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47 Cards in this Set

  • Front
  • Back
In terms of ocular pharm, what are the 4 main compartments in the eye a topical drug may diffuse into?
1) Tearfilm and cul de sac 2) the AC 3) the VC 4) retro and periocular space
in first order kinetics, the absorption and elimination of drugs vary with the ..................
concentration
most ophthalmic drugs exhibit ------- order kinetics.
first order
what ocular characteristic may alter the kinetics of an ocular drug?
iris pigmentation
What is the tear film volume in the range of?
7 to 10 ul
The cul-de-sac can hold perhaps in the region of .................
30 ul
The average eyedrop is of what size?
40-70ul
what can you tell your patient to do to maximise the bioavailability of drug to the eye when they instill drops?
The Pouch method: the lower lid is pulled away from globe to instill drop and then the eye closed gently for 2 minutes.
What advice should you give a patient who has to instill 2 drops?
Wait 5 minutes between drops.
which glaucoma med can cause a drop in libido?
Betablocker
A patient with Fuchs Endothelial dystophy is found to have glaucoma. which medication is contraindicated?
Carbonic anhydrase inhibitors such as TRUSOPT 2% (dorzolamide) and AZOPT 1% (Brinzolamide)
A patient has had CMO after complicated cataract surgery. Which glaucoma med is best avoided?
prostaglandin analogues: Hysite, Lumigan and Travatan.
A patient has a past retinal detachment. Do not use------------- to treat his glaucoma.
Pilocarpine has a contraindication of RD.
Which glaucoma med might be less effective in a dark eyed person?
Timolol.
The iris dilator muscle is rich in WHICH type of receptor?
Alpha adrenergic.
The pupil sphincter has a greater number of what kind of receptor?
Beta adrenergic
which glaucoma meds increase the uveoscleral outflow?
Alpha adrenergic agonists and PGA's
A patient has had a previous HSV infection and subsequent uveitis. What shouldnt you use to lower IOP?
PGA's
what is the mode of action of Timolol?
By blocking beta receptor in the ciliary process epithelium, the production of adenalate cyclase and cyclic amp reduces the active secretion of aqueous.
A patient says they have a sulphonamide allergy. What drug should you avoid?
Carbonic anhydrase inhibitors.
A patient has myasthenia gravis. What glaucoma med is contraindicated?
B-blocker because they worsen the symptoms. MG is a cholinergic receptor disease, where these receptors are blocked by autoimmune complexes.
what should you warn patients about topical betablockers?
"You may notice some stinging and burning when you put these drops in. If your eye becomes sore or red, or your vision blurred please come back in sooner. While these eyedrops are absolutely fine with most people, please let us know if you experience any SOB, feel unwell, or have any symptoms you are concerned about after using the drops."
What should you tell patients before they start topical PGAs?
There may be some stinging or burning on instillation of the drop. These drops may alter your iris colour to darker which is irreversible (green/hazel eyed patients). The drops may also make your lashes longer which lasts as long as you use the drops. If you notice any change to your skin tone around the eyes let us know. If you suffer from sore red eyes or blurred vision please contact us."
Bladder dysfunction and parkinsons is a contraindication in which glaucoma med?
Pilocarpine
Which drops may leave a bitter taste or altered taste?
Carbonic anhydrase inhibitors and alpha adrenergic agonists.
Which drop is most likely to cause the symptoms of fatigue or drowsiness?
alpha-adrenergic agonists: apraclonidine 0.5% 1%/ brimonidine 0.2%; Brimonidine-P 0.15%
which carbonic anhydrase inhibitor would you use?
first choice would be BRINZOLAMIDE 1% as it stings less, probably due to the more similar pH 7.4 to tears.
which glaucoma drug is most likely to give you a headache?
An adrenergic agonist. PGAs can also.
what adrenergic agonist would you choose?
brimonidine-P 0.15%. Less side effects and lower rate of allergic conjunctivitis. Also has a more gentle preservative.
what glaucoma med is associated with tachyphylaxis, and how?
Timolol has been shown to lose effectivity in 50% of patients studied, after 2 years (monotherapy)
How does Brimonidine compare with timolol in lowering IOP?
Same at peak (2 hours after instillation) 20- 30% and less effective at trough.
what is an advantage of Levobunolol (BETAGAN) when compared to the other B-blockers?
Has another active ingredient dihydrolevobunolol that lowers IOP so can use just 1 x daily with same effect for most Px.
what glaucoma med may cause reversible granulomatous uveitis after long term use?
Metipranolol b-blocker
What CNS effects may topical beta-blockers cause? (5)
1) depression 2) anxiety 3) impotence 4) hallucinations 5)fatigue
What glaucoma medications do you need to be cautious of in diabetics?
b-blockers as they may mask a hypoglycaemia.
what is thought to be the mode of action of prostaglandin analogues?
they increase US outflow by remodelling the extracellular matrix via metalloproteinases. They bind to prostanoid receptors. They also relax ciliary muscle.
which PGA causes more conjunctival hyperaemia?
Travoprost >Bimatoprost>latanoprost
a recent small study showed that twice daily timolol with latanoprost might be less effective than once daily. What is the reason given?
That timolol treated eyes have greater collagen density and more amophous material in the eye. This may effect the UV outflow increase created by latanoprost.
what is the difference between ALT and SLT?
ALT involves applying laser burns to the trabeculum. This improves outflow. SLT targets pigmented cells in the trab, and the Nd-YAG laser is used. The process is photothermolysis. The advantage is that the non-pigmented cells sustain less damage.
What is the most frequently observed ADR to voltaren ophtha?
transient eye irritation.
How does voltaren ophtha work?
Inhibits prostaglandin synthesis.
Does diclofenac sodium enter the AC?
only trace amounts. Not significant
how often should diclofenac sodium be administered for pain?
1 drop every 4-6 hours.
Who should you not prescribe diclofenac sodium for?
Any one in whom asthma, urticaria, rhinitis is precipitated by asprin or prostaglandin inhibiting medications.
what type of medication may be a contraindication for diclofenac sodium?
Meds affecting bleeding/clotting. Could make worse.
which NSAID is indicated for SAC?
Ketorolac 0.5% ACULAR
which drugs are most likely to cause an allergic contact dermatitis reaction?
brimonidine, dorzolomide, aminoglycoside antibiotics, atropine.