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200 Cards in this Set
- Front
- Back
Drugs to avoid while taking steroids b/c increase inflammation.
|
prostaglandin
pilocarpine |
|
Steroid responder will respond with increase IOP between _____weeks. After ____weeks of normal IOP then not a steroid responder
|
1-2
4-6 |
|
It is ok to use generic Pred Forte?
T or F |
False
|
|
The more drops of Pred Forte used the better efficacy?
T or F |
True
|
|
Put in order the drus from most to least increase of IOP with weeks of use. Lotemax, Pred forte, FML
|
Most- Pred Forte
middle- FML Least- Lotemax |
|
What is the soft drug concept and give 2 examples.
|
Inactive metabolite and once in body at target tissue becomes active and then becomes quickly inactive. Less side effects.
1. Pred Forte- prednisolone 2. Lotemax- Lotopredenol |
|
According to Dr. Bartlett: use a _______ for dry and _________ for wet.
|
ointment
cream |
|
Used for seasonal conj. and has ) IOP, CAT formation, or problem with infections. Category C for pregnant.
|
ALREX- Lotopredenol
|
|
Management of Contact dermatitis, scelritis, Grave's, Intermed to post uveitis is with topical steriods?
T or F |
F
systemic |
|
More likely to see EIOP with _________ and Cataract with _________.
|
topical steroid
oral steroid |
|
Steroid induced cataract characteristics.
|
1. off-axis VA good
2. PSC |
|
Iatrogenic glaucoma is greater for patients with ________ and a _______% chance with 1st degree offspring.
|
Iatrogenic=steroid induced EIOP
POAG 70% |
|
Iatrogenic glaucoma is a _____problem in the ________ due to increase concentration of _________.
|
outflow
TM GAGS |
|
Steroid induced uveitis occurs in ____%blacks and ____% whites.
|
5.0% blacks
0.5% whites |
|
Cushings can result from_________.
|
Topical steroids
|
|
List contraindicators for steroid usage.
|
1. diabetes
2. infectious disease 3. renal failure 4. heart failure 5. HTN 6. peptic ulcer 7. osteoporosis 8. psychosis 9. glaucoma |
|
GPC is a result of increase amounts of ________ and can be treated wiht _______ or _______.
|
prostaglandins
steroid NSAIDS |
|
List ocular effect of prostaglandins.
|
1. uveitis- cells/flare
2. red eye 3. miosis |
|
#1 choice to prevent CME; also can be used to treat seasonal conjunctivitis.
|
Ketorolac Tromethamine
(Acular or Acular LS) |
|
Difference between Acular and Acular LS?
|
Acular 0.5%
Acular LS 0.4% Less stinging |
|
Cause of CME post-op?
|
During surgery, prostagladin breaches blood retinal barrier. Prostaglandin rushes into AC. miosis. NSAIDS decrease miosis.
|
|
NSAID target Retina.
|
Nepafenac (NEVANAC) 0.005% BAK
|
|
Describe process NEVANAC enters eye.
|
NEVANAC is pro-drug inactive form. Penetrate intraocular tissue active form- AMFENAC through cornea, ICB, and retina/choroid.
|
|
Which have a rebound inflammation effect and must be tapered? NSAIDS or steroids?
|
steroids
|
|
Topical NSAIDS are contraindicated in SCL?
T or F |
T, due BAK
ok if disposable |
|
Dry eye treatment that decreases Lacrimal gland inflammation and increase aqueous production.
|
Restasis=
cyclosporin + refresh endura vehicle |
|
Give and example of a condition that Restasis cannot help.
|
SJS
|
|
Restasis come in a kit of _____ and is approved for ___ dosing.
|
32
BID 1 day. |
|
Dry eye treatment. List steps.
|
1. Artifical tears
2. topical cyclosporin 3. punctal plugs 4. oral pilocarpine |
|
Reason why don't like to use punctal plug in dry eyes?
|
Delays the drainage of the cytokines due to inflammation.
|
|
____% of population has atopic/allergies and ____% have some form of ocular allergy.
|
50%
25% |
|
Topical H-1 anti-histamine can be used for.
|
Allergic Conjunctivitis
|
|
A 1st gen. topical H-1 anti-histamine contains.
|
anti-histamine and vasoconstrictor
|
|
A 2nd gen. topical H-1 anti-histamine contains.
|
anti-histamine only
|
|
An example of a 1st gen. topical H-1 anti-histamine
|
naphazoline
|
|
An example 2nd gen. topical H-1 anti-histamine
|
Levocabastine (Livostin)
Emedastine (Emadine) |
|
Mast cell stabilizers are used for.
|
chronic ocular allergies
|
|
Mast cell stabilizer ok in pregnancy.
|
Nedocromil (alocril)
Category B |
|
Mast cell stabilizer for VKC
|
1. Cromolyn Na
(cromolon, opticrom) 2. Lodoxamide (Alomide) |
|
Mast cell stabilizer for itching that can be used for 4 months. Side effect: headache.
|
Pemirolast (alamast)
|
|
Define dual activity anti-histamine.
|
Anti-histamine and a mast cell stabilizer. H-1 receptor target.
|
|
Dual activity anti-histamine can significantly reduce itching and redness.
T or F |
False. Just itching and some redness.
|
|
Give 4 examples of dual activity anti-histamines.
|
1. Olopatadine (Patanol)
2. Ketotifen (Zaditor) 3. Azelastine (Optivar) 4. Epinastine (Elestat) |
|
Dual-Activity anti-histamines are safe during pregnancy?
T or F |
False
Category C |
|
Dual-Activity anti-histamine that has a side effect of bitter taste.
|
Azelastine (Optivar)
|
|
Dual activity anit-histamine that has 0.01% BAK and ) systemic absorption.
|
Epinastine (Elestat)
|
|
3rd generation systemic anti-histamine.
|
Allegra (fexofenadine)
Clarinex (Desloratadine) |
|
Systemic anti-histamine that does NOT cause drowsiness.
|
1. Allegra
2. Clarinex 3. Clariten (Loratadine) 4. Zyrtec (Cetirizine) |
|
Moderate drowsiness with this systemic anti-histamine.
|
chlor-trimeton (chlorpheniramine)
|
|
Drowisness with this systemic anti-histamine.
|
Benadryl (diphenhydramine)
|
|
Antibiotics that inhibit cell wall synthesis.
|
1. penicillin
2. bacitracin 3. vancomycin 4. cephalosporin |
|
Antibiotics that increase cell membrane permeability.
|
1. polymyxin
|
|
Antibiotics that inhibit protein synthesis.
|
1. aminoglycoside
2. tetracycline 3. macrolide 4. chloramphenicol |
|
Bacitracin effective against:
|
1. gram + (staph bleph)
2. Neisseria |
|
Bacitracin used in combo with:
|
1. neomycin
2. polymyxin |
|
Vancomycin used against:
|
1. gram + serious infections
2. pseudomonas colitis 3. MRSA |
|
Vancomycin oral used in serious cases only b/c:
|
side effects
1. hearing loss 2. fatal uremia |
|
neomycin cannot stop:
|
pseudomonas
|
|
aminoglycosides target:
|
1. staph
2. gram - bacilli |
|
List of aminoglycoside.
|
1. neomycine
2. gentamycin 3. tobramycin |
|
Good against pseudomonas
|
tobramycin
|
|
Good against gentamycin and tobramycin resistant gram - bacilli.
|
Amikan
|
|
Bactericidal antibiotic against infectious bleph and gram -.
|
polymyxin B
|
|
Rare side effect resulting in superinfection and hypersensitivity due to this antibiotic.
|
bacitracin
|
|
Side effect resulting in punctate epi. erosions, corneal ulcerations, and chemosis due to this antibiotic.
|
aminoglycosides
|
|
Macrolide targets.
|
1. gram +
2. gram +bacilli 3. chlamydia 4. H. influenza |
|
Example of a macrolide that is used against Staph bleph and ophthalmia neonatorum.
|
erythromycin
|
|
Why would you not use sulfonamides with a purulent dischg infection?
|
dischg contains PABA which antagonize the drug.
|
|
Sulfonamides are no longer used topically b/c? 2 reasons.
|
1. hypersensitivity
2. SJS |
|
Want can you use instead if a pt is allergic to sulfonamides or infection has purulent dischg?
|
trimethoprim
|
|
PolyTrim is a combo drug of ____ and _____. Used to treat ______.
|
trimethoprim
polymyxin B bacterial conjunctivits |
|
Trimethoprim not useful against______.
|
Pseudo. a.
|
|
Antibiotic that targets DNA synthesis.
|
Fluoroquinolone
|
|
List some Fluoroquinolones.
|
1. Levofloxacin (quixin)
2. Ciprofloxacin (ciloxan) 3. Ofloxacin (ocuflox) |
|
Systemic fluoroquinolones contribute to resistant bacteria while topical fluoroquinolones do not.
T or F |
True
|
|
Fluoroquinolone that targets gram + S. aureus and S. pneumoniae.
|
Levofloxacin
|
|
Levofloxacin ____% targets bacterial conjunc. and_____% targets bacterial keratitis.
|
0.5%
1.5% |
|
3rd generation fluoroquinolones target _______ of gram - or _______ of gram +.
|
DNA gyrase -
Topo IV + |
|
Fluoroquinolones category that is better with gram +, retain gram - coverage, and atypical mycobacteria.
|
4th generation
|
|
FDA approved 4th generation fluoroquinolones for ____________.
|
bacterial conjunctivitis
|
|
4th generation fluoroquinolones targets.
|
DNA gyrase AND Topo IV of +
|
|
Fluoroquinolones with low MIC.
|
Gatifloxacin (Zymar)
Moxifloxacin (Vigamox) |
|
4th generation fluoroquinolones with BAK.
|
Gatifloxacin (Zymar)
|
|
Fluoroquinolones with bulky side chain to which bacteria can't pump out of cell.
|
Moxifloxacin (Vigamox)
|
|
Bacteria resist fluoroquinolones by.
|
1. mutating enzymes
2. decrease permeability to fluoroquinolones 3. increase efflux of fluoroquinolones |
|
Which of the 4th gen. fluoroquinolones has more rapid killing.
|
Gatifloxacin (Zymar)
|
|
4g-FQ # 1 for:
|
1. bacterial conjunctivitis
2. infectious corneal ulcers |
|
Which fluoroquinolones can result in white corneal ppt that are benign.
|
ciprofloxacin
|
|
The 1st choice against dendritic or HSV keratitis is _____________. But due to its toxicity, ___________ is used instead.
|
trifluridine (viroptic)
acyclovir |
|
Anti-viral meds can cause punctal occlusion which results in chronic tearing. T or F
|
True
|
|
Patient younger than 45 presenting with HZO should be tested for _______.
|
HIV
|
|
Neuralgic pain from HZO shows up 1-2 days after the chills, fever, malaise, and headache.
T or F |
True
|
|
Ointments should be used on HZO?
|
False no drying agents!!! Increase scars.
|
|
RX used with 72 hours of skine lesion. dosage
|
Acyclovir
800mg 5x day for 7-10 days |
|
Valtrex can be used for HZO?
T or F |
T
Valtrex is Valacyclovir is acyclovir (prodrug) |
|
Immune compromised persons infected wiht HZO have an increase risk of ________.
|
ARNS
Acute Retinal Neurosis Syndrome |
|
Capsaicin cream called ________ works how?
|
Zostrix
depleted substance P |
|
Active HSV (epithelial keratits) should be treated with _________.
|
Acyclovir 400mg 5x day.
|
|
Acyclovir for HSV helps prevent stromal disease.
T or F |
False
|
|
Viroptic and steroid would be beneficial for _______HSV but not ________HSV.
|
anterior uveitis
epithelial keratitis |
|
Acyclovir low dosage is effective to prevent recurrent HSV keratitis (dendritic or disciform).
T of F |
True
|
|
Preseptal or orbital cellulitis patients can have a ________ discoloration indicating____________.
|
dark purple
Haemophilus |
|
If eye lids of a patient cannot be separated what should you do?
|
order CT scan.
|
|
Facial tenderness and nasal discharge indicate.
|
sinusitis
|
|
Medial canthal tenderness and tearign indicate.
|
dacryocystitis
|
|
Pencillin V is not effective against ___________.
|
staph
|
|
Penicillins resistant to Penicillinase.
|
1. cloxacillin
2. dicloxacillin |
|
B-lactamase inhibitor.
|
potassium clavulanate
|
|
Penicillin with extended spectra of activity but destroyed by pencillinase.
|
Amoxicillin
|
|
Augmentin is _________ +__________.
|
amoxicillin
clavulanate |
|
side effects of penicillin that can result in death.
|
pseudomembranous colitis- diarrhea excessive
|
|
cephalosporins target:
|
1stand 2nd
internal hordeolum preseptal cellulitis 1st bacterial corneal ulcers |
|
1st gen. cephalosporins target gram ____ and 3rd gen target gram ____. As you move from 1st to 3rd what happens?
|
gram +
gram - loss + and gain - coverage |
|
Example 1st gen cephalosporins and 2nd gen.
|
1st Keflex, cefazolin
2nd Ceftin (Cefuroxime) |
|
The macrolide erythromycin that causes less GI upset
|
Erythromycin ethylsuccinate
|
|
The macrolide erythromycin that should be avoided in adults.
|
estolate
|
|
The macrolide that can be taken during pregnancy for preseptal cellulits.
|
Azithromycin (Zithromax-Z-pak)
|
|
Macrolide target H. influenza and chlamydia.
|
Clarithromycin (Biaxin)
|
|
Macrolide more effective in gram (-) coverage for chlamydial conjunc.
|
Azithromycin (Zithromax-Z-pak)
|
|
Short term treatment for acne rosacea
|
tetracycline
|
|
Long term treatment for acne rosacea.
|
doxycyline
|
|
Targets for treatment of acne rosacea.
|
1. anti-collagenase; anti-lipase
2. H. pylori |
|
Problem with diarrhea with doxycycline then ______can be used.
|
doxycycline hyclate (Periostate)
|
|
The quad therapy for acne rosacea to erradicate H. Pylori. Problem is ________.
|
Helidac Therapy
compliance since qid for 7-10 days |
|
The triple therapy for acne rosacea to erradicate H. pylori is _______________>
|
Amoxcillim
clarithromycin lansoprazole bid 10 days compliance better |
|
Systemic drug causing whorl opacity lines coming from below and going to the center. Green-yellow.
|
chloroquine (anit-malaria)
hydroxychloroquine (plaquenil) |
|
Systemic drug caused by interaction of drug and UV so not seen under lid. Interpalpebral fissure Endothelium and Descements. Irreversible discoloration cornea.
|
Chloropromazine (Thorazine_- anti-psychotic
|
|
Systemic drug causing chrysiosis- minute gold particles deposition in posterior 1/3 of stroma. No symptoms.
|
gold salts (rheumatoid arth.)
|
|
Resemble Hudson Stahli line then progresses to whorl then to clumps. Mustache keratopathy.
|
Amiodarone (Cordarone)
|
|
Drug induced lipid storage disease.
|
Mustache keratopathy from Amiodarone (Cordarone)
|
|
Amiodarone (cordarone) must ask patient if problem in this area. MUST stop if yes and refer to cardiologist.
|
breathing problems.
|
|
Bilateral posterior subcapsular opacities that start off axis caused by _________.
|
Steroids.
|
|
Chlorpromazine cause ______.
|
anterior subcapsular
stellate |
|
Minocycline can cause _________.
|
Thinning of the sclera. see choroid-blue.
|
|
Tetracycline can cause ____________.
|
Photosensitive. Burn lids sun lt.
|
|
Sulfonamides can cause__________.
|
rash
|
|
Barbituates can cause____________.
|
bilateral ptosis.
|
|
OD of barbituates can be verified by.
|
tap between eyes and flutter response.
|
|
Atropine reduces aqueous by _______ and scopolamine reduces aqueous by ____________.
|
3ul/min
0.8ul/min |
|
Dry eyes can be made worse by ____________.
|
anti-cholinergics
|
|
The more sedation in a drug the more anti-cholinergic effects.
T or F |
True
|
|
Lomotil (diphenoxylate + atropine) is treatment for ________.
|
diarrhea
shut down GI tract |
|
Detrol LA (tolterodine) treatment for ___________ and is a anti-cholinergic.
|
bladder dys.
|
|
Isotretinoin-Accutane attack the ____________.
|
meibomian gland
|
|
Myopia can be induced by an allergic reaction to drugs. Describe.
|
Ciliary Body edema
Relax zonules Lens moves forward |
|
Allergies to:sulfonamides, diuretics, CAI, isotretinoin, topiramate (topamax)- anticonvulsant, can cause change in VA to _________.
|
myopia
ex. topiramate (topamax) from 20/20 to 20/200!! |
|
phenytoin (dilantin)-anti-convulsant, lithium and alchol can affect ____________ and in high doses can cause _____________.
|
diplopia (H or V) convergence problem
high doses-nystagmus |
|
Tamoxifen is used for treatment of ______________. Bilateral ________ can result from O.D.
|
breast cancer
crystalline maculopathy |
|
Caused from heroine, methadone, codeine, meperidine, pentazocine addiction. 9,000 methadone pills required to see this effect.
|
Talc Retinopathy
tiny, glistening yellow crystals in arterioles if block O2 can see neo and bleeding |
|
Patients diagnosed with Talc Retinopathy will have problems not only with their eyes but also________________.
|
lungs.
Talc embolized from lungs to the eyes. |
|
Ethambutol and anti-TB drug can damage_____________.
|
Optic nerve
|
|
Damage of optic nerve by ethambutol can lead to.
|
scotomas
optic neuropathy blindness R/G prob |
|
Viagra's optic nerve effect is.
|
color vision change for 4-5 hours
|
|
Color vision change in which objects look snow covered caused by O.D. of meds.
|
Digitalis cardiac glycoside
|
|
Adverse rxns of beta blockers
|
slow pulse
shortness breath fatigue asthma hair loss depression impotence |
|
Adverse rxns of pilocarpine
|
brow ache
iritis detached retina (myopia) synechiae angle closure with narrow |
|
Adverse rxns of CAI (neptazane/acetazolamide)
|
hypokalemia
fatigue tingling maliase kidney stones aplastic anemia |
|
Disengage the sphinchter resulting in mydriasis. List in order of potency.
|
Anti-cholinergics
1. atropine 2. homatropine 3. scopolamine 4. cyclopentolate 5. tropicamide |
|
Peak effect of mydriatic phenylephrine within ____min.
|
45-60 min.
|
|
Pigment floaters in AC noted with use of this mydriatic.
|
phenylephrine
|
|
PE (phenylephrine) contraindicated due to HTN effects in these pts.
|
2.5% in orthostatic hypotension pts
MAO inhibitors reserpine, guanethidine, methyldopa (chemical smupathectomy) |
|
Peak mydriatic effect of tropicamide.
|
30 min.
Last 6 hours. |
|
Tropicamide time of loss of accommodation.
|
<30 minutes
|
|
Tropicamide cause a temp. rise in IOP. In POAG pts ______change.
|
.5mmHG
|
|
Tropicamide causes pressor effects?
T or F |
False
|
|
Anti-cholinergic with greater cycloplegic effect than mydiratic.
|
Cyclopentolate
|
|
OD of anti-cholinergics result in:
|
red beet
hot hare mad hatter dry bone |
|
pseudoexfolitaion synd. pts show _______response to dilating and may be _______pts for cat sx
|
poor
poor |
|
In POAG pt study, for every _____mm dilation result in increase IOP.
|
1mm
norm pupil dilate 4mm!! |
|
Infant and neonates avoid large doses of ______ and ____% phenylephrine.
|
large
10% |
|
IN pregnant and nursing avoid ________and __________.
|
scoplamine
phenylephrine |
|
For diabetics, use _______ and _________ for dilation.
|
0.5% tropicamide
2.5% phenylephrine |
|
For asthmatics, avoid _________ and ____________.
|
adrenergics w/bronchodilators
sulfite meds ex. PE |
|
For MAO pts, avoid ___________.
|
adrenergics (potential supersentivity)
|
|
Pediatric population, ____% of pts were found to have 1 or more posterior pole lesion undetectable without dilation.
|
25%
|
|
Non-mydriatic fundus camera was more superior to dilate fundus evaluation to id diabetic retinopathy.
T or F |
True!
|
|
Pediatric pts (2-8) dilated equally well when mydriasis was obtained from spray as conventional drops.
T or F |
True!
|
|
Application of cyclopentolate to medial canthus was found as effective as drops applied to the conj.
T or F |
True!
|
|
Pre-medication with topical anesthetic result in a slight greater pupil diameter only amoung dark eyed pts with use of 0.5%T.
T of F |
False
light but clinically insignificant |
|
Better images are obtained without dilation.
|
GDx
|
|
Test not affect with or without dilation.
|
VF
OCT-NFL thickness HRT central corneal thickness |
|
After effects of pupillary dilation in simulated driving.
|
Reduced Contrast threshold and high contrast VA
No reduction VF or UFOV |
|
Dapiprazole is an _____________.
|
alpha adrenergic block
not available any more |
|
Flower petal leakage into sensory retina due break down blood/brain barrier b/c of ______________ supplement.
|
Niacin 3g/day
|
|
RP patients are told to avoid ________ and take ____________.
|
vit E
vit A |
|
Vit A provide _________addtional uears of useful vision for avg RP pt when supplementation is started by age 32 as measure by ERG.
|
7
|
|
______percursor to vit A and may function in ___________ protection against _______.
|
beta-carotene
antioxidant free radicals |
|
Deficiency in vitA can result in ____________ and OD can result in _____________.
|
night blindness xerophthalmia
papilledema |
|
Fat Soluble vit.
|
ADE and K
|
|
Deficiency in this mineral may lead to optic nerve dysfunction.
|
thaimin (water-soluble)
|
|
Deficiency in this mineral can result in cataract formation, corneal vascularization, angular conj., amd KCS
|
Riboflavin (B-2)
|
|
Deficiency in this mineral may lead to pellagra(optic neuropathy)
|
naicin (B-3)
|
|
Deficiency in this mineral results in anemia. Necessary to supplement with Daraprim for ocular toxoplasmosis.
|
Folate (B complex)
|
|
Deficiency in this mineral result in __________________.
|
toxic optic neuropathies
detoxifies cyanide |
|
Present in retina, aqueous, and lens at >50 x plasma levels.
|
Vit C
|
|
Deficiency in this mineral result in scurvy (conj. & retinal hemes)
|
Vit C
|
|
Positive effect on drusen reduction for ARMD by this mineral.
|
Zinc
|
|
Essential as coenzyme in protection of oxidative damage to hemoglobin.
|
Selenium
|
|
Recommend vitamin ___________. Avoid __________ in smokers due to increase risk lung cancer.
|
Ocuvite Lutein
B-carotene |
|
____________ have been shown recently to reach the macula in sufficient quantity to be of some protective benefit against blue-light damage
|
Lutein
|