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Opthalmology > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

where does occular obsorption come from

A

the cornea

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2
Q

where does systemic absorption of drugs by the eye come from

A

conjunctiva and mucous of the nasopharynx

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3
Q

what are the routes of topical eye administration

A

drops (more frequently)

ointment (sooth eye but blur vision)

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4
Q

what is the stroma

A

a mesenchymal tissue, the thickest layer of the cornea, and is ‘sandwiched’ between the epithelium and the inner endothelium
made of collagen

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5
Q

what makes up the tear film

A

lipid, water, lipid barrier

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6
Q

is epithelium lipophilic/phobic and

hydrophilic/phobic

A

epithelium is hyrophobic and lipophillic

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7
Q

is stroma lipophilic/phobic and

hydrophilic/phobic

A

stroma is lipophobic and hydrophillic

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8
Q

what types of drugs penetrate the epithelium of the eye

A

lipid soluble

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9
Q

what types of drugs penetrate the stroma

A

water soluble drugs

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10
Q

what drugs are good at crossing the cornea

A

drugs with a LMW

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11
Q

what type of drugs get through the eye furthest

A

lipid soluble

or drugs that are both lipo and hydro philic (chloramphenicol)

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12
Q

what drugs will not get through the surface of the eye

A

lipophobic (water soluble)

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13
Q

what can increase penetration of a drug into the eye

A

ocular surface inflammation (reduces the hydrophobic nature of the endothelium- innermost layer of the cornea)

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14
Q

what in tear film might impede drug penetration

A

lipid layer

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15
Q

what limits hydrophilic drugs in the eye

A

epithelium

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16
Q

what limits hydrophobic drugs in the epithelium

A

stroma (better penetration in these drugs)

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17
Q

what properties do topical steroids for the eye need

A

hydrophobic and hydrophilic capability

alcohol/ acetate makes steroids more hydrophobic

phosphate makes it more hydrophilic

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18
Q

when is prednisolone acetate used

A

post op, intraocular inflammation cataracts

hydrophic, good penetration in uninflamed cornea

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19
Q

what is prednisolone phosphate used

A

cornea disease/ when you want low dose steroids

hydrophilic, poor penetration in uninflamed cornea

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20
Q

what pathogen is the most common to cause infection in contact lenses

A

pseudomonas

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21
Q

what is the role of benzalkonium

A

disrupts lipid layer of tear film, aids penetration of some drugs

used to lower IOP in glaucoma

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22
Q

what a side effect of benzalkonium

A

makes eyes red and black

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23
Q

what can limit systemic absorption of a drug at the nasopharynx

A

punctal occulsion

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24
Q

what are the routes of administration of drugs into the eye

A 
topical 
sub conjunctival 
subtenons (fibrous layer that starts at the limbus- this route will go back into the orbit)
intra vitreal 
intracameral 
oral 
intra venous
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25
Q

what anti inflammatory agents are used in the eye

A

steroids, topical NSAIDs, anti-histamines, mast cell stabilisers

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26
Q

what drugs for allergic reactions (hayfever/ allergic conjunctivitis)

A

anti-histamines, mast cell stabilisers

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27
Q

what are the actions of steroids in the eye

A

suppress inflammation, allergy and immune responses

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28
Q

when are steroids used topically in the eye

A

post op cataracts
uveitis
prevent corneal graft rejection

29
Q

what is uveitis

A

inflammation of the uvea (iris, ciliary body and choroid)

30
Q

what route of steroids for inflammation at the back of the eye

A

systemic steroids

31
Q

what are the features of temporal arteritis

A

sudden onset temporal pain, jaw claudication
multinucleated giant cells

can have vague visual symptoms/ complete visual loss

is a blinding condition

32
Q

how is temporal arteritis treated

A

systemic steroids 40 if no visual disturbance, 60 if affected

33
Q

what does the optic disc look like in anterior ischaemic neuropathy

A

swollen due to infarction of the optic nerve

34
Q

what are the local effects of steroids

A

cataract, glaucoma, exacerbation of viral infection

35
Q

what are the systemic effects of steroids

A

gastric ulceration, immunosuppression, osteoporosis, weight gain, diabetes, neuropsychiatric effects

36
Q

what can you give to reduce gastric ulceration in steroids

A

PPI

37
Q

list the topical eye steroids from most to least potent

A

FML
Predsol (prednisolone phosphate)
Betamathasone
Dexamethasone/ prednisolone acetate

38
Q

when are NSAIDs used in the eye

A

for pain relief/ anti inflammatory

39
Q

what can you give for corneal abrasion

A

NSAIDs

local anaesthetic will stop it healing

40
Q

what is glaucoma

A

group of disorders characterised by a progressive neuropathy (damage to the optic nerve) resulting in characteristic field defects

41
Q

what is the only modifiable risk factor for glaucoma

A

raised IOP

42
Q

what happens to the cup in glaucoma

A

gets bigger

43
Q

how do you functionally test for glaucoma

A

field test

44
Q

what can slow the progression of glaucoma

A

lowering IOP - either by reducing the production of aqueous or unblock the drain

45
Q

what visual defects in glaucoma

A

not tunnel vision - brain fills in the gap

46
Q

what glaucoma medications open the drain

A

prostanoids (lanaoprost)

parasympathomimetic (pilocarpine)

47
Q

what glaucoma medication prevents the absorption of aqueous

A

beta blockers

48
Q

what glaucoma medications stop production of aqueous and open the drain

A

carbonic anhydrase inhibitors (topical- dorzolamide, systemic- acetazolamide) (opens drain and reduces production of aqueous)

alpha adrenergic agonist (brimonidine) ( turns of production and opens drain via vasodilation)

49
Q

why do people with glaucoma wear tinted glasses

A

to reduce glare

50
Q

what is the main route of antibiotic administration in endophthalmitis

A

intravitreal

51
Q

what drugs are delivered intra vitreal

A 
antibiotics
intra ocular steroids 
anti VEGF (reduce oedema)
52
Q

what is a hypopyon

A

inflammatory cells in the anterior chamber of the eye

53
Q

how do local anaesthetics work within the eye

A

blocks sodium channels and impedes nerve conduction

54
Q

what does diagnostic dye fluorescein show

A 
shows corneal abrasion
dendritic ulcer 
leaks (seidel test)
tonometry 
nasolacrimal duct obstruction 
angiography
55
Q

what do mydriatics do (tropicamide, cyclopentolate)

A 
dilate pupils, block parasympathetic supply to the iris 
cause cyclopegia (stop lens from focusing)
56
Q

what are the side effects of mydriatics

A

AACG, blurring

57
Q

why do you dilate the pupil

A

to see the back of the eye

58
Q

what is the presentation of acute angle closure glaucoma

A

very painful, throwing up, sudden onset headache, pupil mid dilated not reacting

59
Q

what do sympathomimetics do

A

act on sympathetic system causing the pupil to dilate

e.g. tropicamide, atropine- can cause cyclopegia

60
Q

what is the long term use of atropine

A

given to child with a squint as takes 7-9 days to wear off- will help strengthen other eye

61
Q

why dont systemic drugs reach the eye

A

inner and outer retinal blood brain barrier

62
Q

what do miotics do

A

constrict the pupil (pilocarpine)

63
Q

what can alcohol and ethambutol (TB) cause

A

optic atrophy

64
Q

what can rifampicin cause

A

red tears, stain contact lenses

65
Q

what can digoxin cause

A

changes in colour appreciation

66
Q

what can chloroquine cause

A

maculopathy

67
Q

what can amiodarone cause

A

corneal verticullata

68
Q

what do you never give steroids to

A

herpetic keratitis

Opthalmology (16 decks)

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