Ocular Pharmacology

Question 1

T/F: The eye is small and simple

Answer 1

F: the eye is very complex

Question 2

T/F: The eye has no built-in defense mechanisms

Answer 2

F: ocular defense mechanisms include eyelids, eyelashes, tears and tear components, and the bony orbit

Question 3

T/F: The cornea has many nerve fibers

Answer 3

T: this is an advantage with the administration of eye medication
can be a disadvantage in terms of discomfort

Question 4

What part of the eye do cataracts develop?

Answer 4

Cataracts are a result of clouding IN the lens of the eye-internal, suspended behind the iris and the pupil

Question 5

What is the best type of ocular product?:

Solution
Suspension
Ointment
All are Equal

Answer 5

Solution- there is more surface area because the drug particles are suspended in there

Question 6

Eye drop administration hints:

Answer 6

squeezing the bottle:
done between the middle finger and thumb

refrigeration:
provides the sensation that the drop went into the eye

punctual occlusion:
putting pressure on the corner of the eye with the index finger, ensures drug product is absorbed into the eye

Question 7

Sharp/Stabbing Pain:

Answer 7

sign of: intraocular inflammation, something in the eye

Question 8

Scratchy, gritty feeling

Answer 8

sing of: conjunctivitis and less complicated disorders

Question 9

Vision reduction

Answer 9

reduction in vision is a result of various conditions:

changes in the cornea, cataracts, and intraocular inflammation

Question 10

Length of Symptoms

Answer 10

length of time symptoms have existed reflects whether a situation is acute or chronic

Question 11

Ophthalmologist

Answer 11

surgical interventions

Question 12

Optometrist

Answer 12

manage chronic diseases, inflammatory diseases, and regular vision issues

Question 13

Conjunctivitis

Answer 13

redness associated with conjunctivitis is diffuse and non patterned

can be: bacterial, viral, or allergic

treatment:
topical decongestant, no longer than 72hrs due to rebound congestion

Question 14

Bumps/Water Blisters

in conjunctiva lining

Answer 14

irritating but not painful
allergies are the likely cause: face wash, cream, make up, etc.

treatment:
Ketofilen

Question 15

Bacterial Conjunctivitus:

Answer 15

yellow discharge-associated with bacterial presence
complaints of eye being stuck shut in the morning
staph/strep: most common cause of bacterial infection

treatment:
OTC ointment rubbed in junction of eyelids when eye is closed (QID dosing at first)

Question 16

11% of the population is allergic to what antibiotic?

Answer 16

neomycin

Question 17

Patterened Redness:

Answer 17

begins at the adge of the iris and raidates outward
discomfort: iritis, caused by infalmmation of muscle interal to the eye

treatment:
referral-which will lead to topical corticosterioid & myadriatic/cyclopolegic

Question 18

Topical Corticosteroid:

predinsolone acetate 1%

Answer 18

admin: QID is most cases
cheap and effective
#1 choice
acetate is most potent

Question 19

Topical Corticosteroid:

Fluorometholone acetate or alcohol (use acetate)

Answer 19

increases IOP less than prednisolone

75% of patients will not have significant IOP response, 20% minimal response, and 5% signigicant response

Question 20

Normal IOP

Answer 20

10-20mmHg

steroids increase IOP so long-term use requires monitoring

Question 21

Angle Closure Glaucoma

Answer 21

pupil-mid dialated, redness radiates away from the edge of the iris, intense pain
-aqueous build up leads to pressure on the optic nerve, as result there is too much aqueous humor

IMMEDIATE REFERRAL: occular emergecy: opthamologist or emergency room

treatment:
pilocarpine or hyperosmotic agent

Question 22

Stye

Answer 22

warm compresses may be useful
stye ointment provides no therapeutic value
topical antimicrobial therapy may be useful

OTC stye products are useless
patient may need to optometrist or ophthalmologist

Question 23

Pseudomonas

Answer 23

the cornea is the best-known growth media for Pseudomonas aeruginosa

• 11% of the population pseudomonas in their saliva
• do not wet contact with saliva

Question 24

Eye Spalshes

Answer 24

base-penetrates better into the cornea would rather have acid splashed into the eye

Question 25

Acid Burns

Answer 25

acid burns are less damaging than base burns

Question 26

Base burns

Answer 26

bases cause greater protein denaturation

Question 27

Eye Splashes

Answer 27

• irrigation of the eye -tap water is fine, you don’t need eye wash
• don’t allow patients to use contact solution or saline in the body
• patient should be referred for emergency care immediately
• be careful not to rinse the eye with a strong stream of fluid that directly hits the cornea

Question 28

Open Angle Glaucoma

Answer 28

goal of treatment is to prevent blindness: treating their IOP in order to treat their eyesight

Question 29

Glaucoma

Answer 29

open-angle
angle-closure
ocular hypertension
IOP is a surrogate for effectiveness of therapy

Question 30

Ocular HTN and Glaucoma

Answer 30

monitoring parameters-
drug, dose, frequency: 1st line of treatment for ocular HTN and glaucoma

beta blockers
prostaglandin analogues 
CA-I 
Rho Kinase inhibitors 
Cholinergic 
Sympathomimetics

Question 31

Beta Blockers

Answer 31

block beta 1 and beta 2 receptors 
Timolol (gold standard)
Levobunolol
Metripranolol 
Cartecol 

beta 1 specific:
Betaxolol
given 2x a day
primary side effects: stinging, punctuate keratitis, corneal anesthesia

Question 32

Prostaglandin Analouges

Answer 32

no difference in therapy-just pick any one
administered daily (at bedtime) – increases their efficacy
bimatoprost
latanoprost
latanoprostene
travoprost
tafluprost

primary side effects:
headache, iris pigmentation, superficial punctuate keratitis, latisse, mild-moderate ocular irritation, foreign-body sensation, conjunctival hyperemia

Question 33

Carbonic Anhydrase Inhibitors

Answer 33

basically the same–>
dorzolaide 2%
brinzolamide 1%

oral products
acetazolamide-also injectable
methazolamide

given 3x a day

primary side effects:
metallic taste, drowsiness, malaise (flu-like symptoms), paresthesias (in fingers)
capping the bottle minimizes the risk of administration

Question 34

Rho Kinase Inhibitors

Answer 34

Netarsudil (Rhopressa) 
reduce intraocular pressure
-increase trabecular outflow
-decreases episcleral pressure
-reduces the production of aqueous humor 

primary side effects:
hyperemia, corneal changes, and pain on instillation
dosed once daily in the evening

Question 35

Cholinergics

Answer 35

constrict the pupil and removes the anatomical barrier immediately

pilocarpine 0.25%-10%
carbachol 0.75%-3%
echothiophate iodide 0.03%-0.25%

Question 36

Hyperosmotic Agents

Answer 36

giving someone a hyperosmotic pulls fluid out and into the vasculature
-a symptom is being thirsty defeating the purpose-so patients will have to hold off on water

Mannitol: IV
Glycerin/Isosorbide: PO
(glycerine makes it palatable, isosorbide given to diabetics)

Question 37

Sympathomimetic Agent

Answer 37

administered 2x daily
not used frequently due to adverse effects associated with them

dipivefrin: prodrug reducing toxicity
replaced epinephrine

apraclonidine: administered short term prior to surgery due to tachyphylaxis

Question 38

Oral Corticosteroids

Answer 38

low potency, intermediate potency, high potency

salts forms & acetate forms: acetate form is the most potent

Question 39

Prednisolone Acetate 1%

Answer 39

also known as Pred Forte
the best product to use in terms of efficacy
-treatment is for 4-6 weeks
-if the patient is on it for at least 4 weeks-follow up appt is needed to check IOP
5% population IOP inc. greater than 6-15mmHg
30% population IOP inc. of 6-15mmHg

Question 40

Mydriatic Cycloplegics

Answer 40

patient should know it takes a while for these drugs to wear off
-need to continue to wear sunglasses