Ocular Pharmacology Exam 2

Front 1

what are the pain ocular disorders that require pain management

Back 1

1. scleritis
2. pemphigoid
3. steven johnsons
4. corneal abrasion/erosions
5. uveitis/blunt trauma
6. corneal ulcer
7. herpes zoster

Front 2

in general how should one prescribe pain management

Back 2

1. analgesics given for moderate to sever pain are given on a fixed dose schedule around the clock
2. NOT PRN (Pro Re Nata...AS NEEDED)

Front 3

what is the recommended dose for Acetaminophen and Aspirin?
max dose?
CAUTION??

Back 3

recommended dose:
650-1000mg q4-6h

max:
4000mg/day

caution:
1. acetaminophen caution in liver disease
2. aspirin causes GI problems

Front 4

what schedule is MORPHINE

Back 4

schedule II
-prototypical drug

Front 5

1. general structure of CODEINE
2. metabolism of CODEINE
3. strength compared to morphine
4. schedule

Back 5

1. methylated form of morphine
2. 5-10% metabolized by the liver into MORPHINE, and the rest converted to CONDEINE-6-GLUCURONIDE
3. 10% as strong as morphine
4. SCHEDULE III

Front 6

1. what is HYDROCODONE made from
2. how strong is it (compared to morphine and codeine)
3. schedule

Back 6

1. codeine + thebaine = hydrocodone
2. half as strong as morphine and 6X stronger than codeine
3. SCHEDULE II

Front 7

1. what is the general structure of OXYCODONE
2. strength compared to morphine
3. schedule

Back 7

1. hydroxylized form of codeine
2. 1.5X - 2X as strong as morphine
3. SCHEDULE II

Front 8

1. what is the mechanism of action for TRAMADOL?
2. strength compared to morphine

Back 8

1. AGONIST actions at the μ opioid receptor
2. affects reuptake at the noradrenergic and serotonergic systems
3. ~10% as strong as morphine

Front 9

what is the mechanism of action for TAPENTADOL

Back 9

1. AGONIST at the μ opioid receptor
2. norepinephrine reuptake inhibitor

3. potency between Tramadol and Morphine

Front 10

what is the function of the tear film

Back 10

1. evens out the rough corneal surface to improve refractive qualities
2. removes dead epithelial cells
3. supplies oxygen to corneal epithelial cells (cornea is avascular)
4. lubricate the ocular surface
5. helps to provide immunity (LACTOFERRIN)

Front 11

what is the most common complaint in lacrimal drainage disorder

Back 11

EPIPHORA

Front 12

what is pseudoepiphora?

what is the difference between that and true epiphora

Back 12

1. pseudoepiphora: excess tearing due to dry eye or other irritation
2. pseudoepiphora the patient wont wake up with tearing

Front 13

what is the flow of tears through the lacrimal drainage system?

where is the most common site of infection seen in clinic

Back 13

1. puncta
2. **CANALICULUS**
3. lacrimal sac
4. nasolacrimal duct
5. valve of hasner

Front 14

what is the purpose of the valve of hasner?

where is it?

Back 14

1. prevents backflow of tears and other materials from the nose into the eye
2. at the point where the nasolacrimal duct enters the nose

Front 15

What are the functions of the tear film?

Back 15

1. evens out the rough corneal surface to improve refractive qualities
2. removes dead epithelial cells
3. supplies oxygen to corneal epithelial cells (cornea is avascular)
4. lubricates the ocular surface
5. helps to provide immunity (lactoferrin)

Front 16

What provides efferent innervations to the lacrimal gland?

Back 16

FACIAL NERVES (CN VII)

Front 17

What is the functional unit of the lacrimal system?

Back 17

1. lacrimal gland
2. ocular surface
3. neural connections

-all work together to maintain health and stability of eye/tear film
-interruption of any of the three will result in DRY SYNDROME

Front 18

What are the cutoffs for hyposecretion in...SCHIRMERS

Back 18

SCHIRMERS 1: (basic+reflex)
1. no anesthetics
2. less than 5mm/5min (diagnostic for hyposecretion)
3. if more than 5mm DO SCHIRMER II

SCHIRMERS II: (basic only)
1. topical anesthetic
2. less than 5mm/5min is diagnostic of basal secretion disorder

Front 19

What are the cutoffs for hyposecretion in...Phenol Red

Back 19

after 15 seconds less than 10mm of wetting is abnormal (hyposecretion)

Front 20

what is dacryoadenitis?

clinical presentation?

Back 20

inflammation of the lacrimal gland

1. unilateral local tenderness
2. redness
3. eyelid swelling
4. conj. chemosis
5. discharge
6. +PAN

Front 21

what are common causes of dacryoadenitis

Back 21

1. viral/bacterial infections (acute onset of symptoms)

2. sarcoidosis
3. TB
4. Grave's Disease
5. Mikulicz's syndrome (w/ parotid gland swelling)
6. sclerosing pseudotumors
7. Wegener's

Front 22

what is dacryocystitis?

clinical presentation?

Back 22

1. inflammation of the lacrimal sac, usually due to bacterial infection
2. swelling in upward extent by the medial canthal tendon
3. pain and hyperemia are consistent features
4. however, mucoceles and tumors are often painless

Front 23

osmolarity in tears of a dry eye patient

Back 23

1. elevated tear tonicity
2. HIGH OSMOLARITY

Treatment:
1. hypotonic artificial tears dilute and decrease osmolarity of the tear film

Front 24

What effects do ESTROGENS and ANDROGENS have on the ocular surface?

Back 24

Estrogen:
1. WORSEN dry eye signs and symptoms

Androgens:
1. positive effect on lacrimal system by reducing inflammation and maintain overall health

Front 25

what are the ONLY drugs listed in the chart that is suitable for kids TWO YEARS of age

dosing??

Back 25

acute:
BEPREVE
-BID

chronic:
ALOMIDE
-QID

Front 26

mechanism for type 1 hypersensitivity reaction

Back 26

1. antigen presentation to CD4+ TH2
2. stimulates B cell production of IgE
3. IgE binds to mast cells and basophils
4. degranulation of mast cells and basophils
5. releases histamine, leukotrienes and prostaglandins
6. vasodilation and smooth muscle contractions

Front 27

ocular manifestation of simple allergic conjunctivitis

Back 27

1. itching
2. ropey/stringy discharge
3. chemosis
4. conj and lid edema
5. injection (not as intense as infectious disease)
6. papillae in upper palpebral conj

Front 28

what are the prescription mast cell stabilizers and antihistamines

prediatric cutoff??

Back 28

THREE YEAR OLD CUTOFF

BID:
1. Patanol
2. Elestat
3. Opitvar
4. BEPREVE (2yr old!!!)

QD:
1. Pataday

Front 29

what are the mast cell stabilizers (5)

dosing??
pediatric cutoff?

Back 29

CO-AAA

1. Crolon (4QID)
2. Opticrom (4QID)
3. Alomide (2QID)
4. Alocril (3BID)
5. Alamast (3BID)

-used for chronic care

Front 30

what is the clinical presentation of vernal and atopic conjunctivitis

Back 30

1. horner trantas dots
2. GIANT cobblestone papillae
3. EXTREME ITCHING
4. protective ptosis
5. shield ulcer possible

Front 31

what is the general treatment scheme for managing allergic conjunctivitis

Back 31

1. eliminate allergen
2. desensitization
3. cool compresses
4. artificial tears

Front 32

what is NEEDED for a vernal shield ulcer

Back 32

PROPHYLAX CORNEA with ANTIBIOTIC

treatment:
1. Alrex q1-2h
2. Vigamox TID
3. Pataday QD
4. Homatropine-(IO)

Front 33

mild cases of allergic eye disease DO NOT...

Back 33

mild cases of allergic eye disease DO NOT AFFECT THE CORNEA

DO NOT use antibiotic or combo (OVER TREATMENT)

Front 34

what is the main difference between atopic and vernal conjunctivitis

Back 34

1. atopic is YEAR ROUND
2. vernal is SEASONAL

Front 35

1. Why do women out number men until about age 85
2. Why does the trend disappear then?

Back 35

1. Testosterone is responsible for maintaining a healthy tear film layer—women have less testosterone than men until about 85yo
2. Men loose testosterone at a slower rate than women

Front 36

Why are steroids effective in acute management of dry eye?

Back 36

1. improve the severity of KSC symptoms
2. decrease levels of ocular surface inflammation and cytokines

Front 37

typical medical regimen in treating a symptomatic dry eye patient

Back 37

FIRST TWO WEEKS:
1. Systane q2h
2. Alrex QID
3. Restasis BID

-taper steroid
-LID HYGIENE for associated MGD

Front 38

List six nonsurgical, non-artificial tear treatments for dry eye syndrome.

Back 38

1. Reversible punctual occlusion
2. Low water bandage CL
3. Tape lids shut at bedtime, goggles, plastic shields
4. Nutrition—omega 3
5. Topical hormone therapy
6. Retinoic acid (Vit A)
7. Oral antioxidants
8. Mucomyst

Front 39

What oral medication that can be used in severe cases of dry eye

dosing?

Back 39

Salagen (Pilocarpine p.o.)
5mg TID-QID

Salagen causes SLUDGE
1. Salivation
2. Lacrimation
3. Urination
4. Diarrhea
5. Gasping via pulmonary Edema

Front 40

Which specific nutritional supplement or food is beneficial in ameliorating the symptoms and the cause of dry eye syndrome?

Back 40

Omega 3 FA decreases dry eye syndrome