Pharmacology 3% Flashcards
Used to reduce the chance of contamination in meds
Preservatives
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.
Preservatives
Has to do with shelf life
Stability and storage
_____________can be accelerated by exposure to air, humidity, light, a higher or lower than normal temperature
Degradation
What are steps to take to conserve stability of eye drops?
Do not open till needed
Always replace top immediately after use
Keep bottle out of sun
pH value less than 7 is considered to be
Acidic
pH value greater than 7 is considered to be
Alkaline
pH value of tears is
7.1-7.4
A measure of osmotic pressure
Tonicity
Osmosis occurs when….
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.
Thickness of a drop
Viscosity
Route of drug delivery that includes drops(solution and suspension), ointments, gels, soft CL, and paper strips
Topical application
Advantages of topical application
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
Disadvantages of topical application
Not as effective when treating the posterior segment of the eye
Poor patient compliance, especially with drops, can limit effectivemess.
Drops are liquid medication with the drug in either _______or _______ form.
solution or suspension
Drops: If the drug is dissolved in the liquid, then it is a ________(clear)
Solution
If the drug does not dissolve in the liquid, then it is called a _______(cloudy)
Suspension
Suspensions must be _______before each use
shaken
Advantages of drops:
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.
Disadvantages of drops:
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
Dilating drops lid color
Red
Beta blocker lid color
yellow .5%
Light blue .25%
alphagan lid top color
purple
prostaglandin lid top color
teal
ex. Xalatan
The drug is mixed with a substance that melts at body temperature
ointment
___________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
ointment
Advantages of ointments:
There is prolonged exposure time, decreasing the frequency of application
Disadvantages of ointments:
There is an increased possibility of allergic reaction as compared to drops. Ointments blur the vision and are best used at bedtime.
The liquid medium for the drug is thicker than the liquid used for drops
gels
Advantages of gels:
There is an increased possibility of allergic reaction as compared to regular drops, decreasing the frequency of application needed/
Disadvantages of gels:
Vision is blurred somewhat, but not as much as with ointments.
The lens or shield is soaked in the medication solution and then inserted
Soft CL and shields
These are sterile strips of dry paper containing a dye (rose bengal or fluorescein)
Paper strips
Adavantages to paper strips:
They are preservative free and the chances of contamination are minimal
Disadvantages to strips
They are only useful for delivering dyes
Used when a larger concentration of a drug is required than can be supplied by topical administration
Local injection
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.
Intravitreal Injection
The conjunctiva is lifted up and a small needle is used to inject a medication (antibiotic or steroid) or anesthesia under the conjunctiva.
Subconjunctival injection
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.
Sub-Tenon’s Injection
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.
Peribulbar Injection (around)
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.
Retrobulbar Injection (behind)
_______are injected into the skin of the lids
Local anesthetics
Advantages to local injections:
Larger doses can be used and absorption is more precise
Disadvantages to local injections:
There is a risk of complications such as a hemorrhage or a perforated globe. Some patients don’t tolerate well.
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)
Intravenous Injection
Advantages to Intravenous Injection:
Some drugs cannot be administered topically and some eye diseases are treated most effectively by systemic administration of the drug.
Disadvantages to intravenous Injection:
Increased risk of side effects because the drug reaches all parts of the body
Pills, capsules, or liquids are taken by mouth and the mediation is absorbed by the digestive system.
Oral administration
Advantages to oral adminstration
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.
Disadvantages or oral adminstration
Increased risk of side effects because the drug reaches all parts of the body.
Once a day
q, qd
qod
every other day
q2h
every 2 hours
gtt
drop
gtt
drop
ung
ointment
c
with
s
without
sig
instructions
i
1
ii
2
iii
three
sol
solution
susp
suspenion
ml
milliliters
mg
milligrams
ophth
ophthalmic
wk
week
x
for
drops that dilate the eyes
mydriatic and cycloplegics
degree of dilation ranges from
4-8mm
more highly pigmented irises (brown) dilated——–
less
Ligher colored irises (blue, gray, green) dilated_____
more easily
_______sighted eyes dilated more readily than ____sighted eyes
Near/Far
An eye that is inflamed is ______ ________ to dilate.
More difficult
Younger eyes dilate more _______ than those of the older people
easily
An eye with a _____pupil to start with is more difficult to dilate than an eye with a normally ______ pupil
Small/larger
The one commonly used mydriatic
phenylephrine
Phenylephrine is a _________drug that works by stimulating the dilator muscle in the iris.
Sympathomimetic
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.
Cycloplegic
Side effects of phenylephrine:
elevated blood pressure, cardiac irregularities, vasoconstriction of the conjunctival blood vessels
A weak solution of phenylephrine is sometimes used as an ingredient in drops to _____eyes
whiten
_______drops dilate the eye by paralyzing the sphincter muscle of the iris
Cycloplegic
The _________muscle acts like a purse string to draw the pupil smaller.
Sphincter
_______paralyze the ciliary muscle (This is the muscle that changes the shape of the lens to focus on near objects (accommodation))
cycloplegics
Tropicamide lasts about
3-6 hours
Cyclopentolate last about…
6-24 hours
Homatropine lasts about
3-7 days
Scopolomine lasts about
3-7 days
**Atropine lasts about
7-10 days
(Question was… mom accidentally used child’s atropine..how long should you tell her it will last?)
_______ 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)
Cycloplegics
______is the most commonly used cycloplegic, primarily because it has the weakest action and it wears off relatively quickly.
Tropicamide
Scopolamine and Homatropine are usually only used in the treatment of _______
uveitis
If a child is given Atropine they should be monitored for what symptoms?
hallucinations, loss of coordination, rapid pulse, dryness, of the the mucous membranes, and redness of the skin
_______ _____is used for fluorescein angiography.
Intravenous fluorescein
Fluorescein diffuses(seeps) through the ______ _________ and the _________
choroidal capillaries and the sclera
_________does not normally diffuse through the retinal pigment epithelium, the retinal blood vessels, or the larger choroidal vessels.
Fluorescein
Fluorescein diffuses through cellular spaces and stains skin and mucous membranes for up to ___hours.
4
Patients should b advised of their possible _____ or ________ appearance following the injection.
yellowish or jaundiced (can be reduced by drinking water)
Pt should be advise of _____/____color in urine with Fluorescein.
orange/yellow
Flourescein is eliminated from the body within _____ hours, mainly through the kidneys
48
*Name some mild adverse reactions to fluorescein….
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)
If nausea occurs during fluorescein angiography………
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.
Moderate adverse reactions to fluorescein dye include;
fainting, phlebitis, and seizure
Major adverse reactions to fluorescein dye
bronchospasm, laryngeal edema, cardiac arrest, and anaphylactic shock. (these reactions are rare but must have up to date emergency kit just in case)
Stain used to confirm a disrupted or exposed K epithelium
Rose bengal stain
Beta blockers….
decrease the production of aqueous
_____is administered intravenously and a retina camera is used to photograph the circulation
ICG (Indocyanine green dye)
What is the function of Beta blockers
decrease the production of aqueous
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
Beta blocker
*Carbonic Anhydrase Inhibitors function….
decrease the production of aqueous
Brinzolamide 1% (azopt), Dorzolamide 2% (trusopt), acetazolamide (diamox-pill) Methazolamide (neptazane-pill) are what types of GLC drop
Carbonic Anhydrase inhibitors
*Side effects of Carbonic Anhydrase inhibitors include
tinging in the extremities, nausea, memory problems, depression, and frequent urination
Side effects of Beta blockers include…
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.
Alpha agonists work by
decreasing aqueous production and increasing outflow
Apracloniding (Iopinidine), Brimonide tartrate(Alphagan) are what type of GLC drops
Alpha agonists
Side effects of Alpha agonists include….
drowsiness, fatigue, headache, and dryness of mucous membrane.
Sympathetic system uses what as its main neurotransmitter?
Norepinephrine and epinephrine
Parasympathetic system uses what as its neurotransmitter?
Acetylcholine
Meds that stimulate the sympathetic nervous system
Sympathomemetics
Meds that inhibit the sympathetic nervous system
Sympatholytics
Meds that mimic acetylcholine
And stimulates parasympathetic nervous system(ex:pilocarpine)
Parasympatomimetics
Meds that block action of the parasympathetic nervous system (ex: cyclo)
Parasympatholytics
What are the 2 branches of peripheral nervous system?
Somatic nervous system and autonomic nervous system
What are the 2 branches of autonomic nervous system
Parasympathetic
Sympathetic
Which branch of the autonomic nervous system is the “relax and renew” system controls vegetative functions. In
Parasympathetic
Which branch of the autonomic nervous system allows the body to function under stress “fight or flight”
Sympathetic
Somatic nervous system controls what body functions?
Voluntary
The autonomic nervous system controls which body functions?
Involuntary
What are the 2 branches to the sympathetic nervous system
Beta receptors
Alpha receptors
Parasympathetic nervous system ______
Pupils.
Constricts
(“P” parasympathetic/“p” pilocarpine)
Parasypatholytics _____pupils.
Dilate
Dilation drops that are short actions (lasts hours)
Mydriacyl and neoSynephrine
Dilation drops lasting 1-3 days
Cyclogyl and homatroprine
Dilation drops lasting up to 1 week
Atropine
Dilation drops that paralyze accommodation and exert their effects on the ciliary muscle causing it to contract
Cycloplegics
Put these drops in order from longest acting to shortest acting:
Cyclo, tropicamide, scopolamine, homatropine, atropine
Atropine, scopolamine, homatropine, cyclo, tropicamide
Pink top
Anti inflammatory/steroids
Used to quiet the inflammatory response. Used post op and for iritis and uveitis
Anti inflammatory/steroids
Side effects of anti inflammatory/steroids
IOP increase, CATS, worsen infection
Beige top
Anti- infective/antibacterial
(Abx)
Used to treat known infections or prophylaxis (ointments, drops and injectants)
Anti infectant /antibacterial
(Abx)
Anti infective steroid combination
Tobradex
(Use in caution with herpes infection)
Anti infective
Tobrex
Anti infective and steroid combination drops have what color top
White
One of the most common viruses we deal with in ophthalmology
Herpes
Used to treat herpes zoster
Acyclovir (Zovirax) and valtrex
Drug that blocks the VEGF protein and slows growth of abnormal blood vessels
AntiVEGF drugs
What does VEGF stand for?
Vascular Endothelial Growth Factor
Anti VEGF drugs treat…
WET AMD and macular edema
Avastin, Macugen, Lucentis, and Eylea are all what type of drug
Anti VEGF
NSAIDS have what color top
Gray or white
Used to quiet inflammatory response without steroids, can cause delay of healing process and breakdown of the corneal epithelium
NSAIDS
(Non steroidal anti inflammatory drugs)
Used to quiet the allergic response in eyes
Allergy drops
What are the typical signs and symptoms of an allergic response in the eyes?
Red and itchy and papillae on the bulbar conj
What are the 5 main classes of GLC meds?
Alpha adrenergenics
Miotics
Prostaglandin analogues
Beta blockers
Carbonic anhydrase inhibitors
Which drops decrease the amount of aqueous produced, used 1-2 x per day, and often end in “ol”?
Beta blockers
What color tops do beta blockers have?
Yellow for .5%
Blue for .25%
XE and GFS stand for what in a med?
Gel form solution
Timoptic(timolol) is what type of glc med?
Beta blocker
Timoptic XE (Timolol GFS) is what type of glc med?
Beta blocker gel
Betagan (Levabunolol) is what type of glc med?
Beta blocker
Betoptic S (betaxolol) is what type of glc med?
Betablocker
Ocupress(carteolol) is what type of glc drop
Beta blocker
What are some side effects of beta blockers?
Slow heart rate, difficulty breathing, can worsen depression
Who should not use beta blockers?
Pts with bradycardia (slow HR), asthma, emphysema, COPD, depression
Which beta blocker has less effect on breathing than the rest, causes less cardiopulmonary affects?
Betaxolol
What color top do miotics have?
Green
What do miotics do?
Increase outflow of aqueous humor and constrict the pupil
What is a miotic pupil!
Small pupil
What are miotics used for?
Constrict pupil for laser procedures and angle closure(but not often for glc)
What are side effects of miotics?
Brow ache, headache, burn, worsen iritis, can cause RD in highly myopic pts.
What is the most common known miotic?
Pilocarpine
(Comes in .5%, 1%, 2%, 4%, 6%, and hs gel)
What color top does alpha adrenergics have?
Purple
What does alpha adrenergics do?
Lowers IOP by decreasing the amount of aqueous produced
Alphagan (bromonidine) is what type of glc drop?
Alpha adrenergics
Propine (dipivefrin) are what type of glc drop?
Alpha adrenergics
Iopidine(apraclonidone) are what type of glc drops?
Alpha adrenergics
What are Side effects of alpha adrenergics?
Most likely drop to cause allergic dermatitis, can worsen depression in pts taking MAO inhibitors, drowsiness, fatigue, redness
Carbonic anhydrase inhibitors are what type of drug?
Sulfa drug
What color top does anhydrase carbonic inhibitors have?
Orange
What does carbonic anhydrase inhibitors do?
Diuretic/decrease aqueous production
What two forms do carbonic anhydrase inhibitors come in?
Pill and drop
Which 2 carbonic anhydrase inhibitors cause increase urination?
Diamox(acetazolomide)
Neptazane(methazolamide (MZM))
Diamox (acetazolomide) are what type of glc drop
Carbonic Anhydrase Inhibitors
Neptazane(methazolamide) are what type of glc drop?
Carbonic anhydrase inhibitors
Trusopt (dorzolomide) are what type of glc drop?
Carbonic anhydrase inhibitors
Azopt (brinzolomide) are what type of glc drops?
Carbonic anhydrase inhibitors
Other than glc, what else is carbonic anhydrase inhibitors used for?
Lower eye pressure, treat pseudotumor cerebri, prevent altitude sickness
What are side effects of carbonic anhydrase inhibitors?
Can make liver or kidney problems worse, can cause problems with low potassium, can cause Stevens-Johnson syndrome, acidosis, transient myopia, anemia
Why are combinations drop great?
They increase pt compliance
Cosopt is a combination of what 2 drops?
Timilol and dorzolamide
Combing an is a combination of what 2 drops?
Timolol and brominadine
Which combination drop is ok for pt with cardiopulmonary disease?
Simbrinza
Simbrinza is a combination of which 2 drops?
Brimzolomide and brimonidine
Why can’t pts with cardiopulmonary disease use cosopt or combigan?
Because they are both paired with a betablocker which effects the cardiopulmonary
What color top does prostaglandins have?
Teal
How do prostaglandins work?
Decrease outflow of aqueous humor
What is the only class of glc drugs with no systemic side effects?
Prostaglandins
What are the side effects of prostaglandins?
Redness, iris pigmentation, CME, long lashes, periocular sjin pigmentation
Which prostaglandin is preservative free?
Zioptan
How does Restasis work?
Increase tear production in those with ocular inflammation, it’s a lubricant and anti inflammatory
What is the main side effect of restasis?
Burning
Restasis is used to treat what eye condition?
Dry eyes
Why is inflamed tissue difficult to anesthetize?
Because inflamed blood vessels carry away the blood and anesthetic.
What are the three ways fluorescein sodium comes in?
Strips, drops, and IV
What does fluorescein sodium have a tendency to grow?
Pseudomonas
What are some side effects of injectable anesthetics?
Low BP, respiratory depression, stimulation of the nervous system (nervousness, dizzy spells, nausea, convulsions), and depression of the CNS (respiratory or circulatory collapse)
What are the steps to take with a fainting pt?
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.
What should you do with pt that has tremors or convulsions?
Restrain pt to avoid self injury, loosen collar, have Valium available if doctor wants it
What are the phases of an allergic response?
- Initial exposure to allergen (may have mild reaction.
- Body make antibodies (induction period)
- Subsequent exposure to allergen
- Body releases mast cells filled with antibodies
- Mast cells release enzymes (histamine) causing allergic reaction
Anaphylaxis can cause death in___minutes.
15
Acute allergic reaction typically occurs _______minutes after the exposure to the offending agent
20-30
What is the most common drug used in ophthalmology which can trigger allergic response?
IV fluorescein
(Can happen with any drug though)
What are the typical S&S of allergic reaction
Itching, skin rash, difficulty breathing, rapid or weak pulse, nausea or vomiting (these must be considered allergic reaction if medication has been administered)
What should you have on hand to manage allergic reaction?
Smelling salts, epinephrine, diazepam, corticosteroids, and O2
Tonicity has to do with a medications —–
concentration
Normal saline=
0.9% (equivalent of tears)
The closer the drugs properties are to tears the _____
better tolerated it will be
pH refers to ____
how acidic or how alkaline a med is
Minimal stinging and burning depend on—–
and ideal pH
What is considered alkaline
> 7pH
What is considered acidic?
<7pH
Most drugs are manufactured___
sterily
Once a medication is open it is no longer considered___
sterile
Why are preservatives added?
to keep meds sterile
What does stability refer to?
How much deterioration drug occurs due to exposure uv rays or oxygen.
Most of our drugs are stored in ________containers to help lend more stability
brown or opaque
You should always _______on a medication after you used it even if it’s a drug you’re using all day long.
put cap back on
Why should you always leave the cap on a drop?
because leaving it off exposes the drop to oxygen and uv which can result in deterioration of the drug.
What does a brown crust around the lid of a drop mean?
Drop has been exposed and is deteriorating
What does penetration refer to?
how much the drug will penetrate the eye
Drops that penetrate the eye best will be____
both fat and water soluble.
What are 3 main ways we deliver locally applied eye meds?
solutions, suspensions, and ointments
What are the advantages and disadvantages of solutions?
Instilled in conj sac, do not blur vision
short duration, frequent instillation
What are advantages and disadvantages of ointments?
good for crying children, longer exposure time to the eye, less frequent insillation
blurs va
This drop has the drag and delivery mechanism separate in the bottle and must be shaken.
Suspensions
Which type of drug must me shaken?
Suspensions
What is the purpose of nasolacrimal duct occlusion?
to keep the concentration of the drug as high as possible and keep it on the eye longer
How do you perform nasolacrimal duct occlusion?
intill the drop then have pt apply pressure gently but firmly over the nasal corner of both eyes
The peripheral nervous system is part of the ____nervous system
central
What are the 2 branches to the peripheral nervous system?
Somatic and Autonomic nervous system
Which nervous system controls voluntary function such as raising your hand
Somatic
Which nervous system controls involuntary functions such as digestion, pupil dilation, and respiration.
Autonomic
What are the 2 branches of the autonomic nervous system?
parasympatetic and sympathetic
What is the relax and renew nervous system? It is in control when we are not in stressful situations.
parasympathetic
What is the fight or flight nervous system? It kicks in when we are in a stressful situation.
Sympathetic
What are the 2 branches of the sympathetic nervous system?
Beta receptors and alpha receptors
Betablockers and alphagonist drugs exert their effects on which system?
sympathetic nervous system
What does the parasympathetic nervous system use as main neuro-transmitter.
acetylcholine
The parasympathetic nervous system ______the pupil
constricts
(to remember: correlate p for parasympathetic with p pilocarpine)
What does the suffix mimetic mean?
mimic or copy
A parasympathomimetic drug ____the effects of aceylcholine which ____the pupil
mimics
constricts
Pilocarpine is an example of a ___________drug
parasympathomimetic
What does the suffix lytic mean
to work against
A parasympatholytic drug_____the action of the parasympathetic system and ____the pupil
blocks
dilates
Cyclopentolate is an example off a
parasympatholytic drug
What are the main neurotrasmitters for the sympathetic nervous sytem?
norephinephrine and epinephrine
Another word for norephinephrine and epinephrine is…
adrenaline
Sympathomimetic drugs_____the sympathetic nervous system and the sympathetic nervous system _____the pupil
mimic
dilates
Atropine is an example of what type of drug
sympathomimetic
A Symptholytic drug____the sympathetic nervous system
inhibits
Dilating drugs have a__top
red
Mydriacyl and NeoSynephrine are ___and last___
short acting
hours
Cyclogyl and Homatropine lasts ____
1-3 days
Atropine lasts ___
up to 1 week
Dilating drops are used for ______
dilating the eyes for a better view and to quiet the affects of iritis and post op care
Both mydriatics and cycloplegics facilitate pupillary dilation but cycloplegics also _____
paralyze accommodation
Cycloplegics exert their effects on _____muscle and cause it to _____
ciliary
contract
Phenlyephrine and cycloplegic drug have a ____effect (wide dilation)
synergistic
_________the sum of the 2 drops actions is greater than their individual effect
Synergistic
True or false
Phenlyephrine is a vasoconstrictor and a mydriatic
True
Tropicamide is a ____
cycloplegic
Cycloplegics are used to….
dilate and paralyze accommodation, prevent synechiae, help with pain (iris muscle spasms)
What are some cycloplegics?
Homatropine, Atropine, Cylcopentolate
Phenylephrine take how many minutes to onset
15-60
minutes to onset for Tropicamind/Hydroxyamphetimine
15-60
minutes to onset for atropine
30-45
minutes to onset for homatropine
40-60
minutes to onset for scopiomine
20-25
minutes to onset for cyclopentolate
30-60
minutes to onset for tropicaminde
25-40
What is the longest acting dilating drop
atropine
What is the shortest acting dilating drop
tropicamide
List in order from longest to shortest acting dilating drops
“Mnemonic”
Atropine Annie
Scopolamine sold
Homatropine homemade
Cyclopenalate chocolate
Tropicamide tarts
Anti-inflammatory and steroids have ___tops
pink
Anti-Inflammatory and steroid drops are used to….
quiet the inflammatory response
Anti-Inflammatory and steroids are used for….
post ops and iritis or uveitis
anti-inflammatory and steroids come in what forms
pills, eye drops, injrections
What are the side effects of Anti-inflammatory/steroids
IOP elevation, CATS, worsen infections
Anti-infectives (antibacterial) often a _____top
beige
What are antibiotic drops used for
treatment of bacterial infection and prophylaxis(preventative tx)
Tobradex is an ______ combination tobrex is just an ______
anti-infective steroid combo
anti-infective
Anti-infective and steroid combo have a ___top
white
anti-infective and steroid combos will have the side effects of____
both drugs
One of the most common viruses we deal with in ophthalmology is the ____
herpes virus
What is an anti-infective/anti-viral drug used to treat herpes simplex virus(HSV)?
Viroptic C (trifluridine)
What are the side effects of anit-infective/anti-viral drops
conjunctival and corneal irritation with prolonged use
Meds use to treat herpes zoster
acyclovir (zovirax) and valtrex
pills and ointments
What does “VEGF” in anti-VEGF drugs stand for
Vascular endothelial growth factor
Drug that blocks the VEGF protein growth to slow the abnormal growth of blood vessels
Anti-VEGF
What does anti-VEGF drugs treat
WET AMD and Macular edema
What are some intravitreal anit-VEGF injections
Avastin (bevacizumab)
Macugen (pegaptanib)
Lucentis (ranibizumab)
Eylea (ofibercept)
NSAIDs have a ____or ___top
gray or white
NSAIDs are used for…
post op inflammation
post refractive sx
CME
What are the side effects of NSAIDs
Delay of healing process, breakdown of the K epithelium
NSAIDs are used to quiet the _____ without steroids
inflammatory response
What does NSAID stand for
Non steroidal anti-inflammatory drug
What are allergy drugs used for
to quiet the allergic response
What are the typical signs an symptoms of allergic response in the eye
redness and itching and papillae on bulbar conj
What are the 5 main classes of glc meds
beta blockers
alpha adrenergenics
miotics
prostaglandin analogues
carbonic anhydrase inhibitors
(also Rho Kinase Inhibitors)
What color top does beta blockers have
yellow 0.5%
blue 0.25%
What color top does alpha adrenergenics have
purple
what color top doe miotics have
green
what color top does carbonic anhydrase inhibitors have
orange
what color top doe prostaglandins have
teal
what color top does rock inhibitors have
white
what color top do combo drops have
dark blue
Beta blockers typically end in
“ol”
How do Beta blockers work
decrease the amount of aqueous produced
what is typical instructions for beta blockers
1-2 x per day
if the drug ends in XE or GFS this means the drug is
a gel
timpotic(timilol) is what type of glc drop
beta blocker
timoptic XE (timilol GFS) is what type of glc drop
beta blocker
betagan (levabunolol) is what type of glc drop
beta blocker
Betoptic S (Betaxalol) is what type of glc drop
beta blocker
Ocupress (Carteolol) is what type of glc drop
Beta blocker
What are the side effects of beta blockers
slow heart rate
can affect breathing
Beta blockers affect the cardiopulmonary system so they should not be used in patients with
Bradycardia
asthma
emphysema
COPD
depression
______is a selective and affects breathing to a lesser extent than do other beta blockers
Betaxalol
How do miotics work
they increase the outflow of aqueous humor and constrict the pupil
(not used much for glc)
What are the side effects of miotics
brow ache, retinal detachments, headaches, burn, worsen iritis
How do alpha adrenergics work
the decrease the amount of aqueous produced
Alphagan (brimonidine is what type of glc drop
alpha adrenergics
Propine (dipivefrin) is what type of glc drop
alpha adrenergics
Iopidine (apraclonidine) is what type of glc drop
alpha adrenergics
What is the most likely glc drop to cause an allergic dermatitis
Alpha adrenergics
What are the side effects of alpha adrenergics
allergic dermatitis, worsen depression in someone taking MAO inhibitors, drowsiness, fatigue, and redness
Which glc drops are sulfa drugs
carbonic anhydrase inhibitors
How do carbonic anhydrase inhibitors work
they are a diuretic to they decrease aqueous production
Carbonic anhydrase inhibitors are available in —–
pill and drop form
Which carbonic anhydrase inhibitors will cause increase in urination
diamox and neptazane because they are a diuretic
diamox (acetazolamide) is what type of glc drop
carbonic anhydrase inhibitors
nepatazane (methazolamide ‘MZM’) is what type of glc drop
carbonic anhydrase inhibitors
trusopt(dorzolamide) is what type of glc drop
carbonic anhydrase inhibitors
azopt (brinzolamide) is what type of glc drop
carbonic anhydrase inhibitors
Other than glc what else is carbonic anhydrase inhibitors used to treat?
Pseudotumor cerebri
altitude sickness prevention
What are the side effects of carbonic anhydrase inhibitors
can make liver or kidney problems worse, can cause problems with low postassium, can cause Stevens-Johnson syndrome, acidosis, transient myopia, anemia
What is the benefit of combination drops
increase pt compliance
Cosopt and combigan are both paired with a ___ so we can’t use in pts with cardiopulmonary disease.
betablocker
Cosopt is a combination of
timilol and dorzolamide
combigan is a combination of
timilol and brimonidine
Simbrinza is a combination of
brinsolamide and brimonidine
Rocklatan is a combination of
Latanoprost and netarsudil
How do prostaglandins work
increasing the outflow of aqueous humor
How many times a day is prostaglandins used
once
_____is the only class of glc drops that have no systemic side effects but do have a lot of ocular side effects
prostaglandins
What are the side effects of Prostaglandins
redness, iris pigmentation, iritis, CME, long lashes, periocular skin pigmentation
_____causes the eye lashes to grow and is a prostaglandin
Latisse
_____is a preservative free prosatglandin
Zioptan
How does Restatis work
increased tear production
What drop is used to treat dry eye, is a lubricant and anti-inflammatory, and helps increase the tear production?
Restasis
What are the side effects of Restasis
burning
Why is inflamed tissue difficult to asesthetize
because inflamed blood vessels carry the blood and anesthetic away from the inflamed area.
When doing tonometry you need a ___ anesthetic but when doing a FB removal you’ll need a ______ansethetic
mild
much deeper
Fluorescein Sodium has a tendency to grow ______
Psudomonas
Fluorescein is available in _____
drops, IV, and strips
Injectible anesthetics can_____and ____ central nervous system
stimulate and also depresss
What are the side effects of injectible anesthetics
low BP
Respiratory depression
Stimulation of nervous system (nervousness, dizzy spells, nausea, convulsions)
Depression of CNS (respiratory or circulatory collapse)
What should you do if your pt is fainting
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)
What should you do when a pt has tremors or convulsions
restrain pt to avoid self injury, loosen collar, have valium available if dr wants it
the allergic response is usually aimed at ____
specific allergens
What is the events in order of an allergic response
-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
Acute allergic reactions typically occur ____minutes after exposure to the allergen
20-30
What is the most common drug used in ophthalmolgy that causes an allergic response
IV fluorescein
true or false
a patient can have an allergic reaction to any medication
true
What are the typical signs and symptoms of allergic response
Itching, skin rash, difficulty breathing, rapid and weak pulse, nausea/vomiting (any of these symptoms must be considered and allergic response)
What should you have available to manage an allergic reaction
smelling salts, epinephrine, diazepam, coritcosteroids and O2
**Know which drop in a list of dilating drops do not affect accommodation
