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200 Cards in this Set

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Drugs to avoid while taking steroids b/c increase inflammation.
prostaglandin
pilocarpine
Steroid responder will respond with increase IOP between _____weeks. After ____weeks of normal IOP then not a steroid responder
1-2
4-6
It is ok to use generic Pred Forte?
T or F
False
The more drops of Pred Forte used the better efficacy?
T or F
True
Put in order the drus from most to least increase of IOP with weeks of use. Lotemax, Pred forte, FML
Most- Pred Forte
middle- FML
Least- Lotemax
What is the soft drug concept and give 2 examples.
Inactive metabolite and once in body at target tissue becomes active and then becomes quickly inactive. Less side effects.
1. Pred Forte- prednisolone
2. Lotemax- Lotopredenol
According to Dr. Bartlett: use a _______ for dry and _________ for wet.
ointment
cream
Used for seasonal conj. and has ) IOP, CAT formation, or problem with infections. Category C for pregnant.
ALREX- Lotopredenol
Management of Contact dermatitis, scelritis, Grave's, Intermed to post uveitis is with topical steriods?
T or F
F
systemic
More likely to see EIOP with _________ and Cataract with _________.
topical steroid
oral steroid
Steroid induced cataract characteristics.
1. off-axis VA good
2. PSC
Iatrogenic glaucoma is greater for patients with ________ and a _______% chance with 1st degree offspring.
Iatrogenic=steroid induced EIOP
POAG
70%
Iatrogenic glaucoma is a _____problem in the ________ due to increase concentration of _________.
outflow
TM
GAGS
Steroid induced uveitis occurs in ____%blacks and ____% whites.
5.0% blacks
0.5% whites
Cushings can result from_________.
Topical steroids
List contraindicators for steroid usage.
1. diabetes
2. infectious disease
3. renal failure
4. heart failure
5. HTN
6. peptic ulcer
7. osteoporosis
8. psychosis
9. glaucoma
GPC is a result of increase amounts of ________ and can be treated wiht _______ or _______.
prostaglandins
steroid
NSAIDS
List ocular effect of prostaglandins.
1. uveitis- cells/flare
2. red eye
3. miosis
#1 choice to prevent CME; also can be used to treat seasonal conjunctivitis.
Ketorolac Tromethamine
(Acular or Acular LS)
Difference between Acular and Acular LS?
Acular 0.5%
Acular LS 0.4% Less stinging
Cause of CME post-op?
During surgery, prostagladin breaches blood retinal barrier. Prostaglandin rushes into AC. miosis. NSAIDS decrease miosis.
NSAID target Retina.
Nepafenac (NEVANAC) 0.005% BAK
Describe process NEVANAC enters eye.
NEVANAC is pro-drug inactive form. Penetrate intraocular tissue active form- AMFENAC through cornea, ICB, and retina/choroid.
Which have a rebound inflammation effect and must be tapered? NSAIDS or steroids?
steroids
Topical NSAIDS are contraindicated in SCL?
T or F
T, due BAK
ok if disposable
Dry eye treatment that decreases Lacrimal gland inflammation and increase aqueous production.
Restasis=
cyclosporin + refresh endura vehicle
Give and example of a condition that Restasis cannot help.
SJS
Restasis come in a kit of _____ and is approved for ___ dosing.
32
BID 1 day.
Dry eye treatment. List steps.
1. Artifical tears
2. topical cyclosporin
3. punctal plugs
4. oral pilocarpine
Reason why don't like to use punctal plug in dry eyes?
Delays the drainage of the cytokines due to inflammation.
____% of population has atopic/allergies and ____% have some form of ocular allergy.
50%
25%
Topical H-1 anti-histamine can be used for.
Allergic Conjunctivitis
A 1st gen. topical H-1 anti-histamine contains.
anti-histamine and vasoconstrictor
A 2nd gen. topical H-1 anti-histamine contains.
anti-histamine only
An example of a 1st gen. topical H-1 anti-histamine
naphazoline
An example 2nd gen. topical H-1 anti-histamine
Levocabastine (Livostin)
Emedastine (Emadine)
Mast cell stabilizers are used for.
chronic ocular allergies
Mast cell stabilizer ok in pregnancy.
Nedocromil (alocril)
Category B
Mast cell stabilizer for VKC
1. Cromolyn Na
(cromolon, opticrom)
2. Lodoxamide
(Alomide)
Mast cell stabilizer for itching that can be used for 4 months. Side effect: headache.
Pemirolast (alamast)
Define dual activity anti-histamine.
Anti-histamine and a mast cell stabilizer. H-1 receptor target.
Dual activity anti-histamine can significantly reduce itching and redness.
T or F
False. Just itching and some redness.
Give 4 examples of dual activity anti-histamines.
1. Olopatadine (Patanol)
2. Ketotifen (Zaditor)
3. Azelastine (Optivar)
4. Epinastine (Elestat)
Dual-Activity anti-histamines are safe during pregnancy?
T or F
False
Category C
Dual-Activity anti-histamine that has a side effect of bitter taste.
Azelastine (Optivar)
Dual activity anit-histamine that has 0.01% BAK and ) systemic absorption.
Epinastine (Elestat)
3rd generation systemic anti-histamine.
Allegra (fexofenadine)
Clarinex (Desloratadine)
Systemic anti-histamine that does NOT cause drowsiness.
1. Allegra
2. Clarinex
3. Clariten (Loratadine)
4. Zyrtec (Cetirizine)
Moderate drowsiness with this systemic anti-histamine.
chlor-trimeton (chlorpheniramine)
Drowisness with this systemic anti-histamine.
Benadryl (diphenhydramine)
Antibiotics that inhibit cell wall synthesis.
1. penicillin
2. bacitracin
3. vancomycin
4. cephalosporin
Antibiotics that increase cell membrane permeability.
1. polymyxin
Antibiotics that inhibit protein synthesis.
1. aminoglycoside
2. tetracycline
3. macrolide
4. chloramphenicol
Bacitracin effective against:
1. gram + (staph bleph)
2. Neisseria
Bacitracin used in combo with:
1. neomycin
2. polymyxin
Vancomycin used against:
1. gram + serious infections
2. pseudomonas colitis
3. MRSA
Vancomycin oral used in serious cases only b/c:
side effects
1. hearing loss
2. fatal uremia
neomycin cannot stop:
pseudomonas
aminoglycosides target:
1. staph
2. gram - bacilli
List of aminoglycoside.
1. neomycine
2. gentamycin
3. tobramycin
Good against pseudomonas
tobramycin
Good against gentamycin and tobramycin resistant gram - bacilli.
Amikan
Bactericidal antibiotic against infectious bleph and gram -.
polymyxin B
Rare side effect resulting in superinfection and hypersensitivity due to this antibiotic.
bacitracin
Side effect resulting in punctate epi. erosions, corneal ulcerations, and chemosis due to this antibiotic.
aminoglycosides
Macrolide targets.
1. gram +
2. gram +bacilli
3. chlamydia
4. H. influenza
Example of a macrolide that is used against Staph bleph and ophthalmia neonatorum.
erythromycin
Why would you not use sulfonamides with a purulent dischg infection?
dischg contains PABA which antagonize the drug.
Sulfonamides are no longer used topically b/c? 2 reasons.
1. hypersensitivity
2. SJS
Want can you use instead if a pt is allergic to sulfonamides or infection has purulent dischg?
trimethoprim
PolyTrim is a combo drug of ____ and _____. Used to treat ______.
trimethoprim
polymyxin B
bacterial conjunctivits
Trimethoprim not useful against______.
Pseudo. a.
Antibiotic that targets DNA synthesis.
Fluoroquinolone
List some Fluoroquinolones.
1. Levofloxacin (quixin)
2. Ciprofloxacin (ciloxan)
3. Ofloxacin (ocuflox)
Systemic fluoroquinolones contribute to resistant bacteria while topical fluoroquinolones do not.
T or F
True
Fluoroquinolone that targets gram + S. aureus and S. pneumoniae.
Levofloxacin
Levofloxacin ____% targets bacterial conjunc. and_____% targets bacterial keratitis.
0.5%
1.5%
3rd generation fluoroquinolones target _______ of gram - or _______ of gram +.
DNA gyrase -
Topo IV +
Fluoroquinolones category that is better with gram +, retain gram - coverage, and atypical mycobacteria.
4th generation
FDA approved 4th generation fluoroquinolones for ____________.
bacterial conjunctivitis
4th generation fluoroquinolones targets.
DNA gyrase AND Topo IV of +
Fluoroquinolones with low MIC.
Gatifloxacin (Zymar)
Moxifloxacin (Vigamox)
4th generation fluoroquinolones with BAK.
Gatifloxacin (Zymar)
Fluoroquinolones with bulky side chain to which bacteria can't pump out of cell.
Moxifloxacin (Vigamox)
Bacteria resist fluoroquinolones by.
1. mutating enzymes
2. decrease permeability to fluoroquinolones
3. increase efflux of fluoroquinolones
Which of the 4th gen. fluoroquinolones has more rapid killing.
Gatifloxacin (Zymar)
4g-FQ # 1 for:
1. bacterial conjunctivitis
2. infectious corneal ulcers
Which fluoroquinolones can result in white corneal ppt that are benign.
ciprofloxacin
The 1st choice against dendritic or HSV keratitis is _____________. But due to its toxicity, ___________ is used instead.
trifluridine (viroptic)
acyclovir
Anti-viral meds can cause punctal occlusion which results in chronic tearing. T or F
True
Patient younger than 45 presenting with HZO should be tested for _______.
HIV
Neuralgic pain from HZO shows up 1-2 days after the chills, fever, malaise, and headache.
T or F
True
Ointments should be used on HZO?
False no drying agents!!! Increase scars.
RX used with 72 hours of skine lesion. dosage
Acyclovir
800mg 5x day for 7-10 days
Valtrex can be used for HZO?
T or F
T
Valtrex is Valacyclovir is acyclovir (prodrug)
Immune compromised persons infected wiht HZO have an increase risk of ________.
ARNS
Acute Retinal Neurosis Syndrome
Capsaicin cream called ________ works how?
Zostrix
depleted substance P
Active HSV (epithelial keratits) should be treated with _________.
Acyclovir 400mg 5x day.
Acyclovir for HSV helps prevent stromal disease.
T or F
False
Viroptic and steroid would be beneficial for _______HSV but not ________HSV.
anterior uveitis
epithelial keratitis
Acyclovir low dosage is effective to prevent recurrent HSV keratitis (dendritic or disciform).
T of F
True
Preseptal or orbital cellulitis patients can have a ________ discoloration indicating____________.
dark purple
Haemophilus
If eye lids of a patient cannot be separated what should you do?
order CT scan.
Facial tenderness and nasal discharge indicate.
sinusitis
Medial canthal tenderness and tearign indicate.
dacryocystitis
Pencillin V is not effective against ___________.
staph
Penicillins resistant to Penicillinase.
1. cloxacillin
2. dicloxacillin
B-lactamase inhibitor.
potassium clavulanate
Penicillin with extended spectra of activity but destroyed by pencillinase.
Amoxicillin
Augmentin is _________ +__________.
amoxicillin
clavulanate
side effects of penicillin that can result in death.
pseudomembranous colitis- diarrhea excessive
cephalosporins target:
1stand 2nd
internal hordeolum
preseptal cellulitis
1st bacterial corneal ulcers
1st gen. cephalosporins target gram ____ and 3rd gen target gram ____. As you move from 1st to 3rd what happens?
gram +
gram -
loss + and gain - coverage
Example 1st gen cephalosporins and 2nd gen.
1st Keflex, cefazolin
2nd Ceftin (Cefuroxime)
The macrolide erythromycin that causes less GI upset
Erythromycin ethylsuccinate
The macrolide erythromycin that should be avoided in adults.
estolate
The macrolide that can be taken during pregnancy for preseptal cellulits.
Azithromycin (Zithromax-Z-pak)
Macrolide target H. influenza and chlamydia.
Clarithromycin (Biaxin)
Macrolide more effective in gram (-) coverage for chlamydial conjunc.
Azithromycin (Zithromax-Z-pak)
Short term treatment for acne rosacea
tetracycline
Long term treatment for acne rosacea.
doxycyline
Targets for treatment of acne rosacea.
1. anti-collagenase; anti-lipase
2. H. pylori
Problem with diarrhea with doxycycline then ______can be used.
doxycycline hyclate (Periostate)
The quad therapy for acne rosacea to erradicate H. Pylori. Problem is ________.
Helidac Therapy
compliance since qid for 7-10 days
The triple therapy for acne rosacea to erradicate H. pylori is _______________>
Amoxcillim
clarithromycin
lansoprazole
bid 10 days compliance better
Systemic drug causing whorl opacity lines coming from below and going to the center. Green-yellow.
chloroquine (anit-malaria)
hydroxychloroquine (plaquenil)
Systemic drug caused by interaction of drug and UV so not seen under lid. Interpalpebral fissure Endothelium and Descements. Irreversible discoloration cornea.
Chloropromazine (Thorazine_- anti-psychotic
Systemic drug causing chrysiosis- minute gold particles deposition in posterior 1/3 of stroma. No symptoms.
gold salts (rheumatoid arth.)
Resemble Hudson Stahli line then progresses to whorl then to clumps. Mustache keratopathy.
Amiodarone (Cordarone)
Drug induced lipid storage disease.
Mustache keratopathy from Amiodarone (Cordarone)
Amiodarone (cordarone) must ask patient if problem in this area. MUST stop if yes and refer to cardiologist.
breathing problems.
Bilateral posterior subcapsular opacities that start off axis caused by _________.
Steroids.
Chlorpromazine cause ______.
anterior subcapsular
stellate
Minocycline can cause _________.
Thinning of the sclera. see choroid-blue.
Tetracycline can cause ____________.
Photosensitive. Burn lids sun lt.
Sulfonamides can cause__________.
rash
Barbituates can cause____________.
bilateral ptosis.
OD of barbituates can be verified by.
tap between eyes and flutter response.
Atropine reduces aqueous by _______ and scopolamine reduces aqueous by ____________.
3ul/min
0.8ul/min
Dry eyes can be made worse by ____________.
anti-cholinergics
The more sedation in a drug the more anti-cholinergic effects.
T or F
True
Lomotil (diphenoxylate + atropine) is treatment for ________.
diarrhea
shut down GI tract
Detrol LA (tolterodine) treatment for ___________ and is a anti-cholinergic.
bladder dys.
Isotretinoin-Accutane attack the ____________.
meibomian gland
Myopia can be induced by an allergic reaction to drugs. Describe.
Ciliary Body edema
Relax zonules
Lens moves forward
Allergies to:sulfonamides, diuretics, CAI, isotretinoin, topiramate (topamax)- anticonvulsant, can cause change in VA to _________.
myopia
ex. topiramate (topamax) from 20/20 to 20/200!!
phenytoin (dilantin)-anti-convulsant, lithium and alchol can affect ____________ and in high doses can cause _____________.
diplopia (H or V) convergence problem
high doses-nystagmus
Tamoxifen is used for treatment of ______________. Bilateral ________ can result from O.D.
breast cancer
crystalline maculopathy
Caused from heroine, methadone, codeine, meperidine, pentazocine addiction. 9,000 methadone pills required to see this effect.
Talc Retinopathy
tiny, glistening yellow crystals in arterioles
if block O2 can see neo and bleeding
Patients diagnosed with Talc Retinopathy will have problems not only with their eyes but also________________.
lungs.
Talc embolized from lungs to the eyes.
Ethambutol and anti-TB drug can damage_____________.
Optic nerve
Damage of optic nerve by ethambutol can lead to.
scotomas
optic neuropathy
blindness
R/G prob
Viagra's optic nerve effect is.
color vision change for 4-5 hours
Color vision change in which objects look snow covered caused by O.D. of meds.
Digitalis cardiac glycoside
Adverse rxns of beta blockers
slow pulse
shortness breath
fatigue
asthma
hair loss
depression
impotence
Adverse rxns of pilocarpine
brow ache
iritis
detached retina (myopia)
synechiae
angle closure with narrow
Adverse rxns of CAI (neptazane/acetazolamide)
hypokalemia
fatigue
tingling
maliase
kidney stones
aplastic anemia
Disengage the sphinchter resulting in mydriasis. List in order of potency.
Anti-cholinergics
1. atropine
2. homatropine
3. scopolamine
4. cyclopentolate
5. tropicamide
Peak effect of mydriatic phenylephrine within ____min.
45-60 min.
Pigment floaters in AC noted with use of this mydriatic.
phenylephrine
PE (phenylephrine) contraindicated due to HTN effects in these pts.
2.5% in orthostatic hypotension pts
MAO inhibitors
reserpine, guanethidine, methyldopa (chemical smupathectomy)
Peak mydriatic effect of tropicamide.
30 min.
Last 6 hours.
Tropicamide time of loss of accommodation.
<30 minutes
Tropicamide cause a temp. rise in IOP. In POAG pts ______change.
.5mmHG
Tropicamide causes pressor effects?
T or F
False
Anti-cholinergic with greater cycloplegic effect than mydiratic.
Cyclopentolate
OD of anti-cholinergics result in:
red beet
hot hare
mad hatter
dry bone
pseudoexfolitaion synd. pts show _______response to dilating and may be _______pts for cat sx
poor
poor
In POAG pt study, for every _____mm dilation result in increase IOP.
1mm
norm pupil dilate 4mm!!
Infant and neonates avoid large doses of ______ and ____% phenylephrine.
large
10%
IN pregnant and nursing avoid ________and __________.
scoplamine
phenylephrine
For diabetics, use _______ and _________ for dilation.
0.5% tropicamide
2.5% phenylephrine
For asthmatics, avoid _________ and ____________.
adrenergics w/bronchodilators
sulfite meds ex. PE
For MAO pts, avoid ___________.
adrenergics (potential supersentivity)
Pediatric population, ____% of pts were found to have 1 or more posterior pole lesion undetectable without dilation.
25%
Non-mydriatic fundus camera was more superior to dilate fundus evaluation to id diabetic retinopathy.
T or F
True!
Pediatric pts (2-8) dilated equally well when mydriasis was obtained from spray as conventional drops.
T or F
True!
Application of cyclopentolate to medial canthus was found as effective as drops applied to the conj.
T or F
True!
Pre-medication with topical anesthetic result in a slight greater pupil diameter only amoung dark eyed pts with use of 0.5%T.
T of F
False
light but clinically insignificant
Better images are obtained without dilation.
GDx
Test not affect with or without dilation.
VF
OCT-NFL thickness
HRT
central corneal thickness
After effects of pupillary dilation in simulated driving.
Reduced Contrast threshold and high contrast VA
No reduction VF or UFOV
Dapiprazole is an _____________.
alpha adrenergic block
not available any more
Flower petal leakage into sensory retina due break down blood/brain barrier b/c of ______________ supplement.
Niacin 3g/day
RP patients are told to avoid ________ and take ____________.
vit E
vit A
Vit A provide _________addtional uears of useful vision for avg RP pt when supplementation is started by age 32 as measure by ERG.
7
______percursor to vit A and may function in ___________ protection against _______.
beta-carotene
antioxidant
free radicals
Deficiency in vitA can result in ____________ and OD can result in _____________.
night blindness xerophthalmia
papilledema
Fat Soluble vit.
ADE and K
Deficiency in this mineral may lead to optic nerve dysfunction.
thaimin (water-soluble)
Deficiency in this mineral can result in cataract formation, corneal vascularization, angular conj., amd KCS
Riboflavin (B-2)
Deficiency in this mineral may lead to pellagra(optic neuropathy)
naicin (B-3)
Deficiency in this mineral results in anemia. Necessary to supplement with Daraprim for ocular toxoplasmosis.
Folate (B complex)
Deficiency in this mineral result in __________________.
toxic optic neuropathies
detoxifies cyanide
Present in retina, aqueous, and lens at >50 x plasma levels.
Vit C
Deficiency in this mineral result in scurvy (conj. & retinal hemes)
Vit C
Positive effect on drusen reduction for ARMD by this mineral.
Zinc
Essential as coenzyme in protection of oxidative damage to hemoglobin.
Selenium
Recommend vitamin ___________. Avoid __________ in smokers due to increase risk lung cancer.
Ocuvite Lutein
B-carotene
____________ have been shown recently to reach the macula in sufficient quantity to be of some protective benefit against blue-light damage
Lutein