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Chapter 14
Preparations for ocular surface disease
57
Pharmacology
Professional
09/20/2014

Additional Pharmacology Flashcards

 


 

Cards

Term
Name the three places tears exist in the eye:
Definition

1.) Cul-de-sac

2.) tear meniscus

3.) tear film

Term
How do tears exit the eye?
Definition

1.) Conjunctival Capillaries

2.) tear film evaporation

3.) puncta

Term
What are the four layers of the traditional tear film model?
Definition

1.) superficial meibomian oils

2.) aqueous liquid phase

3.) innermost mucin layer

4.) microvilli

Term
Define Dry eye:
Definition
A multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by an increased osmolarity of the tear film and inflammation of the ocular surface.
Term
Keratoconjunctivitis sicca (KCS) 
Definition

= Dry eye

Some reserve KCS for people with Sjogren syndrome.

Term
What is Sjögren Syndrome?
Definition
A chronic autoimmune disease affecting moisture- producing glands.
Term
What are the symptoms of sjogren syndrome and who is most likely to experience this disease?
Definition

1.) dry eyes

2.) dry mouth

3.) kidney, GI, blood vessel, lungs, pancrease, CNS dysfunction. 

 

1.) 9/10 people with sjogren syndrome are women.

2.) 50% of it occurs alone.

3.) 50% of it accompanies another autoimmune disorder of the connective tissue. (In this case it's called secondary sjogren.

 

Term

How many office visits are for dry eye complaints?

Definition
20-25%
Term
What percentage of the population experiences dry eye?
Definition
7-34%
Term
Are dry eye sufferers usually male or female?
Definition
78% are female.
Term
How many people use artificial tears?
Definition
60 million world wide!!!
Term
How do you test for dry eye? Give four examples:
Definition

1.) Schirmer strips

2.) Tear Osmolarity

3.) TBUT

4.) Staining

Term
In tests for dry eye, there is a lack of consensus on ...
Definition

1.) What tests to use.

2.) Interpretation of the tests.

3.) Diagnostic criteria.

Term
Dryness of the ocular surface results in excess ______ which may lead to neurogenic _______.
Definition
Dryness of the ocular surface results in excess nervous stimulation which may lead to neurogenic inflammation.
Term
The release of _____ causes the dysfunction and destruction of the lacrimal glands, tear film, and conjunctiva in dry eye disease.
Definition
The release of inflammatory cytokines causes the dysfunction and destruction of the lacrimal glands, tear film, and conjunctiva in dry eye disease.
Term
In dry eye, what is the key mechanism of ocular surface injury?
Definition
Inflammation!
Term
What are the two main categories of dry eye?
Definition

1.) Aqueous deficient (not enough tears)

2.) Evaporative (lipid layer is fucked-up)

 

Note: You can have both of these problems at the same time.

Term
Refer to table at the bottom of page 2 of your CH 14 notes.
Definition
Do it now. Or else.
Term
List 3 treatments for aqueous deficient dry eye:
Definition

1.) Tear supplements

2.) Tear conservation

3.) Tear stimulation

Term
Is there active drug in artificial tears?
Definition
Nope! The vehicle polymer gives relief.
Term

 What do you call it when Batman skips church?

Definition

Christian Bale.

Term
Name the 11 polymers used in artificial tears:
Definition

1.) MC

2.) HPMC
3.) CMC

4.) HPC

Above are all cellulose ethers

5.) Polyvinyl alcohol (PVA)

6.) Polyvinylpyrrolidone (PVP)

7.) Dextran

8.) Propylene glycol 

9.) glycerin

10.) sodium hyaluronate

11.) HP-Guar

 

Term
What type of tears do dry eye patients usually have? Isotonic, hypotonic, or hypertonic?
Definition
hypertonic tears.
Term
What are the 7 possible components of artificial tears?
Definition

1.) Polymers

2.) Electrolytes

3.) Buffers

4.) Preservatives

5.) Nutrients

6.) Mucolytic agents

7.) Disappearing Tears

 

You can remember this list by using:

BAD MEN P.

 

Term
What is the tonicity of normal tears?
Definition
290 mOsm/L
Term

Some artificial tears use electrolytes in their formulations.  Name three brands with hypotonic electrolyte formulations:

Definition

1.) Hypotears (214mOsm/L)

2.) Theratears (175 mOsm/L)

3.) Retaine MGD

 

Note that most artificial tears are isotonic.

Term
The buffers in artificial tears are usually: acidic, basic, or neutral?
Definition
Artificial tears have slightly basic buffers.
Term

True or false: 

BAK is a great preservative in artificial tears. You should recommend tears with BAK to your patients.

Definition

FALSE.

DO NOTTTT Select artificial tears with BAK. It is irritating and there are better options!!! DON'T. DO. IT.

Term
What types of nutrients are added to artificial tears?
Definition
Vitamin A
Term
Which artificial tear uses vitamin A as a nutrient?
Definition
Viva-Drops
Term
Most artificial tears don't have mucolytic agents. However, they are sometimes used. What are the two mucolytic agents that could be present in artificial tears?
Definition

1.) N-acetylcysteine

2.) tyloxapol (in many rewetting drops)

Term
Name the brands of artificial tears that use disappearing preservatives, and name the preservative that each uses, and tell how that preservative works.
Definition

1.) Genteal (Novartis) 

GenAqua

Sodium perborate --> H2O2 --> H2O + O2


2.) Refresh Products (Allergan)

Purerite

Sodium chlorate --> NaCl + H2O



3.) Blink Tears and Blink Gel Tears (AMO)

OcuPure

Sodium Chlorate --> NaCl + H2O



Term
Do single use artificial tear vials contain preservative? How long are they safe to use?
Definition
No. They should be thrown away after 12 hours.
Term
What is Goniosol used for? What polymer does it contain? Preservative?
Definition
NOT FOR DRY EYE PATIENTS
Used as a contact medium between the eye and gonioscope. Let us you look at the angle very well.
*Has 2.5% HPMC as polymer-->very thick
*Preserved with BAK
*It is very harsh on the cornea
Term
What is wrong with giving a 10mL bottle of viva drops to your patient?
Definition
That's 200 drops of a preservative free artificial tear! That's 2 months of drops sans preservative! Ew.
Term
How does Freshkote work?
Definition
*It treats all 3 layers of tears.
i. Lipid layer-->Amisol clear
ii. Aqueous layer--> lacrophilic aqueous solution
iii. Mucin layer--> mucomimetic polymer
Has a Unique polymer= Polixetonium
*Indicated for moderate to severe dry eye
*Used 3-4x/day
Term
What is Nature's Tears EyeMist? What does it claim about artificial tears?
Definition

This is a biological grade water mist. 

It claims that artifical tears flush lipids, mucin and actually increases evaporation!

Term
What dry eye medication is homeopathic? 
Definition

Similasan Dry Eye Relief 

Contains: mercurius sublimatis, belladonna, and euphrasia 

Term
What is the method of action of Retaine MGD? What type of dry eye disfunction is it treating?
Definition

It delivers ingredients through electrostatic attraction between the positively charged droplets (cationic droplets) and the negatively charged ocular surface. 

This is used to treat meibomian gland disfunction. 

**This is an emulsion, it is HYPOtonic and preservative free **

Term
What preservative does Alcon Products contain?
Definition
Polyquad
Term
What Alcon products contain a preservative? Which ones are preservative free?
Definition

Contain preservative (polyquad): 

i. Systane

ii. Systane Ultra

iii. Systane Gel Drops

iv. Systane Balance 

Preservative Free: 

i. Systane PF

ii. Systane Ultra PF 

iii. Systane Nighttime Ointment 

Term
What is the vehicle found in the Alcon drops?
Definition
HP-Guar
Term
What is the preservative found in Allergan drops?
Definition
Purite 
Term
What Allergan lubricants contain a preservative? 
Definition

1. Refresh Liquigel 

2. Refresh Optive

3. Refresh Optive Advanced 

4. Refresh Tears

Term
What Allergan lubricants are preservative free?
Definition

1. Refresh Celluvisc

2. Refresh Classic

3. Preservative Fresh Refresh Optive

4. Preservative Free Refresh Optive Advanced

5. Refresh Plus 

Term
What vehicle is found in most Allergan Artificial Tear Products?
Definition
Carboxymethylcellulose 
Term
Which of the Allergan lubricants has the highest Carboxymethylcellulose concentration? And what does this mean for the patient?
Definition

Refresh Celluvisc. 

The 1% concentration makes the drop very thick, its usually too thick for most patients and causes a lot of blurry vision. 

Term
Systane Nighttime ointment is contraindicated for what patients?
Definition

Patient with allergies to wool (sheep?)

The ointment contains Lanolin 

Term
List the Tear Gels that we have.
Definition

1. Genteal Gel

2. Refresh LiquiGel

3. Tears Again Night and Day

4. Systane Gel Drops

5. Etc. 

**With these usually can get away with patients using BID since they are so thick instead of the usual 4x/day**

Term
What is the method of action of Liposome spray? How is it deliverd? What does the spray contain?
Definition

1. It helps seal in naturally-occuring lipids which are transferred to tear film. 

2. It is dilerved through closed lids. 

3. It contains tiny microspheres (liposomes) that contain phopholipids. It is all natural, also contains Vitamins A, C and E. 

Term
How do Artifical Tear inserts (Lacrisert) work?
Definition
They are water soluble rods that are placed in the inferior cul-de-sac. They contain 5mg HPC and dissolves in about 6-8 hours. It is used to treat moderate to severe dry eye!
Term
What is the method of action of Salagen (oral pilocarpine)? What is it approved for?
Definition

1. It treats dry eye via tear stimulation. 

2. It is approved for xerostomia after radiation and Sjogren sydrome. 

**off label use for severe, recalcitrant dry eye**

Term
What is the method of action of Evoxac? What is it approved for?
Definition

1. It treats dry eye via tear stimulation. 

2. It is approved for xerostomia in sjogren syndrome. 

**This is a cholinergic agonist**

Term
What are the methods/medications we use for Tear Stimulation?
Definition

1. Salagen

2. Evoxac

3. Gland Transplantation

4. Hormones 

Term
What are our methods for Tear Conservation?
Definition

1. Decrease evaporation 

i. Goggles

                ii. Moisture chambers

     iii. humidifiers

                                 iv. minimizing aggravating factors

  v. ointments

2. Obstruct Tear Outflow

i. Punctal plugs

                        a. temporary-collagen

                      b. extended duration 

                       c. silicone- perminant

  ii. electrocautery

                      iii. argon laser puntal occlusion 

Term
How does Restasis (cyclosporin A 0.05%) work? What FDA Pregnancy Category is it?
Definition

1. This is a anti-inflammatory medication. It is a T-cell Modulator that inhibits T-lymphocytes. It take a minimum of 3months to see results. 

2. Category C 

**This is a emulsion, Rx only, Single use Vials PF, BID use, and need to presecribe 2 trays for 30 day use **

Term
List the different methods we have to treat underlying causes of dry eye. (7 total) 
Definition

1. Restasis

2. Supplements

                               i. Fatty acids- flax seed, fish oil, etc. 

3. topical corticosteroids

4. systemic tetracylines

                    i. if meibomian gland dysfunction

5. Sex hormones

6. Autologous Serum 20% 

                                i. this uses blood serum, contains vit A, epidermal growth facto, TGF-beta

7. Botulinum Toxin

                                i. increased tearing/decreased lacrimal drainage

8. amniotic membrane

i. prokera

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