TMOD

Question 1

what drug should be used if you suspect Adie’s tonic pupil?

Answer 1

Pilo 0.125%, if will constrict if it’s Adie’s and will not constrict if anything else

Question 2

drugs used to confirm corners

Answer 2

10% cocaine (will not dilate hornets pupil)
1% apraclonidine (will not dilate the normal pupil)

can use phenylephrine 1%

Question 3

dosage of ibuprofen RXed for relief of mild to mod pain

Answer 3

400mg po q4-6h with food

Question 4

which steroids are best for uveitis and which are not that great

Answer 4

• diflupredinate strong
• prednisolone and dexamethasone have similar efficacy
• loteprednol etabonate 0.5% slightly less effective
• FML with its alcohol derivative not favored

Question 5

off label drugs for ophthalmic uses

Answer 5

when the practitioner departs from the FDE approved labeling of a medication, including clinical indications or drug dosage, there should be documented suppler for such uses in the published literature, and ideally, the doctor should have received the patient’s informed consent. Such “unlabeled uses” are certainly legal

Question 6

Ocular TRUST study

Answer 6

Tracking Resistance in the United States Today

landmark research to document resistance patterns among common ocular isolates to frequently used topical antibiotics. With regard to MRSA isolates, the most potent ocular antibiotics are trimethoprim and tobramycin, the former being considerably more potent. For topical ocular use, trimethoprim is commercially available only in combination with polymyxin B. Other studies have also documented the superior potency of besifloxacin and Vancomycin against MRSA

Question 7

if no organisms or multiple organisms are seen on the great stain of a corneal ulcer, or if there are risk factors that differ from the gram stain results, treatment is initiated with

Answer 7

cephazolin (50mg/mL), one drop q15-30m and tobramycin (14mg/mL) one drop every 15 to 30m. this is the most common fortified antibiotic regimen suggested for sight threatening infections and is often considered the standard against which other treatments are compared. When initiating treatment, it is important to give a loading dose by instilling 5 drops of each of the antibiotics, 1m apart.

Question 8

contraindications of steroids

Answer 8

osteoporosis
infection
diabetes

Question 9

which of the following oral PCN would not be appropriate for a patient with preseptal cellulitis secondary to an internal hordeolum?
amoxicillin 
oxacillin
dicloxacillin
cloxacilin

Answer 9

amoxicillin

it is important to remember that staph aureus is the causative organism in almost every patient with an internal hordeolum. In turn, most S aureus organism produce beta lactamase enzymes, which destroy the beta lactam ring that confers the biologic activity of PCN. Both ampicillin and amoxicillin have no defense against the beta lactamase enzymes. However penicillinase resistant PCNs were developed specifically to be effective against S aureus infections. These include oxacillin, dicloxacilin, and cloxacillin, Beware that amoxicillin formulated with clavulanate (Augmentin) IS effective against S aureus because clavulanate is a beta lactamase inhibitor

Question 10

side effects of acyclovir and valacyclovir

Answer 10

nausea, diarrhea, and abdominal pain

most prominent with renal impairment

Question 11

classic triple therapy for too

Answer 11

pyrimethamine plus sulfidi, along with steroids to reduce inflammation. As an alternative, trimethoprim/sulfamethoxazole (Bactrim) is commonly used, which has a clinical efficacy similar to that above. Bactrim has the advantage of being readily available, less expensive, and does not require either folinic acid supplementation or hematologic monitoring. Clindamycin is an effective alternative in cases of allergy to sulfa drugs

Question 12

Clarks Rule

Answer 12

for children under the age of 13yo, simply divide the patient’s weight in pounds by 150, and multiple that by the adult dosage

Question 13

treatment for HZO

Answer 13

acyclovir 800mg 5x/day
valacyclovir 1000mg TID
Famcyclovir 500mg TID

Question 14

RXing allergy drops for pregnancy women

olopatadine 0.1%
olopatadine 0.2%
bepotastine 1.5%
alcaftadine 0.25%
loteprednol 0.2%

Answer 14

alcaftadine

if this patient were not pregnant, loetprednol 0.2% (Alex) would possibly be the best choice. Since she is pregnant, however, we need to use the deafest medication possible. Among the choices given here, the only one with an FDA preg cat B is alcaftadine (Lastacaft). All others are preg cat C

Question 15

treating a toxic response to the cornea from latanoprost

Answer 15

resemble those of HSK, but disappear once the drug Is d/c.

DC the drug and use topical ATs and/pr antibiotics

Question 16

adult inclusion conjunctivitis treatment

Answer 16

Azithromycin 1g single does
doxy 100mg orally BID x 7 days

pregnant and lactating women should avoid oral doxy. In these patients, erythromycin base 500mg QID x 7 days or amoxicillin 500mg TID x 7 days is an alt to doxy

Question 17

what is the most appropriate treatment option for an internal hordeolum to optimize efficacy, discourage development of resistant organisms, and to enhance patient compliance

Answer 17

cephalexin 500mg PO q12h x 10 days

This asks what meets the three criteria. So which drug would be effective, specific for staph aureus, and used the fewest times daily to enhance patient compliance. Doxy is not effective for staph A and meds used 4x day are inconvenient

Question 18

side effects valacyclovir

Answer 18

headache 
naruse 
diarrhea 
nephrotoxicity 
CNS symptoms 

high doses have been associated with confusion and hallucinations, and uncommonly, severe thrombocytopenia syndromes, which can be fatal in immunocompromised patients.

Question 19

to combat symptoms of nausea during opioid therapy, which of the following agents may be administered concomitantly with the opioid?

Answer 19

promethazine (phenergan) 25mg

this is an antiemetic agent

Question 20

alternative to atropine for uveitis

Answer 20

homatripine 5%

Question 21

an 8yo child weighing 75lbs is found to have preseptal cellulitis. Hx is noncontributory and there is no apparent URI, sinus, or middle ear infection. Using Clark’s rule, the oral dosage of amoxicillin/clavulonate 250mg/62.5mg/5mL for this patient should be (note: adult dosing is 500mg BID)

Answer 21

75/150=0.5
0.5x500=250

the commercial dose is given
there is 5mL in a tsp

so 2 tsp BID

Question 22

reasonable options for managing steroids induced ocular hypertension

Answer 22

DC or reduce steroid dosing freq
reduce the steroid concentration while maintaining the same frequency
chang eto FML
avoid prostaglandins

Question 23

corneal ulcers vs infiltrates

Answer 23

bacterial K is associated with cells in the AC, whereas infiltrates generally do not. Patients with infiltrates can generally be treated with a topical steroid/abx combo and will achieve rapid resolution. Steroids must be used cautiously in patients with bac K

Question 24

research has confirmed which topical steroid to generally be the agent of choice for treatment of patients with GPC associated with CL wear?

Answer 24

Lotemax (loteprednol etabonate 0.5%)

Question 25

systemic antihistamines and ocular symtoms

Answer 25

it is now recognized that systemic antihistamines have little value in the treatment of allergic conjunctivitis. Moreover, these are well;l documented to induce dry eye, in some cases making things worse. topical steroids can be used esp in patients with significant ocular signs and symptoms. inhaled or intranasal steroids, RXed by an allergist can be extremely beneficial for nasal or sinus symptoms, topical ocular antihistamine/mast cell stabilizers are of course widely used for patients with mild to moderate symptoms

Question 26

what would be an appropriate treatment for someone with significant ocular hyperemia associated with seasonal allergic conjunctivitis

Answer 26

topical steroid

almost all topical antihistamine/mast cell are minimally effective for ocular redness and are FDA approved for only the itching, not redness. topical ocular decongestants can be used by rebound redness.

Alrex (loteprednol etabonate 0.2%) is FDA approved for this

Question 27

topical steroid that is FDA approved for treatment of signs and symptoms of seasonal allergic conjunctivitis

Answer 27

loteprednol etabonate 0.2%

Question 28

which of the following would not be appropriate for the treatment of lid eczema associated with atopic dermatitis?

• triamcinolone 0.1% cream or ointment
• loteprednol 0,5% ointment
• hydrocrotisone 1.0% cream or ointment
• tacrolimus 0.03% ointment

Answer 28

non of the above, since each may play a role in treatment of atopic dermatitis of the eyelids

Question 29

what is a good way of using steroids drops in a CL wearer

Answer 29

instill the first drop in the AM 5-15m before inserting CL; additional drops can be instilled after the lenses are removed in the evening