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II. Ocular Pharmacology > Dosing (M1) > Flashcards

Dosing (M1) Flashcards

1
Q

What are the “vanishing” preservatives that are denatured by light (Brand and product names)?

A
  1. Purite (Refresh and Alphagan P)

2. OcuPure (Blink)

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2
Q

What are the “vanishing” preservatives that are denatured by the enzymes in tears (Brand and product names)?

A
  1. Sodium Perborate (GenTeal and TheraTears)

2. SofZia (Travatan-Z)

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3
Q

When is a cycloplegic refraction required?

A
  1. Infants, toddlers, and peds patients
  2. Latent hyperopes
  3. Pseudomyopia, accommodative spasm
  4. Esotropia, high esophoria
  5. Pre-op refractive surgery
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4
Q

What is the combination used for DFE of first eye exam pediatric populations?

A
  1. 1gt 1% tropicamide

2. 1% cyclopentolate

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5
Q

What are the guidelines for prescribing when off-label?

A
  1. make clinical sense
  2. some clinical judgement or support (case reports, etc)
  3. disclose to patient
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6
Q

For mild to moderate inflammation, what is the common steroid dosage?

A

QID x 7 days

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7
Q

For moderate to severe inflammation, what is the common steroid dosage?

A

pulse dose of q1-2h x 1-2 days then QID for 5-6 days

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8
Q

What is the initial steroid dosage (with proper medication) for uveitis?

A

Q1h with Pred Forte or Q2h with Durezol

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9
Q

When is steroid tapering necessary?

A
  1. high dosage (>QID)

2. long duration or treatment (>10 days)

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10
Q

What are the steps needed to taper a steroid initially dosed at q1hr x 5 days?

A
  1. dec to q2hr x 5d
  2. dec to QID x 5d
  3. dec to BID x 5d
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11
Q

What are the therapeutics used following PRK (photorefractive keratectomy)?

A
  1. Voltaren
  2. steroids
  3. bandage CL
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12
Q

What are the off-label uses for topical NSAIDs?

A
  1. Post PRK/refractive surgery
  2. Corneal abrasion/erosion/Post FB removal
  3. Bullous keratopathy
  4. pre/post Betadine Tx
  5. GP contact lens adaptation
  6. Allergic conjunctivitis
  7. cystoid macular edema (CME) prevention/Tx
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13
Q

What is the indication where oral NSAIDs are indicated as the Tx of choice?

A

scleritis

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14
Q

What are the oral NSAIDs used (and their dosage) in the Tx of scleritis?

A
  1. Naproxen (500 mg BID)
  2. Indomethacin (25mg TID)
  3. Ibuprofen (400-600mg QID)
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15
Q

What are the oral NSAIDs used (and their dosage) for pain?

A
  1. Ibuprofen (400-600mg QID; max is 2400mg/24hrs)
  2. ketoprofen (50mg q6-8h)
  3. Naproxen (up to 250-500mg BID)
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16
Q

What is an alteration in management of prescribing Restasis with the example?

A
  1. steroid trial to see if inflammatory so Lotemax QID x 2wk

2. dose with steroid and taper off steroid eventually BID x 2wks then D/C

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17
Q

What is the main medication used for uveitis (and the dose)?

A
  1. pred acetate, Pred Forte DAW (every 1 hr initially)

2. durazol (every 2 hrs initially)

18
Q

When should additional anti-inflammatory options be used to treat uveitis besides just topical steroids?

A
  1. no improvement on topical therapy

2. posterior uveitis

19
Q

What are the additional treatments used for posterior uveitis (with the medications used)?

A
  1. subtenons steroid injection (triamcinolone or methylprednisolone)
  2. intraocular steroid injection (triamcinolone)
  3. intravitreal implant (Retisert (flucinolone) or Ozurdex (dexamethasone))
  4. systemic steroids (oral prednisolone or methylprednisolone)
  5. oral immunosuppressive agents (cyclosporine, methotrexate, humira)
20
Q

What are the cycloplegics used to treat uveitis (and benefit of each)?

A
  1. Atropine (long duration)
  2. Homatropine (works for a few days)
  3. Cyclopentalate (more available and works for a few days)
21
Q

What are the common treatment protocol (drug and how often taken) for mild to moderate uveitis?

A
  1. pred forte (q1hr) or durezol (q2hr)

2. 5% homatropine (tid) or 1% cyclopentolate (tid)

22
Q

What are the common treatment protocol (drug and how often taken) for moderate to severe uveitis?

A
  1. pred forte (q1hr) or durezol (q2hr)

2. 1% atropine (bid)

23
Q

What is the medication (with how often taken) to prevent posterior synechiae?

A

1% cyclopentolate (tid)

24
Q

What is used to break a posterior synechiae?

A
  1. 1% atropine bid

2. if still persists then 2.5-10% phenylephrine bid

25
What are the topical anti-glaucoma agents used to treat steroid-induced glaucoma while there is a uveitis?
1. Beta blocker 2. alpha agonist 3. carbonic anhydrase inhibitor
26
What anti-glaucoma agent is contraindicated for the treatment of steroid-induced glaucoma with a uveitis (and why)?
1. pilocarpine (opens blood-aqueous barrier so worsens uveitis and causes pain) 2. prostaglandins (inflammatory mediator)
27
How long is the use of hyperosmotic agents in the prevention of recurrent corneal erosions following EBMD usually? 1. What is an alternative to this treatment? 2
1. 3 months | 2. PTK surgery
28
What is the standard treatment groups for acute allergic conjunctivitis or seasonal flare-ups?
1. topical antihistamine/mast cell stabilizers 2. topical steroids 3. oral antihistamines
29
What is the standard treatment groups for chronic/year round allergic conjunctivitis?
1. topical antihistamine/mast cell stabilizers | 2. oral antihistamines
30
What are the aspects of a illness script?
1. epidemiology 2. temporal pattern 3. syndrome statement
31
What is the illness script for episcleritis?
1. epi: young adults without underlying immunological disease 2. temp. pattern: acute, recurrent 3. SS: unilateral, sectoral injection with a pattern of superficial conjunctival vessels that move on manipulation and blanch with phenyl. No signs in anterior chamber, palpebral conj, or cornea and little eye discomfort
32
What is the illness script for solution toxicity?
1. epi: any reusable CL wearer 2. TP: acute 3. SS: bilateral presentation of red eyes that can be diffuse but is more often circumlimbal. Presents with irritation, photophobia, and tearing. Often hav punctate keratitis in diffuse or annular pattern
33
What is the illness script for EKC?
1. epi: 2. TP: acute and recurrent 3. SS: bilateral large, fluffy infiltrates in subepithelial layer with injection and clear discharge.
34
What is the illness script for epithelial basement membrane dystrophy?
1. epi: hx of penetrating corneal injury 2. TP: chronic, recurring 3. SS: bilateral or unilateral with a white and quiet conj, smooth infiltrates and worse pain in morning with recurrent corneal erosions
35
What is the illness script for Thygessons superficial punctate keratopathy?
1. epi: any age 2. TP: long course of weeks to months 3. SS: immunological inflammatory keratitis that presents with photosensitivity with a white eye. Granular infiltrates are throughout the epithelium of the cornea
36
What is the illness script for superior limbic keratoconjunctivitis?
1. epi: middle-aged females with thyroid dysfunction 2. TP: chronic with remissions and exasperations 3. SS: Bilateral superior sectoral injection, sandy and gritty irritation, limbal greyness from heaped up dead cells
37
What is the illness script for nodular scleritis?
1. epi: middle-aged to elderly with underlying systemic diseases 2. TP: chronic with remissions and exasperations 3. SS: present with painful red eye with deep diffuse or sectoral injection. Will not blanch with phenyl or move on manipulation. Can have blue/purple hue
38
What is the illness script for acute allergic conjunctivitis?
1. epi: anyone 2. TP: acute, chronic, or seasonal 3. SS: bilateral presentation with itch (often made worse by rubbing eyes), diffuse injection, can have bulbar conj reaction, palpebral injection and rope discharge
39
What is the illness script for contact dermatitis?
1. epi: taking drops or applying ointment or cream 2. TP: acute 3. SS: bilateral allergic inflammation concentrated on periorbital adnexa with no eye inflammation. Has follicular conjunctivitis in palpebral conj but not swollen
40
What is the illness script for giant papillary conjunctivitis?
1. epi: CL wearers, prosthetics, post surgical 2. TP: chronic 3. SS: giant papillae (>0.4mm) in superior palpebral conjunctiva with a papillary reaction in inferior lid
41
What is the illness script for vernal keratoconjuntivitis?
1. epi: male, teenage 2. TP: acute with recurrence in spring or summer 3: SS: trantas dots along limbus, sever bilateral itch and can't open eyes, cobblestone like papillae, purulent discharge, shield ulcer

II. Ocular Pharmacology (18 decks)

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