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Ocular Pharm > To remember for final > Flashcards

To remember for final Flashcards

1
Q

Tear film volume
Normal-
max-

A

Normal is 8-10 micrometers

Max is 30 microliters

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2
Q

Normal eye drop in micrometers and mL

A

50 micro = 1 drop

20 drops = 1mL

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3
Q

1 spray is how many microliters

A

105 microliters, so basically 2 drops

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4
Q

Peds dose

A

Adult dose x (lbs/150)

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5
Q

Amide and ester linked anesthetics

A

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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6
Q

two main outcomes of phenylephrine

A

Vasoconstriction of vessels- blanching

Dilation

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7
Q

phenylephrine caution and contra

A

Caution- Pts under 5, CVD, hyperthyroidism

Contra- HTN, thyrotoxicosis, less than 1 yr.

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8
Q

Determine horners eye effected:

A

Cocaine or apraclonidine
Cocaine causes no dilation
Apraclonidine dilates horners

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9
Q

Determine location of lesion once horners eye is determined

A

Hydroxyamphetamine
Pheynephrine

Phenyl: pupil dilates? Lesion post gang.

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10
Q

Steroid side effects

A

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

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11
Q

Two groups of steroids

A

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

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12
Q

Indications for steroids

A

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

Off label: K transplant

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13
Q

Steroid chemical bases

Best penetration to worst

A

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

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14
Q

Pred forte works better than

A

generic!!

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15
Q

Two group types for anesthetics and steroids

A

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

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

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16
Q

Triamcinolone Acetonide/Kenalog 40 off label use

A

Most common injectable steroid

Chalazion, ant seg and p seg inflammation

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17
Q

4 types of implantable steroids

A

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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18
Q

Acetaminophen

A

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

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19
Q

Topical NSAID indications

A

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

20
Q

topical NSAID side effects

A

Delayed wound healing
K melt syndrome

stings, hyperemia

21
Q

Older NSAIDs QUID
Vs
Newer NSAIDS BID

A

Diclofenac
Ketorolac

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

22
Q

Ilevro is a pro drug that is converted to

A

Amfenac in the tissues. Leads to better penetration.

23
Q

Indications for opioid use

A

Orbital injury

K abrasion, laceration or burn

24
Q

Tramadol

A

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

25
Q

Buprenorphine MOA

A

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

26
Q

Naloxone

A

Opiode antagonist. Reverses effects of overdose.

27
Q

Methadone

A

less intense withdrawal

28
Q

Opioid contra

A

Shock
head injuries
Obstetrics
Asthma

29
Q

Opiod combos

A

Lortab (Hydro + Acetaminophen)
Percocet (Oxy + acetaminophen)
Percodan (Oxyt + Acetylsalicylic acid)

Tylenol # (codeine + acetaminophen)
2- 15/300
3- 30/300
4- 60/300

30
Q

Opioid rx

A

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

31
Q

4 requirements on Rx

A

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

32
Q

2 oral hyperosmotics and MOA

A

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

33
Q

Topical hyper osmotic

A

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

34
Q

NAFL

A

Cornea staining

Stains spaces between cells and injured cells

35
Q

Rose bengal vs lisamine green

A

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.

36
Q

3 components to artificial tears

A

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

37
Q

Freshkote MOA

A
  1. High osmotic pressure.
  2. Aqueous lubricant
  3. Amisol will increase lipid layer of tear film
38
Q

Restasis

  • MOA
  • side effect
  • should see effect in how many months. max?
  • CI?
A

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

39
Q

Xiidra
MOA
Side effects

A

LFA1 antagonist. Reduction in inflammatory products associate with DED

discomfort, altered taste, blurry vision after drop

40
Q

Eysuvius indication

A

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

41
Q

drugs that tx HSV MOA

A

Pro drugs. Activated by virus. (except trifluorodine)

Blocks viral DNA synthesis

42
Q

Trifluoriodine and Gancyclovir dose

A

Trifluoriodine: 9x per day 7-10 days
Gancyclovir: 5x per day

Only for HSK, not VZO

43
Q

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

A

Acyclovir 400 5x per day
Valacyclovir 500 TID
Famcyclovir 250 TID

Side effects; mild GI and HA
Eliminated by Kidney. Caution if on dialysis

44
Q

Antifungal meds

-MOA

A

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.

45
Q

Natamycin and amphotercin B dose

A

Antifungal. Only FDA approved.

1 drop Q hour around the clock 4-6 weeks.

46
Q

Acanthamoeba Keratitis

  • When to suspect it
  • Signs
  • Tx
A

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

Ocular Pharm (3 decks)

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