegics

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71
Q

degree of dilation ranges from

A

4-8mm

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72
Q

more highly pigmented irises (brown) dilated——–

A

less

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73
Q

Ligher colored irises (blue, gray, green) dilated_____

A

more easily

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74
Q

_______sighted eyes dilated more readily than ____sighted eyes

A

Near/Far

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75
Q

An eye that is inflamed is ______ ________ to dilate.

A

More difficult

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76
Q

Younger eyes dilate more _______ than those of the older people

A

easily

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77
Q

An eye with a _____pupil to start with is more difficult to dilate than an eye with a normally ______ pupil

A

Small/larger

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78
Q

The one commonly used mydriatic

A

phenylephrine

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79
Q

Phenylephrine is a _________drug that works by stimulating the dilator muscle in the iris.

A

Sympathomimetic

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80
Q

Phenylephrine is a weak dilating agent when used by itself and is usually used in combination with a _________drop in order to achieve maximum dilation more quickley.

A

Cycloplegic

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81
Q

Side effects of phenylephrine:

A

elevated blood pressure, cardiac irregularities, vasoconstriction of the conjunctival blood vessels

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82
Q

A weak solution of phenylephrine is sometimes used as an ingredient in drops to _____eyes

A

whiten

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83
Q

_______drops dilate the eye by paralyzing the sphincter muscle of the iris

A

Cycloplegic

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84
Q

The _________muscle acts like a purse string to draw the pupil smaller.

A

Sphincter

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85
Q

_______paralyze the ciliary muscle (This is the muscle that changes the shape of the lens to focus on near objects (accommodation))

A

cycloplegics

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86
Q

Tropicamide lasts about

A

3-6 hours

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87
Q

Cyclopentolate last about…

A

6-24 hours

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88
Q

Homatropine lasts about

A

3-7 days

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89
Q

Scopolomine lasts about

A

3-7 days

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90
Q

**Atropine lasts about

A

7-10 days
(Question was… mom accidentally used child’s atropine..how long should you tell her it will last?)

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91
Q

_______ are also used to put the ciliary muscle to rest when the eye is inflamed. This serves to relieve the eye muscle spasms and to help prevent the adhesion of the iris to the anterior lens capsule (synechiae)

A

Cycloplegics

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92
Q

______is the most commonly used cycloplegic, primarily because it has the weakest action and it wears off relatively quickly.

A

Tropicamide

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93
Q

Scopolamine and Homatropine are usually only used in the treatment of _______

A

uveitis

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94
Q

If a child is given Atropine they should be monitored for what symptoms?

A

hallucinations, loss of coordination, rapid pulse, dryness, of the the mucous membranes, and redness of the skin

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95
Q

_______ _____is used for fluorescein angiography.

A

Intravenous fluorescein

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96
Q

Fluorescein diffuses(seeps) through the ______ _________ and the _________

A

choroidal capillaries and the sclera

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97
Q

_________does not normally diffuse through the retinal pigment epithelium, the retinal blood vessels, or the larger choroidal vessels.

A

Fluorescein

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98
Q

Fluorescein diffuses through cellular spaces and stains skin and mucous membranes for up to ___hours.

A

4

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99
Q

Patients should b advised of their possible _____ or ________ appearance following the injection.

A

yellowish or jaundiced (can be reduced by drinking water)

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100
Q

Pt should be advise of _____/____color in urine with Fluorescein.

A

orange/yellow

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101
Q

Flourescein is eliminated from the body within _____ hours, mainly through the kidneys

A

48

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102
Q

*Name some mild adverse reactions to fluorescein….

A

Sneezing, itching, and hives usually occur within minutes of the injection.
Nausea and vomiting usually occurs within minutes of injection.
Pain and swelling at the injection site(tx: cold/warm compresses)

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103
Q

If nausea occurs during fluorescein angiography………

A

pause the photos and have the patient take several deep breaths away from the camera and with a trach can at hand incase of vomiting. Nausea usually passes within a few minutes.

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104
Q

Moderate adverse reactions to fluorescein dye include;

A

fainting, phlebitis, and seizure

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105
Q

Major adverse reactions to fluorescein dye

A

bronchospasm, laryngeal edema, cardiac arrest, and anaphylactic shock. (these reactions are rare but must have up to date emergency kit just in case)

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106
Q

Stain used to confirm a disrupted or exposed K epithelium

A

Rose bengal stain

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107
Q

Beta blockers….

A

decrease the production of aqueous

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108
Q

_____is administered intravenously and a retina camera is used to photograph the circulation

A

ICG (Indocyanine green dye)

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109
Q

What is the function of Beta blockers

A

decrease the production of aqueous

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110
Q

Timilol maleate .5%, Timilol gel .25%, .5% (timoptic xe), Betaxolol .25% and .5%(Betoptic S), Levobunolol .25% and .5% (Betagan), Metipranolol .3% (optipranolol), Timilol hemihydrate .25% and .5% (Betimol) are all what type of GLC drop

A

Beta blocker

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111
Q

*Carbonic Anhydrase Inhibitors function….

A

decrease the production of aqueous

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112
Q

Brinzolamide 1% (azopt), Dorzolamide 2% (trusopt), acetazolamide (diamox-pill) Methazolamide (neptazane-pill) are what types of GLC drop

A

Carbonic Anhydrase inhibitors

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113
Q

*Side effects of Carbonic Anhydrase inhibitors include

A

tinging in the extremities, nausea, memory problems, depression, and frequent urination

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114
Q

Side effects of Beta blockers include…

A

Shortness of breath with asthma or other respiratory disorders
additive effect with beta blockers taken for heart disease and blood pressure problems
reduced cardiac response during exercise.
Contraindicated for some patients with heart disease.

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115
Q

Alpha agonists work by

A

decreasing aqueous production and increasing outflow

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116
Q

Apracloniding (Iopinidine), Brimonide tartrate(Alphagan) are what type of GLC drops

A

Alpha agonists

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117
Q

Side effects of Alpha agonists include….

A

drowsiness, fatigue, headache, and dryness of mucous membrane.

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118
Q

Sympathetic system uses what as its main neurotransmitter?

A

Norepinephrine and epinephrine

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119
Q

Parasympathetic system uses what as its neurotransmitter?

A

Acetylcholine

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120
Q

Meds that stimulate the sympathetic nervous system

A

Sympathomemetics

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121
Q

Meds that inhibit the sympathetic nervous system

A

Sympatholytics

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122
Q

Meds that mimic acetylcholine
And stimulates parasympathetic nervous system(ex:pilocarpine)

A

Parasympatomimetics

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123
Q

Meds that block action of the parasympathetic nervous system (ex: cyclo)

A

Parasympatholytics

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124
Q

What are the 2 branches of peripheral nervous system?

A

Somatic nervous system and autonomic nervous system

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125
Q

What are the 2 branches of autonomic nervous system

A

Parasympathetic
Sympathetic

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126
Q

Which branch of the autonomic nervous system is the “relax and renew” system controls vegetative functions. In

A

Parasympathetic

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127
Q

Which branch of the autonomic nervous system allows the body to function under stress “fight or flight”

A

Sympathetic

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128
Q

Somatic nervous system controls what body functions?

A

Voluntary

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129
Q

The autonomic nervous system controls which body functions?

A

Involuntary

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130
Q

What are the 2 branches to the sympathetic nervous system

A

Beta receptors
Alpha receptors

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131
Q

Parasympathetic nervous system ______
Pupils.

A

Constricts
(“P” parasympathetic/“p” pilocarpine)

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132
Q

Parasypatholytics _____pupils.

A

Dilate

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133
Q

Dilation drops that are short actions (lasts hours)

A

Mydriacyl and neoSynephrine

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134
Q

Dilation drops lasting 1-3 days

A

Cyclogyl and homatroprine

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135
Q

Dilation drops lasting up to 1 week

A

Atropine

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136
Q

Dilation drops that paralyze accommodation and exert their effects on the ciliary muscle causing it to contract

A

Cycloplegics

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137
Q

Put these drops in order from longest acting to shortest acting:
Cyclo, tropicamide, scopolamine, homatropine, atropine

A

Atropine, scopolamine, homatropine, cyclo, tropicamide

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138
Q

Pink top

A

Anti inflammatory/steroids

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139
Q

Used to quiet the inflammatory response. Used post op and for iritis and uveitis

A

Anti inflammatory/steroids

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140
Q

Side effects of anti inflammatory/steroids

A

IOP increase, CATS, worsen infection

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141
Q

Beige top

A

Anti- infective/antibacterial
(Abx)

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142
Q

Used to treat known infections or prophylaxis (ointments, drops and injectants)

A

Anti infectant /antibacterial
(Abx)

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143
Q

Anti infective steroid combination

A

Tobradex
(Use in caution with herpes infection)

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144
Q

Anti infective

A

Tobrex

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145
Q

Anti infective and steroid combination drops have what color top

A

White

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146
Q

One of the most common viruses we deal with in ophthalmology

A

Herpes

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147
Q

Used to treat herpes zoster

A

Acyclovir (Zovirax) and valtrex

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148
Q

Drug that blocks the VEGF protein and slows growth of abnormal blood vessels

A

AntiVEGF drugs

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149
Q

What does VEGF stand for?

A

Vascular Endothelial Growth Factor

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150
Q

Anti VEGF drugs treat…

A

WET AMD and macular edema

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151
Q

Avastin, Macugen, Lucentis, and Eylea are all what type of drug

A

Anti VEGF

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152
Q

NSAIDS have what color top

A

Gray or white

153
Q

Used to quiet inflammatory response without steroids, can cause delay of healing process and breakdown of the corneal epithelium

A

NSAIDS
(Non steroidal anti inflammatory drugs)

154
Q

Used to quiet the allergic response in eyes

A

Allergy drops

155
Q

What are the typical signs and symptoms of an allergic response in the eyes?

A

Red and itchy and papillae on the bulbar conj

156
Q

What are the 5 main classes of GLC meds?

A

Alpha adrenergenics
Miotics
Prostaglandin analogues
Beta blockers
Carbonic anhydrase inhibitors

157
Q

Which drops decrease the amount of aqueous produced, used 1-2 x per day, and often end in “ol”?

A

Beta blockers

158
Q

What color tops do beta blockers have?

A

Yellow for .5%
Blue for .25%

159
Q

XE and GFS stand for what in a med?

A

Gel form solution

160
Q

Timoptic(timolol) is what type of glc med?

A

Beta blocker

161
Q

Timoptic XE (Timolol GFS) is what type of glc med?

A

Beta blocker gel

162
Q

Betagan (Levabunolol) is what type of glc med?

A

Beta blocker

163
Q

Betoptic S (betaxolol) is what type of glc med?

A

Betablocker

164
Q

Ocupress(carteolol) is what type of glc drop

A

Beta blocker

165
Q

What are some side effects of beta blockers?

A

Slow heart rate, difficulty breathing, can worsen depression

166
Q

Who should not use beta blockers?

A

Pts with bradycardia (slow HR), asthma, emphysema, COPD, depression

167
Q

Which beta blocker has less effect on breathing than the rest, causes less cardiopulmonary affects?

A

Betaxolol

168
Q

What color top do miotics have?

A

Green

169
Q

What do miotics do?

A

Increase outflow of aqueous humor and constrict the pupil

170
Q

What is a miotic pupil!

A

Small pupil

171
Q

What are miotics used for?

A

Constrict pupil for laser procedures and angle closure(but not often for glc)

172
Q

What are side effects of miotics?

A

Brow ache, headache, burn, worsen iritis, can cause RD in highly myopic pts.

173
Q

What is the most common known miotic?

A

Pilocarpine
(Comes in .5%, 1%, 2%, 4%, 6%, and hs gel)

174
Q

What color top does alpha adrenergics have?

A

Purple

175
Q

What does alpha adrenergics do?

A

Lowers IOP by decreasing the amount of aqueous produced

176
Q

Alphagan (bromonidine) is what type of glc drop?

A

Alpha adrenergics

177
Q

Propine (dipivefrin) are what type of glc drop?

A

Alpha adrenergics

178
Q

Iopidine(apraclonidone) are what type of glc drops?

A

Alpha adrenergics

179
Q

What are Side effects of alpha adrenergics?

A

Most likely drop to cause allergic dermatitis, can worsen depression in pts taking MAO inhibitors, drowsiness, fatigue, redness

180
Q

Carbonic anhydrase inhibitors are what type of drug?

A

Sulfa drug

181
Q

What color top does anhydrase carbonic inhibitors have?

A

Orange

182
Q

What does carbonic anhydrase inhibitors do?

A

Diuretic/decrease aqueous production

183
Q

What two forms do carbonic anhydrase inhibitors come in?

A

Pill and drop

184
Q

Which 2 carbonic anhydrase inhibitors cause increase urination?

A

Diamox(acetazolomide)
Neptazane(methazolamide (MZM))

185
Q

Diamox (acetazolomide) are what type of glc drop

A

Carbonic Anhydrase Inhibitors

186
Q

Neptazane(methazolamide) are what type of glc drop?

A

Carbonic anhydrase inhibitors

187
Q

Trusopt (dorzolomide) are what type of glc drop?

A

Carbonic anhydrase inhibitors

188
Q

Azopt (brinzolomide) are what type of glc drops?

A

Carbonic anhydrase inhibitors

189
Q

Other than glc, what else is carbonic anhydrase inhibitors used for?

A

Lower eye pressure, treat pseudotumor cerebri, prevent altitude sickness

190
Q

What are side effects of carbonic anhydrase inhibitors?

A

Can make liver or kidney problems worse, can cause problems with low potassium, can cause Stevens-Johnson syndrome, acidosis, transient myopia, anemia

191
Q

Why are combinations drop great?

A

They increase pt compliance

192
Q

Cosopt is a combination of what 2 drops?

A

Timilol and dorzolamide

193
Q

Combing an is a combination of what 2 drops?

A

Timolol and brominadine

194
Q

Which combination drop is ok for pt with cardiopulmonary disease?

A

Simbrinza

195
Q

Simbrinza is a combination of which 2 drops?

A

Brimzolomide and brimonidine

196
Q

Why can’t pts with cardiopulmonary disease use cosopt or combigan?

A

Because they are both paired with a betablocker which effects the cardiopulmonary

197
Q

What color top does prostaglandins have?

A

Teal

198
Q

How do prostaglandins work?

A

Decrease outflow of aqueous humor

199
Q

What is the only class of glc drugs with no systemic side effects?

A

Prostaglandins

200
Q

What are the side effects of prostaglandins?

A

Redness, iris pigmentation, CME, long lashes, periocular sjin pigmentation

201
Q

Which prostaglandin is preservative free?

A

Zioptan

202
Q

How does Restasis work?

A

Increase tear production in those with ocular inflammation, it’s a lubricant and anti inflammatory

203
Q

What is the main side effect of restasis?

A

Burning

204
Q

Restasis is used to treat what eye condition?

A

Dry eyes

205
Q

Why is inflamed tissue difficult to anesthetize?

A

Because inflamed blood vessels carry away the blood and anesthetic.

206
Q

What are the three ways fluorescein sodium comes in?

A

Strips, drops, and IV

207
Q

What does fluorescein sodium have a tendency to grow?

A

Pseudomonas

208
Q

What are some side effects of injectable anesthetics?

A

Low BP, respiratory depression, stimulation of the nervous system (nervousness, dizzy spells, nausea, convulsions), and depression of the CNS (respiratory or circulatory collapse)

209
Q

What are the steps to take with a fainting pt?

A

Have them put their head between their knees(lower than their heart) or lay chair all the way back, smelling salts, loosen tight collars, observe for 20-30 minutes.

210
Q

What should you do with pt that has tremors or convulsions?

A

Restrain pt to avoid self injury, loosen collar, have Valium available if doctor wants it

211
Q

What are the phases of an allergic response?

A
  1. Initial exposure to allergen (may have mild reaction.
  2. Body make antibodies (induction period)
  3. Subsequent exposure to allergen
  4. Body releases mast cells filled with antibodies
  5. Mast cells release enzymes (histamine) causing allergic reaction
212
Q

Anaphylaxis can cause death in___minutes.

A

15

213
Q

Acute allergic reaction typically occurs _______minutes after the exposure to the offending agent

A

20-30

214
Q

What is the most common drug used in ophthalmology which can trigger allergic response?

A

IV fluorescein
(Can happen with any drug though)

215
Q

What are the typical S&S of allergic reaction

A

Itching, skin rash, difficulty breathing, rapid or weak pulse, nausea or vomiting (these must be considered allergic reaction if medication has been administered)

216
Q

What should you have on hand to manage allergic reaction?

A

Smelling salts, epinephrine, diazepam, corticosteroids, and O2

217
Q

Tonicity has to do with a medications —–

A

concentration

218
Q

Normal saline=

A

0.9% (equivalent of tears)

219
Q

The closer the drugs properties are to tears the _____

A

better tolerated it will be

220
Q

pH refers to ____

A

how acidic or how alkaline a med is

221
Q

Minimal stinging and burning depend on—–

A

and ideal pH

222
Q

What is considered alkaline

A

> 7pH

223
Q

What is considered acidic?

A

<7pH

224
Q

Most drugs are manufactured___

A

sterily

225
Q

Once a medication is open it is no longer considered___

A

sterile

226
Q

Why are preservatives added?

A

to keep meds sterile

227
Q

What does stability refer to?

A

How much deterioration drug occurs due to exposure uv rays or oxygen.

228
Q

Most of our drugs are stored in ________containers to help lend more stability

A

brown or opaque

229
Q

You should always _______on a medication after you used it even if it’s a drug you’re using all day long.

A

put cap back on

230
Q

Why should you always leave the cap on a drop?

A

because leaving it off exposes the drop to oxygen and uv which can result in deterioration of the drug.

231
Q

What does a brown crust around the lid of a drop mean?

A

Drop has been exposed and is deteriorating

232
Q

What does penetration refer to?

A

how much the drug will penetrate the eye

233
Q

Drops that penetrate the eye best will be____

A

both fat and water soluble.

234
Q

What are 3 main ways we deliver locally applied eye meds?

A

solutions, suspensions, and ointments

235
Q

What are the advantages and disadvantages of solutions?

A

Instilled in conj sac, do not blur vision
short duration, frequent instillation

236
Q

What are advantages and disadvantages of ointments?

A

good for crying children, longer exposure time to the eye, less frequent insillation
blurs va

237
Q

This drop has the drag and delivery mechanism separate in the bottle and must be shaken.

A

Suspensions

238
Q

Which type of drug must me shaken?

A

Suspensions

239
Q

What is the purpose of nasolacrimal duct occlusion?

A

to keep the concentration of the drug as high as possible and keep it on the eye longer

240
Q

How do you perform nasolacrimal duct occlusion?

A

intill the drop then have pt apply pressure gently but firmly over the nasal corner of both eyes

241
Q

The peripheral nervous system is part of the ____nervous system

A

central

242
Q

What are the 2 branches to the peripheral nervous system?

A

Somatic and Autonomic nervous system

243
Q

Which nervous system controls voluntary function such as raising your hand

A

Somatic

244
Q

Which nervous system controls involuntary functions such as digestion, pupil dilation, and respiration.

A

Autonomic

245
Q

What are the 2 branches of the autonomic nervous system?

A

parasympatetic and sympathetic

246
Q

What is the relax and renew nervous system? It is in control when we are not in stressful situations.

A

parasympathetic

247
Q

What is the fight or flight nervous system? It kicks in when we are in a stressful situation.

A

Sympathetic

248
Q

What are the 2 branches of the sympathetic nervous system?

A

Beta receptors and alpha receptors

249
Q

Betablockers and alphagonist drugs exert their effects on which system?

A

sympathetic nervous system

250
Q

What does the parasympathetic nervous system use as main neuro-transmitter.

A

acetylcholine

251
Q

The parasympathetic nervous system ______the pupil

A

constricts
(to remember: correlate p for parasympathetic with p pilocarpine)

252
Q

What does the suffix mimetic mean?

A

mimic or copy

253
Q

A parasympathomimetic drug ____the effects of aceylcholine which ____the pupil

A

mimics
constricts

254
Q

Pilocarpine is an example of a ___________drug

A

parasympathomimetic

255
Q

What does the suffix lytic mean

A

to work against

256
Q

A parasympatholytic drug_____the action of the parasympathetic system and ____the pupil

A

blocks
dilates

257
Q

Cyclopentolate is an example off a

A

parasympatholytic drug

258
Q

What are the main neurotrasmitters for the sympathetic nervous sytem?

A

norephinephrine and epinephrine

259
Q

Another word for norephinephrine and epinephrine is…

A

adrenaline

260
Q

Sympathomimetic drugs_____the sympathetic nervous system and the sympathetic nervous system _____the pupil

A

mimic
dilates

261
Q

Atropine is an example of what type of drug

A

sympathomimetic

262
Q

A Symptholytic drug____the sympathetic nervous system

A

inhibits

263
Q

Dilating drugs have a__top

A

red

264
Q

Mydriacyl and NeoSynephrine are ___and last___

A

short acting
hours

265
Q

Cyclogyl and Homatropine lasts ____

A

1-3 days

266
Q

Atropine lasts ___

A

up to 1 week

267
Q

Dilating drops are used for ______

A

dilating the eyes for a better view and to quiet the affects of iritis and post op care

268
Q

Both mydriatics and cycloplegics facilitate pupillary dilation but cycloplegics also _____

A

paralyze accommodation

269
Q

Cycloplegics exert their effects on _____muscle and cause it to _____

A

ciliary
contract

270
Q

Phenlyephrine and cycloplegic drug have a ____effect (wide dilation)

A

synergistic

271
Q

_________the sum of the 2 drops actions is greater than their individual effect

A

Synergistic

272
Q

True or false
Phenlyephrine is a vasoconstrictor and a mydriatic

A

True

273
Q

Tropicamide is a ____

A

cycloplegic

274
Q

Cycloplegics are used to….

A

dilate and paralyze accommodation, prevent synechiae, help with pain (iris muscle spasms)

275
Q

What are some cycloplegics?

A

Homatropine, Atropine, Cylcopentolate

276
Q

Phenylephrine take how many minutes to onset

A

15-60

277
Q

minutes to onset for Tropicamind/Hydroxyamphetimine

A

15-60

278
Q

minutes to onset for atropine

A

30-45

279
Q

minutes to onset for homatropine

A

40-60

280
Q

minutes to onset for scopiomine

A

20-25

281
Q

minutes to onset for cyclopentolate

A

30-60

282
Q

minutes to onset for tropicaminde

A

25-40

283
Q

What is the longest acting dilating drop

A

atropine

284
Q

What is the shortest acting dilating drop

A

tropicamide

285
Q

List in order from longest to shortest acting dilating drops

A

“Mnemonic”
Atropine Annie
Scopolamine sold
Homatropine homemade
Cyclopenalate chocolate
Tropicamide tarts

286
Q

Anti-inflammatory and steroids have ___tops

A

pink

287
Q

Anti-Inflammatory and steroid drops are used to….

A

quiet the inflammatory response

288
Q

Anti-Inflammatory and steroids are used for….

A

post ops and iritis or uveitis

289
Q

anti-inflammatory and steroids come in what forms

A

pills, eye drops, injrections

290
Q

What are the side effects of Anti-inflammatory/steroids

A

IOP elevation, CATS, worsen infections

291
Q

Anti-infectives (antibacterial) often a _____top

A

beige

292
Q

What are antibiotic drops used for

A

treatment of bacterial infection and prophylaxis(preventative tx)

293
Q

Tobradex is an ______ combination tobrex is just an ______

A

anti-infective steroid combo
anti-infective

294
Q

Anti-infective and steroid combo have a ___top

A

white

295
Q

anti-infective and steroid combos will have the side effects of____

A

both drugs

296
Q

One of the most common viruses we deal with in ophthalmology is the ____

A

herpes virus

297
Q

What is an anti-infective/anti-viral drug used to treat herpes simplex virus(HSV)?

A

Viroptic C (trifluridine)

298
Q

What are the side effects of anit-infective/anti-viral drops

A

conjunctival and corneal irritation with prolonged use

299
Q

Meds use to treat herpes zoster

A

acyclovir (zovirax) and valtrex
pills and ointments

300
Q

What does “VEGF” in anti-VEGF drugs stand for

A

Vascular endothelial growth factor

301
Q

Drug that blocks the VEGF protein growth to slow the abnormal growth of blood vessels

A

Anti-VEGF

302
Q

What does anti-VEGF drugs treat

A

WET AMD and Macular edema

303
Q

What are some intravitreal anit-VEGF injections

A

Avastin (bevacizumab)
Macugen (pegaptanib)
Lucentis (ranibizumab)
Eylea (ofibercept)

304
Q

NSAIDs have a ____or ___top

A

gray or white

305
Q

NSAIDs are used for…

A

post op inflammation
post refractive sx
CME

306
Q

What are the side effects of NSAIDs

A

Delay of healing process, breakdown of the K epithelium

307
Q

NSAIDs are used to quiet the _____ without steroids

A

inflammatory response

308
Q

What does NSAID stand for

A

Non steroidal anti-inflammatory drug

309
Q

What are allergy drugs used for

A

to quiet the allergic response

310
Q

What are the typical signs an symptoms of allergic response in the eye

A

redness and itching and papillae on bulbar conj

311
Q

What are the 5 main classes of glc meds

A

beta blockers
alpha adrenergenics
miotics
prostaglandin analogues
carbonic anhydrase inhibitors
(also Rho Kinase Inhibitors)

312
Q

What color top does beta blockers have

A

yellow 0.5%
blue 0.25%

313
Q

What color top does alpha adrenergenics have

A

purple

314
Q

what color top doe miotics have

A

green

315
Q

what color top does carbonic anhydrase inhibitors have

A

orange

316
Q

what color top doe prostaglandins have

A

teal

317
Q

what color top does rock inhibitors have

A

white

318
Q

what color top do combo drops have

A

dark blue

319
Q

Beta blockers typically end in

A

“ol”

320
Q

How do Beta blockers work

A

decrease the amount of aqueous produced

321
Q

what is typical instructions for beta blockers

A

1-2 x per day

322
Q

if the drug ends in XE or GFS this means the drug is

A

a gel

323
Q

timpotic(timilol) is what type of glc drop

A

beta blocker

324
Q

timoptic XE (timilol GFS) is what type of glc drop

A

beta blocker

325
Q

betagan (levabunolol) is what type of glc drop

A

beta blocker

326
Q

Betoptic S (Betaxalol) is what type of glc drop

A

beta blocker

327
Q

Ocupress (Carteolol) is what type of glc drop

A

Beta blocker

328
Q

What are the side effects of beta blockers

A

slow heart rate
can affect breathing

329
Q

Beta blockers affect the cardiopulmonary system so they should not be used in patients with

A

Bradycardia
asthma
emphysema
COPD
depression

330
Q

______is a selective and affects breathing to a lesser extent than do other beta blockers

A

Betaxalol

331
Q

How do miotics work

A

they increase the outflow of aqueous humor and constrict the pupil
(not used much for glc)

332
Q

What are the side effects of miotics

A

brow ache, retinal detachments, headaches, burn, worsen iritis

333
Q

How do alpha adrenergics work

A

the decrease the amount of aqueous produced

334
Q

Alphagan (brimonidine is what type of glc drop

A

alpha adrenergics

335
Q

Propine (dipivefrin) is what type of glc drop

A

alpha adrenergics

336
Q

Iopidine (apraclonidine) is what type of glc drop

A

alpha adrenergics

337
Q

What is the most likely glc drop to cause an allergic dermatitis

A

Alpha adrenergics

338
Q

What are the side effects of alpha adrenergics

A

allergic dermatitis, worsen depression in someone taking MAO inhibitors, drowsiness, fatigue, and redness

339
Q

Which glc drops are sulfa drugs

A

carbonic anhydrase inhibitors

340
Q

How do carbonic anhydrase inhibitors work

A

they are a diuretic to they decrease aqueous production

341
Q

Carbonic anhydrase inhibitors are available in —–

A

pill and drop form

342
Q

Which carbonic anhydrase inhibitors will cause increase in urination

A

diamox and neptazane because they are a diuretic

343
Q

diamox (acetazolamide) is what type of glc drop

A

carbonic anhydrase inhibitors

344
Q

nepatazane (methazolamide ‘MZM’) is what type of glc drop

A

carbonic anhydrase inhibitors

345
Q

trusopt(dorzolamide) is what type of glc drop

A

carbonic anhydrase inhibitors

346
Q

azopt (brinzolamide) is what type of glc drop

A

carbonic anhydrase inhibitors

347
Q

Other than glc what else is carbonic anhydrase inhibitors used to treat?

A

Pseudotumor cerebri
altitude sickness prevention

348
Q

What are the side effects of carbonic anhydrase inhibitors

A

can make liver or kidney problems worse, can cause problems with low postassium, can cause Stevens-Johnson syndrome, acidosis, transient myopia, anemia

349
Q

What is the benefit of combination drops

A

increase pt compliance

350
Q

Cosopt and combigan are both paired with a ___ so we can’t use in pts with cardiopulmonary disease.

A

betablocker

351
Q

Cosopt is a combination of

A

timilol and dorzolamide

352
Q

combigan is a combination of

A

timilol and brimonidine

353
Q

Simbrinza is a combination of

A

brinsolamide and brimonidine

354
Q

Rocklatan is a combination of

A

Latanoprost and netarsudil

355
Q

How do prostaglandins work

A

increasing the outflow of aqueous humor

356
Q

How many times a day is prostaglandins used

A

once

357
Q

_____is the only class of glc drops that have no systemic side effects but do have a lot of ocular side effects

A

prostaglandins

358
Q

What are the side effects of Prostaglandins

A

redness, iris pigmentation, iritis, CME, long lashes, periocular skin pigmentation

359
Q

_____causes the eye lashes to grow and is a prostaglandin

A

Latisse

360
Q

_____is a preservative free prosatglandin

A

Zioptan

361
Q

How does Restatis work

A

increased tear production

362
Q

What drop is used to treat dry eye, is a lubricant and anti-inflammatory, and helps increase the tear production?

A

Restasis

363
Q

What are the side effects of Restasis

A

burning

364
Q

Why is inflamed tissue difficult to asesthetize

A

because inflamed blood vessels carry the blood and anesthetic away from the inflamed area.

365
Q

When doing tonometry you need a ___ anesthetic but when doing a FB removal you’ll need a ______ansethetic

A

mild
much deeper

366
Q

Fluorescein Sodium has a tendency to grow ______

A

Psudomonas

367
Q

Fluorescein is available in _____

A

drops, IV, and strips

368
Q

Injectible anesthetics can_____and ____ central nervous system

A

stimulate and also depresss

369
Q

What are the side effects of injectible anesthetics

A

low BP
Respiratory depression
Stimulation of nervous system (nervousness, dizzy spells, nausea, convulsions)
Depression of CNS (respiratory or circulatory collapse)

370
Q

What should you do if your pt is fainting

A

position them so that their head is below their heart, have smelling salts available, loosen tight collar, observe for 20-30 minutes (do not leave them alone)

371
Q

What should you do when a pt has tremors or convulsions

A

restrain pt to avoid self injury, loosen collar, have valium available if dr wants it

372
Q

the allergic response is usually aimed at ____

A

specific allergens

373
Q

What is the events in order of an allergic response

A

-initial exposure to allergen
-Body makes antibodies(induction period)
-Subsequent exposure to allergen
-body releases mast cells filled with antibiotics
-Mast cells release enzymes (histamine) causing allergic reaction

374
Q

Acute allergic reactions typically occur ____minutes after exposure to the allergen

A

20-30

375
Q

What is the most common drug used in ophthalmolgy that causes an allergic response

A

IV fluorescein

376
Q

true or false
a patient can have an allergic reaction to any medication

A

true

377
Q

What are the typical signs and symptoms of allergic response

A

Itching, skin rash, difficulty breathing, rapid and weak pulse, nausea/vomiting (any of these symptoms must be considered and allergic response)

378
Q

What should you have available to manage an allergic reaction

A

smelling salts, epinephrine, diazepam, coritcosteroids and O2

379
Q

**Know which drop in a list of dilating drops do not affect accommodation

A

COT (28 decks)

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