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diagnostic drugs Flashcards

1
Q

What is mydriatics?

A

used to dilate the pupil ( open up)

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2
Q

what is the importance of mydriatic drugs?

A

expansion of co management schemes ( primary open angle glaucoma
-increase in professional negligence cases

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3
Q

what conditions do you dialate?

A 
Diabetes 
uveitis 
pigmented fundus lesion
hypertension 
suspected glaucoma 
FH of retinal detachment 
peripheral retinal degeneration 
cataract 
AMD
history of metastic cancer
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4
Q

which symptoms do you dilate?

A
  • -Flashes or floates
  • –new distortion
  • -unexplained vision loss
    • recent blunt force trauma
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5
Q

which px do you dilate?

A 
nystagmus 
squint 
stereoscopic view of retina 
systemic mediactions with potential side effects 
get good fundus photograph
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6
Q

what are the benefits for dilation?

A

ability of ophthalmoscopy to grade correctly diabetic retinopathy more 50% through dilated pupil than through undilated pupil

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7
Q

What Myrdiatics are use?

A

Tropicamide 0.5%
Tropicamide 0.1%
Phenlepharine

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8
Q

when using drugs what do you have to remember under collage of optometrist guidelines?

A

batch number
dosage
date of expiry

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9
Q

what precautions do you take with mydriasis ?

A 
prev experience of mydriatic and allergy
medical history 
current medication 
iop measurment 
assessment of risk of angle closure glaucoma
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10
Q

what is most risk of px getting with mydriatics?

A

acute attack of ACG

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11
Q

what do you need to tell patient?

A 
what mydriatics are for 
duration 
stings 
risks
glare problems
temp vision reduced
drivingh difficulties
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12
Q

what is the risk of provoking acute ACG?

A

more risk with phenlyepharine

no risk with tropicamide

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13
Q

what other points do you need to note for acute ACG?

A

if someone has very narrow angle should refer anyway as at high risk of attack of ACG at any time.

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14
Q

if px has suspect of retinal detachment wet AMD etc what do you do?

A

if px has retinal detachment and wet AMD you cannot obtain sufficient view must either dilate or refer on worst case scenario

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15
Q

how do you assess angle closure?

A 
Van herick 
or hospital - gonioscopy 
flashlight test 
smith's slit- lenth method
methods using pachmymeters]
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16
Q

During dilation what is the most common problem?

A

glare

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17
Q

what do drivers need to be told when dilated?

A

it is recommended that driving should be avoided whilst your vision is affected

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18
Q

what is tropicamide?

A

tropicamide is an anti muscarinic drug which causes mydriasis by relaxing the sphincter muscle of the iris and cycloplegia by relaxing the ciliary muscle

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19
Q

what is the onset of action of tropicamide?

A

10-30 mins

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20
Q

what is the max effect of tropicamide?

A

20-40 mins

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21
Q

what is recovery to normal of tropicamide?

A

4-9 hours

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22
Q

how do drugs duration in patient vary?

A

individual responses to drugs are very variable

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23
Q

what are risk associated with tropicamide?

A
  • few allergic reaction
  • CNS affected can occur with cyclopentalate
  • risk of ACG in predisposed eye
  • be careful with possible interaction with other anti mscarinic drugs
24
Q

What is Phenylepharine?

A

A sympathomimetic drug which causes mydriasis by stimulating the dilator muscle of the iris

25
Q

what is not complete with phenylepharine

A

mydriasis not complete

light not abolished

26
Q

what do you use if patients are difficult to dilate?

A

tropicamide+ phenylepharine

27
Q

what is the onset action of phenylepharine?

A

10-30 mins

28
Q

what is the max affect of phenylepharine?

A

30-90 mins

29
Q

what is the recovery to normal for phenylepharine?

A

5-12 hours

30
Q

when should u not use phenylepharine ?

A

px with vascular hypertension & long standing insulin dependent diabetes ( type 1)
long standing bronchial asthma
cerebral arteriosclerosis

31
Q

what does cycloplegic drugs do?

A

drug is used to produce cycloplegia

partially paralyse the ciliary muscle so that accommodation is disabled

32
Q

when do you use cycloplegic drugs?

A

indication of fluctuating or excessive accommodation

33
Q

cycloplegic drug is mainly used in?

A

Children

young latent hypermetropes

34
Q

which drug is more effective if disabling accommodation in young

A

tropicamide and cyclopentolate are both cycloplegic agents but cyclopentolate is more effective at disabling accommodation in young people

35
Q

what is cycloplentolate?

A

and anti muscarinic drug which causes mydriasis by relaxing the spincter muscle and cycloplegia by relaxing the ciliary muscle

36
Q

what is cycloplentolate used for?

A

mostly used for cycloplegia not mydriasis

37
Q

what is onset action for cycloplentolate ?

A

10-30 mins

38
Q

what is max affect for cycloplentolate?

A

20-60 mins

39
Q

what is the recovery to normal for cycloplentolate?

A

within 24 hours

40
Q

what dosage if cycloplentolate available in?

A

cycloplentolate 1% cycloplentolate 5%

41
Q

what cycloplentolate is used on which px?

A

cycloplentolate 1% under 12 years age

cycloplentolate 5% over 12 years age

42
Q

which drug effect the CNS more?

A

cycloplentolate

43
Q

how does colour iris effect mydriasis?

A

drugs bind with the melanin on the iris and is slowly released.

44
Q

how does the action of mydriatics work on dark irides?

A

dark irides

  • -slower onset of action
  • longer duration of action
45
Q

how does the action of mydriatics work on light coloured irides?

A

light irides

    • quicker onset of action
  • slower duration of action
46
Q

what are local anaesthetics used for?

A

used to anaesthetise the cornea and conjunctiva

47
Q

what type anaesthetics are there?

A

ester type

amide type

48
Q

what are the ester type anaesthetics and the dosage?

A 
tetracaine hydrochloride (amethocaine) 0.5%
oxybuprocaine hydrochloride ( benoxinate) 0.4%
proxymetacaine hydrochloride 0.5% 1%
49
Q

what is the amide type of anaesthetics?

A

lidocaine 4%

50
Q

when do you use amide type anaesthetics?

A

used in previous toxic reaction to easter anaesthetics

51
Q

what should you do before giving any drugs?

A

VA
Vision
Slit lamp
IOP

52
Q

what should you tell px when putting ocular local anaesthetics?

A
  • complete anaesthesia within 1 min
  • sting on instillation
  • time to recovery varies usually 25 mins +
  • do not rub eyes
  • may cause toxic reaction check for staing before px leaves
53
Q

which drug is most uncomfortable and stings?

A

tetracaine hydrochloride (amethocaine) 0.5%

oxybuprocaine hydrochloride ( benoxinate) 0.4%

54
Q

what are the effects of prior instillation of local anaesthetics?

A

corneal penetration increased by adding local aneasthetic before tropicamide or phenylepharine to give quicker response and can lead to bigger pupils

55
Q

what is fluorescien used ?

A

contact applanation tonometry - goldmann
contact lens fitting
assessing corneal damage

56
Q

how did fluorescien come packed in?

A

fluorets ( in march 2013 by bausch and lomb)

57
Q

what is fluorescien now available in?

A

paper strip as a medical device

clinical skills (13 decks)

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