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Methods BLOCK 3 > Anesthetics And Methods Of Drop Delivery > Flashcards

Anesthetics And Methods Of Drop Delivery Flashcards

1
Q

What is the reason we use topical ocular anesthetic

A

Used to prevent eye pain during several procedures

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2
Q

Use topical ocular aesthetics to prevent eye pain during:

A
  • diagnostics testing and procedures
  • applanation tonometry
  • gonioscopy
  • ophthalmic examinations
  • removal of foreign bodies or sutures
  • surgery
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3
Q

What are some commonly used anesthetics used?

A
  • cocaine
  • tetracaine
  • benoxinate
  • proparacaine
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4
Q

Mechanism of action of topical anesthetics

A
  • blocks nerve conduction to superficial cornea and conjunctiva by disabling the ability of the nerve cells to generate an action potential
  • suppresses corneal and conjunctival sensitivity
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5
Q

Efficacy of topical anesthetic

A

-determined by their ability to suppress corneal sensitivity

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6
Q

Combining two ore more topical anesthetics

A

Does not produce an additive effect, but does increase the risk of slide effects

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7
Q

Side effects of topical ocular anesthetics

A

Severe local reaction are rare, systemic reaction are even more uncommon

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8
Q

Ocular toxicity of topical of anesthetic

A
  • mild stinging and burning
  • desquamation of corneal epithelium
  • retards epithelial healing
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9
Q

What the most common side effect

A

Mild stinging and burning

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10
Q

What can increase the risk of adverse effects of topical anesthetic

A

Self medication

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11
Q

System toxicity of ocular anesthetic

A

Overdose from topical administration theoretically possible

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12
Q

Local hypersensitivity reactions to anesthetics

A
  • Allergy can develop due to repeat exposure (glaucoma patients)
  • mild transient blepharoconjunctivitis occurring 5-10 minutes following instillation
  • little cross reactivity among topical anesthetics
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13
Q

Cross reactivtiy among topical anesthetics

A

Little cross reactivity

Usually only sensitive to one drug

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14
Q

Systemic hypersensitivity reactions to local anesthetics

A

No lifer threatening reactions reported

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15
Q

Self administration of topical anesthetic

A
  • risk of adverse effects due to corneal toxicity

- vision loss secondary to permanent scarring

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16
Q

Hypersensitivity to topical anesthetics

A

Substitute different agent; little cross-sensitivity

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17
Q

Topical anesthetic and cultures

A
  • they are toxic to micro organisms plus proparacaine least toxic
  • will making getting a culture of bacterial infection difficult
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18
Q

Dry eye testing and topical anesthetics

A

-epithelial toxicity can confuse clinical picture

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19
Q

Pachymetry and topical anesthetics

A

Transient corneal swelling following anesthetic use

20
Q

Perforating injuries and topical anesthetics

A

Endothelial toxicity

21
Q

what is the concentration of proparacaine?

A

0.5% soln

22
Q

How should proparacaine be stored?

A

In a tightly capped, opaque, and (ideally) refrigerated container to retard degradation

23
Q

What should you do if proparacaine shows more than a faint yellow color?

A

It should not be used

24
Q

Systemic toxicity of proparacaine

A

Extremely low

25
Q

Penetration of proparacaine

A

Poor penetration of the conjunctiva and cornea

-quick to work, quick to wear off

26
Q

Which is the least bacteriocidal of the topical anesthetics?

A

Proparacaine

27
Q

Order of topical anesthetics in corneal toxicity from high to low

A

Tetracaine
Proparacaine
Benoxinate

28
Q

Which topical anesthetic is least uncomfortable?

A

Proparacaine

Use prior to routine office procedures

29
Q

Duration of action of proparacaine

A

Onset 10-20s

Duration 10-20 min

30
Q

Contraindications and precautions of proparacaine

A
  • corneal thickness instability lasting 5 minutes

- pregnancy category C (not completely safe to use if pregnant

31
Q

Side affects of proparacaine

A

Allergy (rare)

32
Q

Goal of eye drop instillation

A

To deliver a full dose of the drug to the eye while minimizing systemic exposure and maximizing patient safety and comfort

33
Q

What is the preferred method for routine eye drop instillation?

A

Inferior fornix delivery

34
Q

Why is inferior fornix delivery the preferred method for routine eye drop instillation?

A
  • maximizes ocular contact time of drug
  • minimizes drug loss
  • increases ocular absorption
  • and decreases systemic absorption
35
Q

Steps for inferior fornix delivery

A
  • tilt head back
  • tell pt to look up
  • pull lower lid away from globe
  • check expiration date, shake and remove cap
  • instill gt in lower eyelid (hold about 1” above the pocket)
  • AVOID CONTAMINATION OF TIP
  • place drop on conjunctiva, not cornea
  • close eyes gently for 3 min
  • apply pressure to puncta
36
Q

Purpose of punctual occlusion after eye drops

A
  • minimize drainage of medication into nasolacrimal apparatus, thereby maximizing ocular contact
  • decrease systemic absorption of drug through nasal mucosa, minimizing risk of systemic adverse effects
37
Q

Method of punctual occlusion after eye drops

A

Following eye drop instillation, instruct patient to close his eyes and apply gentle pressure to the medial canthal region for about 3 minutes

38
Q

Recording eye drop instillation

A

-record name of the pharmaceutical agents used, including its cxn, how many drops used in each eye, and time of day

1 gt of 0.5% proparacaine OD and OS @ 11.35 AM

39
Q

Alternatives to the instillation of eye drops

A
  • medial canthus delivery
  • spray bottle
  • pledgets
40
Q

Medial canthus delivery of eye drops

A

A lower anxiety technique for persons unable to cooperate with inferior fornix delivery

41
Q

Technique for medial canthus delivery

A
  • Head inclined back
  • eyes closed
  • eye drops placed on top of medial canthus
  • patient instructed to blink repetitively
42
Q

Spray bottle technique

A
  • mist applied to closed lids with spray bottle and the patient be instructed to blink
  • excess solution should be wiped off
  • a second spray might be necessary, especially if the eyes were closed too tightly
43
Q

Advantages of spray bottle

A
  • efficacy reported to be equivalent as ophthalmic drops and more tolerable
  • patients were more compliant and experienced less burning when the spray was used than when the ophthalmic drops were used
44
Q

Disadvantages to spray bottle

A
  • inability to deliver precise dosage
  • lack of an established dose-response relationship for this type of administration
  • potential for drug contamination
  • most ophthalmic medications are not currently formulated for this type of application
45
Q

Pledgets

A
  • cotton swab saturated with drug solution then placed in the eye
  • permits very long or very short contact time
  • useful of inferior sector dilation, breaking synechia

Methods BLOCK 3 (6 decks)

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