Medications And The Eye (Tues., 1/6/2015)

Front 1

Briefly explain how to use eye drops.

How much of instilled dose remains in tear film after 10 minutes?

Back 1

• Wash hands and wear gloves.
• Tilt their head back and look up
• Retract lower lid and place drop into inferior fornix (not the cornea)
• Have them gently close their eyes

4%

Front 2

What is the advantages of eye drops?

What is there a great potential for?

Back 2

Systemic absorption and avoid 1st pass metabolism, increasing bioavailability.

Toxicity.

Front 3

What type are reactions involved in local toxicity and what two things can cause them?

Back 3

Type I IgE mediated or delayed hypersensitivity.

Medications or preservatives used.

Front 4

How can ocular absorption be improved?

Back 4

• Spacing
• Eyelid closure
• Nasolacrimal occlusion

Front 5

What are the four ophthalmic routes of delivery?

Back 5

• Drops
• Ointments
• Periocular injections
• Intraocular injections

Front 6

What is fleuorescein dye used for in examination?

Back 6

To highlight epithelial defects. It stains green under cobalt blue. Remove contact lenses first.

Front 7

What are anesthetics used for in examination?

Back 7

Pressure check, removal of foreign body, or to allow evaluation.

Repeated use can lead to corneal and ulceration and perforation.

Front 8

Why are cholinergic blocking (parasympatholytic) drugs used in examination?

Back 8

They temporarily paralyze the pupil sphincter.

They produce cycloplegia (paralysis of accomodation, blurring near vision) to facilitate accurate refraction of children and young adults.

Front 9

Why are adrenergic stimulating (sympathomimetic) drugs used in examination?

Back 9

Stimulate the pupillary dilator muscle. Combine tropicamide and phenylephrine for maximum dilation.

Front 10

What are the side effects of OTC topical decongestants? Why are they used?

Back 10

Used to temporarily whiten the conjunctiva.

• Rebound effect with prolonged use.
• Mucosal atrophy and dry eyes.
• Might dilate pupil slightly and may even precipitate angle-closure glaucoma (safe in open angle glaucoma.

Front 11

What are the four therapeutic drug classes used for allergic conjunctivitis?

Back 11

• Lubricants/artificial tears - beware of preservative allergy
• Antihistamines - may cause pupil issues and become addictive
• Mast cell stabilizers
• Combination therapies

Front 12

What is used in cases of severe allergic conjunctivitis?

Back 12

Mild topical corticosteroids, systemic antihistamines (i.e. dyphenhydramine), or chronic mast cell stabilizers.

Front 13

What are topical NSAIDS used for and what are the potential side effects?

Back 13

Allergic conjunctivitis, pain control for abrasions and surgery, maintain mydriasis (pupil dilation) during surgery, and treatment of macular edema.

Corneal melting with chronic use in older forms.

Front 14

What are topical corticosteroids used for and what are potential risks?

Back 14

Uses:

• Anterior uveitis
• External inflammatory disease
• Post-operative inflammation

Risks:

• Unmask and worsen herpetic keratitis or fungal infections
• Increased IOP
• Cause cataracts

Front 15

What are some of the topical therapeutics for dry eyes, and what are their risks?

Back 15

Artificial tears - Irritate eyes if used frequently (due to the preservative)

Ointments - effective but blur vision

Topical cyclosporine - for severe symptoms and must be prescribed

Front 16

What are some topical antibiotics used and what are their potential side effects?

Back 16

Fluoroquinolones - broad spectrum, use judiciously

Sulfonamides - hypersensitivity reactions

Erythromycin or bacitracin ointment - good lubricants

Aminoglycosides - Oto-toxicity

Vancomycin - epithelial toxicity

Front 17

What is trifluridine used for and what is its possible side effect?

Back 17

Topical treatment for Herpes simplex keratitis, interfering with DNA synthesis.

Risk of corneal epithelial toxicity.

Front 18

What is Ganciclovir used for?

Back 18

Secondary opportunistic infections with CMV, EBV, and V-Z in immune compromised.

Front 19

What are beta blockers used for and what are thy systemic side effects?

Back 19

Ocular hypotensive; reduce secretion of aqueous humor.

Side effects:

• Exacerbate COPD or asthma
• Worsen CHF
• Bradycardia, hypotension

Betaxolol (beta-1 selective) has less pulmonary effect but also less ocular hypotensive effect.

Front 20

What are cholinergics used for and what are the systemic side effects?

Back 20

Ocular hypotensive; cause contraction of long. muscle of ciliary body to open the AC angle. Formerly first line for glaucoma.

Side effects:

• Miosis
• Accom. spasm
• Headache
• Retinal detachment

Front 21

What are carbonic anhydrase inhibitors used for and what are their system effects?

Back 21

Systemic drug treatment for galucoma.

Side effects:

• Drowsiness, fatigue
• Paresthesias
• GI disturbances
• Metallic taste
• Renal calculs
• More!

Front 22

What are the systemic side effects of adrenergics (used as an ocular hypotensive)?

Back 22

Cardiac arryhthmias, hypertension, deposits in conjunctiva

Front 23

What are the system side effects of Alpha-2 agonists and what are they used for?

Back 23

Decreased aqueous production and increased uveoscleral outflow.

Side effects:

• Hypotension, apnea
• Local sensitivity issues

Front 24

What are prostaglandin analogues used for and what are their systemic side effects?

Back 24

Treatment of glaucoma, increase uveoscleral outflow.

Side effects:

• Hyperemia, changes in periocular skin, lash growth

Front 25

What are the potential ocular effects of corticosteroids?

Back 25

-Posterior subcapsular cataracts

- Increased IOP, permanent vision loss from glaucoma

Front 26

What are the potential ocular effects of chloroquines?

Back 26

- Corneal deposits

- Bull's-eye maculopathy

Front 27

What are the potential ocular effects of amiodarone?

Back 27

Used for cardiac arrhythmia

- Whorl-shaped corneal epithelial deposits

- Rarely optic neuropathy

Front 28

What are the potential ocular effects of Digitalis/Digoxin?

Back 28

-Blurred vision

- Abnormal perception of colors

- Halos on dark objects

Front 29

What are the potential ocular side effects of Diphenylhydantoin?

Back 29

Used for anti-seizure.

Side effects are irreversible:

- Nystagmus

- Vertigo

- Ataxia

- Diplopia

Front 30

What are the potential ocular side effects of Ethambutol?

Back 30

Mycobacteria therapy.

- Optic neuropathy

- Retrobulbar neuritis

- Visual loss is reversible but will take time.

Front 31

What are the potential ocular side effects of the antipsychotics Chlorpromazine and Thioridazine?

Back 31

- Reversible corneal and lens opacities

- Retinal depigmentation and atrophy

Front 32

What are the potential ocular side effects of Phosphdiesterase inhibitors (i.e. sildenafil and tadalafil)?

Back 32

- Impairment of color discrimination, possibly associated with ischemic optic neuropathy.

Front 33

What are the potential ocular side effects of Topiramate (Topamax)?

Back 33

Anti-seizure/migrane.

- Ciliary body efusions

- Angle closure glaucoma

- Sudden onset myopia (nearsightedness)

Front 34

What are the potential ocular side effects of systemic antihistamines?

Back 34

- Dry eyes from decreases lacrimal secretion

- Pupil changes or decreased accommodation

Front 35

What are the potential ocular side effects of ACE-Inhibitors and Niacin?

Back 35

- Angioedema of eyelids

- Cystoid macular edema

Front 36

What are the potential ocular side effects of Accutane (Isotrentinoin)?

Back 36

-Light sensitivity, conjunctivitis, dry eye

- Optic neuritis

- Pseudotumor cerebri

Front 37

What are the potential ocular side effects of hormone replacement therapy?

Back 37

- Pseudotumor cerebri

- Dry eye

- Vascular occulsions

Front 38

What are the potential ocular side effects of Tamoxifen?

Back 38

Breast cancer treatment.

- Pigmentary retinopathy

- Corneal deposits

Front 39

What are the potential ocular side effects of Tamsulosin (Flomax)?

Back 39

- Intraoperative floppy iris syndrome

- More complicated cataract surgery

Stopping the medication gives no relief.

Front 40

What are the beneficial effects of smoking marijuana on glaucoma?

Back 40

IOP is lowered for 3 hours.