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Ophthalmology > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What is the main route of administration of drugs into the eye?

A

Topical :

either Drops OR Ointment

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2
Q

Describe the makeup of the cornea and therefore what drugs are best at penetrating this barrier

A

Lipid:Water:Lipid

=> Low molecular weight drugs easily cross the barrier

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3
Q

What type of drugs penetrate the epithelium vs the stroma?

A

Lipid soluble drugs penetrate epithelium

Water soluble drugs penetrate stroma

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4
Q

If a drug is lipoPHOBIC (i.e dissolves in water) will it reach into the eye?

A

No it will dissolve in the tear film and be washed away

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5
Q

If a drug is hydroPHOBIC (i.e dissolves in lipid) will it reach into the eye?

A

It will take a while to get through the stroma (as this is water soluble) but a high enough concentration will be present for the drug to eventually get to the back of the eye

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6
Q

Give an example of an eye drop which possesses both hydrophilic and lipophilic properties

A

Chloramphenicol

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7
Q

How are topical steroids made to be more hydrophobic?

A

Alcohol or acetate = added

=> easier to dissolve in lipid

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8
Q

How can a topical steroid become more hydrophilic?

A

Phosphate added

=> dissolves more easily in water

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9
Q

What topical steroid is used in the eyes?

A

Prednisolone

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10
Q

What steroid is used after a cataracts operation?

A

Prednisolone acetate

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11
Q

What steroid is used in conjunctival inflammation?

A

Prednisolone Phosphate (as it only need to reach surface)

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12
Q

What chemical is found in eye drop preparations to prevent organisms growing in the bottles?

A

Benzalkonium Chloride

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13
Q

What effect does Benzalkonium Chloride have on the cornea?

A

strips away the lipid layer

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14
Q

How can topical drugs be systemically absorbed?

A

Tears = pumped out of lacrimal sac rapidly
Excess is absorbed at nasopharynx
(hence bad taste at back of throat)

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15
Q

How can systemic absorption be minimised?

A

Limited by punctal occlusion

pressing fingers on nasal part of lacrimal apparatus

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16
Q

What is the side effect of high dose Bimatoprost (0.03%) that contains low Benzalkonium Chloride?

A

Red/Black staining around the eye

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17
Q

Give an example of drops that can cause systemic side effects?

A

Beta Blocker drops (e.g. Timolol)

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18
Q

When would a subconjunctival injection be used?

A

Very inflamed uveitis

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19
Q

Where in the eye is a subtenon injection?

A

Into back of the orbit

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20
Q

What part of the eye is spared in an intravitreal injection?

A

Retina

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21
Q

An intracameral injection is put into where?

A

The anterior part of the eye

22
Q

What anti-inflammatory agents are used in the eye?

A

Steroids
Topical NSAIDs
Anti-histamines
Mast cell stabilisers

23
Q

When are steroid most commonly used in the eye?

A

1) post op cataracts
2) uveitis
3) prevent corneal graft rejection

24
Q

What can be seen if a corneal graft is being rejected?

A

vascularisation of the cornea

25
How does temporal arteritis usually present?
- Sudden temporal pain - Older patients - Multi-nucleated giant cells seen on artery biopsy
26
What structure is affected in Anterior Ischaemic Neuropathy?
Optic nerve infarct
27
What are the local eye side effects of steroids?
cataract glaucoma exacerbation of viral infection
28
What are the systemic side effects of steroids in the eye?
- Gastric ulceration - Immunosuppression - Osteoporosis - Weight gain - Diabetes - Neuropsychiatric effects
29
Give examples of steroid eye drops from lowest to highest strength
- Fluorometholone (FML) - Predsol - Betamethasone - Dexamethasone/ prednisolone
30
What type of analgesia is used after refractive laser treatment
NSAIDs
31
What word is used to describe the vision of patients with glaucoma?
Tunnel vision
32
What types of eye drops can be used in glaucoma?
``` Prostaglandins Beta blockers Carbonic anhydrase inhibitors (Topical or Systemic) Alpha-2 adrenergic agonist Parasympathomimetic drops ```
33
Give an example of a prostaglandin eye drop used in glaucoma
Latanoprost
34
Give an example of a topical and systemic carbonic anhydrase inhibitor
``` Topical = Dorzolamide (‘Trusopt’) Systemic = acetazolamide ```
35
Give an example of a Beta Blocker used in glaucoma
Timolol
36
GIve an example of an Alpha-2 Agonist drop used in glaucoma
Brimonidine (‘Alphagan’)
37
Give an example of a Parasympathomimetic eye drop used in glaucoma
pilocarpine
38
Give an example of eye drops which come in combination specifically for glaucoma
Cosopt = dorzolamide and timolol
39
When is Anti-VEGF given via intravitreal injection?
Wet macular degeneration
40
What eye drops are used for diagnosis?
Proxymetacaine | Fluorescein
41
What drops are usually used for dilation?
Tropicamide | Phenylephrine
42
When are local anaesthetics used?
1) Foreign Body removal 2) Tonometry (IOP measurement) 3) corneal scraping 4) comfort
43
What can fluorescein dye be used for?
1) Identifying Corneal abrasion 2) Tonometry 3) Diagnosing Nasolacrimal duct obstruction 4) Angiography
44
How do mydriatic drops cause dilatation?
pupil dilation by blocking parasympathetic supply to iris
45
What are sympathomimetics?
- Act on sympathetic system - Causes pupil to dilate - Do not affect the ciliary muscle
46
Give examples of sympathomimetics
Phenylephrine | Atropine
47
Give an example of a medication for another condition which can irreversibly constrict the visual field
Vigabatrin - epilepsy medication (anticonvulsant)
48
If tropicamide does not dilate the eye enough, what should be added and what should the patient be warned?
Phenylephrine added | Tell patient it will probably take about 24hrs to wear off (rather than original tropicamide which would take less time)
49
How can you tell a patient has definitely developed an allergy to their eye drop?
Reaction is symmetrical in both eyes
50
Hydroxychloroquine is known to cause maculopathy. TRUE/FALSE?
TRUE | but only at accumulative doses
51
What drug can cause vortex keratinopathy and how does it appear?
Amiodarone | Brown pigment visible in epithelium

Ophthalmology (13 decks)

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