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mpharm stage 3 > Special senses > Flashcards

Special senses Flashcards

1
Q

what is the function of the aqueous humour of the eye

A

transports nutrients to the eye and waste products from the eye.

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2
Q

what is IOP

A

intraocular pressure

  • It is the balance between aqueous humour production and aqueous humour removal.
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3
Q

What is normal IOP

A

12-21 mmHg

  • IOP usually lowest at night and highest during the day
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4
Q

What is Glaucoma

A

Optic nerve damage due to an increased IOP.

  • Loss of retinal ganglion cells
  • atrophy of optic nerve
    ^ these are usually asymptomatic
  • then peripheral vision is lost, if left untreated could cause blindness.
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5
Q

What is POAG

A

Primary open angle glaucoma

  • a type of glaucoma: where the drainage channels of the eye become blocked, causing an increase in IOP.
  • where the anterior chamber angle appears to be normal, but IOP is high with no sign of disease.
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6
Q

POAG treatment:

A

Decrease IOP by 20-40%

Drug therapy
then
laser therapy
then
surgery

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7
Q

What are 5 common reasons for treatment failure generally ?

A

1) lack of adherence
2) Intolerance to treatment
3) Hypersensitive to excipient
4) OTC drugs
5) Other contraindicated prescription drugs, not disclosed during prescribing.

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8
Q

What types of drugs reduced aqueous humour production

A

B antagonists

  • carbonic anhydrase inhibitors
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9
Q

Examples and side effects of Beta antagonists that reduce aqueous humour production

A

Examples:
Timolol
Betaxolol
Brinzolamide
Dorzolamide
Acetazolamide

Side effects

Timolol: Blurred vision, burning/ stinging in the eye, discharge.

Betaxolol: Nausea, diarrhoea, joint pain, heart burn

Brinzolamide:
Eye irritation, blurred vision, allergic reaction

Dorzolamide: blurred vision, skin rash, redness or sweeling of the eye.

Acetazolamide:
Skin rash, swelling, headache, nausea, vomit.

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10
Q

Timolol mechanism of action ?

A

Decreases aqueous humour production, causing decrease in blood supply to ciliary body, decreasing IOP.

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11
Q

What type of drugs reduce aqueous humour production and increase aqueous humour removal
(dual effect)

A

Alpha 2 receptor agonists

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12
Q

Examples and side effects of A2 agonists (dual effect)

A

Examples:
Apraclonidine
Brimonidine

Side effects:
Apraclonidine:
Red swollen. itchy eyes
blurred vision
irregular heartbeat
dry eyes

Brimonidine:
Itchy eyes
eye irritation
red stinging/burning eyes
dry eyes
blurred vision
headache
drowsiness.

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13
Q

What type of drugs increase Aqueous humour removal

A

Prostaglandin analogues

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14
Q

Examples and side effects of prostaglandin analogues

A

Bimatoprost: itchy eye, red eye, eye swelling, blurred vision, headache.

Latanoprost: change in eye colour, dry eyes, headache, dizziness

Travoprost: Eye discolouration, dry eye, eye discomfort, headache, blurred vision

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15
Q

What is another drug type that treats POAG ?
And what is the MOA ?

A

Cholinergic agents

  • by stimulating cholinergic receptors in the eye,

causing spasm of ciliary muscle and contraction of the pupil

causes trabecular meshwork to open and increases aqueous humour removal out of the eye. Lowering IOP.

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16
Q

Examples and side effects of cholinergic agents?

A

Pilocarpine: headache, nausea, diarrhoea, fainting

Carbachol: blurred vision, headache, stomach pain

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17
Q

Other treatment options for POAG

A

Laser trabeculoplasty: 120 burns made in the trabecular meshwork, to increase drainage of aqueous humour, causing lower IOP

Laser ciliary body ablation: applying burns to ciliary body, reduces aq humour production, lower IOP.

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18
Q

PCAG

A

Primary closed angle glaucoma

  • Increase in IOP, due to decreased aqueous humour removal, due to the closure of the chamber angle by the peripheral iris.
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19
Q

symptoms of pcag

A

headache
blurred vision
vomit

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20
Q

What may cause PCAG

A

1) Small or large lens size
2) small corneal diameter
3) secondary to late stage POAG
4) Dilator and
5) sphincter muscle theory

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21
Q

Dilator muscle theory (PCAG)

A

1) Dilator muscle contracts, causing posterior movement , increases apposition between iris and anteriorly located lens.

2) pupil dilates simultaneously

3) Peripheral iris becomes more flaccid, causing posterior chamber pressure to increase

4) Iris bows anteriorly, peripheral iris obstructs angle, IOP increases.

22
Q

Sphincter muscle theory

A

1) Sphincter of the pupil precipitates angle closure
2) pupilary blocking force of the sphincter is highest when diameter of pupil is around 4mm.

23
Q

Pre surgery preparation for PCAG

A

1) Timolol 0.5% (one drop every 30 mins) 2 doses

2) Pilocarpine 2-4% one drop every 15 mins for the first 1-2 hours

3) Apraclonidine 0.5-1% one drop every 30 mins (2 doses)

4) Acetazolamide 500mg oral initially, then 250 mg every 6 hrs.

5) Osmotic agent (e.g. oral glycerol) 1ml/kg diluted with a equal amount cold water

24
Q

Viral conjuctivitis treatment

A

warm compress and eye drops

25
Q

Adults chronic onjuctivitis treatment

A

chloramphenicol or fusidic acid

26
Q

Neonatal conjunctivitis treatment

A

Oral erythromycin (50mg/kg 4 times a day for 14 days)

27
Q

Scleritis

A

NSAIDs

28
Q

symptoms of excess build up of earwax

A

Earache
hearing loss
tinnitus
itchiness in/around ear
Vertigo (spinning sensation)
ear infection

29
Q

Rinne test (ear test)

A

1) Strike a 512 Hz tuning fork gently
2) Place the vibrating tuning fork onto the mastoid bone, located behind the ear.

3) Ask patient, when they can no longer hear the sound.

4) move the tuning fork to the auditory meatus, which is in the front of the ear canal
5) Ask the patient when they can no longer hear the sound.

30
Q

Weber’s test (ear test)

A

same as rinnes but hold the fork by the stem and place it on the middle of the patient’s head,

  • then ask if they hear the sound louder in one ear, or equally.
31
Q

Non pharmalogical treatment for earwax build up

A

Olive oil drops

warm water in a bulb syringe

32
Q

Different types of Pharmalogical ear drops ?

A

1) sodium bicarbonate

2) urea-hydrogen peroxide

3) docusate sodium

33
Q

Sodium bicarbonate MOA (ear drops)

A

Reacts with ear wax neutralising it to produce water and salt, dissolves ear wax.

causes ear wax to break down

34
Q

Urea-hydrogen peroxide MOA (ear drops) 2 ways

A

Releases oxygen, breaking up ear wax

  • Reduces keratin load in ear wax debris, by inducing keratolysis.
35
Q

Docusate sodium MOA (ear drops)

A

Emulsifying action, softens ear wax plug.

36
Q

Should ear drops be used if the ear drum is perforated

A

no

37
Q

What to do if ear drops don’t work

A

Syringing
use warm water to wash out softened ear wax

  • dont use cold water- could cause diziness
  • can cause increased risk of ruptured ear drum, infection, tinnitus
  • if syringing doesn’t work- then transferred to ENT specialist
38
Q

what are the 3 different ways ear wax removed by ENT

A

1) ear irrigation: electric pump pushes water in ear and washes wax out

2)Micro suction: Small device sucks ear wax out of ear

3) Aural toilet: small instrument used to clean and scrape ear wax out

39
Q

Otitis Externa

A

inflammation of the external ear canal
- also known as “swimmers ear”
- usually only one ear is affected

40
Q

Symptoms of otitis externa

A

1) ear pain
2) itchy ear canal
3) Discharge
4) Hearing loss

41
Q

What are the 4 main causes for otitis externa ?

A

1) Seborrheic dermatitis: Skin condition, where greasy areas of the skin become irritated and inflamed, which can affect the ears.

2) Fungal infections: more common if ear drop use is long term.

3) Middle ear infection (otitis media): an infection deeper in the ear, causes discharge, may lead to otitis externa.

4) Allergies

42
Q

6 drugs to treat otitis externa:

A

1) Otomize

2) Sofradex

3) Gentamicin

4) FML drops

5) Clotrimazole drops

6) Betnesol

43
Q

Otomize mechanism of action (otitis externa)

A

The glacial acetic acid present, creates an acidic environment making it harder for the bacteria to grow.

44
Q

Sofradex mechanism of action (otitis externa)

A

1) contains antibiotics framycetin sulfate and gramicidin, to kill bacteria
2) contains dexamethasone: to stop inflammation and itching.

45
Q

Gentamicin

A

Bind to the 30S subunit of the bacterial ribosome, causing an affect on protein synthesis.

46
Q

FML drops mechanism of action

A

Fluorometholone
A type of corticosteroid

induce phospholipase A2 inhibitory proteins (lipocortin). This causes inhibition of arachidonic acid, which affects synthesis of prostaglandins and leukotrienes.

47
Q

Clotrimazole drops mechanism of action

A

1) reduces permeability of the cell membrane of fungi

2) Causes inhibition of ergosterol

3) cell no longer able to construct a functional cell membrane.

48
Q

Betnesol moa

A

Betamethasone
1) Blocks production of prostaglandins
- also reduces activity of leukocytes and macrophages in the inflamed area.

2) Reduces inflammation (redness, itching and soreness).

Neomycin
1) Binds to 30S sub unit of bacterial ribosome, prevents synthesis of proteins.

49
Q

page 18

A

page 18

50
Q
A

mpharm stage 3 (4 decks)

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