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Theory & Methods > Diagnostic Ophthalmic Agents: Drops > Flashcards

Diagnostic Ophthalmic Agents: Drops Flashcards

1
Q

What chemical class group is proparacaine in? What is another name for proparacaine?

A

Meta-aminobenzoic acid esters
AKA Proxymetacaine

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2
Q

What percent of ophthalmic solution is proparacaine?

A

0.5%

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3
Q

How long does proparacaine last?

A

10-20 minutes

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4
Q

Mechanism of action for proparacaine (3)

A

1) Selectively blocks conductivity of sodium ion permeability
2) Inhibits action potential
3) Changes in phospholipid bilayer of cell membrane and blocks nerve signals

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5
Q

Proparacaine effects on ocular surface

A

1) Anesthetizes the surface which decreases blink reflex and removes touch sensation.
2) Opens intracellular spaces of corneal epithelium

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6
Q

When do you use proparacaine?

A

For any procedures when we have to touch the eye or before using dilating drops.

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7
Q

Side effects of proparacaine

A

-May delay wound healing
-Prolonged use can cause corneal opacification
- may cause cytotoxicity and diffuse epithelial keratitis.
-may cause conjunctival redness

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8
Q

What is fluress made of?

A

Componen74s.
0.25% sodium flourescein
0.4% benoxinate hydrochloride (oxybuprocaine (anesthetic))

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9
Q

What is the shelf life of fluress?

A

18 months

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10
Q

What chemical class group is fluress in?

A

Para-aminobenzoic acid ester

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11
Q

Ocular side effects for fluress

A

burning, stinging,redness, blur (rare)

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12
Q

What color light filter do you use when using the fluress dye?

A

blue

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13
Q

What do you see on a positive stain when using fluress? What things could potentially give a positive stain?

A

You see hyperfluorescent areas.
Could be due to superficial punctate keratitis (SPK), corneal ulcers, or corneal abrasions.

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14
Q

If you use fluress and see hyperfluorescent dots, what are you looking at? How is it documented?

A

Dots = superficial punctate keratitis
Documentation: graded trace to 4+, and then note the location of the dots.

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15
Q

If you use fluress and see hyperfluorescent round stains, what are you looking at? How is it documented?

A

Round stains = corneal ulcers
Documentation: Note location, measure to track progression over time

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16
Q

If you use fluress and see hyperfluorescent scratches, what are you looking at? How is it documented?

A

Scratch = corneal abrasion
Documentation: Note location

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17
Q

What do you see on a negative stain when using fluress? What things could potentially give a negative stain?

A

You would see hypoflourescent areas.
Could be due to raised lesions or epithelial basement membrane dystrophy (EBMD).

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18
Q

If you use fluress and see a hypoflourescent raised lesion, what could you be looking at?

A

scarring or neoplastic lesion

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19
Q

If you use fluress and see hypoflourescent shapes (maps, dots, fingerprints), what could you be looking at?

A

Various shapes (dots maps, fingerprints) = EBMD (epithelial basememnt bembrane dystrophy.) AKA map dot dystrophy

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20
Q

What are the 5 ophthalmic dyes?

A

1) Flourescein
2) Lissamine Green
3) Rode Bengal
4)Tryptan Blue
5) Indocyanine Green

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21
Q

How much dye is in fluorescein strip?

A

0.6-1 mg of dye

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22
Q

What is fluorescein made of?

A

Fluress ophthalmic solution with benoxinate (anesthetic)

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23
Q

How can fluorescein be administered for fluorescein angiography?

A

Oral or IV injection

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24
Q

What are some properties of fluorescein?

A

Orange, water soluble dye
Absorbs blue light at 490nm and emits yellow-green at 530nm

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25
Q

What color light filter do you use with fluorescein?

A

Blue filter

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26
Q

What would you use fluorescein for?

A

-Ocular surface diseases/ dry eye
-Identifying corneal epithelial defects/abrasions/ulcers
-Applanation tonometry
-Perforating injury or surgery
-Nasolacrimal duct patency
-Rigid contact lens fitting
-Intravenous fluorescein angiography

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27
Q

What concentrations does lissamine green come in?

A

1%, 2%, 3%

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28
Q

How many mg of lissamine green are on strips?

A

1.5 mg

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29
Q

What color light does lissamine green absorb?

A

Absorbs red light (630 nm)

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30
Q

When an area is stained with lissamine green and a red-free filter is applied, what does the stained area look like?

A

Stained area is black.

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31
Q

What does lissamine green stain?

A

Dead and degeneerated cells including mucous strands

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32
Q

When would you use lissamine green?

A

-Diagnosis of dry eye
-In Sjogren’s syndrome, suspects to rule out keratoconjunctivitis sicca
-to access contact lens-induced conjunctival staining
-Assess lid margins for lid wiper epitheliopathy

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33
Q

How much dye is on Rose bengal strips?

A

1.3 mg dye

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34
Q

What does rose bengal stain?

A

dead and devitalized cells, including mucous strands

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35
Q

What should you warn your patients about before administering rose bengal?

A

Make patients eye red due to ocular toxicity

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36
Q

What would you use rose bengal for?

A

-Corneal staining for herpetic corneal epithelial dendrites
-Diagnosis of dry eye disease
-dysplastic or squamous metaplastic cells of conjunctival squamous neoplasm

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37
Q

What 5 things would you use tryptan blue for?

A

1)Anterior capsular staining
2)Descemets stripping endothelial keratoplasty
3)Deep anterior lamellar keratoplasty
4)Posterior segment surgeries
5)Enucleation surgery for Tenon’s capsule

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38
Q

What purpose does tryptan blue have for enucleation surgeries for tenons capsule?

A

Stains tenon’s capsule

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39
Q

What purpose does tryptan blue have for posterior segment surgeries?

A

To stain the ERM

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40
Q

What purpose does tryptan blue have for deep anterior lamellar keratoplasty?

A

Strips corneal endothelium from donor

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41
Q

What purpose does tryptan blue have for descemets stripping endothelial keratoplasty?

A

To stain and strip Descemet’s membrane

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42
Q

What purpose does tryptan blue have for anterior capsule staining?

A

Useful in eyes with a decreased red reflex, or weak zonules, as the dye can immediately allow the surgeon to detect a radial shift of the capsular bag

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43
Q

What is indocyanin green used for?

A

Staining the anterior capsule during cataract surgery

44
Q

In chromovitrectomy, what does indocyanine green do?

A

Helps visualize the ILM

45
Q

What do cycloplegias do?

A

Paralyse the ciliary muscle
Reduce accomodation

46
Q

Dilation of the pupil

A

Mydriasis

47
Q

What anatomical structures do cycloplegics and mydriatics effect?

A

Iris dilator muscle
Iris sphincter muscle
Ciliary Body

48
Q

What are two cycloplegics and mydriatics used in this class?

A

Phenylephrine
Tropicamide

49
Q

What drop contracts the radial dilator muscle of the iris causing a dilation of the pupil?

A

Phenylephrine

50
Q

Is phenylephrine direct-acting sympathomimetic or indirect-acting?

A

Direct acting

51
Q

What 3 effects does phenylephrine have?

A

1)Contraction of the radial dilator muscle of the iris = dilation of pupil
2)Vasoconstriction of blood vessels = conjunctival blanching
3) Widening of the palpebral aperture

52
Q

How long does phenylephrine last?

A

up to 6 hours

53
Q

If a bottle of phenylephrine had a concentration of 0.12%, what would it be used for? How many times do you take it a day? How many drops? How many days?

A

Used for ocular decongestant
Treats ocular allergies/redness
1 drop 0.12% solution every 3 to 4 hours for 1-2 days.

54
Q

If a bottle of phenylephrine had a concentration of 2.5%, what would it be used for?

A

It functions as a mydriatic.
Used in routine pupil examination or Pre/Post operative ocular surgery.

55
Q

For a routine eye exam, what drop of phenyl do you use to dilate the pupil? How long does it take for the effect?

A

1 drop of 2.5% phenylephrine solution
Achieves effect in 15-20 minutes

56
Q

For a pre/post-operative exam on an adult, what drop do you use to dilate the pupil? How early before surgery would you apply the drop?

A

1 drop 2.5% or 10% of phenylephrine
Apply 30-60 minutes before surgery.

57
Q

For a pre/post-operative exam on a child, what drop do you use to dilate the pupil? How early before surgery would you apply the drop?

A

1 drop 2.5% solution of phenylephrine
Apply 30-60 minutes before surgery

58
Q

A bottle of phenylephrine has a concentration of 10%, what is it used for?

A

Used to break posterior synechia

59
Q

Common side effects for phenylephrine (5)

A

Burning
Tearing
Photophobia
Brow ache
headache

60
Q

What are 6 rare systemic side effects of phenylephrine 10%?

A

1) Tachycardia
2) High Blood Pressure
3) Sweating
4) Trembling
5) Dizziness
6) Paleness

61
Q

In what patients would you caution the use of phenylephrine? (5)

A

1) Severe cardiac disease
2) Systemic hyper or hypotension
3) Insulin-dependent diabetes
4) Aneurysms
5) Advanced arteriosclerosis

62
Q

What concentrations does phenylephrine come in?

A

0.12%, 2.5% , 10%

63
Q

True or false:
Tropicamide is a muscurinic receptor antagonist.

A

True

64
Q

How does tropicamide work? What does it cause?

A

Blocks the muscarinic receptors in the iris sphincter muscle. Causes strong mydriasis but weak cycloplegia.

65
Q

What concentrations does tropicamide come in?

A

0.5% and 1%

66
Q

How long does tropicamide last?

A

6 hours

67
Q

For routine eye exams, what drop of tropicamide would you use? How long does it take to achieve the effect?

A

Either 0.5% or 1%.
Takes 15-20 minutes to achieve effect

68
Q

For routine eye exams, what drop of tropicamide would you use? How long does it take to achieve the effect?

A

Either 0.5% or 1%.
Takes 15-20 minutes to achieve the effect

69
Q

For weak cycloplegic refraction, what drop of tropicamide would you use for adults and kids?

A

Adults: 1 drop of 1% solution followed by 1 drop in 5 minutes

Children: 1 drop of 0.5% solution followed by 1 drop in 5 minutes

70
Q

For pre/post-op surgery, what drop of tropicamide would you use? Is it before or after the dilation drop (phenyl)

A

1 drop of 1% tropic amide before the dilation drops of phenylephrine.

71
Q

Ocular side effects of tropicamide

A

Blurry vision at near and distance

72
Q

When performing a routine exam on new patients, dark irides, pre-existing retinal disease, risk of peripheral posterior segment disease, or history of ocular surgery, what drops would I use to dilate the patient?

A

Tropicamide(1%) followed by Phenylephrine(2.5%)

73
Q

What are different combinations of tropicamide and phenyl that you can use in a routine eye exam?

A

Tropicamide(1%)
Phenylephrine(2.5%)
Tropicamide(0.5%) + Phenyl (2.5%)
Tropicamide (1%) + Phenyl (2.5%)

74
Q

What might cause you to add more drops or use punctal occlusion when dilating?

A

When the patient has:
-narcotic drug use
-iris pathology/damage
-prior ocular surgery
-dark irides.

75
Q

Why do darker irides take longer to dilate?

A

Melanin competes with receptor sites for the active ingredients in the eye drop. It can reduce the overall effect of the drops

76
Q

Why would you caution use of cycloplegics/mydriatics in patients with chromosomal that have intellectual defects?

A

Condition can be aggravated by the instillation of drops

77
Q

Why would you caution use of cycloplegics/mydriatics in patients with low birth weight and/or premature infants with respiratory distress syndrome?

A

Can cause risk of vomiting, bradycardia, hypotonia, and aspiration

78
Q

What may happen when using cycloplegics/mydriatics in patients who are diabetic?

A

Can cause a denervated pupil and result in poor dilation. May need to add more drops.

79
Q

What may occur in a geriatric patient when using cycloplegics/ mydriatics?

A

Senile myosis. May need to add more drops
(Usually isn’t a concern)

80
Q

Is there a concern of using cycloplegics/mydriatics on pediatric patients?

A

No

81
Q

What is Paremyd a combination of? What effect does it provide? What may it not work as well on?

A

Tropicamide(0.25%), Hydroxyamphetamine(1%)
Good dilation with minimal effect on accomodation.
Expensive.
May not work well against patients with dark irides, diabetics, or older patients

82
Q

What is Cyclopentate a combination of? What concentrations does it come in?

A

Parasympatholytic / Antimuscarinic
0.5%, 1%, 2%

83
Q

What would you use Cyclopentate for?

A

1) Cycloplegic refraction (wet)
2) Pupil dilation
3) Uveitis treatment

84
Q

For a cycloplegic refraction, what combo drop may you use? (Adults/children, infants) How long does it take to get effect?

A

Adults/Children: 2 drops of cyclopentate(1%) 5 minutes apart. Effect in 30-45 minutes.

Infants: 1 drop(0.5%)

85
Q

For pupil dilation using cyclopentate, what is the dosing?

A

Adults/Children: 2 drops of cyclopentate(1%) 5 minutes apart. Effect in 30-45 minutes.

Infants: 1 drop(0.5%)

86
Q

For uveitis treatment using cyclopentate, what is the effect? What is the dosing?

A

-Prevent anterior/posterior synechiae
-Reduce pain – immobilize iris.
1 drop of 1% or 2% 2-3 times per day

87
Q

Ocular side effects for cyclopentate.

A

Blurred vision, photophobia, stinging

88
Q

Systemic effects of cyclopentate in adults.

A

Clumsiness/unsteadiness
confusion
constipation
full feeling
passing gas
stomach cramps
tachycardia
hallucinations
skin rash
slurred speech
disorientation
increased thirst
dry mouth

89
Q

Systemic effects of cyclopentate in infants/children.

A

swollen stomach
restlessness
hyperactivity
drowsiness
weakness

90
Q

What is the length of dilation for cyclopentate?

A

6-24 hours

91
Q

MOA of tropicamide and cyclopentate

A

Compete with acetylcholine at affected receptor site of iris sphincter and ciliary muscle.

92
Q

Tropicamide vs. Cyclopentate:
Which is better with mydriasis of the pupil?

A

Tropicamide

93
Q

Tropicamide vs. Cyclopentate:
Which is better at paralyzing accommodation?

A

Cyclopentolate

94
Q

What are the 3 dilation combo drops?

A

Paremyd
Cyclopentate
Atropine

95
Q

What could you use atropine for?

A

Uveitis treatment
Dialted eye exams

96
Q

When treating Uveitis with Atropine, what is the dosing for adults and children?

A

Adults: 1 drop of 1% atropine 1-2 times a day.

Children: 1 drop of 1% atropine 1-3 times a day

97
Q

When using atropine for dilated eye exams, what is the dosing for adults and children?

A

Adults: varies

Children: 1 drop of 1% atropine 1-3 days PRIOR to examination

98
Q

How long does the mydriasis effects of atropine last for?

A

Up to 15 days

99
Q

How long does the cycloplegia effects of atropine last for?

A

up to 120 minutes (2 hours)

100
Q

What is the onset of action for atropine?

A

30-40 minutes

101
Q

True or false:
Atropine also comes in an ointment form.

A

True

102
Q

Systemic side effects of atropine for adults

A

Clumsiness/unsteadiness
confusion
constipation
full feeling
passing gas
stomach cramps
tachycardia
hallucinations
skin rash
slurred speech
disorientation
increased thirst
dry mouth

102
Q

Systemic side effects of atropine for children

A

swollen stomach
restlessness
hyperactivity
drowsiness
weakness

103
Q

What are you warned against using atropine?

A

When patient has:
History of brain damage
Down’s Syndrome
Angle Closure Glaucoma
Spastic Paralysis

104
Q

For Atropine 1%, what is the onset and duration of effects?

A

Onset: 40 minutes
Duration: 7-14 days

105
Q

For Cyclopentate (0.5% or 1%), what is the onset and duration of effects?

A

Onset: 20-45 minutes
Duration: 6-24 hours; up to several days

106
Q

For Tropicamide (0.5% or 1%), what is the onset and duration of effects?

A

Onset: 15-30 minutes
Duration: Up to 3-8 hours; up to 1 day

Theory & Methods (11 decks)

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