Intro to Ophthalmic pt 2 Flashcards
Ophthalmic drug classes
topical anti-infective
topical anti-inflammatory
anti-glaucoma
what types of anti-infective medications are used for the eye?
Antibiotics
Antivirals
Antifungals
What types of antibiotics are used for eye conditions?
Fluoroquinolones
Aminoglycosides
Polymyxin B combo
Others: Erythromycin, azasite
What types of antivirals are used for eye conditions?
Oral: Valacyclovir, Acyclovir
Topical: Zirgan, Viroptic, Gancyclovir, Iodine
What types of anti-inflammatory drugs are used for the eyes?
NSAIDs
Antihistamines
Dry Eye formulations: Restatis + Xiidra
Steroidal
What types of anti-glaucoma drugs are used for the eyes?
Beta-blockers Carbonic Anhydrase inhibitors Adrenergic Agonists Cholinergic Agonists Prostaglandin Agonists New: ROCK Inhibitors: Rho-kinase pathway
What are the clinical warning signs of eye conditions?
- Vision affected?
- Is there pain?
- Is it getting better or worse with the current treatment?
What are the danger signs of the red eye in patients?
- Vision loss
- Corneal cloudiness
- Severe pain
- Circumcorneal injection
- Fix mid-dilated pupil
- Unresponsive to treatment
Which conditions can be managed by primary care providers?
dry eye conjunctivitis blepharitis stye pterygium subconjunctival hemorrhage
Three forms of artificial tears and their benefits:
1) Oil-based: Replace the oils in tears and cause temporary blurry vision
2) Aqueous based: Thinner tears = temporary relief for allergies and dry eyes
3) Mucomimetics: Thicker tears that cause blurred vsion but last a longer time
Jane comes into the pharmacy and asks you to recommend something for her eye issue. She complains of “eye crusties” in the mornings, and oily secretions coming from her eyelid that is very red. Upon closer look, you can see little bumps along her eye lid.
What is the condition and likely cause? Treat or Refer?
Condition: Blepharitis
Cause: Staph/poor lid hygiene
May treat or Refer to PCP:
- Treat: Lid scrubs, massage with heat
- PCP: antibiotics, Demodex kit
Describe the contents of ophthalmic ointments:
Use petrolatum or lanolin base
- Good for night time administration due to stickiness
Which conditions can be managed by primary care providers?
dry eye conjunctivitis blepharitis stye pterygium subconjunctival hemorrhage
Jessie comes to your pharmacy complaining of itchy eyes. She says each morning she has to use a wash cloth to remove these red crusties from her eyes.
What is the condition and likely cause? Treat or Refer?
Condition: Phthirasis Palepebrarum
Causes: exposure to pubic/body lice + poor hygiene
Refer to PCP (& Public health) for “lash lice”
Tx: Avoid commerical preps in eyes
Use removal/bland ointment to smother the louse
Practice good hygiene + Fix source
A truck driver stops in at your pharmacy and complains of a bump in the eye that is red and painful. He is experiencing blurry vision as well.
What is the condition and likely cause? Treat or refer?
Condition:
1) Pinguecula - sclera (white part)
2) Pterygium - cornea
Causes: UV exposure
May treat/Refer to PCP
- Prevention = primary (hat, glasses)
- Artificial tears
- Steroids if inflamed
Lorin comes to your pharmacy complaining about how her eye feels like theres something in it and burns. She wears contacts every day.
What is the condition and likely cause? Treat or Refer?
Condition: Dry Eye Syndrome Cause: Contact lens wearers Other possible causes: - Inflammatory conditions (RA, Graves disease), - EPIPHORA: excessive watering of the eyes - Nocturnal exposure - "Bells Phenomenon" - Bells Palsy, Sjogrens - Post menopausal women - Some Medications
May treat/Refer to PCP:
OTC Products:
#1 = artificial tears
Also, lubricating ointments, Rx drops, tape lids if they open at night
A patient calls you on the phone and states that he has blood in his eye but isn’t touching the color part of his eye. It doesn’t hurt, but looks awful and he would like a recommendation on what to do.
What is the likely condition and how can you help this patient?
Condition: Subconjunctival Hemorrhage
Cause: subtle trauma or vascular disorder
May treat/Refer to PCP:
Use drops to temporarily and state that it may take 1 week to 4 weeks before it clears up.
Be aware of recurrent episodes or large hemorrhages = PCP referral
Patient presents with a red rash on the right side of her forehead around her eye are but not on the left side.
What is the condition?
Condition: Herpes Zoster Ophthalmicus
Refer to Opthalmology
Tx: Antivirals - Acyclovir or valacyclovir
Cool compress for palliative relief
Gage comes to you at the pharmacy for help with where he should go. He’s been experiencing extreme light senstivity and pain. You notice a red ring around his iris and lots of blood vessels in the sclera.
What is the condition and likely cause? Treat or Refer?
Condition: Iritis/Uveitis
Causes: trauma, autoimmune disease or idopathic
Sign: Ciliary flush, pain, light sensitivity
Refer to Opthalmology
Tx: Topical steroids + cycloplegics and artifical tears for palliative relief
Under a microscope, you notice a patient has this tree root-like or a dendritic cell.
This is a classic sign of which infection of the eye?
Can you treat or do you need to refer to a PCP or Opthalmologist?
Herpes Simplex Keratitis
Refer to Opthalmology
Tx: Antivirals + cycloplegics for palliative relief
Patient presents with severally red sclera and eye lids as well as a white spot on the cornea when a light is shined on it.
What is the condition and likely cause? Treat or refer?
Condition: Bacterial Keratitis
Cause: Bacterial infection + contact lense wearers
** Most common = pseudomonas aeruginosa **
Refer to Opthalmology
Info: Culture the ulcers, Risk of corneal perforation
Jessica comes to your pharmacy and asks you to look at her eye. It’s extremely red and has pus and mucous discharge seeping from the area. It looks worse on the upper eye after she hold her lid up.
What is the condition and likely cause? Treat or Refer?
Condition: Bacterial Conjunctivitis
Causes: Staph Aureus, Streptococcus pneumoniae
Refer to PCP
- Empiracal Tx:
a) Polymyxin B/trimethoprim = broad + MRSA coverage
b) Aminoglycosides = toxic to cornea
c) Fluoroquinolones = GNB
Which bacterial infections associated with STIs may cause conjunctivis if the eye is exposed?
Neisseria gonococcus and Chlamydia
What is the leading cause of newborn conjunctivis and how to we decrease prevalence?
Chlamydia
- Treat newborns with erythromycin right away
