Mechanism of Action
What is the mechanism of action for pataday
Anthistamine and Mast Cell Stabilizer (extra points if you can tell yourself what a mast cell stabilizer does)
What is the topical DOC for treatment of uveitic and angle recession glaucoma?
Timolol
Muro 128 is a hyperosmotic used in multiple cases, name an indication and what is the mechanism of action
MOA: increase the osmolarity of the tear film to enhance fluid movement out of the cornea across and intact epithelium
Indication: Fuchs, bullous Keratopathy, Acute corneal hydrop prevention of RCE (bonus if you can tell yourself why for all of them and what layer of the cornea each indication impacts)
What is a disadvantage of Punctal Occlusion
Only effective for aq def dry eye, not really effective for MGD, not for inflammatory related dry eye
What test leads to the differentiation between a keratitis and a uveitis
(bonus if you can name a topical drug to do so and tell yourself what the mechnism of action is)
test: topical anesthetic (gets rid of keratitis pain) or cyclo gets rid of CB pain
What is the mechanism of action of a steroid
bind receptor, pass through cell membrane, bind cytoplasmic receptor, enter nucleus to alter protein synthesis creates lipocortin 1 which inhibits phospholipase A2 which limits formation of arachidonic acid which is the precursor to prostaglandins and leukotrienes
SO basically inhibits PLA2
Bonus if you can tell me the molecule in Omega 6 that acts like arachidonic acid
What is an Rx-only DOC for MGD?
What is the DOC for SLK and what is the presentation of SLK
Since its chronic: Restasis or Xiidra (an immunomodulator) and use lotemax Gel or something to calm the inflammation first bc they take a while to work
Name which study decided the definition of MGD we use in class today, what is that definition
The TFOS MGD Workshop (same between who made DEWS 1 took a break and made this before DEWS2)
MBGD is a chronic, diffuse abnormality of the meibomian glands, characterized by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion--> alters tear film, symptoms of eye irritation, inflammation, and OSD results
What is the MOA of Miebo and how does it remain preservative free
Low surface tension allows for even spread of a monolayer at the air liquid interface - hinders evap (acts like lipid layer)
it is water free (water is a breeding ground for contamination)
What is the mechanism of action of tryptyr
DOC for Bacterial Conjunctivitis and what is the pathognomic sign
Polytrim, Tobramycin, Gentamycin (there are others chk doc assignment)
Mucopurulent discharge (bonus: what is the pathognomonic of fungal? Acanthomoeba? Allergies? what in toxo requires treatment? )
What is the 1,2,3 rule and what is it used for
Culture a problem if it is 1+ cells in AC , 2mm dense infiltrate, and the edge of a large central infiltrate is 3 mm from the central cornea
What is the MGD management hierarchy
Bonus: What is the three settings for lower level light therapy
1. eyelid warming digital massage and lid hygiene
2. in office lid/lash expholiation, prescrips (Oral doxy or Zithromax or topical miebo), in office gland expression like iLUX, IPL/LLLT
Red: MGD/Chalazia (enhances Cell activtiy), Orange: promotes detoxifying action to relieve swelling, Blue: staph and demodex (causes cell death)
What is the recommendation for pregnant moms with glaucoma
SLT most recommended (could be on topical CAI d/t world glaucoma association)
What is the Mechanism of Action for hypochlorous acid products and name two
Avenova, Heyedrate, Ocusoft HydroChlor, Bruder Hygienic Eyelid Solution
DOC for Herpes Simplex Dendritic Keratitis , bonus if you can tell me what to use if Zirgan is unavailable
Zirgan (oral antiviral, preferably Valcyclovir)
What seizure/migraine medication can increasse myopia, is a risk for angle closure, can induce optic neuropathy, and can increase IOP
Bonus: name the 4 drugs and one systemic effect that can induce IIH
Topomax
Bonus: Vitamin A, Tetracycline, nalidixic acid, hormone based birth control and withdrawal of sys steroids
What is the MOA of prostaglandins? Rhopressa? Pilo? BB? CAI? Aagonist?
Prostaglandins: remodels collagen in UV pathway making more space between long fibers, start inflammation to increase Active transport in TM (this is how SLT works so tests if SLT would fix someone)
Rhopressa: Rhokinase inhibitor that decreases the rigidity of the TM
Pilo: binds musc receptors of iris sphincter causes pupil constriction (increases outflow by opening TM channels)
BB: antagonist of B receptors in the non pigmented ciliary epi --> aq suppressant
A agonist: alpha 2 blocks alpha 1, no release of NER to the beta receptors so also no binding to the non pigmented ciliary epi --> aq suppressant (maybe acts as an outflow enhancer by relaxing CB muscle for UV flow)
CAI: inhibits CA decreases bicarb(water follows salt)les bicarb means less water movement through to the post chamber so aq suppressant
What is the LOGTS study and what was Dr Nixons conclusion
Low tension glaucoma treatment study: is brimonidine neuroprotective
it showed Vf progession over 2.5 year period: 9.1 percent on brimonidine progressed compared to 39.2 percent timolol, Dr Nixon thinks this moreso shows Timolol is neurodestructive
What is the mechanism of action of a tetracycline and how can it be used for MGD
in MGD, normal meibomian gland secretion is cleaved by bacterial lipases, this creates FFA (which is omega 6/proinflammatory) and solid meibum
Tetracyclines normal MOA as an antibacteria is a protein synthesis inhibitor, but there can be usage of this that is not due to infection, but overgrowth. In this case, tetracyclines like doxy inhibit bacterial lipases which stops the process of splitting the Meibomian secretion into solid pieces and FFA
DOC for Scleritis, second choice, third? Dosage pattern of each?
What is Horners Syndrome and tell me the four drugs used to test it and how
Sympathetic denervation
Cocaine (blocks reuptake so it would fail to dilate a horners pupil), Apraclonidine (he didnt tell us i think and i dont remember), Hydroxyamphetamine (fails to dilate a post ganglionic horner bc it tells it to dump its NER but there isnt any) ,and Phenylephrine (will dilate a horners bc it upregulates alpha receptors on the target tissue and phenyl can bind it themselves, but dilute phenyl shouldnt be strong enough to dilate a normal person significantly)
What is Maximal medical Therapy
Currently: what drug is usually used for MMT
when a pt maxes out meds that can effectively lower IOP (could be on 5 drops) , currently line of thinking is 3-4 meds (2 bottles, bc if 2 combo meds thats 4 or if one combo and an add on thats three)
Contemporary MMT usually takes the form of Rocklatan and another combo drug
What did the Near 1 and 2 study determine about Vizz
73 percent of patients improve more than 3 lines of mesopic distance corrected near VA without losing more than 1 line of letters, 93 percent get 20/40 or better (as opposed to Qlosi which is 40 percent and 80 percent)