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OD2 Semester 2 - Applied Clinical Training > wk4: AED - Allergy [DG] > Flashcards

wk4: AED - Allergy [DG] Flashcards

1
Q

What is the main cause of allergic conjunctiva presentations?

A

Contact lens wear

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2
Q

In regards to type 1 immune-mediated inflammation:

  • when does it occur?
  • is it an immediate or delayed response?
A
  • occurs on second or later exposures (after primary exposure)
  • immediate
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3
Q

In regards to type 4 immune-mediated inflammation:

  • when does it occur?
  • is it an immediate or delayed response?
A
  • occurs on second or later exposures

- delayed

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4
Q

In regards to non-immune-mediated inflammation:

  • what would cause this?
  • when does it occur?
  • is it immediate or delayed?
A

Direct injury/pharm effect (i.e. cell damage)
First exposure
Can be either immediate or delayed

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5
Q

In regards to type 1 immune-mediated inflammation:

  • What cells and mediators are involved? (3)
  • is it mainly cell or chemical mediators driving the response?
A

Mast cells
Eosinophils
Histamine

Response is mainly chemical mediators released from mast cells

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6
Q

In regards to type 4 immune-mediated inflammation:

  • what cells and/or mediators are involved? (3)
  • is the response mainly driven by cellular or chemical mediators?
A

Mainly cell mediators

Lymphocytes, Macrophages, Others

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7
Q

In regards to non-immune mediated inflammation:

  • what cells and/or mediators are involved? (2)
  • is the response driven by mainly cell or chemical mediators?
A

Chemical mediators from tissue and cells (usually neutrophil/macrophage)

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8
Q

In regards to type 1 immune-mediated inflammation:

- what kind of stimuli are responsible? (4)

A

usually pollen, dust mites, soft CLs, very rarely drugs

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9
Q

In regards to type 4 immune-mediated inflammation:

- what kind of stimuli are responsible? (4)

A

cosmesis, drugs, other biological FBs, ‘autoantigens’

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10
Q

In regards to non-immune-mediated inflammation:

- what kind of stimuli are responsible? (2)

A

drugs, chemicals

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11
Q

In regards to type 1 immune-mediated inflammation:

- how can this present in the eyelids? (1)

A

papillae

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12
Q

In regards to type 4 immune-mediated inflammation:

- how can this present in the eyelids? (3)

A

papillae, follicles, phlyctenules

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13
Q

In regards to non-immune mediated inflammation:

- how can this present in the eyelids? (1)

A

papillae

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14
Q

Name 4 kinds of allergic conjunctivitis

A

seasonal/perennial
vernal keratoconjunctivitis (VKC)
atopic keratoconjunctivitis
giant papillary conjunctivitis (GPC)

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15
Q

Which of the 4 kinds of allergic conjunctivitis are sight threatening? (2)

A

VKC and atopic

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16
Q

Which of the 4 kinds of allergic conjunctivitis are about px comfort?

A

seasonal/perennial conjunctivitis

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17
Q

Which of the 4 kinds of allergic conjunctivitis are associated with soft CLs?

A

GPC

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18
Q

Seasonal/Perennial conjunctivitis:

  • how common?
  • when might symptoms persist all year?
A

common

if px allergic to perennial allergen

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19
Q

Seasonal/Perennial conjunctivitis:

  • what type of hypersensitivity? What mediates it?
  • what proportion of population affected?
A

pure type 1 hypersensitivity (IgE mediated)

affects 5-20% of population, 80% under 30yrs

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20
Q

Seasonal/Perennial conjunctivitis:

- list its clinical features (7)

A 
usually bilateral
conj papillae
hyperaemia (injection)
oedema (chemosis)
lids may also be oedematous
serous + mucus discharge
cornea unaffected
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21
Q

List the symptoms of seasonal/perennial conjunctivitis (3)

A

itchy eyes (hallmark)
watery eyes
associated sneezing etc.

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22
Q

What does the mast cell do in terms of the inflammatory response?

A

doesn’t do much other than alerting other cells to cause inflammation

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23
Q

What mediators and factors are released by mast cells? (6ish)

A

Histamines, Leukotrienes, Chemokines, LTB4, Proinflammatory cytokines, IL-4, IL-5, Tryptase

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24
Q

What cell and mediator is responsible for activating mast cells?

A

IgE from B cells

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25
Q

What mediators are released from mast cells to cause bronchospasm? (4)

A

histamines
leukotrienes
chemokines
LTB4

26
Q

What mediators are released from mast cells to recruit neutrophils? (1)

A

tryptase

27
Q

What mediators are released from mast cells to recruit eosinophils? (1)

A

IL-5

28
Q

What mediators are released from mast cells to recruit T cells? (2)

A

pro-inflammatory cytokines

IL-4

29
Q

In regard to the histamine response of mast cell activation:

  • what symptoms does this cause? (2)
  • how can we tx? (3)
A

red, itchy eye

Lubricant, antihistamine, mast cell stabilisers

30
Q

In regard to the cellular response of mast cell activation:

  • what 2 cells and factors are involved?
  • how can we tx? (1)
  • when might we treat? (1)
A

eosinophil and neutrophil chemotatic factors (ECF, NCF)
cyclosporin (a steroid)
steroids can block these cell responses while waiting for the mast cell stabiliser to kick in

31
Q

In regard to the cytokine production from mast cell activation:
- What does heparin do? (3)

A

anti-coagulant, chemosis, swell

32
Q

In regard to the cytokine production from mast cell activation:

  • what does tryptase do? (3)
  • how can we tx?
A

COX-2, PG production and fibroblast proliferation

Use NSAIDs

33
Q

In regard to the cytokine production from mast cell activation:
- what does chymase do? (2)

A

increase vascular permeability via angiotensin II, chemosis

34
Q

In regard to the cytokine production from mast cell activation:
- name 2 ways we can tx?

A

Steroids (all)

NSAIDs (for tryptase)

35
Q

Which type of drug is the best choice to use to tx Type 1 allergic response?

A

Steroids (if side effects can be handled)

36
Q

What DDx exist for seasonal conjunctivitis? (3)

A

other allergic conjunctivitis
dry eye related surface disease
mechanisms of conjunctivitis

37
Q

How can we assess seasonal conjunctivitis? (4)

A

hx, slit lamp, fluoroscein, lid eversion

38
Q

Why is lid eversion crucial when assessing seasonal conjunctivitis?

A

lid eversion can diagnose or rule out seasonal conjunctivitis among the list of ddx

39
Q

How can we treat/manage seasonal conjunctivitis? (8)

A 
Allergen avoidance
Cold compresses
Tears
Topical vasoconstrictors/antihistamines
Topical antihistamines/mast cell stabilisers
Topical NSAIDs
Topical steroids
Topical cyclosporin A
40
Q

When should we prescribe topical vasoconstrictors for a patient with seasonal conjunctivitis?

A

do not prescribe unless absolutely needed in an acute situation

41
Q

What does chronic use of topical vasoconstrictors cause?

A

oversaturation of alpha receptors, blocking them, which will cause vasodilation instead and prompt the patient to put in more drops, which won’t work

42
Q

What is the most common vasoconstrictor used?

A

Naphazoline (e.g. naphcon, vizine)

43
Q

How fast do vasoconstrictors tx seasonal conjunctivitis?

A

instantaneous relief of redness of eyes

44
Q

Name an example of an S4 and S3 topical antihistamine/MCS. Are these examples covered by PBS?

A

Patanol (olapatidine) - S4
Zatiden (ketoifen) - S3
no

45
Q

What is the difference between S4 and S3 drugs?

A

S3 - over the counter, needs a pharmacist to dispense

S4 - needs a script

46
Q

How effective is patanol in treating seasonal conjunctivitis?

A

very

47
Q

Why are no anti-allergy drugs covered by PBS?

A

b/c they are palliative tx and don’t protect or prevent anything

48
Q

How often do you take patanol to tx conjunctivitis? Why is this?

A

twice a day. b/c once a day is ineffective b/c you need to maintain a therapeutic dose (for this reason, px compliance is very important)

49
Q

How long do livostin and opticrom antihistamines/MCS take to have a therapeutic effect? What does this suggest?

A

4-6 weeks, which makes them useless as antihistamines, can only use as mast cell stabilisers. However, can be good as a maintenance dose in perennial conjunctivitis

50
Q

How high are the side-effects of patanol? What does this suggest?

A

Very low, so can be used on patients as young as 3 years

51
Q

How do NSAIDs compare to steroids?

A

Have the advantages of steroids without the adverse effects

52
Q

How often are NSAIDs used for the following:

  • anterior eye disease
  • macular oedema
  • post cataract surgery
A

Not often
often
often

53
Q

Name 2 examples of NSAIDs used to tx seasonal conjunctivitis

A

Ketorolac, Diclofenac

54
Q

What is the difference between fluoromethalone and flarex steroids? (6)

A

Fluoromethalone: alcohol version. Good for allergic conjunctivitis. Almost immediate effect
Flarex: acetate version. Good for iris + deeper corneal changes. Effects absorption

55
Q

Is a seasonal allergy a surface problem or is it deeper? How does this affect mx?

A

surface problem, so we want a drug that doesn’t get absorbed systemically

56
Q

Name 2 major side effects of steroid use

A

IOP rise

Risk of Cataract

57
Q

How might we use steroid and patanol together?

A

Add together than slowly reduce steroid as patanol kicks in

58
Q

If using patanol and steroid together, how long must you wait before putting the other drug in?

A

wait 5 minutes between the two so one drug doesn’t wash out the other

59
Q

Is it easy to overdose on patanol and FML?

A

No

60
Q

When using steroids, how should we hit the condition?

A

Hit it hard and early. A lot at the start then quickly withdraw

61
Q

Is topical cyclosporin available in Australia?

A

No

62
Q

If mast cells don’t work to tx conjunctivitis, what might you suspect? And how will you manage?

A

Due to eosinophil activity then, use steroids concurrently with MCS/anti-histamine for 2 weeks
- steroid (FML) 2 weeks, IQID week, then IBD week

OD2 Semester 2 - Applied Clinical Training (63 decks)

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