Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
143 Cards in this Set
- Front
- Back
|
Non-neovascular macular degeneration is known as? accounts for? What is damaged?
|
dry macular degeneration, accounts for 80-90% of all. photoreceptor damage leads to vision loss.
|
|
|
Neovascular macular degeneration is known as? what is damaged?
|
wet, exudative. VEGF leads to leaky new vessels in choroid under macula. significant retinal damage with resultant visual loss.
|
|
|
AREDs study found that the conversion from?
|
dry to wet can be slowed by administration of:
vit c 500 mg vit e 400 IU beta carotene 15 mg zinc 80 mg copper 2 mg to offset zinc |
|
|
AREDs2 study is evaluating the effects of?
|
lutein, zeaxanthin, omega 3 epa and dha.
|
|
|
cancer prevention study found that
|
beta carotene and smoking actually increases the risk of lung cancer.
|
|
|
Photodynamic therapy consists of what drug and how? What must the px be careful of following this?
|
Visudyne, IV infusion, preferentially abosorbed by the endo layer of cnvm, but is also absorbed into normal retinal vessels. Dye is then activated by 689 nm laser that causes the formation of a reactive oxygen species that damaged the cnvm endo that leads to the release of leukotrienes and eicosanoids causing thomus and vessel occlusion. All parts of the body must be protected from light for 5 days following the therapy.
|
|
|
Pegaptonib, Maengen does?
|
selectively binds and blocks action of iso form vegf165. has been shown to slow but not stop vision loss.
|
|
|
Ranibizumab, lucentis.
|
inhibits ALL forms of VEGF, very high cost, 2000 per dose.
|
|
|
Bevacizumab, avastin
|
FDA approval for colorrectal cancer, but off label used for wet ARMD. Cost is ~150.
|
|
|
inflammation is the?
|
final common pathway of many conditions.
|
|
|
primary concern of the clinician is to...
|
manage the inflammation process while attempting to eliminate the cause.
|
|
|
Edema
|
acc. of fluid in tissue
|
|
|
exudate
|
edema with a high protein concentration
|
|
|
serous exudate
|
exudate with mostly protein
|
|
|
fibrinous exudate
|
exudate with high fibrin content, results of activation of coagulation system
|
|
|
sanguineous exudate
|
rbc's
|
|
|
purulent exudate
|
prominent cellular components, neutrophils
|
|
|
suppurative exudate
|
purulent exudate and liquefactive necrosis
|
|
|
leukocytes are attracted by? and leve what to enter tissue?
|
attracted by chemotactic gradients and leave blood vessels to enter affected tissue.
|
|
|
What invades tissue and degrades ingested material? do they proliferate?
|
neutrophils. They do not proliferate in the tissue, they are delivered via the bloodstream. They carry out their function and then die.
|
|
|
types of chronic inflammation? What are giant cells?
|
1. non-granulomatous having lymphocytes, plasma cells and macrophages.
2. granulomatous that has all of the above and epitheliod cells, which are modified macrophages. they form when macrophages encounter large quantities of antigenic material that is insoluable or indigestable. Giant cells are fusion of epithelioid cells that wall off foreign material. |
|
|
Abscess
|
localized area of intense acute inflammation.
|
|
|
cellulitis
|
diffusely spreading acute inflammation
|
|
|
ulcer
|
a localized loss of tissue at organ surface
|
|
|
blister
|
localized accumulation of fluid within or immediately deep to epi of skin or mucosa.
|
|
|
phthisical eye
|
blind hypotonus eyes, soft, partially collapsed, cubodial shape.
|
|
|
phthisis bulbi
|
markedly atrophic and disorganized and thickened foldered sclera, eye filled with scar tissue.
|
|
|
suspensions are? and work better for?
|
Acetates and alcohols, work better internally.
|
|
|
solutions are? and work better for?
|
phosphates and generally work better externally.
|
|
|
Hydrocortisone
|
is not avaliable as a single drug, only in combos
|
|
|
Prednisolone
|
analog of cortisol drug of first choice, acetate form is considered the most effective anti inflam for ant seg.
|
|
|
Dexanethasone
|
less effective than prednisolone and more prone to raise IOP, drug of second choice.
|
|
|
Fluorometholone
|
analog of progesterone, good drug for long term treatment.
|
|
|
medrysone
|
synthetic derivative of progesterone. Least likely to elevate IOP, also the least efficacious.
|
|
|
loteprednol and rimxolone
|
less tendancy to raise IOP. Loteprednol is metabolized to an inactive form upon enter cornea.
|
|
|
Triamcinolone
|
dermatological cream, useful for eyelid skin inflammation
|
|
|
surodex
|
biodegradable anterior chamber implant. zero order kinetics for days to weeks
|
|
|
retiscert
|
intravitreal implant, up to 3 years of drug release, may become a substitute for systemic or sub-tenon's injection.
|
|
|
Steriod precautions
|
DM, infect diseases, chronic renal failure, congestive heart failure, hypertension, may reduce the effects of anticoagulant drugs.
|
|
|
inhibition of cox1
|
gives some adverse reactions, mucous production in stomach and mediateion of platelet aggregation, clot formation and bleeding inhibited.
|
|
|
inhibition of Cox2
|
desirable anti inlammatory effects, ie prostaglandins.
|
|
|
Dialotenac sodium, voltaren
|
acetic acid derivative, reduce pain and inflammation with no sig effect on IOP. FDA: post op cataracts. OL: prevent and tx CME. precautions, bleeding tendancies, delayed wound healing. SPK, corneal erosions, infiltration, thinning and ulceration of cornea
|
|
|
Keterolac, acular
|
reduce inflammation and pain without sig effects on IOP. FDA: relief of ocular itching for seaonal itching. post op cataracts.
|
|
|
Flurbiprofen, ocufen
|
blockade of intraop miosis. ***May inactivate CARBACHOL. ***
|
|
|
Suprofen, protenal
|
FDA intraoperative miosis, ***may inactivate CARBACHOL***
|
|
|
Neptanac
|
first FDA drug approved topical ocular non-sterodial anti inflammatory PRODRUG. converted to ametenac when hydrolyzed. FDA: tx of inflammation and pain ass. with cataracts.
|
|
|
Diphenhydramine, Benedryl
|
comp blocks h1 in cns and periphery. lipid solubility allows entrance into brain which leads to sedation.
|
|
|
Chlorpheniramine, chlor-trimeton
|
noncomp h1, little sedation due to low lipid solubility.
|
|
|
loratadine, desloratadine, texotenadine, and cetirizine
|
very polar molecules, little cns penetration, little to no sedation
|
|
|
Antihistamines side effects
|
can be additive with anticholinergics, adrenergic agonists or MAOI.
|
|
|
Antihistamines contras
|
pregancy or breast feeding, peptic ulcer, prostate hypertrophy.
|
|
|
Antihistamines adverse
|
palpitation, tachycardia, pvc's
|
|
|
cromolyn sodium, opticrom, crolom
|
mast cell stabilizer, useful for management of CHRONIC allergies. DOES NOT ACCUMULATE IN SOFT CL. no systemic effects from ocular use.
|
|
|
nedrocromil, alocril
|
same mech as cromolyn sodium, but more potent. INHIBIT THE CHEMOTAXIS OF EOSINOPHILS AND RELEASE OF PRO INFLAM SUB. do not apply with cl's. excreted in human milk.
|
|
|
lodoxamide, alomide, alcon
|
mast cell stab, vernal keratoconj. contra: cl wear.
|
|
|
pemivolast potassium, alamast
|
mast cell stab, PRECENTS CHEMOTAXIS OF EOSINOPHILS AND RELEASE OF MEDIATORS OF INFLAM. DO NOT ADMIN WITH CL. EXCRETED IN MILK.
|
|
|
pataday
|
relatively selective h1 antihist and mast cell stab. DECREASES CHEMOTAXIS AND INHIBITS EOSINOPHIL ACTIVATION.
|
|
|
patanol versus pataday?
|
patanol is 0.1% versus 0.2%.
|
|
|
Zaditor, optivar
|
relatively non selective h1 antagonist, mast cell stab and DECREASES CHEMOTAXIS AND INHIBITES ACTIVITY OF EOSINOPHILS. no CL.
|
|
|
elastat
|
selective h1 antagonist and mast cell stab also have affinity for h2. do not CL.
|
|
|
restasis
|
immunomodulator with anti inflammatory effects. Kerato conjunctivitis sicca secondary to reduced tear production.
|
|
|
Lataoprost, xalatan
|
1st prostaglandin analog fda approval as first line drug. mst be protected from light and refrigerated. SE: increase in iris pigmentation, no reversible, darkening in periorbital skin and increase eyelash number and length
|
|
|
travatan
|
f2alpha analog.
|
|
|
lumingan
|
2nd line drug, increase outflow through both TM and uveoscleral routes
|
|
|
rescula
|
no longer manufacturered, iris color change and eyelash growth.
|
|
|
Acetazolamide, diamox
|
oral or IV, hypotensive effect within a minute. excreted by kidney, can be used to break aacg. SE: often intolerable, decreased libido, depression, fatigue, malaise and weight loss. MYOPIC SHIFT. CAI
|
|
|
Methazolamide, neptazane
|
lower dose required than diamox, safer for COPD and renal calculi. CAI
|
|
|
dichorphenamide, daranide
|
poor tolerance, symptoms more severe and frequent, more confusion and anorexia than diamox. CAI
|
|
|
ethoxzolamide, cardrase
|
similar to diamox but more potent. ELECTROLYTE IMBALANCE PREVENTS LONG TERM USE. CAI
|
|
|
dorzolzamide, trusopt
|
inhibits CA isoenzyme II slowing prd of bicarb in cb. CAI. Adverse reaction can lead to steven's johnson syndrome.
|
|
|
azopt
|
must shake well before use. single metabolite, both are excreted by kidney. no sig effect on kidneys in healthy adults.
|
|
|
urea
|
hyperosmotic, TISSUE SLOUGHING, severe headache and arm pain, nausea, confusion, disorientation.
|
|
|
Mannitol
|
hyperosmotic, IV AGENT OF CHOICE, MOST EFFECTIVE AGENT, does not cause tissue necorosis.
|
|
|
Glycerin, glycerol
|
MOST COMMON AGENT FOR INITIAL TX OF AACG. Caution in diabetes. hyperosmotic
|
|
|
Isosorbide
|
similar to mannitol but oral, not metabolized so safer for diabetics. hyperosmotics.
|
|
|
epi
|
adrenergic agnoist. direct acting on alpha and beta. increase facility of aqueous outflow. unstable to light and air. Contra: narrow angles, aphakis (CME) and soft CL's.
|
|
|
propine, DPE, dipiretrin
|
prodrug of epi, better absorbed into eye. SE: CME in aphakia and pseudophakia.
|
|
|
iopidine
|
relatively selective alpha2 agonist. stimulate the receptor = decreased norepi = lowered aqueous prd = decrease in IOP.
|
|
|
alphagan P
|
relatively selective alpha 2 agonist. decrease in aqueous production and increase in outflow. REDUCED EFFICACY OVER TIME. ADDITIVE WITH CNS DEPRESSION, ALCOHOL, BARBITUATES, OPIATES, SEDATIVES
|
|
|
timoptic
|
reduce iop by inhibiting aqueous production. non selective, no local anesthetic effect. MAX EFFECT SEEN IN SEVERAL DAYS. AS EFFECTIVE AS PILOCARPINE AND ACETAZALAMIDE, MORE EFFECTIVE THAN EPI. DRUG OF CHOICE FOR GLAUCOMA, CSOAG, 2NDARY GLAUCOMA, CONGENITAL GLAUCOMA. SE: REFRACTIVE SHIFTS, MACULAR EDEMA IN APHAKICS. MAY MASK ACUTE HYPOGLYCEMIA IN DIABETICS, MAY MASK TACHYCARDIA IN HYPERTHYROIDISM.
|
|
|
Timoptic XE
|
gel, different carrier than timoptic otherwise same.
|
|
|
Betimol
|
newer form of timolol, lower cost.
|
|
|
cosopt
|
combo of timolo and dorzolamide hydrochloride.
|
|
|
betagen
|
non selective beta blockers, SE similar to timolol but less severe.
|
|
|
metipranolo, optipranolo
|
non selective beta 1 and 2 blockers
|
|
|
carteolol, ocupress
|
non selective without anesthetic effect.
|
|
|
Betaoptic
|
SEELECTIVE BETA 1, SAFER FOR COPD PX.
|
|
|
pilocarpine
|
direct. naturally occuring, effects cario, exocrine and smooth muscle. causes miosis, spasm of acc, increased aqueous outflow, thickening of lens and narrowing of anterior chamber. used for acc. esotropia or DIA OF ADIE'S TONIC PUPIL.
|
|
|
Carbachol
|
direct acting choline ester resistant to AChE, longer duration than pilo.
|
|
|
Eserine
|
reversible indirect inhibits AChE. induced myopia, iris pigment, epi cyst formation after prolonged use, increased IOP.
|
|
|
Demercarium
|
increased potential and longer duration, reversible indirect action, primary csoag if pilo or cabachol ineffective.
|
|
|
Phenylephrine
|
adrenergic agonist. direct alpha, little beta, subjection oxidation in air light and heat. CAN BE USED TO BREAK POSTERIOR SYNECHIA. 10% for caution in cardiac disease, idiopathic orthostatic hypotension, hbp, aneurysms, dm.
|
|
|
Hydroxyampetamine
|
release of norepi and inhibits MAO and uptake. little effect on acc. used in routine dialation, only avail with tropicamide. HELPFUL FOR DIA BETWEEN PRE AND POST HORNER'S. SIMILAR TO PHENYL BUT SAFER.
|
|
|
Cocaine
|
blocks reuptake of norepi. rapid systemic absorbtion through mucous membranes. USED TO DIAGNOSIS PREGANG FROM POST GANG HORNER'S.
|
|
|
Naphazoline,
|
more alpha than beta, cns depression, used in visine.
|
|
|
Thymoxid
|
blocks post synaptic alpha on radial muscle, causing iris miosis and reduced IOP. DIAGNOSTIC FOR CSOAG VERSUS NAG. ADRENERGIC ANTAGNOISTS
|
|
|
dapiprozole, rev-eyes
|
REVERSE MYDRIASES INDUCED BY TROPIC AND PHENYL. ADRENERGIC ANTAGNOSTS
|
|
|
DFP
|
irreversible indirect, activates AChE and BuCHe. HIGHLY LIPID SOLUABLE, PEN BBB EASILY. ANXIETY, TREMORS, CONVULSIONS, COMA, RESP. DISTRESS. RESPIRATORY FAILURE CAN LEAD TO DEATH.
|
|
|
Echothiophate
|
irreversible indirect action, inhibits AChE and BuChe, low lipid solubility limits CNS pen. PREPARED FRESH FROM A POWDER. DX AND TX OF ACC ESOTROPIA.
|
|
|
Atropine
|
LONGEST DURATION OF ACTION AND MOST RESISTANT TO REVERSAL. DEATHS HAVE OCCURED IN CHILDREN
|
|
|
homatropine
|
1/10 AS EFFECTIVE AS ATROPINE BUT SHORTER DURATION
|
|
|
scopolamine
|
SIMILAR TO ATROPINE BUT SHORTER DURATION. MORE TOXICITY THAN ATROPINE.
|
|
|
cyclopentalate
|
DOES NOT ALTER IOP IN NORMAL EYES.
|
|
|
tropicamide
|
GREATER OCULAR PEN THAN OTHER DRUGS. fast onset short duration. DRUG OF CHOICE FOR ROUTINE DIALATION. SAFEST MYDRIATIC FOR CARDIO PX.
|
|
|
Chloroquine and hydroxycloroquine used for lupus and arthritis
|
YELLOW/GREEN DEPOSITS, halos around lights, glare and photophobia.
|
|
|
chlorpromazine for psychiatric disorder
|
anterior cap lens opacities, corneal endo, descemet's mebrane.
|
|
|
DUVA therapy
|
ABSORB UV AND VISIBLE UNDEROGING RXN WITH MODIFIES NEARBY MOLECULES OF TISSUE.
|
|
|
gold salts for rheumatoid artheritis
|
GOLD DEPOSITS CORNEAL STROMA
|
|
|
Corticosteroids for inflammatory disorders
|
PSC after prolong used, increase in IOP.
|
|
|
amiodarone for atrial and arrhythmias
|
epei deposit anterior to bowman's.
|
|
|
chlorpromazine
|
slate blue discoloration on bulbar conj, sclera and skin after 1-6 years of daily use.
|
|
|
decrease in aqueous production
|
anticholinergics, antihistamines, isotretinoin, beta bockers, oral contraceptives
|
|
|
increase in aqueous production
|
cholinergics, adrenergics, anti hymetromedsoidndia
|
|
|
nystagmus can be caused by
|
gold salts and barbituates
|
|
|
diplopia can be caused by
|
anti anxiety an anti depressants
|
|
|
myopic refractive shifts can be caused by
|
sulfonamides, diuretics, CAI, up to 7 D.
|
|
|
Chloroquine and hydroxycholorquine for collagen diseases
|
fine pigment mottling, bull eye appearance. retinopathy can start 1-10 years after stopping therapy.
|
|
|
thioridazine, anti psychotic drug
|
retinopathy resulsts in reduced A, abnormal color vision and dark adaptation. symptoms start 30-90 days after starting.
|
|
|
quinine, malaria
|
slight va reduction, distortion of color vision defects, photophobia, hallucinations to complete loss of vision with non reactive pupils. Papilledema, optic atrophy. toxic effect on photoreceptors and ganglion cells.
|
|
|
talc, filler for oral meds
|
or for cutting heroin and cocaine. MULTIPLE YELLOW WHITE PARTICLES SCATTERED THROUGHOUT RETINAL VESSELS. LEADS TO NEOVAS.
|
|
|
Cardiac glycosides for congestive heart failure and arrhythmias
|
changes in color vision and impaired va.
|
|
|
NSAIDS for antiplatelet effect
|
central vision defect, dark adaptation, vf color vision effected.
|
|
|
Tamoxifen, tx of estrogen gen metastatic breast carcinoma.
|
WHITE OR YELLOW REFRACTIVE OPACITIES IN CENTRAL AND PERIPHERAL RET.
|
|
|
Viagra
|
color perception alteration, bluish tinge, and increase in light sensitivity.
|
|
|
ethambutol for tb
|
optic nerve hyperemia, edema or flame hemorrhage.
|
|
|
chloraphenicol for typhoid fever
|
optic neuritis with severe vision loss.
|
|
|
epi resists
|
movement of fluid into cornea from tear film. insult results in epi or stromal edema.
|
|
|
endo strcture
|
responsible for proper hydration. actively pumping of fluid out of cornea into aqueous.
|
|
|
if stromal edema reaches what percent from increase in iop epi edema results
|
30%.
|
|
|
epi edema is
|
reversible, more responsive to topical hyperosmotic therapy
|
|
|
stroma edema
|
less effect on vision, may not be reversible, less responsive to topical hyperosmotic therapy.
|
|
|
sodium chloride
|
most effective when epi is intact.
|
|
|
glycerin, glycerol
|
AACG, BULBOUS KERATOPATHY, FUCH'S ENDODYSTROPHY.
|
|
|
anticholingeric drugs
|
hot as a hare
red as a beet dry as a bone blind as a bat mad as a hatter |
|
|
Scopolamine
|
hallucinations and ataxia
|
|
|
homatropine
|
ataia, hallucinations and speech difficulty
|
|
|
cyclopentalate
|
psychotic rxn, ataxia, restlessness, hallucinations
|
|
|
phenylephrine SE
|
severe bp elevation, avoid 10% in elderly and infants.
|
|
|
Iopidine and alphagan
|
alpha 2, caution in px, raynaud's syndrome, depression, recent mi, cornary insuf, cario disease
|
|
|
Sulfonamides se
|
steven's johnson syndrom
|
|
|
cocaine 10% horner's if pre then? if post then? can do what to cornea?
|
if pre horner's won't dialate, if post horner's will dialate. corneal graying or pitting, erosion.
|
|
|
proparacaine
|
poor corneal and conj penetration compared to tetracaine. DISCARD IS DISCOLORED.
|
|
|
Benoxinate
|
only aval with NaFL. primary for goldmann, great antibiotic property. less corneal insult than proparacaine.
|
