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Opthalmology > Pharmacology > Flashcards

Pharmacology Flashcards

(50 cards)

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1
Q

How are drugs administered to the eye

A 
Topically 
As drops or ointment
Subconjunctival 
Subtenons (under fibrous layer below conjunctiva)
Intravitreal 
Intracameral
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2
Q

What are the pros and cons to the two types of eye treatment

A

Ointments

  • last longer so give better relief
  • often blur the vision

Drops

  • thinner and easier to administer
  • Not as many visual effects - need to be given more frequently
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3
Q

Which part of the eye can lipid soluble drugs penetrate

A

The epithelium
It is lipophilic/hydrophobic
Limits the absorption of hydrophilic drugs

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4
Q

Which part of the eye can water soluble drugs penetrate

A

The stroma
It is hydrophilic/lipophobic
Limits the absorption of hydrophobic drugs

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5
Q

Name a drug that has both lipophilic and hydrophilic properties

A

Chloramphenicol

Can penetrate the cornea easily

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6
Q

What can make topical steroids more hydrophobic

A

Alcohol or acetate

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7
Q

What can make topical steroids more hydrophilic

A

Phosphate

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8
Q

Describe the use of prednisolone acetate

A

Topical steroid
Hydrophobic - due to acetate
Good penetration of an uninflamed cornea
Used post-operatively

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9
Q

Describe the use of prednisolone phosphate

A

Hydrophilic - due to phosphate
Poor penetration of uninflamed cornea
Used for cornea disease, surface inflammation or when want low dose steroids

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10
Q

What is Bezalkonium

A

Surfactant and antibacterial agent
Common in household cleaners
Used as a preservative is eye drops
It aids penetration of drugs by disrupting lipid layer of tear film

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11
Q

How can you prevent the systemic absorption of topical eye drugs

A

Punctal occlusion
After administration, press on the tear ducts for around 5 mins
This stops the drug flowing down the lacrimal system and entering the throat (this would be the site of systemic absorption)

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12
Q

What is bimatoprost

A

Drug used to lower IOP in glaucoma

contains benzalkonium

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13
Q

What are the subconjunctival and subtenons routes of administration used for

A

Putting drugs in the back of the eye
In subtenons you place a small catheter around the eye under the tenons layer
Used for anaesthetics and steroids

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14
Q

What is a major risk of injecting into the back of the eye

A

If the retina is punctured by the needle it can lead to a retinal detachment

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15
Q

What are steroids used for in eye disease

A

Topically given in post-op cataracts
Uveitis
Prevention of corneal graft rejection
May be given in allergic eye disease (if other drugs haven’t worked)

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16
Q

What is one of the first signs of corneal graft rejection

A

New vascularisation of the cornea

Vision will go hazy

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17
Q

What are keratic precipitants in the eye

A

White dots in the eye which are deposits of white cells

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18
Q

What are the local side effects of steroids in the eye

A

Cataracts
Glaucoma
Exacerbation of viral infection - such as herpes simplex
Impaired wound healing

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19
Q

What are the systemic effects of steroids

A 
Gastric ulceration
Immunosuppression
Osteoporosis
Weight gain
AND many more
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20
Q

What anti-inflammatory agents can be used in eye disease

A

Steroids
Antihistamines and mast cell stabilisers (sodium chromoglycate) for allergic disease
NSAIDs are good for pain relief

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21
Q

Why might people not notice the vision loss in glaucoma

Study These Flashcards
A

Slowly progressing

The brain compensates the missing parts of the image by filling it in with what it expects to be there

22
Q

List drugs that can be used in the treatment of glaucoma

Study These Flashcards
A

Prostanoids - prostaglandin analogues
Beta blockers
Carbonic anhydrase inhibitors - topical and systemic
Alpha adrenergic agonists - sympathomimetics
Parasympathomimetic drugs

23
Q

Give an example of a prostanoid/prostaglandin analogue and explain how it helps treat glaucoma

Study These Flashcards
A

Latanoprost

They increase uveoscleral outflow - open up the drains to reduce pressure

24
Q

Give an example of a beta blocker and explain how it helps treat glaucoma

Study These Flashcards
A

Timolol

Reduces secretion of aqueous humour

25
Give an example of a carbonic anhydrase inhibitor and explain how it helps treat glaucoma
Dorzolamide, other -mides and Trusopt | Reduces production of aqueous humour by blocking one of the enzymes in its production pathway
26
Give an example of an alpha adrenergic agonist/ sympathomimetic and explain how it helps treat glaucoma
Brimonidine and alphagan Dilates pupil Reduces production of humour Increases uveoscleral outflow
27
Give an example of a parasympathomimetic and explain how it helps treat glaucoma
Pilocarpine | Constricts the pupil to help open up the trabecular meshwork = drain
28
Describe how the intravitreal route is used in eye medication administration
Delivers effective concentration of drug at target site instantly Used for antibiotics for endophthalmitis, intra-ocular steroids and anti-VEGF However many drugs are toxic to the retina
29
What is anti-VEGF treatment used for
Shrinking newly formed blood vessels | Useful in wet macular degeneration, diabetic maculopathy etc.
30
What is local anaesthetic used for in ophthalmology
``` Removal of foreign bodies Tonometry Corneal abrasions - pain relief and allows examination Corneal scraping Comfort Cataract surgery ```
31
How is fluorescein used
Dye that is placed in the eye and then a blue light is shone on it to illuminate de-epithelialised areas Will show corneal abrasions, ulcers, leaks (suggestive of injury) Can be used to diagnose duct obstruction
32
What is the effect of mydriatic drugs
They cause pupil dilation by blocking parasympathetic supply to the iris
33
Give examples of mydriatics
Tropicamide - most common but short acting Cyclopentolate - lasts a whole day Atropine - lasts up to 3 weeks
34
What are the potential side effects of mydriatics
Blurring | Acute angle closure glaucoma
35
How do Sympathomimetics work
Act on the sympathetic system to dilate the pupil
36
What drug must never be given to someone with herpetic keratitis
Steroids | Will cause a corneal melt
37
How do eye drop allergies present
usually symmetrical reaction around both eyes | redness and swelling
38
Steroids can cause cataracts - true or false
True | Even inhaled ones increase your risk
39
Why are mydriatic/dilating drugs used in ophthalmology
Used for diagnostic procedures - easier to visualize back of eye Used to gain access in cataract surgery Cyclopentolate can be used to reduce pain from cilliary muscle spasm as it paralyses this muscle
40
How are eye drops written in a prescription
G....drug name
41
How are eye ointments written in a prescription
Oc... drug name
42
List examples of topical antibiotics used in the eye
Most common is chloramphenicol | Ulcers cab be treated with gentamicin or quinolones as well
43
List examples of topical antivirals used in the eye
Aciclovir | Ganciclovir
44
Local anaethetic drops can be very toxic to the epithelium of the eye - true or false
True
45
What is Seidel's test
A test used to show leaks from the cornea, sclera, or conjunctiva following injury or surgery. You add fluroscein to the eye and if there is a leak the aqueous fluid coming through will dilute it and cause a colour change - Seidel positive
46
List side effects of prostanoids
Hyperpigmentation of iris, lashes and/or skin
47
List side effects of carbonic anhydrase inhibitors
For the systemic ones: Parasthesia in the fingers, toes and/or lips Renal calculi Metabolic acidosis Topical ones can cause local irritation
48
List side effects of beta-blockers
Systemic side effect - reduced by shutting eyes for a few minutes Bradycardia Fatigue Contra-indicated in asthma and COPD
49
List side effects of sympathomimetics
``` Allergy Lethargy/drowsiness local irritation, hyperaemia cardiovascular side effects Contraindicated in kids – restricts their breathing ```
50
List side effects of parasympomimetics
Brow ache during first few weeks of use Poor vision in low light Due to persistent constriction of pupil

Opthalmology (9 decks)

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