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Flashcards in Mydriatics Deck (92):
1

name 3 reasons WHY you will use mydriatics on a patient

- enables more thorough examination of the eye e.g. peripheral crystalline lens, vitreous, fundus

- stereo fundus examination

- for treatment e.g. uveitis (mostly my ophthalmologists)

2

name 4 reasons/times WHEN you will use mydriatics on a patient

- on patients at risk of a retinal detachment
- patients with symptoms
- for screening
- inadequate fundus view

3

which 3 types of patients may be at risk of a retinal detachment

- high myopia
- family history
- trauma

4

list what types of symptoms a patient may have that you will need to use mydriatics on

- unexplained vision loss/visual field loss
- visual disturbance
- floaters
- flashes
- veils
- shadows

5

which 3 types of patients will you need to do screening on with mydriatics

- diabetics (neovascular vessels and tortuosity)
- high myopia
- prior to ocular surgery

6

which 2 reasons may you want to use mydriatics on when experiencing inadequate fundus view

- lens/media opacities
- miotic pupils (especially elderly patients, who also more likely to have cataracts and diabetes)

7

what are the 6 ideal properties of a mydriatic

- rapid onset
- adequate duration (lasts long enough to see back of eye)
- fast recovery
- no associated cycloplegia and adverse effects
- light reflex is abolished
- no rise in intraocular pressure (easily reversed in an emergency)

8

what 7 things must you do/check prior to dilation

- have a good reason to use the drug
- explain the procedure (px can't drive after etc)
- px consent
- issue written information
- advise about the effects - glare, loss of stereo vision, driving, operating machinery
- check for contraindications (incase of an allergic reaction, check BNF)
- minimise the risk of adverse reactions (check IOPs before insertion)

9

list the 4 D test

- Drug
- Dosage
- Date
- Disposal

and time

all should be checked/written/done

10

where should the drugs be disposed

in the yellow bin

11

why should you note down the time that the drug was instilled

to know when the maximum effect is

12

list 6 general contraindications of using mydriatics

- hypersensitivity to drug
- iris clip IOLs
- narrow angles (do slit lamp examination before instilling)
- patient with symptoms suggestive (e.g. high hyperope) of sub acute or chronic closed angle glaucoma (CAG)
- patient with diagnosed CAG
- px using pilocarpine for glaucoma treatment

13

what happens within the eye during closed angle glaucoma

the iris is bowed forward and can touch the back of the cornea which blocks the outflow of aqueous

14

list the signs and symptoms of closed angle glaucoma

- blurred vision from cloudy cornea
- haloes
- headache
- painful
- vomiting/nausea
- photophobia
- sudden increase in IOP (usually >40mmHg)
- conjunctival hyperaemia
- cloudy cornea
- fixed mid-dilated pupil
- closed angle

15

list 4 things you will do/check to minimise the risk of a CAG

- IOP, pre and post dilation
- anterior angles
- existing symptoms?
- use of biotic drug

16

what will you do and how when checking IOP pre and post dilation in order to minimise risk of CAG

- check if theres a significant rise in IOP or an asymmetric rise (as CAG is most likely to happen in one eye)
- monitor rises in IOP (post dilation)
- refer to eye casualty if continues to rise

17

how will you check anterior angles in order to minimise risk of CAG

- gonioscopy
- van herrick

if you see narrow angles without symptoms, still refer for further checks

18

list 2 other names for antimuscarinic mydriatics

- muscarinic antagonists
- anticholinergic

19

list the three types of anti muscarinic mydriatics

- tropicamide
- cyclopentolate
- atropine

20

which anti muscarinic is rarely used as a mydriatic

cyclopentolate

21

which anti muscarinic is very unlikely to be used as a mydriatic

atropine

22

which anti muscarinic is most likely to be used as a mydriatic

tropicamide

23

which anti muscarinic mydriatic is only available to independent prescribers

atropine

24

how do anti muscarinic drugs work

by blocking Ach effects on muscarinic receptors

25

list another name for a sympathomimetic mydriatic

alpha agonist

26

name the type of sympathomimetic mydriatic

phenylephrine

27

how do sympathomimetic mydriatic drugs work

enhancing noradrenaline effects on alpha 1 adrenoceptors

28

what 2 other things does phenylephrine do to the eye

- makes the eyes look whiter, as it constricts the blood vessels
- widens the interpalpebral aperture, as it contracts mullers muscle

29

which ANS branch do antimuscarinic mydriatics work on

parasympathetic

30

which mydriatic is involved in affecting accommodation and why

antimascurinics as it affects the ciliary muscle as well as the sphincter

31

which branch of the ANS won't affect accommodation or light reflex

sympathetic

32

which muscle does the sympathetic branch of the ANS affect

dilator

33

which ANS branch does the iris sphincter muscle innervate

parasympathetic

34

what do antimuscarinic drugs cause paralysis of

the parasympathetic nervous system

35

what do antimuscarinic drugs inhibit the action of

Ach at the end of postganglionic nerves

36

what three things does antimuscarinic drugs produce

- mydriasis
- cycloplegia
- reduced tear secretion

37

which type of drug is a alpha agonist

sympathomimetic/phenylephrine

38

which transmitter do sympathomimetic drugs work on

neurohumoral transmitter at most sympathetic postganglionic neuro-effector junctions

39

what 2 things in the body do sympathomimetic drugs have exceptions on

- sweat glands
- vasodilator fibres on skeletal muscle

40

list the alpha and beta receptors that sympathomimetic drugs bind with

- mainly alpha 1 receptors in dilator papillae muscle
- alpha 1 excitatory, alpha 2 inhibitory
- beta 1 excitatory, beta 2 inhibitory

41

in how long does tropicamide cause mydriasis within

15 minutes

42

after how long is recovery from tropicamide

8-9 hours

43

with which drug is light reflect absent

tropicamide

44

which drug induces a mild cycloplegic effect

tropicamide

45

what may tropicamide cause

a rise in IOP but likely to be transitory

46

which drug has fewer contraindications

tropicamide

47

how long does phenylephrine cause mydriasis within

30 minutes

48

how long does phenylephrine cause mydriasis for

12-24 hours

49

with which drug is light reflex retained

phenylephrine

50

what is phenylephrine less likely to produce

a rise in IOP as sector mydriasis

51

which drug is associated with numerous contraindications with other medications

phenylephrine

52

which category of medicine is tropicamide

a POM for use and supply by all optometrists

53

which two forms/packaging is tropicamide available in

- single use, minims by bausch and lomb
- multi-dose containers, mydriacyl by alcon

54

what single use doses is tropicamide available in

0.5% and 1.0%

55

at what temperature should tropicamide single use minims be stored below

25 degrees celsius

56

what dose of tropicamide will you use if you want to paralyse some accommodation

1.0%

57

what multi use doses is tropicamide available in

0.5% and 1.0%

58

at what temperature should tropicamide multi dose containers be stored below

2-8 degrees celsius and protect from light

59

what % of tropicamide is used on darker irides

1%

60

which mydriatic is better to use during pregnancy

Tropicamide is better to use than phenylephrine

61

what must women who are using tropicamide not do

breast feed

62

list the 4 immediate side effects or using tropicamide

- transient stinging
- transient blurring
- photophobia
- raised IOP?

63

list 4 side effects of tropicamide as a result of prolonged administration

- irritation
- hyperaemia
- oedema
- conjunctivitis

64

what is the general body side effect of tropicamide
which type of patient does it mainly affect

- CNS which effects dry mouth
- mainly affects children, with blue eyes and blonde hair

65

which category of medicine is phenylephrine

P medicine - such as lemsip etc

66

which forms/packaging is phenylephrine available in

single use, minims by Bausch & Lomb

67

what doses is phenylephrine available in

- 2.5%
- 10%

68

at what temperature should phenylephrine single use minims be stored below

25 degrees celsius and protect from light

69

which type of patients is 10% phenylephrine contraindicated in and why

children and the elderly (>65 years)
because of its increased risk of systemic toxicity

70

which type of eyes may phenylephrine be less effective on

highly pigmented

71

what does phenylephrine cause vasoconstriction of

conjunctival blood vessels

72

list 7 things that phenylephrine is contraindicated with

- medication for cardiovascular problems
- medication for depression
- thyrotoxicosis
- insulin dependent diabetes
- asthma
- pregnancy/lactation
- use of pilocarpine

73

list the 2 medications for cardiovascular problems that phenylephrine is contraindicated with

- anti hypertensives
- tachycardia

74

list the 2 medications for depression that phenylephrine is contraindicated with

- monoamine oxidase inhibitors
- tricyclic antidepressants

75

which type of mydriatic will you use on a insulin dependent diabetic

tropicamide

76

how is phenylephrine contraindicated with pregnancy/lactation

it may cause transient fatal hypoxia

77

how is phenylephrine is contraindicated with pilocarpine and on which type of patients

- older px = pupil block
- young px = accommodative spasm, causing contraction of the ciliary muscle

78

list the 6 immediate side effects of phenylephrine

- transient stinging
- transient blurring
- photophobia
- lid retraction
- conjunctival allergic reaction
- punctate keratitis

79

list the 5 general body side effects of phenylephrine

- palpitations
- tachycardia
- cardiac arrhythmias
- hypertension
- headaches

80

how does phenylephrine cause all these general body side effects

the drug gains access to systemic blood supply via the puncta, blood vessels or mucous

81

name the two drugs which can be used as synergistic combinations and for what purpose they're used for

combinations of antimuscarinics and sympathomimetics
e.g. tropicamide 0.5% and phenylephrine 2.5%

this allows for lower concentrations of antimuscarinic to be used which results in less cyclo effect

82

what category of medicine is mydriasert

prescription only medicine POM

83

in what form does mydriasert come in

insoluble ophthalmic insert

84

what does mydriasert contain

phenylephrine and tropicamide

85

how fast is mydriasert released

gradually

86

when is mydriasert used

pre-operatively and diagnostically

87

how is mydriasert instructed for use

in adults insert up to max. 2 hours before procedure
remove within 30 mins of mydriasis and within 2 hours of application

88

name 2 other mydriatic drugs other than tropicamide, phenylephrine and mydriasert

- cyclopentolate
- homatropine

both antimuscarinics

89

when does the mydriatic effect of homatropine commence in

10-20 mins

90

when does maximal mydriasis occur with homatropine

30-40 mins

91

what 2 things are absent with homatropine

- light reflex
- accommodation

92

after how long is recovery achieved with homatropine

up to 3 days (so its rarely used)