NU 578
Unit 5 Study Guide
Key Concepts & Exam Review
University of South Alabama.
This document provides a focused
study guide
It summarizes key concepts, lecture highlights, and
exam-relevant material to support efficient last-
minute review. The guide is structured to help students reinforce
understanding, identify weak areas, and prepare confidently for
the assessment.
,Exam 5 Study Guide NU 578
Eye/Ear/Skin
Pilocarpine (eye) 1276-77 The muscarinic agonist pilocarpine may cause paradoxical increases
in intraocular pressure. It is indicated for the treatment of primary congenital glaucoma but not
glaucoma secondary to other conditions. The cholinesterase inhibitor echothiophate and the muscarinic
agonist pilocarpine are Pregnancy Risk Category Ca because there are no current results of animal
reproduction studies on which to base any conclusion. In patients with open-angle glaucoma, IOP is
reduced because the tension generated by contracting the ciliary muscle promotes widening of the
spaces within the trabecular meshwork, thereby facilitating outflow of aqueous humor.
Therapeutic Uses. Although used widely in the past, pilocarpine is now considered a second-line drug for
open-angle glaucoma. Pilocarpine can also be used for emergency treatment of acute angle-closure
glaucoma. Adverse Effects.
The major side effects of pilocarpine concern the eye. Contraction of the ciliary muscle focuses the lens
for near vision; corrective lenses can provide partial compensation for this problem. Occasionally,
sustained contraction of the ciliary muscle causes retinal detachment. Constriction of the pupil, caused
by contraction of the iris sphincter, may decrease visual acuity. Pilocarpine may also produce local
irritation, eye pain, and brow ache. Rarely, pilocarpine is absorbed in amounts sufficient to cause
systemic effects. Stimulation of muscarinic receptors throughout the body can produce a variety of
responses, including bradycardia, bronchospasm, hypotension, urinary urgency, diarrhea,
hypersalivation, and sweating. Caution should be exercised in patients with asthma or bradycardia.
Systemic toxicity can be reversed with a muscarinic antagonist (e.g., atropine).
Like pilocarpine, echothiophate can cause myopia (secondary to contraction of the ciliary muscle) and
excessive pupillary constriction.
macular degeneration 1279 Age-related macular degeneration (ARMD) is a painless,
progressive disease that blurs central vision and thereby limits perception of fine detail.
TX Angiogenesis Inhibitors Ranibizumab
Symptoms result from injury to the macula, the central part of the retina that contains the highest
density of photoreceptors, and hence provides the high-resolution central vision used for reading,
driving, sewing, recognizing faces, and so forth. ARMD is the leading cause of blindness in older
Americans
ARMD, macular photoreceptors undergo gradual breakdown, leading to gradual blurring of central
vision. The disease is characterized by the appearance of drusen (yellow deposits under the retina).
Drusen develop before any visual impairment occurs. Whether drusen actually cause visual loss is
unknown. However, we do know that an increase in the size or number of drusen increases the risk of
symptomatic ARMD. Dry ARMD has three stages of increasing severity
Early—characterized by a few small or medium-sized drusen and no change of vision • Intermediate—
characterized by many medium-sized drusen (or one or more large drusen) and minor visual changes (a
, need for increased light for reading, possible blurred spot in the center of the visual field) • Advanced—
characterized by drusen, breakdown of photoreceptors and supporting tissue, and progressive blurring
of central vision
Wet ARMD, macular degeneration is caused by the growth of new subretinal blood vessels, which are
often fragile and leaky. Fluid leakage lifts the macula from its normal place, which quickly causes
permanent injury. As noted, all people with wet ARMD have dry ARMD first. Vision loss occurs only in
[Lucentis], aflibercept [Eylea], and bevacizumab [Avastin]—can be used to inhibit growth of new blood
vessels in patients with neovascular ARMD. Benefits derive from antagonizing vascular endothelial
growth advanced dry ARMD and in wet ARMD
We have three standard treatments for neovascular ARMD: laser therapy, photodynamic therapy (PDT),
and therapy with angiogenesis inhibitors (i.e., drugs that suppress growth of new blood vessels). All
three treatments can slow disease progression. In some cases, treatment partially reverses vision loss. At
this time, treatment with an angiogenesis inhibitor is preferred to the other two options.
Angiogenesis Inhibitors Actions and Benefits. Four drugs—pegaptanib [Macugen], ranibizumab factor
(VEGF), an endogenous compound that (1) induces angiogenesis, (2) increases vascular permeability, and
(3) promotes inflammation—all of which can contribute to neovascular ARMD. Adverse Effects. The
biggest concern is endophthalmitis, an inflammation inside the eye caused by bacterial, viral, or fungal
infection. F
Laser Therapy In laser therapy, high-energy laser light is used to seal leaky blood vessels via coagulation.
Unfortunately, the procedure has several drawbacks. First, laser light can damage nearby retinal tissue,
and hence treatment is limited to regions away from the center of the macula. As a result, only a small
percentage of leaky vessels can be sealed. Se
Photodynamic Therapy PDT employs a photosensitive drug in combination with infrared light. The drug
—verteporfin [Visudyne]—has a high affinity for neovascular tissue. In the procedure, verteporfin is
delivered by IV infusion, and then an infrared laser is shined on the retina for 90 seconds. a severe burn.
Dry ARMD Although we can’t prevent vision loss in people with advanced ARMD, we may be able to
slow, or perhaps prevent, progression of intermediate disease. In the Age-Related Eye Disease Study
(AREDS), sponsored by the National Eye Institute, researchers showed that taking high doses of vitamin C
(500 mg), vitamin E (400 IU), beta-carotene (15 mg), and zinc (80 mg), all taken once a day, significantly
reduces the risk of developing advanced ARMD. In addition, participants took 2 mg of copper daily to
prevent copper deficiency anemia, which can develop when we consume lots of zinc. The AREDS
formulation is recommended for people at high risk of developing advanced ARMD, identified as those
with (1) intermediate ARMD in one or both eyes or (2) advanced ARMD (dry or wet) in one eye but not
the other. In AREDS, the formulation did not benefit people with early ARMD. The AREDS formulation is
available commercially as Ocuvite PreserVision.
Unit 5 Study Guide
Key Concepts & Exam Review
University of South Alabama.
This document provides a focused
study guide
It summarizes key concepts, lecture highlights, and
exam-relevant material to support efficient last-
minute review. The guide is structured to help students reinforce
understanding, identify weak areas, and prepare confidently for
the assessment.
,Exam 5 Study Guide NU 578
Eye/Ear/Skin
Pilocarpine (eye) 1276-77 The muscarinic agonist pilocarpine may cause paradoxical increases
in intraocular pressure. It is indicated for the treatment of primary congenital glaucoma but not
glaucoma secondary to other conditions. The cholinesterase inhibitor echothiophate and the muscarinic
agonist pilocarpine are Pregnancy Risk Category Ca because there are no current results of animal
reproduction studies on which to base any conclusion. In patients with open-angle glaucoma, IOP is
reduced because the tension generated by contracting the ciliary muscle promotes widening of the
spaces within the trabecular meshwork, thereby facilitating outflow of aqueous humor.
Therapeutic Uses. Although used widely in the past, pilocarpine is now considered a second-line drug for
open-angle glaucoma. Pilocarpine can also be used for emergency treatment of acute angle-closure
glaucoma. Adverse Effects.
The major side effects of pilocarpine concern the eye. Contraction of the ciliary muscle focuses the lens
for near vision; corrective lenses can provide partial compensation for this problem. Occasionally,
sustained contraction of the ciliary muscle causes retinal detachment. Constriction of the pupil, caused
by contraction of the iris sphincter, may decrease visual acuity. Pilocarpine may also produce local
irritation, eye pain, and brow ache. Rarely, pilocarpine is absorbed in amounts sufficient to cause
systemic effects. Stimulation of muscarinic receptors throughout the body can produce a variety of
responses, including bradycardia, bronchospasm, hypotension, urinary urgency, diarrhea,
hypersalivation, and sweating. Caution should be exercised in patients with asthma or bradycardia.
Systemic toxicity can be reversed with a muscarinic antagonist (e.g., atropine).
Like pilocarpine, echothiophate can cause myopia (secondary to contraction of the ciliary muscle) and
excessive pupillary constriction.
macular degeneration 1279 Age-related macular degeneration (ARMD) is a painless,
progressive disease that blurs central vision and thereby limits perception of fine detail.
TX Angiogenesis Inhibitors Ranibizumab
Symptoms result from injury to the macula, the central part of the retina that contains the highest
density of photoreceptors, and hence provides the high-resolution central vision used for reading,
driving, sewing, recognizing faces, and so forth. ARMD is the leading cause of blindness in older
Americans
ARMD, macular photoreceptors undergo gradual breakdown, leading to gradual blurring of central
vision. The disease is characterized by the appearance of drusen (yellow deposits under the retina).
Drusen develop before any visual impairment occurs. Whether drusen actually cause visual loss is
unknown. However, we do know that an increase in the size or number of drusen increases the risk of
symptomatic ARMD. Dry ARMD has three stages of increasing severity
Early—characterized by a few small or medium-sized drusen and no change of vision • Intermediate—
characterized by many medium-sized drusen (or one or more large drusen) and minor visual changes (a
, need for increased light for reading, possible blurred spot in the center of the visual field) • Advanced—
characterized by drusen, breakdown of photoreceptors and supporting tissue, and progressive blurring
of central vision
Wet ARMD, macular degeneration is caused by the growth of new subretinal blood vessels, which are
often fragile and leaky. Fluid leakage lifts the macula from its normal place, which quickly causes
permanent injury. As noted, all people with wet ARMD have dry ARMD first. Vision loss occurs only in
[Lucentis], aflibercept [Eylea], and bevacizumab [Avastin]—can be used to inhibit growth of new blood
vessels in patients with neovascular ARMD. Benefits derive from antagonizing vascular endothelial
growth advanced dry ARMD and in wet ARMD
We have three standard treatments for neovascular ARMD: laser therapy, photodynamic therapy (PDT),
and therapy with angiogenesis inhibitors (i.e., drugs that suppress growth of new blood vessels). All
three treatments can slow disease progression. In some cases, treatment partially reverses vision loss. At
this time, treatment with an angiogenesis inhibitor is preferred to the other two options.
Angiogenesis Inhibitors Actions and Benefits. Four drugs—pegaptanib [Macugen], ranibizumab factor
(VEGF), an endogenous compound that (1) induces angiogenesis, (2) increases vascular permeability, and
(3) promotes inflammation—all of which can contribute to neovascular ARMD. Adverse Effects. The
biggest concern is endophthalmitis, an inflammation inside the eye caused by bacterial, viral, or fungal
infection. F
Laser Therapy In laser therapy, high-energy laser light is used to seal leaky blood vessels via coagulation.
Unfortunately, the procedure has several drawbacks. First, laser light can damage nearby retinal tissue,
and hence treatment is limited to regions away from the center of the macula. As a result, only a small
percentage of leaky vessels can be sealed. Se
Photodynamic Therapy PDT employs a photosensitive drug in combination with infrared light. The drug
—verteporfin [Visudyne]—has a high affinity for neovascular tissue. In the procedure, verteporfin is
delivered by IV infusion, and then an infrared laser is shined on the retina for 90 seconds. a severe burn.
Dry ARMD Although we can’t prevent vision loss in people with advanced ARMD, we may be able to
slow, or perhaps prevent, progression of intermediate disease. In the Age-Related Eye Disease Study
(AREDS), sponsored by the National Eye Institute, researchers showed that taking high doses of vitamin C
(500 mg), vitamin E (400 IU), beta-carotene (15 mg), and zinc (80 mg), all taken once a day, significantly
reduces the risk of developing advanced ARMD. In addition, participants took 2 mg of copper daily to
prevent copper deficiency anemia, which can develop when we consume lots of zinc. The AREDS
formulation is recommended for people at high risk of developing advanced ARMD, identified as those
with (1) intermediate ARMD in one or both eyes or (2) advanced ARMD (dry or wet) in one eye but not
the other. In AREDS, the formulation did not benefit people with early ARMD. The AREDS formulation is
available commercially as Ocuvite PreserVision.
