To remember for final Flashcards by Emme Gilchrist

Tear film volume
Normal-
max-

Normal is 8-10 micrometers

Max is 30 microliters

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Normal eye drop in micrometers and mL

50 micro = 1 drop

20 drops = 1mL

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1 spray is how many microliters

105 microliters, so basically 2 drops

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Peds dose

Adult dose x (lbs/150)

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Amide and ester linked anesthetics

Amide- lidocaine. Good for injection because doesn’t get broken down quickly. More systemic effects.

Ester- cocaine, tetracaine, bonoxinate, proparacaine. Contra in sulfa.
*metabolized locally, less systemic effects.

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two main outcomes of phenylephrine

Vasoconstriction of vessels- blanching

Dilation

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phenylephrine caution and contra

Caution- Pts under 5, CVD, hyperthyroidism

Contra- HTN, thyrotoxicosis, less than 1 yr.

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Determine horners eye effected:

Cocaine or apraclonidine
Cocaine causes no dilation
Apraclonidine dilates horners

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Determine location of lesion once horners eye is determined

Hydroxyamphetamine
Pheynephrine

Phenyl: pupil dilates? Lesion post gang.

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Steroid side effects

Immumosuppression
ICSC
Cataract
10 or more IOP increase (steroid responder)

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Two groups of steroids

Ketones- Longer contact, more side effects. All of them except loteprednol, which is an ester. Broken down quickly.

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Indications for steroids

Inflammation
Pain associated with surgery
Allergic conjunctivitis (loteprednol/Alrex)

Off label: K transplant

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Steroid chemical bases

Best penetration to worst

Acetate (suspension)
Alcohol (suspension)
Phosphate (soln)

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Pred forte works better than

generic!!

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Two group types for anesthetics and steroids

Anesthetics:
Amides (lidocaine) and ester (all others)

Steroids:
Ketones (all others) and ester (loteprednol)

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Triamcinolone Acetonide/Kenalog 40 off label use

Most common injectable steroid

Chalazion, ant seg and p seg inflammation

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4 types of implantable steroids

Retisert and iluvien are fluocinolone acetonide
retisert is for posterior uveitis
Iluvien is for diabetic ME

Ozurdex and dextensa are dexamethasone
Ozurdex is for ME and posterior uveitis
Dextensa is resorbable in punctal plug

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Acetaminophen

Good CNS penetration for anti fever but poor peripheral for anti inflammation

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Topical NSAID indications

Allergies (Acular)
Pain control
Treatment of CME
Post op inflammation

topical NSAID side effects

Delayed wound healing
K melt syndrome

stings, hyperemia

Older NSAIDs QUID
Vs
Newer NSAIDS BID

Diclofenac
Ketorolac

Bromfenac and Nepafenac
Better dosing due to pH adjustments, halogenation, prodrug, and concentration

Ilevro is a pro drug that is converted to

Amfenac in the tissues. Leads to better penetration.

Indications for opioid use

Orbital injury

K abrasion, laceration or burn

Tramadol

Weak inhibition’s or serotonin and NE reuptake. Caution when pt is taking SSRI, TCA, or MAOIs

Buprenorphine MOA

Partial agonist. Acts as morphine in pts who haven't taken opioids and causes withdrawal in pts who have

Naloxone

Opiode antagonist. Reverses effects of overdose.

Methadone

less intense withdrawal

Opioid contra

Shock head injuries Obstetrics Asthma

Opiod combos

Lortab (Hydro + Acetaminophen) Percocet (Oxy + acetaminophen) Percodan (Oxyt + Acetylsalicylic acid) Tylenol # (codeine + acetaminophen) 2- 15/300 3- 30/300 4- 60/300

Opioid rx

1-2 PO every 4-6 hours for pain 2-3 day No refil Avoid opioid and benzo together

4 requirements on Rx

Suprascription- dr info, pt info, rx, date Inscription - meds, form, concentration Subscription- Instructions to pharmacist Signatura- instructions to pt

2 oral hyperosmotics and MOA

Glycerin- caution in diabetics. Side effects include nausea, HA, dehydration. Contra in heart, kidney and lung disease. Mannitol- Safe for diabetics. Rapid reduction in IOP by increasing blood serum osmolarity *Sulfa allergy

Topical hyper osmotic

Sodium Chloride/Muro 128 to treat K disorders. Will increase tonicity of tear film and pull water out of the K. Solution burns. Ointment QHS

NAFL

Cornea staining | Stains spaces between cells and injured cells

Rose bengal vs lisamine green

Both for conj staining Rose bengal- Sting, stain healthy and dead cells, toxic to K cells/bacteria/virus, difficult red contrast Lisamine green- Stains dead cells. Not toxic, no sting.

3 components to artificial tears

Preservative Active ingredient (lipid, wetting, or viscosity) Inactive for pH

Freshkote MOA

1. High osmotic pressure. 2. Aqueous lubricant 3. Amisol will increase lipid layer of tear film

Restasis - MOA - side effect - should see effect in how many months. max? - CI?

Cyclosporin that inhibits T cells Stings 1 month. 3-6 months max Active infection

Xiidra MOA Side effects

LFA1 antagonist. Reduction in inflammatory products associate with DED discomfort, altered taste, blurry vision after drop

Eysuvius indication

Indication short term relief of inflammatory dry eye. 2 week use

drugs that tx HSV MOA

Pro drugs. Activated by virus. (except trifluorodine) | Blocks viral DNA synthesis

Trifluoriodine and Gancyclovir dose

Trifluoriodine: 9x per day 7-10 days Gancyclovir: 5x per day Only for HSK, not VZO

Dose, side effects, and eliminated by what organ Acyclovir Valacyclovir Famcyclovir

Acyclovir 400 5x per day Valacyclovir 500 TID Famcyclovir 250 TID Side effects; mild GI and HA Eliminated by Kidney. Caution if on dialysis

Antifungal meds | -MOA

Increase cell membrane permeability through pores. Funicidal. Natamycin- Only FDA approved anti fungal. 1 drop Q hour around the clock for 4-6 weeks Amphotercin B must be fortified. May take 1-2 weeks to see response.

Natamycin and amphotercin B dose

Antifungal. Only FDA approved. | 1 drop Q hour around the clock 4-6 weeks.

Acanthamoeba Keratitis - When to suspect it - Signs - Tx

CL wear, use tap water, swimming, fishing, hot tub. Symptoms worse than signs, sub epi infiltrate, ring shape. ``` Polyhexamethyl Biguanide 0.02% 1 drop q hour Must be compounded D/c CL wear Oral NSAID/analgesic ```