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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
Q

How does temporal arteritis usually present?

A
  • Sudden temporal pain
  • Older patients
  • Multi-nucleated giant cells seen on artery biopsy
26
Q

What structure is affected in Anterior Ischaemic Neuropathy?

A

Optic nerve infarct

27
Q

What are the local eye side effects of steroids?

A

cataract
glaucoma
exacerbation of viral infection

28
Q

What are the systemic side effects of steroids in the eye?

A
  • Gastric ulceration
  • Immunosuppression
  • Osteoporosis
  • Weight gain
  • Diabetes
  • Neuropsychiatric effects
29
Q

Give examples of steroid eye drops from lowest to highest strength

A
  • Fluorometholone (FML)
  • Predsol
  • Betamethasone
  • Dexamethasone/ prednisolone
30
Q

What type of analgesia is used after refractive laser treatment

A

NSAIDs

31
Q

What word is used to describe the vision of patients with glaucoma?

A

Tunnel vision

32
Q

What types of eye drops can be used in glaucoma?

A 
Prostaglandins
Beta blockers 
Carbonic anhydrase inhibitors (Topical or Systemic)
Alpha-2 adrenergic agonist 
Parasympathomimetic drops
33
Q

Give an example of a prostaglandin eye drop used in glaucoma

A

Latanoprost

34
Q

Give an example of a topical and systemic carbonic anhydrase inhibitor

A 
Topical = Dorzolamide (‘Trusopt’)
Systemic = acetazolamide
35
Q

Give an example of a Beta Blocker used in glaucoma

A

Timolol

36
Q

GIve an example of an Alpha-2 Agonist drop used in glaucoma

A

Brimonidine (‘Alphagan’)

37
Q

Give an example of a Parasympathomimetic eye drop used in glaucoma

A

pilocarpine

38
Q

Give an example of eye drops which come in combination specifically for glaucoma

A

Cosopt = dorzolamide and timolol

39
Q

When is Anti-VEGF given via intravitreal injection?

A

Wet macular degeneration

40
Q

What eye drops are used for diagnosis?

A

Proxymetacaine

Fluorescein

41
Q

What drops are usually used for dilation?

A

Tropicamide

Phenylephrine

42
Q

When are local anaesthetics used?

A

1) Foreign Body removal
2) Tonometry (IOP measurement)
3) corneal scraping
4) comfort

43
Q

What can fluorescein dye be used for?

A

1) Identifying Corneal abrasion
2) Tonometry
3) Diagnosing Nasolacrimal duct obstruction
4) Angiography

44
Q

How do mydriatic drops cause dilatation?

A

pupil dilation by blocking parasympathetic supply to iris

45
Q

What are sympathomimetics?

A
  • Act on sympathetic system
  • Causes pupil to dilate
  • Do not affect the ciliary muscle
46
Q

Give examples of sympathomimetics

A

Phenylephrine

Atropine

47
Q

Give an example of a medication for another condition which can irreversibly constrict the visual field

A

Vigabatrin - epilepsy medication (anticonvulsant)

48
Q

If tropicamide does not dilate the eye enough, what should be added and what should the patient be warned?

A

Phenylephrine added

Tell patient it will probably take about 24hrs to wear off (rather than original tropicamide which would take less time)

49
Q

How can you tell a patient has definitely developed an allergy to their eye drop?

A

Reaction is symmetrical in both eyes

50
Q

Hydroxychloroquine is known to cause maculopathy. TRUE/FALSE?

A

TRUE

but only at accumulative doses

51
Q

What drug can cause vortex keratinopathy and how does it appear?

A

Amiodarone

Brown pigment visible in epithelium

Ophthalmology (13 decks)

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