To remember for final Flashcards
Tear film volume
Normal-
max-
Normal is 8-10 micrometers
Max is 30 microliters
Normal eye drop in micrometers and mL
50 micro = 1 drop
20 drops = 1mL
1 spray is how many microliters
105 microliters, so basically 2 drops
Peds dose
Adult dose x (lbs/150)
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.
two main outcomes of phenylephrine
Vasoconstriction of vessels- blanching
Dilation
phenylephrine caution and contra
Caution- Pts under 5, CVD, hyperthyroidism
Contra- HTN, thyrotoxicosis, less than 1 yr.
Determine horners eye effected:
Cocaine or apraclonidine
Cocaine causes no dilation
Apraclonidine dilates horners
Determine location of lesion once horners eye is determined
Hydroxyamphetamine
Pheynephrine
Phenyl: pupil dilates? Lesion post gang.
Steroid side effects
Immumosuppression
ICSC
Cataract
10 or more IOP increase (steroid responder)
Two groups of steroids
Ketones- Longer contact, more side effects. All of them except loteprednol, which is an ester. Broken down quickly.
Indications for steroids
Inflammation
Pain associated with surgery
Allergic conjunctivitis (loteprednol/Alrex)
Off label: K transplant
Steroid chemical bases
Best penetration to worst
Acetate (suspension)
Alcohol (suspension)
Phosphate (soln)
Pred forte works better than
generic!!
Two group types for anesthetics and steroids
Anesthetics:
Amides (lidocaine) and ester (all others)
Steroids:
Ketones (all others) and ester (loteprednol)
Triamcinolone Acetonide/Kenalog 40 off label use
Most common injectable steroid
Chalazion, ant seg and p seg inflammation
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
Acetaminophen
Good CNS penetration for anti fever but poor peripheral for anti inflammation
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
- High osmotic pressure.
- Aqueous lubricant
- 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
