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OPT204 > SAQ > Flashcards

SAQ Flashcards

1
Q

Trans corneal diffusion

A
  1. Ratio of charged and uncharged drug has to be preserved on both sides
  2. Uncharged can pass through the epithelium into stroma
  3. Charged molecules left behind become uncharged to maintain ratio and pass through to the storma until all the drug passed through epithelium
  4. Inside stroma, some of drug becomes charged and passes through stroma
  5. Charged molecules become uncharged on the other end to preserve ratio and pass through endothelium
  6. Uncharged molecules become charged in endothelium
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2
Q

How to choose administration routes

A 
Target tissue 
Speed of action 
Stability of drug 
Duration of action
Solubility in water 
Physiology of patient 
Comorbidities 
Age, compliance
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3
Q

Legal classification

A

GSL - general sales list
P - pharmacy medicine
POM - prescription only medicine

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4
Q

Pharmacological classification

A

Mode of action
Chemical composition
Effect of drug

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5
Q

Pupil pathway

A

Autonomic nervous system:

  • sympathetic
  • parasympathetic
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6
Q

Sympathetic

A
  • Stimulates

- adrenergic stimulation and blockers

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7
Q

Ocular uses of adrenergic stimulation in sympathetic

A
  • dilation
  • testing for oculosympathetic lesions eg horners syndrome
  • constrict conjunctival vessels
  • relief of minor allergic reactions
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8
Q

Ocular uses of adrenergic blocking in sympathetic

A
  • beta blockers: control IOP
  • alpha blockers: reverse dilation
  • for pupil miosis
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9
Q

Parasympathtic nervous system

A
  • cholinergic blocking:

Prevents miosis of pupil causing dilation

Paralyses accommodation

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10
Q

Sympathetic

A

Carotid artery - 6th cranial nerve - ophthalmic division of 5th CN - ciliary ganglion - long ciliary nerve - IRIS DILATOR MUSCLE AND MUELLERS MUSCLE

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11
Q

Parasympathetic

A

Edding westphal nucleus - 3rd nerve - ciliary ganglion - IRIS SPHINCTER

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12
Q

Indications for mydriasis (dilation)

A
  • flashes floaters
  • sudden vision loss
  • progressive cataracts/ other media opacities
  • small pupils
  • ocular surgery
  • imaging
  • px with risk of retinal diseases
  • high myopes
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13
Q

Mode of action for mydriatics

A
  • SYMPA: DIRECT AGONIST: alpha and beta receptors stimulate contraction of IRIS DILATOR MUSCLE
  • PARA: DIRECT ANTAGONIST: block SPHINCTER MUSCLE
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14
Q

Tropicamide

A
  • muscarinic antagonist (blocks sphincter muscle - para)
  • anticholinergic
  • POM
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15
Q

Ocular side effects TROPICAMIDE

A
  • transient stinging
  • elevation of IOP
  • photophobia
  • blurred vision
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16
Q

Systemic side effects of TROPICAMIDE

A
  • less severe than cyclopentolate and atropine
  • safest
  • ask px to bring sunglasses
  • px not drive or operate machinery
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17
Q

Phenyephrine

A
  • sympathimimetix amine
  • stimulates iris dilator muscle via alpha receptors
  • POM
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18
Q

Ocular side effects:

A
  • pain
  • teary
  • keratitis
  • pigmented aqueous floaters
  • rebound miosis
  • rebound conjunctival congestion
  • conjunctival hypoxia
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19
Q

Systemic side effects

A
  • hypertension
  • occipital headache
  • subarachnoid haemorrhage
  • ventricular arrhythmia
  • tachycardia
  • blanching of skin
  • reflex bradycardia
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20
Q

Cautions when using mydriatics

A
  • allergies
  • angle closure or narrow angles
  • iris mounted IOLs
  • new born babies

Tropicamide: angle closure glaucoma

Phenylephrine: hyperthyroidism, asthma, diabetes, stroke, other meds

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21
Q

Mode of action for Miotics (constrict)

A
  • DIRECT CHOLINERGIC AGONIST
  • indirect cholinergic agonist
  • adrenergic antagonist
22
Q

Pilocarpine POM

A
  • 1,2,4 % minims
  • pupil miosis
  • spasm of accommodation
  • reduce IOP
23
Q

Contraindications of pilocarpine

A
  • known sensitivity
  • uveitis/ iritis
  • iris mounted iol
  • fragile iris
  • retinal detachment
  • exfoliation syndrome
24
Q

Cyclopegics

A
  • relax accommodation
  • block acetylcholine at iris sphincter muscle and ciliary body
  • use for: strabismus, children and infants, young hyperopia
25
Q

Which one is most potent (powerful)

A
  • AHCT
  • atropine (most)
  • homatropine
  • cyclopentalate
  • tropicamide (least)
26
Q

Atropine

A
  • available to optoms with additional supply or independent prescriber
  • complete paralysis of accommodation
  • amblyopia
27
Q

Cyclopentalate

A
  • optoms use in practice
  • dark skin and iris can resist cyclopegia
  • light eyes: 0.5% -20mins
  • brown eyes: 1% -30/40 mins
  • children: 1%
28
Q

Cyclopentalate ocular effect

A 
Irritation
Lacrimation 
Conjunctival hyperaemia 
Allergic blepharo-conjunctivitis 
Elevated IOP
29
Q

Cyclopentalate systemic effect

A 
Drowsiness 
Ataxia 
Disorientation 
Incoherent speech 
Restlessness 
Visual hallucinations
30
Q

Sodium fluorescein

A
  • not true dye
  • max absorption : 493nm
  • emits at 520nm
  • 1 %, 2%,
  • 0.25% with 4% lidocaine
  • use before any topical anaesthetics
31
Q

Uses of fluorescein

A 
RGP fitting 
Tear film assessment 
Corneal observations 
Foreign bodies/stray CLs
Corneal staining 
Contact Tonometry
Angiography
Assess nasolacrimal drainage system 
Jones dye test 
Seidel rest
32
Q

Rose Bengal

A 
True stain
Stains dead cells 
Maybe causes cell damage 
Not available in uk 
Stings 
Viewed with white light 
Instil and then wash away excess with saline 
Stings more than lissamine green 
Bind to unprotected corneal epithelial cells
33
Q

Uses of rose Bengal

A
  • Diagnose dry
  • Evaluate corneal and conjunctival lesions
  • differentiate between HSV and HZV
34
Q

Lisaamine green

A 
True dye 
Conjunctival staining for dry eye 
Good at identifying Marx line 
Impregnated strip with 1.5mg of dye 
Into lower fornix
Viewed with white light 
Bind to unprotected corneal epithelial cells
35
Q

Dry eyes assessment

A

S ubjective
O bjective
A ction
P lan

36
Q

Artificial tears legal classification

A

P, POM, GSL

37
Q

Hypromellose (P)

A

4 times a day
Thin watery
Low viscousity
Used preserved

38
Q

Factors affecting eye drop bioavailability

A 
Drug dosage 
Drug formulation and design 
Corneal integrity 
Topical anaesthetics used? 
Iris pigmentation 
Physiological features of px
39
Q

Compare and contrast delivery modes of ocular drugs

A

Eye drops and eye ointments

See pictures

40
Q

Anaesthetics actions

A

It’s an antagonist - blocks sodium channels

Nerve fibres:
Pain - touch - temperature - pressure

Softens cornea (affect IOP)
Reduce blink rate
Delay cell regeneration

41
Q

Uses for anaesthetics

A 
Contact tonometry 
Foreign body removal 
Punctual plugs 
Eye impression 
Diagnostic procedures 
Irrigation of the eye
42
Q

Contraindications for anaesthetics

A 
Known hypersensitivity 
Premature babies 
Global penetrating injuries 
Pregnancy and breastfeeding 
Where wound healing would be compromised
43
Q

Which ones stings least

A

POLT

Proxymetacaine (least)
Oxybuprocaine
Lidocaine
Tetracaine (most)

44
Q

Proxymetacaine (0.5%)

A
  • less punctate staining than tetracaine
  • stings least
  • more potent than tetracaine
  • stored in fridge
Uses: 
Tonometry 
Deep anaesthesia 
Removal of sutures 
Remove foreign bodies
45
Q

Oxybuprocaine 0.4%

A
  • produces less punctate staining than tetracaine
  • stored room temperature

Use:
Tonometry/CLs
Foreign body removal

46
Q

Lidocaine 4% with fluorescein 0.25%

A

Useful:

  • contact Tonometry
  • if pc has adverse reaction to any Esther anaesthetic group
47
Q

Tetracaine (0.5% and 1%)

A

Above 1% can damage cornea

Not used on pc with known hypersensitivity

48
Q

Analgesia - painkillers

A

Non-opioid:

  • paracetamol
  • aspirin
  • ibuprofen

Opioid:

  • morphine
  • methadone
  • tramadol
  • codeine
49
Q

Nonsteriodals anti inflammatory (NSAID)

A

Ocular painkiller

50
Q

Selection of drop for glaucoma

A 
HReduction of IOP 
Duration of effect 
Preservation of visual field 
Maintenance of effect 
Compatibility with other medication 
Lack of topical side effects 
Lack of systemic side effects 
Patient compliance

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