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Opthalmology > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

How are drugs administered to the eye

A 
Topically 
As drops or ointment
Subconjunctival 
Subtenons (under fibrous layer below conjunctiva)
Intravitreal 
Intracameral
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2
Q

What are the pros and cons to the two types of eye treatment

A

Ointments

  • last longer so give better relief
  • often blur the vision

Drops

  • thinner and easier to administer
  • Not as many visual effects - need to be given more frequently
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3
Q

Which part of the eye can lipid soluble drugs penetrate

A

The epithelium
It is lipophilic/hydrophobic
Limits the absorption of hydrophilic drugs

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4
Q

Which part of the eye can water soluble drugs penetrate

A

The stroma
It is hydrophilic/lipophobic
Limits the absorption of hydrophobic drugs

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5
Q

Name a drug that has both lipophilic and hydrophilic properties

A

Chloramphenicol

Can penetrate the cornea easily

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6
Q

What can make topical steroids more hydrophobic

A

Alcohol or acetate

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7
Q

What can make topical steroids more hydrophilic

A

Phosphate

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8
Q

Describe the use of prednisolone acetate

A

Topical steroid
Hydrophobic - due to acetate
Good penetration of an uninflamed cornea
Used post-operatively

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9
Q

Describe the use of prednisolone phosphate

A

Hydrophilic - due to phosphate
Poor penetration of uninflamed cornea
Used for cornea disease, surface inflammation or when want low dose steroids

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10
Q

What is Bezalkonium

A

Surfactant and antibacterial agent
Common in household cleaners
Used as a preservative is eye drops
It aids penetration of drugs by disrupting lipid layer of tear film

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11
Q

How can you prevent the systemic absorption of topical eye drugs

A

Punctal occlusion
After administration, press on the tear ducts for around 5 mins
This stops the drug flowing down the lacrimal system and entering the throat (this would be the site of systemic absorption)

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12
Q

What is bimatoprost

A

Drug used to lower IOP in glaucoma

contains benzalkonium

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13
Q

What are the subconjunctival and subtenons routes of administration used for

A

Putting drugs in the back of the eye
In subtenons you place a small catheter around the eye under the tenons layer
Used for anaesthetics and steroids

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14
Q

What is a major risk of injecting into the back of the eye

A

If the retina is punctured by the needle it can lead to a retinal detachment

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15
Q

What are steroids used for in eye disease

A

Topically given in post-op cataracts
Uveitis
Prevention of corneal graft rejection
May be given in allergic eye disease (if other drugs haven’t worked)

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16
Q

What is one of the first signs of corneal graft rejection

A

New vascularisation of the cornea

Vision will go hazy

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17
Q

What are keratic precipitants in the eye

A

White dots in the eye which are deposits of white cells

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18
Q

What are the local side effects of steroids in the eye

A

Cataracts
Glaucoma
Exacerbation of viral infection - such as herpes simplex
Impaired wound healing

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19
Q

What are the systemic effects of steroids

A 
Gastric ulceration
Immunosuppression
Osteoporosis
Weight gain
AND many more
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20
Q

What anti-inflammatory agents can be used in eye disease

A

Steroids
Antihistamines and mast cell stabilisers (sodium chromoglycate) for allergic disease
NSAIDs are good for pain relief

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21
Q

Why might people not notice the vision loss in glaucoma

A

Slowly progressing

The brain compensates the missing parts of the image by filling it in with what it expects to be there

22
Q

List drugs that can be used in the treatment of glaucoma

A

Prostanoids - prostaglandin analogues
Beta blockers
Carbonic anhydrase inhibitors - topical and systemic
Alpha adrenergic agonists - sympathomimetics
Parasympathomimetic drugs

23
Q

Give an example of a prostanoid/prostaglandin analogue and explain how it helps treat glaucoma

A

Latanoprost

They increase uveoscleral outflow - open up the drains to reduce pressure

24
Q

Give an example of a beta blocker and explain how it helps treat glaucoma

A

Timolol

Reduces secretion of aqueous humour

25
Q

Give an example of a carbonic anhydrase inhibitor and explain how it helps treat glaucoma

A

Dorzolamide, other -mides and Trusopt

Reduces production of aqueous humour by blocking one of the enzymes in its production pathway

26
Q

Give an example of an alpha adrenergic agonist/ sympathomimetic and explain how it helps treat glaucoma

A

Brimonidine and alphagan
Dilates pupil
Reduces production of humour
Increases uveoscleral outflow

27
Q

Give an example of a parasympathomimetic and explain how it helps treat glaucoma

A

Pilocarpine

Constricts the pupil to help open up the trabecular meshwork = drain

28
Q

Describe how the intravitreal route is used in eye medication administration

A

Delivers effective concentration of drug at target site instantly
Used for antibiotics for endophthalmitis, intra-ocular steroids and anti-VEGF

However many drugs are toxic to the retina

29
Q

What is anti-VEGF treatment used for

A

Shrinking newly formed blood vessels

Useful in wet macular degeneration, diabetic maculopathy etc.

30
Q

What is local anaesthetic used for in ophthalmology

A 
Removal of foreign bodies 
Tonometry 
Corneal abrasions - pain relief and allows examination 
Corneal scraping 
Comfort 
Cataract surgery
31
Q

How is fluorescein used

A

Dye that is placed in the eye and then a blue light is shone on it to illuminate de-epithelialised areas
Will show corneal abrasions, ulcers, leaks (suggestive of injury)
Can be used to diagnose duct obstruction

32
Q

What is the effect of mydriatic drugs

A

They cause pupil dilation by blocking parasympathetic supply to the iris

33
Q

Give examples of mydriatics

A

Tropicamide - most common but short acting
Cyclopentolate - lasts a whole day
Atropine - lasts up to 3 weeks

34
Q

What are the potential side effects of mydriatics

A

Blurring

Acute angle closure glaucoma

35
Q

How do Sympathomimetics work

A

Act on the sympathetic system to dilate the pupil

36
Q

What drug must never be given to someone with herpetic keratitis

A

Steroids

Will cause a corneal melt

37
Q

How do eye drop allergies present

A

usually symmetrical reaction around both eyes

redness and swelling

38
Q

Steroids can cause cataracts - true or false

A

True

Even inhaled ones increase your risk

39
Q

Why are mydriatic/dilating drugs used in ophthalmology

A

Used for diagnostic procedures - easier to visualize back of eye
Used to gain access in cataract surgery
Cyclopentolate can be used to reduce pain from cilliary muscle spasm as it paralyses this muscle

40
Q

How are eye drops written in a prescription

A

G….drug name

41
Q

How are eye ointments written in a prescription

A

Oc… drug name

42
Q

List examples of topical antibiotics used in the eye

A

Most common is chloramphenicol

Ulcers cab be treated with gentamicin or quinolones as well

43
Q

List examples of topical antivirals used in the eye

A

Aciclovir

Ganciclovir

44
Q

Local anaethetic drops can be very toxic to the epithelium of the eye - true or false

A

True

45
Q

What is Seidel’s test

A

A test used to show leaks from the cornea, sclera, or conjunctiva following injury or surgery.
You add fluroscein to the eye and if there is a leak the aqueous fluid coming through will dilute it and cause a colour change - Seidel positive

46
Q

List side effects of prostanoids

A

Hyperpigmentation of iris, lashes and/or skin

47
Q

List side effects of carbonic anhydrase inhibitors

A

For the systemic ones:
Parasthesia in the fingers, toes and/or lips
Renal calculi
Metabolic acidosis

Topical ones can cause local irritation

48
Q

List side effects of beta-blockers

A

Systemic side effect - reduced by shutting eyes for a few minutes
Bradycardia
Fatigue
Contra-indicated in asthma and COPD

49
Q

List side effects of sympathomimetics

A 
Allergy 
Lethargy/drowsiness
local irritation, hyperaemia
cardiovascular side effects
Contraindicated in kids – restricts their breathing
50
Q

List side effects of parasympomimetics

A

Brow ache during first few weeks of use
Poor vision in low light
Due to persistent constriction of pupil

Opthalmology (9 decks)

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