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98 Cards in this Set
- Front
- Back
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What type of allergies is involved?
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Type 1 hypersensitivity
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Type 1 hypersensitivity rxn is mediated by what kind of antibody?
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IgE
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What does mast cells release when they rupture?
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Mediators
-Histamine -Prostaglandins -Leukotrienes -Cytokines -Eosinophil chemotactic factor |
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What are the most common causes of increased eosinophil count?
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N = neoplasms (cancer)
A = allergies A = asthma C = collagen vascular disease P = parasitic infxn |
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What does histamine do?
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Activates H1 receptors on blood vessel
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Activation of H1 receptors on blood vessels by histamine causes...?
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Vasodilation
Leakage of fluid Tissue swelling |
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Common signs and sx of Type-1 rxn
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Redness
Swelling Itching |
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Type-1 rxn typically occurs in which diseases/conditions?
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Hay fever
Allergic conjunctivitis Asthma Hymenoptera stings Chemical and toxin sensitivities |
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Ocular conditions characterized by Type-1 rxn
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Seasonal allergic conjunctivitis
Vernal conjunctivitis Atopic keratoconjunctivitis GPC |
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What is vernal conjunctivitis?
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Seasonal disorder that peaks during warm months
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Who is at risk for vernal conjunctivitis?
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Adolescent males
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Is vernal conjunctivitis associated with bilateral or unilateral inflammation?
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Bilateral
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Where does inflammation from vernal conjunctivitis usually manifest?
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Upper tarsal conjunctiva
(Sometimes limbal conjunctiva) |
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Distinguishing characteristics of vernal conjunctivitis
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1. Large papillae
-On upper tarsal conj -Cobblestones appearance 2. Papillary hypertrophy -Gelatinous thickening of superior limbus 3. Higher level of histamine in tears |
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Sx of vernal conjunctivitis
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Intense itching
Thick, ropy discharge Photophobia (if involves cornea) Ptosis (if severe papillary involvement) |
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Causes of atopic conjunctivitis
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Predispositional
Constitutional Hereditary *Usually involves personal or family hx of allergies |
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Distinguishing characteristics of atopic conjunctivitis
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1. Patches of thickened, excoriated skin
-Dry and itchy 2. Conjunctival chemosis and hyperemia 3. Classic shield ulcer or pannus *Corneal involvement is uncommon |
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What is GPC?
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-Giant Papillary Conjunctivitis
-Inflammatory rxn to irritation such as proteins on CLs -Represents chronic inflammatory rxn to denatured proteins |
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Distinguishing characteristics of GPC
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1. Papillary hypertrophy
-Upper tarsal conj 2. Lens instability 3. CL intolerance 4. Itching and mucus discharge |
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What provides topical decongestant effects in eye?
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Sympathomimetic, vasoconstricting effects of adrenergic agonists
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Ocular decongestants are usually effective at low or high concentrations?
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Low
Results in minimal systemic side effects |
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How long should ocular decongestants be used for?
Why? |
Limited or short period of time b/c may mask sx of more serious conditions (i.e. infxn)
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If a condition does not respond to decongestants w/in 48 hrs, what should be done next?
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Re-evaluate for more serious condition
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Decongestant: MOA
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Concentration dependent
Alpha-adrenergic effect -Vasoconstriction -Pupil dilation |
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Decongestants consist of which chemicals in their formulation?
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Phenylephrine
Imidazole derivatives (NOT) -Naphazoline -Oxymetazoline -Tetrahydrozoline |
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Higher concentrations of Phenylephrine (2.5% and 10%) causes...
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Vasoconstriction
Pupillary dilation -DFE -Surgeries -Uveitis: prevent synechiae formation |
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Do you need a rx for 2.5% Phenylephrine?
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Yes.
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What is 0.12% Phenylephrine used for? Does it require rx?
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Used as ocular decongestant
No rx needed |
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What is the duration of action of 0.12% Phenylephrine?
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0.5 to 1.5 hr
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What class does Naphazoline belong to?
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Imidazoles
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Naphazoline is available in which concentrations? Does it require rx?
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0.012% - no rx
0.03% - no rx 0.1% - rx only |
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What is the duration of action of Naphazoline?
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3-4 hrs
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Oxymetazoline belongs to which class of drug?
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Imidazoles
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What is the duration of action of Oxymetazoline?
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4-6 hrs
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Oxymetazoline is available in which concentrations? Does it require rx?
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0.025% - no rx
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Tetrahydrozoline belongs to which class of drug?
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Imidazoles
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What is the duration of action of Tetrahydrozoline?
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1-4 hrs
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Tetrahydrozoline is available in which concentrations? Does it require rx?
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0.05% - no rx
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Decongestant: Indications
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Ocular decongestants
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Decongestant: Contraindications
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1. Hypersensitivity
2. Narrow angle glaucoma 3. Anatomically narrow angle (no glaucoma 4. Before peripheral iridectomy in eyes capable of angle closure |
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Can you use ocular decongestants in conjunction w/ anesthetics?
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No. Should discontinue decongestants before using anesthetics.
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Overuse of ocular decongestants can result in
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Rebound vasodilation
Increased redness |
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Pregnancy Category of decongestants
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C
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Why is caution in elderly pts necessary?
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They may develop pigment floaters after using phenylephrine
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Can there be sufficient absorption of decongestants to cause systemic vasopressor effects?
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Yes. In pts w/ suppressed lacrimation
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Decongestant: Caution in which type of pts?
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-Low birth weight children
-Elderly -HTN -DM -Hyperthyroidism -Arteriosclerosis -Cardiovascular abnormalities |
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Decongestant: Ocular ADRs
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-Mydriasis
-Increased Redness -Irritation -Punctate keratitis -Lacrimation -Increased IOP |
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ADRs of phenylephrine decongestant in elderly pts
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Rebound miosis
Decreased mydriatic response to therapy |
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Decongestant: Cardiac ADRs
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-Palpitations
-Tachycardia -Cardiac arrhythmias -Coronary occlusion -Subarachnoid hemorrhage -MI -CVA |
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Decongestant: Systemic ADRs
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-HA
-Brow ache -Sweating -Dizziness -Nausea -Nervousness -Weakness -Drowsiness -Higher blood glucose |
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Naphazoline HCl: Indication
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Relieve redness caused by minor irritations
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Naphazoline HCl: Dosage
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1-2 gtt
3-4 hrs Up to 4 times daily |
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0.012% Naphazoline HCl soln
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1. Advanced Eye Relief
2. Redness Instant Relief 3. Clear Eyes ACR Seasonal Relief 4. Clear Eyes for Dry Eyes Plus Redness Relief |
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0.03% Naphazoline HCl soln
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1. Advanced Eye Relief
2. Redness Maximum Relief |
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0.1% Naphazoline HCl soln
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1. Naphazoline HCl (generics)
2. AK-Con |
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Oxymetazoline HCl: Indication
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Relieve redness caused by minor irritations
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Oxymetazoline HCl: Dosage
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1-2 gtt
Q6H Adult and children > 6 y/o |
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0.025% Oxymetazoline HCl soln
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Visine L.R.
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Tetrahydrozoline HCl: Indication
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-Relieve redness and discomfort caused by minor irritations
-Temporary relief of irritation and burning caused by dry eye |
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Tetrahydrozoline HCl: Dosage
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1-2 gtt
Up to 4 times daily |
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0.05% Tetrahydrozoline HCl soln
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1. Tetrahydrozoline HCl (generics)
2. Visine 3. Murine Plus 4. Visine Advanced Relief 5. Altazine Irritation Relief |
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What is the decongestant component of decongestant/antihistamine combinations?
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Naphazoline HCl
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What is the antihistamine component of decongestant/antihistamine combinations?
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Pheniramine
or Antazoline |
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What is used to increase viscosity of decongestant/antihistamine combinations?
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Hydroxypropyl methylcellulose
or Polyvinyl alcohol |
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Decongestant/Antihistamine combinations should be used w/ caution in which pts?
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-Narrow angles
-Hx of glaucoma |
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0.025% Naphazoline HCl = 0.3% Pheniramine maleate soln
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Naphcon-A
Visine-A |
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What are the components of Visine-A or Naphcon-A?
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0.025% Naphazoline HCl
0.3% Pheniramine maleate soln |
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Visine-A dosage
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1 gtt
QID PRN Up to 4 days |
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0.05% Naphazoline HCl + 0.5% Antazoline phosphate
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Vasocon-A
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What are the components of Vasocon-A?
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0.05% Naphazoline
0.5% Antazoline phosphate |
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Vasocon-A dosage
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1 gtt
QID PRN Up to 4 days |
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0.03% Naphazoline HCl + 0.32% Pheniramine maleate soln
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Opcon-A
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Opcon-A dosage
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1 gtt
QID PRN Up to 4 days |
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MOA of antihistamine
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-Block effect of histamine on H1 receptors
-Prevent release of other allergic mediators |
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Antihistamines: Contraindications
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-Concurrent use w/ MAO inhibitors
-Pts w/ hypersensitivity |
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Pregnancy Category of antihistamines
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C
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Effects of antihistamine overdose in children
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Decreased mental alertness
Hypersensitivity Hallucinations Convulsions Death |
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Elderly pts need ___ doses of oral antihistamines because ___.
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Lower
Potential for -Sedation -Dizziness -Confusion -BP changes |
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Antihistamines should be used w/ caution in pts w/ ____.
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Asthma
CAD Heart disease Narrow angle glaucoma HTN Hyperthyroidism Irregular heart beat Liver disease Pregnancy |
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Antihistamines: Ocular ADRs
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Blurred vision
Eye pain Dry eyes Photophobia |
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Antihistamines: Systemic ADRs
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Constipation
N/V/D Sleepiness/drowsiness HA Insomnia Tinnitus Irregular heartbeat |
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Antihistamines: Pt info
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-Avoid concurrent use w/ alcohol
-Wait 10 mins before inserting CLs |
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Pure antihistamines
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Emedastine
Levocabastine |
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Emedastine: Indications
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Allergic conj relief
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Emedastine: Dosage
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1 gtt
QID |
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0.05% emedastine difumarate oph. suspension
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Emadine
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Do you need rx for pure antihistamines?
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Yes. Both Emadine and Livostin
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Levocabastine: Indications
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Vernal keratoconjunctivitis
Allergic conj |
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Levocabastine: Dosage
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1 gtt
Up to 4 times daily For 2 wks |
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0.05% Levocabastine HCl oph. suspension
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Livostin
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Dual antihistamines and mast cell stabilizers
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Azelastine
Epinastine Ketotifen Olopatadine |
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Azelastine: Indications
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Relief itching fr allergic conj
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Azelastine: Dosage
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1 gtt
BID |
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0.05% Azelastine HCl oph soln
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Optivar
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Do you need rx for dual antihistamine and mast cell stabilizers?
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Yes, EXCEPT:
Ketotifen -Alaway -Zatidor |
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Dual antihistamine and mast cell stabilizers: Indications
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Allergic conj
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Epinastine: Dosage
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1 gtt
BID Continue during period of exposure |
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0.05% Epinastine HCl oph. soln.
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Elestat
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