Ocular Pharm Final

Front 1

Anesthetics:

weak base + neutral/alkaline environment

Back 1

1. in tears
2. MORE ANESTHETIC enters nerve cell membrane

Front 2

Anesthetics:

weak base + acidic environment

Back 2

1. area of infection
2. decreases anesthetic effect

Front 3

duration of effect for ester linkages

Back 3

shorter effect (topical anesthetic)

Front 4

duration of effect for amide linkages

Back 4

longer duration (injectables)

Front 5

where is the site of action for anesthetics

Back 5

CELL MEMBRANE
-selectively interacts with the receptors

Front 6

how can you manipulate duration of effect for anesthetics

Back 6

contact time with nerve tissue determines duration of action

vasoconstriction:
1. injectables for LONGER duration
2. localizes anesthetics at desired site and slows systemic absorption
3. less risk of toxicity by can cause tissue hypoxia

vasodilation:
1. injectables for SHORTER duration

Front 7

what is the most commonly used ophthalmic injectable

Back 7

LIDOCAINE

Front 8

what is the ONSET TIME and DURATION for Lidocaine?

Back 8

Onset: 4-6 minutes
Duration: 45min to 1 hour
-1-2 hours with Epinephrine

Front 9

what is the max dose for Lidocaine

Back 9

300mg (500mg with Epinephrine)

Front 10

what is the Lidoderm patch used for?

Back 10

POST HERPETIC NEURALGIA
1. up to 3 patches for 12 hrs/day
2. 5% lidocaine, used on SKIN ONLY

Front 11

topical anesthetic characteristics

Back 11

1. ester linkages for SHORT DURATION
2. corneal desensitization and reduced blink reflex
3. hydrolyzed by plasma pseudocholinesterase
4. no additive effect
5. ocular/systemic toxicity possible if overused

Front 12

what are the FOUR topical anesthetics used

Back 12

1. Cocaine
2. Tetracaine
3. Benoxinate
4. Proparacaine

Front 13

what are the FIVE injectable anesthetics used

Back 13

1. Procaine (Novocaine)
2. Lidocaine
3. Mepivacaine (Carbocaine) - fastest onset!!
4. Bupivacaine- long acting
5. Etidocaine (Duranest)

Front 14

what is the mechanism of Cocaine Hydrochloride

Back 14

1. Anesthetic
2. Adrenergic Agonist
- used in diagnosis in Horner's (10%)

Front 15

what is the ONSET and DURATION for Cocaine Hydrochloride (2%)

Back 15

1. 20 minute of corneal anesthesia
2. 5-10 minute onset

Front 16

what is the ONSET and DURATION for Tetracaine Hydrochloride

Back 16

Onset: 10-20 seconds
Duration: 10-20 minutes

Front 17

what are the disadvantages of Tetracaine Hydrochloride

Back 17

1. moderate burning and stinging
2. greater corneal toxicity
3. structural damage to cell membrane
4. loss of microvilli
5. desquamation of epithelial cells
6. ester of PABA (allergies)

MAX 7 drops/eye

Front 18

what is in Fluress and Flurox

Back 18

1. Benoxinate 0.4%
2. Sodium Fluoroscein
3. Chlorobutanol 1%

Benoxinate is an ester of PABA (allergies)

Front 19

what is in Flurasafe?

what is an advantage?

Back 19

1. Benoxinate 0.4%
2. Disodium Fluorexon 0.35%

**does not stain hydrogel contact lenses**

Front 20

what is Benoxinate Hydrochloride primarily used for?

advantages?

Back 20

APPLANATION TONOMETRY
- substantial bactericidal properites
- less risk for Pseudomonas contamination
-only available in combos with vital dyes

Front 21

what are some CONTRAINDICATIONS for topical anesthetics

Back 21

1. known hypersensitivity to anesthetic or preservatives
2. patient using anticholinesterase meds
3. Dry Eye Testing (apply dye first!!)
4. Perforating Ocular Injuries (corneal endothelial toxicities)
5. Cultures (except non-preserved Proparacaine)

Front 22

what is the treatment for Topical Anesthetic Abuse?

Back 22

D/C TOPICAL ANESTHETICS

1. Broad Spectrum Abx
2. Cycloplegic agents
3. Systemic Analgesics
4. BSCL

-healing may be very prolonged (6+ months)

Front 23

what are some disadvantages of Akten

Back 23

1. burning, headaches, conj hyperemia, corneal compromise with repeated use
2. NOT INJECTABLE!!!

however not expected to result in systemic exposure

Front 24

what is the difference between Mydriatics and Mydriolytics

Back 24

Mydriatics
1. Adrenergic divison of ANS
2. sympathomemtics and adrenergic agonist

Mydriolytics
1. sympathetic nervous system action blocked
2. adrenergic receptor antagonist
3. Controls IOP (beta blocker)
4. Reverse effects of mydriatics drugs

Front 25

what are the sympathetic receptors in the Pupil Dilator Muscle and Ciliary Muscle

Back 25

Pupil Dilator Muscle (ALPHA 1):
contracts causes MYDRIASIS

Ciliary Muscles (BETA 2)
relaxes causes long range focus

Front 26

what is the parasympathetic receptors in the Pupil Dilator Muscle and Ciliary Muscle

Back 26

Pupil Dilator Muscle (M3):
contracts circular muscle causes MIOSIS

Ciliary Muscles (M3)
contracts causes short range focus

Front 27

alpha 1 agonist will do what to the iris dilator? pupil?

Back 27

alpha 1 will CONTRACT the iris dilator muscle and also cause the pupil DILATION

Front 28

what are the clinical indications for Phenylephrine

Back 28

1. dilation of pupil for diagnostic purposes (episcleritis vs. scleritis)
2. mydriasis when ACCOMMODATION is desired
3. before intraocular surgery
4. confirmation of HORNER'S SYNDROME

Front 29

how is phenylephrine used to differentiate between episcleritis and scleritis

Back 29

1. smooth muscle contraction of conjunctival arterioles
2. blanching of conjunctiva

Front 30

CONTRAINDICATIONS of Phenylephrine

Back 30

1. hypersensitivity
2. narrow angle glaucoma
3. long standing insulin dependent diabetes
4. MOA inhibitors and TCA's
5. HTN pts using Reserpine or Gaunethidine

Front 31

what is a safer mydriatic to use when you have narrow angles

Back 31

HYDROXYAMPHETAMINE

1. indirect acting adrenergic agonist
2. no change in IOP
3. little effect on accommodation/refractive state

Front 32

what is the mechanism of cycloplegics

Back 32

INHIBIT action of Ach on muscarinic sites innervated by autonomic fibers on smooth muscle cells

-anticholinergics
-antimuscarinics
-cholinergic antagonists

Front 33

what are the FOUR direct acting muscarinic agonists

Back 33

C.A.M.P.

1. Carbachol
2. Acetylcholine
3. Methacholine bromide
4. Pilocarpine

Front 34

what are the Cholinesterase Inhibitors (indirect acting muscarinic agents)

Back 34

P.E.N.D.

1. Physostigmine
2. Echothiophate
3. Neostigmine
4. Disopropyl fluorophosphate

Front 35

what are THREE indications for cycloplegics

Back 35

1. cycloplegic refraction
2. uveitis/iridocyclitis
3. penalisation for treatment of amblyopia (alt to patch)

Front 36

contraindications for cycloplegics

Back 36

1. allergy to belladonna alkaloids
2. narrow angle glaucoma
3. elderly patients (prone to bladder distension)

Front 37

what are the most abundant Muscarinic receptor in the eye

Back 37

M3
-60-75%

Front 38

what is a cycloplegic safe to use in cardiac and HTN patients

Back 38

TROPICAMIDE

Front 39

what are indications for Tropicamide

Back 39

1. dilation of pupil for diagnostic purposes
2. mydriasis/cycloplegia for refraction
3. before intraocular surgery/post op
4. prevent synechiae formation
5. uveitis
6. provocative test for ACG (DONT DO IT THOUGH)

Front 40

what is the mechanism for tropicamide

Back 40

blocks effect of Ach released from cholinergic nerve endings at IRIS SPHINCTER and CILIARY MUSCLE

Front 41

what does Paremyd contain

Back 41

1. Hydroxyamphetamine 1%
2. Tropicamide 0.25%

combined effect of adrenergic agent and anticholinergic agent

Front 42

most common uses of cycloplegic refractions

Back 42

1. children
2. latent hyperopia/high refractive error
3. accommodative esotropia/spasm

Front 43

what is the procedure for cycloplegic refraction

Back 43

1. instill 1gtt proparacaine
2. instill 1gtt cyclopentalate 1%
3. wait 5 min
4. second drop of cyclopentalate 1%
5. wait 40 mins
6. refract and DFE

Front 44

in respects to Rx what should you expect for cycloplegic refraction

Back 44

1. expect to find more (+) after cycloplegia
2. use as a guide to how accommodative system is functioning, determine Rx
3. full Rx not always given (conside BV status)

Front 45

what is the mechanism for ANTI-INFLAMMATORY in steroids

Back 45

1. Reduction of T and B cells involved in the inflammatory response
2. Inhibition of macrophage and neutrophil migration
3. Inhibition of prostaglandin synthesis by inhibition of phospholipase

Front 46

what is the mechanism for HYPERGLYCEMIA in steroids

Back 46

1. Increased liver glycogen storage
2. Increased insulin resistance
3. Inhibition of glucose oxidation

Front 47

what is the mechanism for LIPID DISTRIBUTION in steroids

Back 47

1. Fat deposits on face and neck (Humpback and moonface)
2. Decreased fat from extremities
3. Increased LDL, decreased HDL

Front 48

what is the "control" steroid for which all others are compared to

Back 48

HYDROCORTISONE (1):
- medium strength (4-5x)
- higher strength (20-25x)

Front 49

what are the ABSOLUTE contraindications of systemic steroids

Back 49

P.P.O.D.

Peptic Ulcers
Psychoses
Osteoporosis
Drug Interactions

Front 50

what are the RELATIVE contraindications of systemic steroids

Back 50

1. Diabetes mellitus
2. Infectious disease
3. Chronic renal failure
4. CHF
5. Mental health problems
6. Systemic hypertension

Front 51

what is the dosing procedure for Prednisone

Back 51

1. 20-100mg/day
2. taper
- reduce by ~10% of original every 3-4 days
-maintain at low dose (5-20mg/day) for 1-2 weeks before d/c

Front 52

what is the max therapeutic effect duration?

what is the max amount you can take a once

Back 52

1. maximum therapeutic effects q6h
2. amounts up to 60mg can be taken at once
3. take with food

Front 53

what must you consider when you are tapering oral steroids

Back 53

1. for long term therapy DO NOT reduce more than 1mg every 2-3 weeks
2. shorter durations of treatment can be tapered more rapidly
3. BIGGEST RISK is adrenal suppression

Front 54

what are possible adverse reactions for NSAIDS

Back 54

1. corneal melt with topical diclofenac and bromfenac
2. abnormal expression of MMP's in susceptible patients

Front 55

what are some indications of Topical NSAIDS

Back 55

1. post-cataract sx inflammation
2. post-cataract sx ocular pain
3. post refractive ocular pain
4. photophobia
5. ocular itching (seasonal allergies)

Front 56

what happens during Fluorescein Angiogram

Back 56

1. NaFl excited at 465nm and emits at 525nm
2. Binds to Albumins and RBC
- this is why blood vessels hyperfluoresce
- this is why non vascular lesions block fluorescence

Front 57

what is the main purpose of Fluorexon

Back 57

Evaluation of Hybrid Lenses
- similiar to NaFl but doesn't as readily penetrate SCL
- larger molecule with reduced contamination

Front 58

what does rose bengal do to cells and microorganisms

Back 58

1. kills microorganisms
2. dye is retained in nuclei of cells
3. dry eye patients are particularly prone to staining with RB
4. stains DEAD CELLS

Front 59

what is Lissamine green very useful for

Back 59

1. antiviral effects
2. staining conjunctiva (DES, CL overwear, SLK)

Front 60

what is ICG commonly used for

Back 60

1. identify CVNM and examine vascular retina and choroid
2. when fluorescein is poorly visualizes nets in areas of hemorrhage and/or previous treatment
3. works in presence of cataracts and ret hemorrhages

Front 61

what is methylene blue used for?

Back 61

1. staining lacrimal before dacryostorhinostomy
2. outlining glaucoma filtering blebs

Front 62

why doesnt NaFl freely penetrate the corneal layers

Back 62

1. NaFl is HYDROPHILIC
2. CORNEAL EPITHELIUM is LIPOPHILIC

Front 63

name the ELEVEN artificial tears that CONTAINS PRESERVATIVES

Back 63

1. Tears Naturale II
2. Tears Naturale Forte
3. Systane
4. Optive
5. Refresh Liquigel
6. Refresh Tears
7. NutraTear
8. Moisture Eye
9. Moisture Liquigel
10. GenTeal Mild
11. GenTeal

Front 64

what are the SEVEN artificial tears that DOES NOT contain PRESERVATIVES

Back 64

1. Theratears
2. Bion Tears
3. Tear Naturale Free
4. Refresh
5. Refresh Celluvisc
6. Refresh Endura
7. Refresh Plus

Front 65

name the FIVE OPHTHALMIC POLYMERS

Back 65

1. methylcellulose
2. polyvinyl alcohol
3. povidone
4. dextran
5. propylene glycol

Front 66

what are the FIVE OPHTHALMIC THICKENERS

Back 66

1. gelatin
2. glycerin
3. polyethylene glycol
4. poloxamer
5. polysorbate

Front 67

what are the FIVE OPHTHALMIC PRESERVATIVES

Back 67

1. BAK
2. Chlorbutanol
3. Sodium perborate
4. EDTA, polyquaternium
5. Methylparaben

Front 68

what are the THREE common retinal entities associated with vision loss?

Back 68

1. uveitis
2. vascular retinopathies
3. AMD

Front 69

what are the THREE "whammies" of VEGF

Back 69

1. Stimulates Angiogenesis
2. Promotes vascular permeability
3. Pro-inflammatory

Front 70

what is the classic triple therapy for Toxoplasmosis

Back 70

1. Pyrimethamine: 100mg loading dose, followed by 50mg QD
2. Sulfadiazine: 2g loading dose, followed by 1g QD
3. STEROIDS!!
4. MUST ADD FOLIC ACID 3-5mg 2-3x/week

Uveitis: Pred Forte and Atropine

Front 71

since TOXO is self limiting within 4 WEEKS...how do you know when to treat?

Back 71

1. active for ONE MONTH
2. lesion in HIV patient
3. MACULA ON
4. moderate/severe VITRITIS associated with vision loss
5. LARGE LESIONS (>1DD)
6. MONOCULAR patient

if small in the periphery...JUST OBSERVE

Front 72

what is in Bactrim?
how is it dosed?

Back 72

800mg Sulfamethoxaloze
160mg Trimethoprim

-use for 4-6wks
-ask patient for sulfa allergies

Front 73

IF you decide to treat CAT SCRATCH DISEASE...what are your options??

Back 73

Tx efficacy has been difficult to establish

1. Azithromycin 250mg p.o.
2. Erythromycin 500mg QD
3. Bactrim QD
4. Ciprofloxacin 20-30mg/kg BID
5. Rifampin 600-900mg p.o. QD
6. Doxycycline 100-200mg BID

Front 74

what are the THREE STAGES of LYME DISEASE

Back 74

1. RASH!!! (Erythema migrans)...flu like symptoms
2. neurological (Bell's palsy, peripheral neuropathy, and optic neuropathy)
3. associated ocular signs (posterior uveitis), Carditis, arthritis

Front 75

Pars Planitis is a diagnosis of...

Back 75

EXECLUSION...meaning you find everything else negative

Front 76

what are the FIRST LINE treatments for LYME DISEASE

Back 76

D.A.P.T.

1. Doxycycline 100mg BID
2. Amoxicillin 500mg TID
3. PNC 500mg QID
4. Tetracycline 500mg QID


Amoxicillin and PNC can be used in children/preggos

Front 77

what happens if the person is allergic to the first line treatments of lyme disease

Back 77

1. Erythromycin 250mg QID
2. Cefuroxime axetil 500mg BID

E-mycin safe in kids and preggos

Front 78

how would you diagnosis Lyme disease

Back 78

1. RASH hx exposure within month
2. NO RASH then Hx of exposure and organ involvement
3. NO Hx then TWO ORGANS and RASH
4. ELISA then WESTERN BLOT for confirmation