OPTHALMOLOGY > Pharms > Flashcards

Pharms Flashcards

(20 cards)

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1
Q

Diagnostic agents

A
  1. Fluorescein
  2. Topical anaesthetics: proxymetacaine, benoxinate, tetracaine.
  3. Mydriatics and cyclopegics
    Parasympathetic: Cyclopentolate, Tropicamide, Atropine
    Sympathetic: phenylephrine HCl 2,5%.
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2
Q

Ocular side effects of Corticosteroids

A
  1. Posterior subcapsular cataracts.

2. Glaucoma.

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3
Q

Ocular side effects of Chloroquine

A
  1. Corneal deposits: Reversible and usually asymptomatic, but may cause photophobia or glare.
  2. Maculopathy: Dose related and initially asymptomatic, but on prolonged exposure it becomes progressive and irreversible, and produces a decrease in visual acuity.
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4
Q

Ocular side effects of Digitalis

A
  1. Dull vision
  2. Chromatopsia (abnormal colour vision).
  3. Ocular toxicity occurs with high doses, and classically everything appears yellow to the patient, although other colour aberrations may occur.
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5
Q

Ocular side effects of Phenytoin

A

Indication: Epilepsy and trigeminal neuralgia.

  1. Cerebellovestibular effects: Horizontal nystagmus in lateral gaze, vertical nystagmus in upward gaze, vertigo, ataxia
  2. Ophthalmoplegia: > blood levels may produce diplopia.
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6
Q

Ocular side effects of Ethambutol

A

Indication: TB.

  1. Optic neuropathy: 1 month of starting treatment. May be slow recovery or may be irreversible.

10 mg/kg/day - 1% probability
25 mg/kg/day - 5% probability
50 mg/kg/day - 15% probability

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7
Q

Ocular side effects of Phenothiazines

A
  1. Chlorpromazine:
    - reversible punctate corneal epithelial opacities
    - irreversible lenticular opacities.
  2. Thioridazine:
    - pigmentary retinopathy that can resemble retinitis pigmentosa.> l000 mg/day.
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8
Q

FLUORESCEIN

A

Characteristics:

  • A nonirritating, water soluble, orange dye
  • fluoresces bright yellow-green under cobalt blue light.

MOA:
- stains collagen and mucus.

Indication:
- Corneal damage: only stain if epithelial cell layers absent and underlying basement membrane or stroma is exposed.

Contraindication:
- soft contact lenses are in the eye – it stains the contact lenses

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9
Q

TOPICAL ANAESTHETICS

A

Examples: proxymetacaine, benoxinate, tetracaine.

Indication:

  • Assist in examining painful corneal conditions
  • Schiøtz tonometry
  • Foreign body removal from the cornea or conjunctiva.

MOA:

  • 15 min
  • anaesthetise cornea and conjunctiva

Contraindications:
- Never prescribe to take home–> Corneal damage if longterm use

Side effects:

  • Seldom local or systemic allergic reactions
  • Dont prescribe home–> Corneal damage: toxic to the epithelium–> Inhibit mitosis and cell migration
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10
Q

MYDRIATICS & CYCLOPLEGICS:

PARASYMPATHOLYTICS (ANTICHOLINERGICS)

A

PARASYMPATHOLYTICS (ANTICHOLINERGICS)
Examples: Cyclopentolate, Tropicamide, Atropine

Indication: According to time of action
• Atropine: Hyphaema where total immobilisation of the iris is desired to prevent 2° haemorrhage and little tendency to form posterior synechiae.
• Cyclopentolate: anterior uveitis for pain relief, but where some movement of the pupil is desired as there is a strong tendency to form posterior synechiae. (Occasionally omit dose to allow pupil to constrict further and break incipient posterior synechiae)
• Tropicamide: Diagnostic purposes because of its short duration of action.

MOA:
- Cause paralysis of sphincter pupillae and the ciliary muscle.
- < duration of action and cycloplegic potency:
Atropine sulphate 0.5% or 1% (longest acting and most potent cycloplegic)
Cyclopentolate HCl 0.5%
Tropicamide 0.5% or 1% (shortest acting and weakest cycloplegic)

Side effects:

  • nausea, vomiting
  • pallor
  • vasomotor disturbances.
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11
Q

Topical ocular agents

A
  1. Decongestants:
    - Naphazoline HCl 0.12%,
    - Phenylephrine HCl 0.12%
    - Tetrahydrozaline HCl 0.05%
  2. Antimicrobial agents:
    - Sulphacetamide
    - Neomycin
    - gentamicin
    - tobramycin
    - trimethoprim
    - chloramphenicol
    - bacitracin + polymyxin B
    - tetracycline
    - various fluoroquinolones (ciprofloxacin and ofloxacin are 2nd generation agents; gatifloxacin and moxifloxacin are 4th generation agents).
  3. Antivirals:
    - Acyclovir
  4. Antifungals
    - Amphotericin B
    - Natamycin.
  5. NSAIDS
    - indomethacin (Indocid®)
    - Na diclofenac (Naclof®).
  6. Corticosteroids
    - prednisolone
    - betamethasone
    - dexamethasone
    - fluoromethalone.
  7. Antiallergy agents
    - Levocabastine (Livostin®)
    - Lodoxamide (Alomide®)
    - Emedastine (Emadine®)
    - Spaglumate (Naaxia®)
    - Olopatidine (Patonol®)
    - Epinastine HCl (Relestat®)
    - Ketotifen (Zaditen®)
    - Naphazoline (vasoconstrictor) and antazoline (anti-histamine) - (Antistin Privine® and Spersallerg®).
    - Sodium chromoglycate 2% (Opticrom®)
  8. Agents used in glucoma
    - Cholinergic agonists:pilocarpine
    - Adrenergic agonists: adrenaline, apraclonidine (Iopidine®), brimonodine (Alphagan®)
    - Nonselective β-blockers: timolol maleate (Timoptol®), levobunolol (Betagan®)
    - Cardioselective β-blockers: betaxolol (Betoptic®)
    - Carbonic anhydrase inhibitors: acetazolamide, dorsolamide, brinzolamide.
    - Prostaglandin agonists: latanoprost, bimatoprost, travoprost.
    - hyperosmotic–> acute angle closure glaucoma
  9. Artificial Tears:
    - Cellulose derivates
    (a) Hydroxypropylmethylcellulose (HPMC): IsoptoPlain®, Spersatears®, Viscotraan®.
    (b) Carboxymethylcellulose: Refresh Liquigel®.
    - Polyvinyl alcohol: Liquifilm®, Tears Plus®.
    - Mucomimetics: HPMS plus Dextrane 70: Tears Naturale®.
    - Carbomers: Viscotears®
    - HP-Guar derivatives: Systane®
    - Petrolatum ointments: Duratears®.
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12
Q

Decongestants

A

Examples:
Naphazoline HCl 0.12%, Phenylephrine HCl 0.12%, Tetrahydrozaline HCl 0.05%

Indications:

MOA:

  • weak adrenergic–> vasoconstrictor
  • make the eyes whiter

Contraindications:

  • not used >4x daily
  • not used > 3 or 4 days
  • precipitate angle closure glaucoma due to mydriasis in predisposed patients.

Side effects:
- rebound vasodilation
worsening of redness
irritation.

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13
Q

Artificial tears

A

Examples:

  • Cellulose derivates
    (a) Hydroxypropylmethylcellulose (HPMC): IsoptoPlain®, Spersatears®, Viscotraan®.
    (b) Carboxymethylcellulose: Refresh Liquigel®.
  • Polyvinyl alcohol: Liquifilm®, Tears Plus®.
  • Mucomimetics: HPMS plus Dextrane 70: Tears Naturale®.
  • Carbomers: Viscotears®
  • HP-Guar derivatives: Systane®
  • Petrolatum ointments: Duratears®.

Indications

  • dry eyes
  • Abnormal tear film
  • Lacrimal gland abnormality

Side effects:

  • preservative sensitivity
  • irritation.
  • Gels provide > relief, but interfere with vision –> @ night
  • Ointments cause»_space; blurring vision–> only severe cases.
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14
Q

SYSTEMIC SIDE EFFECTS OF OCULAR MEDICATIONS: β-BLOCKERS

A

AGENTS USED IN GLAUCOMA

  1. Bronchospasm: Avoid in asthma and COAD.
  2. Aggravate cardiac conduction defects and cardiac failure.
  3. Aggravate peripheral vascular disease.
  4. > blood glucose, so use with caution in DM
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15
Q

SYSTEMIC SIDE EFFECTS OF OCULAR MEDICATIONS: PARASYMPATHOMIMETICS (CHOLINERGIC AGONISTS)

A 
AGENTS USED IN GLAUCOMA
5-10x the recommended dose 
1. lacrimation
2. salivation
3. perspiration
4. nausea, vomiting
5. diarrhoea.
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16
Q

SYSTEMIC SIDE EFFECTS OF OCULAR MEDICATIONS: SYMPATHOMIMETICS (ADRENERGIC AGONISTS)

Study These Flashcards
A

MYDRIATICS & CYCLOPLEGICS, DECONGESTANTS, AGENTS USED IN GLAUCOMA

  1. Hypertension.
  2. Cardiac arrhythmias.
17
Q

MYDRIATICS & CYCLOPLEGICS

SYMPATHOMIMETICS

Study These Flashcards
A

Examples: phenylephrine HCl 2,5%.

MOA:

  • Dilate the pupil by stimulating dilator pupillae.
  • No cycloplegic effects.
  • Mydriasis is not as fast or as complete as with parasympatholytic agents.
  • Used in combination with parasympatholytics.

Side effects:
- 10 % solution cause cardiovascular side effects

18
Q

NSAIDS

Study These Flashcards
A

Examples:

  • indomethacin (Indocid®)
  • Na diclofenac (Naclof®)

MOA:
inhibit enzyme cyclooxygenase involved in prostaglandin synthesis.

Indications

  • after surgery
  • ocular allergies.
19
Q

Agents used in glucoma

Study These Flashcards
A

Examples:

  • Cholinergic agonists:pilocarpine
  • Adrenergic agonists: adrenaline, apraclonidine (Iopidine®), brimonodine (Alphagan®)
  • Nonselective β-blockers: timolol maleate (Timoptol®), levobunolol (Betagan®)
  • Cardioselective β-blockers: betaxolol (Betoptic®)
  • Carbonic anhydrase inhibitors: acetazolamide, dorsolamide, brinzolamide.
  • Prostaglandin agonists: latanoprost, bimatoprost, travoprost.
  • hyperosmotic–> acute angle closure glaucoma

MOA:
intraocular pressure in an attempt to prevent optic nerve damage.

20
Q

Antiallergy agents

Study These Flashcards
A

Examples and MOA

  • Lodoxamide (Alomide®): mast cell stabiliser and eosinophyl chemotaxis inhibitor.
  • Spaglumate (Naaxia®): Mast cell stabiliser. Prevents complement opsonisation. Inhibits biosynthesis of leucotrines.
  • Sodium chromoglycate 2% (Opticrom®): Mast cell stabilisers for vernal conjunctivitis.
  • Olopatidine (Patonol®): Antihistamine+mast cell stabiliser. >1000 times more selective for H1 than H2 receptors.
  • Epinastine HCl (Relestat®): Fast and long acting: 12 hourly dosage. Mast cell stabiliser. Prevents histamine binding to both H1 and H2 receptors.
  • Ketotifen (Zaditen®): Antihistamine, mast cell stabilizer and IgE inhibitor.
  • Levocabastine (Livostin®): Antihistamine nasal spray
  • Emedastine (Emadine®): Second generation, selective H1-receptor antagonist. Non-sedating. Dosage: 2 x /day.
  • Naphazoline (vasoconstrictor) and antazoline (anti-histamine) - (Antistin Privine® and Spersallerg®).

Mast cell inhibitor:
Lodoxamide (Alomide®)
Spaglumate (Naaxia®)
Sodium chromoglycate 2% (Opticrom®)

Anti Histamine:
Levocabastine (Livostin®)
Naphazoline (vasoconstrictor) and antazoline (anti-histamine) - (Antistin Privine® and Spersallerg®).

Combination:
Olopatidine (Patonol®)
Epinastine HCl (Relestat®)
Ketotifen (Zaditen®)

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