University of Connecticut



An Octet of Ocular Conditions: Current “Eye” diologyPost-test – PharmacistsLearning ObjectivesAfter completing this continuing education activity the pharmacist will be able to: DISCUSS common ocular condition’s pathophysiology and causes IDENTIFY recent changes in available medications to treat ocular conditionsDISTINGUISH each FDA-approved product by the condition that it treatsDISCUSS barriers to care, adherence, and administration of eye drop wasteMAXIMIZE pharmacist’s role in identifying OTC products, referring patients for prescription strength medication, and counseling patients about both A patient presents you a prescription for cromolyn 4% solution. Which of the following conditions can be managed with this medication? Bacterial conjunctivitisDry eyeRetinal detachmentAllergic conjunctivitis A patient with glaucoma presents to the pharmacy to pick up a new prescription for brimonidine 0.1% eye drops. The patient already uses timolol 0.5% eye drops and asks for an advice on when to administer each drop. How do you instruct this patient?Have the patient hold one bottle in each hand and administer one drop of each simultaneouslyBrimonidine and timolol can be used concurrently. Just wait at least five minutes in between each dropInstruct the patient to instill brimonidine one hour after instilling timololThese drops should not be used together. Contact the patient’s prescriber immediately for an alternative therapyYou are working with a second year pharmacy intern who is preparing a prescription for atropine 1% eye drops. The intern mentions she has not learned about this drug yet and wants to know how it works. What do you tell her? It works by decreasing the production of aqueous humorIt stabilizes mast cells to prevent degranulation It paralyzes the ciliary muscle and causes pupil dilation It binds to VEGF receptors to prevent neovascularization A patient with age-related macular degeneration brings in a prescription for timolol to be filled. The patient states that he was diagnosed with increased intraocular pressure shortly after receiving a dose of a new mediation. Which medication most likely caused this side effect? PegaptanibRanibizumabAfliberceptBevacizumab A patient is prescribed erythromycin ointment, Apply ? inch four times a day for five days, for treatment of bacterial conjunctivitis. She states that she is very active at work, so it’s difficult for her to wear her glasses on a daily basis; she prefers her contacts. How should you instruct this patient on how to use her medication with her contacts?“Keep your contacts in while applying the ointment, there is no need to wear glasses.”“Contacts should be avoided while using the eye ointment. Wearing glasses while using the ointment is recommended.”“Take your contacts out while applying the ointment. They can be put back in right after application.”“Apply the ointment to the top lid rather than the bottom eyelid to avoid contact with the lens.”In which of the following instances is a patient appropriately prescribed TobraDex? solution?A patient who complains of itchy, red eyes when she’s around her friend’s new catA patient who has just been diagnosed with acute bacterial conjunctivitisA patient with a corneal abrasionTobraDex? is contraindicated in all eye conditionsA patient calls your pharmacy complaining of some eye irritation. He mentions that he recently started using betaxolol 0.5% solution yesterday. He administered it twice a day as directed on the prescription label. Shortly after each dose, he noted some stinging in the eye that was bothersome. He wants to know if there is anything that can done to minimize the irritation. All of the following would be appropriate responses EXCEPT? “Let me check the package and see if there are any preservatives in the product. Preservatives can sometimes cause irritation.”“I will call your prescriber. Perhaps you can be switched to an alternative medication with less irritation.”“There is a 0.25% solution available. It may cause less irritation since it is less concentrated. I can call your prescriber and see if he wants to switch it.”“It sounds like you are having an severe allergic reaction. Fortunately, you can take an OTC antihistamine such as loratidine to help.” A patient presents to the pharmacy to pick up refills on his chronic medications (finasteride, amlodipine, tamsulosin and rosuvastatin). He tells you that he has cataract surgery scheduled in three weeks. Which of his medications poses a safety risk and should prompt as call to his surgeon? FinasterideAmlodpineTamsulosinRosuvastatinA patient with rheumatoid arthritis comes to you in the pharmacy to pick her prescriptions and mentions that her vision “just isn’t as clear as it used to be.” The medications she is picking up include ibuprofen 600 mg one tablet every eight hours as needed, amlodipine 5 mg daily, prednisone 20 mg daily and methotrexate 2.5 mg take 10 mg every week. She also is picking up a bottle of over the counter “eye vitamins” to help with the blurriness. Which of her medications could possibly be contributing to her current symptoms?MethotrexatePrednisoneIbuprofenAmlodipineA patient calls the pharmacy complaining of purulent discharge of the eye. This symptom is most consistent with which ocular condition? Dry eyeBacterial conjunctivitisAge-related macular degenerationUveitis A 77-year old female presents with a new diagnosis of macular degeneration. She has a 35 pack-year history of smoking. She wants to purchase a multivitamin to prevent further worsening of her vision. Which of the following is best to recommend? Vitamin C, vitamin D, beta-caroteneVitamin C, vitamin E, zincVitamin B complex, omega-3 fatty acids Any general multivitamin will do A 63-year old male presents to the ambulatory care clinic for follow-up of his glaucoma. He has a history of HTN and type 2 diabetes, both well controlled. His current medications include lisinopril 10 mg daily, aspirin 81 mg daily, metformin ER 500 mg twice daily and latanoprost one drop in both eyes once daily at bedtime. His intraocular pressure remains elevated. Which would be the most appropriate therapy to add at this time? BimatoprostCarbacholTimololTravoprostA patient is going in for a cataract surgery next week. He brings in a prescription for prednisolone acetate 1% to be used before and after the surgery, but is concerned because he didn’t receive a prescription for antibiotics like he did for his last cataract surgery 4 years ago. How can you help this patient?Call the surgeon immediately because all patients should receive a topical antibiotic pre-operativelyCounsel the patient that most patients don’t require antibiotics before cataract surgery. Suggest the patient call the surgeon if he remains concernedFax the surgeon for a refill of the antibiotic used four years agoRecommend an OTC topical antihistamine as a safer alternative A patient is on Travatan? eye drops at home, but this medication is not on the formulary at your hospital. Which of the following agents would be an appropriate alternative for this medication while the patient is hospitalized?Xalatan?Vigamox?Patanol?Voltaren?Which of the following products would be a good option to recommend for a patient with dry eye who has ommetaphobia (fear of eyes) that causes the patient to have intense anxiety about getting anything in her eyes or touching her eyes?Use an eye ointment instead of eye dropsStart taking fish oil capsules 4 times a day Tell the patient that they have no other option besides eye drops for the treatment of dry eyesRecommend trying a TrueTear? device to stimulate tear productionA patient has been refilling her FML? eye drops every month for about two years for treatment of “itchy eyes.” She complains about feeling antsy lately and doesn’t know what has changed in her regimen to make her feel this way. What might explain the patient’s symptoms? The patient is likely experiencing systemic effects from this medication. Contact the prescriberRecommend Alaway? for treatment of allergic conjunctivitisRecommend the patient starts taking cetirizine 10mg dailyThe patient likely has glaucoma and is antsy because of the loss of her field of vision. Recommend she sees her optometrist as soon as possibleA patient was recently started on amiodarone for the management of atrial fibrillation. How often should he have his eyes checked? Every two yearsEvery six months for the first year, then once a year thereafterEvery three months for the first year, then once every 2 years thereafter Every five yearsA patient is currently on a complicated regimen for the treatment of his glaucoma. His medications include: brimonidine 0.15%, one drop in each eye twice a day, dorzolamide 2%, one drop in each eye twice day, timolol 0.5% one drop in each eye twice a day and latanoprost 0.005% one drop in each eye at bedtime. How can you help this patient simply his regimen?Recommend discontinuation of latanoprost as this medication is not helpful in the treatment of glaucomaSwitch dorzolamide to brinzolamide as this agent is much more affordableRecommend a fixed-dose combination product of brimonidine and latanoprostRecommend a fixed-dose combination product of timolol and dorzolamideA patient presents to the pharmacy counter holding an ice pack over his eye and places a 500-count bottle of acetaminophen. He mentions that he was hit in the face with a baseball 15 minutes ago and his eye is quite painful. Upon removing the ice pack from his eye, you notice a significant amount of swelling and bleeding around the eye. How should you further assist this patient?Recommend the patient also picks up a bottle of ibuprofen to help the swellingAsk the pharmacist to recommend an allergy eye drop to help with the redness in the patient’s eyeTell the patient they don’t need the acetaminophen as the condition will heal by itselfTell the patient that he has a serious medical emergency and he must go to the nearest urgent care or ERA patient is looking for a product recommendation for the management of dry eye. She appears overwhelmed by all of the OTC eye care products and can’t choose one. She brings four different products to the counter and wants to know which can help manage dry eye. Which OTC product can be used for the treatment of dry eye? Cyclosporine KetotifenSodium carboxymethylcelluloseTetrahydrozoline ................
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