Module Overview

1 Legislation relating to the use of pharmaceutical agents by Optometrists in ROI and UK (making reference to Irish statute book, relevant statutory instruments to Irish Opticians Act, ROI Medicinal product regulations 2003, UK Opticians Act, UK Medicines Act 1968). Including notes on:

• drugs classification (General sales, Pharmacy medicines and prescription only medication),
• opticians formulary (tariff),
• emergency supply,
• obtaining a supply of diagnostic drops (signed order- requirements),
• UK-Crown review 1999,
• UK- History of optometrist prescribing,
• Supplementary prescribing,
• Patient group directions,
• Independent prescribing for Optometrists (UK),
• UK- Optometrists formulary (Level 1 v Level 2 medicines),
• UK- Competency framework for optometrist prescribers.

 

2 Drug formulation and sterilisation

• Available ophthalmic drug formulations,
• Formulation of eye drops (active ingredient, water (WFI or purified water), buffering agent, stabiliser, preservative, viscoliser, reducing agent, sequestering agent),
• Eye drops used as anaesthetics, anti-inflam, antiseptic, diagnostic drop, miotic, mydriatic, artificial tears,
• Use of preservatives (options),
• Sterilisation of eye drops/ eye ointments (autoclave, heating with preservative, filtration, ionising radiation, ulstasonics),
• Shelf life and storage considerations,
• Identifying product details from packaging eg minim box (name of drops, drug classification, strength, date of manufacture, expiry date, product license number, bath number etc.).

 

3 Pharmacokinetics

• Pharmacodynamicvs. pharmacokinetic,
• Pharmacokinetic factors (Absorption, distribution, metabolism, excretion),
• Methods of drug movement across membrane barriers (Aqueous diffusion, lipid diffusion, via carriers, pinocytosis),
• Routes of administration,
• Bioavailability,
• Bioequivalence,
• The major body compartments,
• Features of the blood brain barrier and blood retinal barrier,
• Volume of distribution,
• Compartment models (1, 2, and 3 compartment models),
• Pharmacokinetic modelling,
• Drug half life (t ½),
• Cytochrome p450enzymatic oxidation,
• Enzyme inducers v enzyme inhibitors,
• Biliary excretion and enterohepatic circulation,
• Renal excretion.

 

4 Pharmacology

• Principles of drug action,
• Drug receptors (configuration and action),
• General features of peripheral autonomic neurotransmission,
• Enzymes,
• Transporters,
• Ion channels,
• Drug specificity,
• Efficacy and potency,
• Agonists,
• Antagonists/ partial agonists.

 

5 Autonomic nervous system

• Functional subdivisions- sympathetic/ parasympathetic,
• Features of sympathetic/ parsympatheticneuronal transmission,
• Cholinergic neurones,
• Adrenergic neurones,
• Autonomic innervation of the eye.

 

6 Action, usage, dose, duration, cautions and side effects for:

• Cyclopegics (esp- cyclopentolate),
• Mydriatics (esptropicamide and phenylephrine),
• Miotics (esppilocarpine).

Also:

• Pupil block,
• Angle closure glaucoma,
• Treatment of acute angle closure.

 

7 Action, usage, dose, duration, cautions and side effects for:

• Local/ topical anaesthetics,
• Non-steroidal anti inflammatories.

 

8 Immune system

• Non-specific body defences,
• Specific defences,
• Classes of circulating antibodies,
• T cells,
• Immunity,
• Auto immune disease,
• Allergy,
• Hypersensitivity reactions (type 1- type 4),
• Anaphylaxis,
• Action/ usage/ dose/ side effects/ caution s for steroids, anthistamines, ocular decongestants and mast cell stabilisers.

 

9 Antimicrobials

• Principles and definitions (MIC/ MBC),
• Gram stain,
• Prokaryotic v Eukaryotic cells,
• Bacteriocidal v bacteriostatic,
• Morphology and classification and action of bacteria, viruses, prions, fungi, yeasts, actinomycetes, protozoans,
• Antibiotic susceptibility testing,
• Narrow spectrum v broad spectrum,
• Antibiotics- bacterial cell wall inhibitors (e.g., B-lactam antibiotics),
• Antibiotics- Protein synthesis inhibitors (aminoglycosides, tetracyclines, chloramphenicol, macrolides),
• Antibiotics- interfere with elongation factors- fuscidic acid,
• Antibiotics- inhibitors of nucleic acid synthesis- Rifampicin,
• Antibiotics- inhibitors of DNA Synthesis (quinolones),
• Antmetabolites (sulfonamides, trimethoprim, methotrexate),
• Anti-mycobacterial antibiotics (Para-aminosalicyclic acid, dapsone),
• Ant-microbial drug resistance,
• Antivirals/ antifungals/ anti protozoas.

 

10 Glaucoma

• The Glaucomas (E.G.S. Guidelines) – Primary Congenital; Primary Open-Angle; Secondary Open-Angle; Primary Angle-Closure; Secondary Angle-Closure,
• Ocular Hypotensive agents,
• Prostaglandin analogues and prostamides,
• Beta-blockers,
• Sympathomimetics,
• Carbonic anhydrase inhibitors,
• Systemic drugs,
• Miotics,
• Anti-metabolites.

 

11 Medical Retina

• Corticosteroids,
• Anti-VEGF agents (ranibizumab, bevacizumab, pergaptanib, aflibercept,
• Benzoporphyrin deriavtives,
• Anti-oxidant supplementation (including macular carotenoids),
• Disease pathophysiology and treatment of: neovascular AMD, Diabetic macular oedema, Retinal Vein Occlusions, non-infective posterior uveitis, “dry” forms of AMD.

Lectures, practicals, E-learning, directed study, self-directed study, tutorials, specialist clinics, and/or school vision screenings.

Module Content & Assessment
Assessment Breakdown	%
Formal Examination	60
Other Assessment(s)	40