ABC of Ocular Pharmacology for Optometrists in Nigeria 2-Drugs terminologies commonly encountered in our practices and their what they mean!

A primary eye care Optometrist, in the rural or urban setting, is faced with the tasks of prescribing ocular medications from time to time. The professional should also be able to read through the drug history of patients as passed on by a former colleague or another medical professional without much hassles.
In our continuing bid to empower the primary eye care Optometrist in Nigeria, Africa and beyond; this blog has decided to put down most of the latinized terminologies on how to write drug prescriptions. It cannot be over emphasized, the importance of such primary knowledge to Optometric practice in Nigeria and beyond.
Excerpt:

Abbreviation	Latin	Meaning
aa	ana	of each
ad	ad	up to
a.c.	ante cibum	before meals
a.d.	aurio dextra	right ear
ad lib.	ad libitum	use as much as one desires; freely
admov.	admove	apply
agit	agita	stir/shake
alt. h.	alternis horis	every other hour
a.m.	ante meridiem	morning, before noon
amp		ampule
amt		amount
aq	aqua	water
a.l., a.s.	aurio laeva, aurio sinister	left ear
A.T.C.		around the clock
a.u.	auris utrae	both ears
bis	bis	twice
b.i.d.	bis in die	twice daily
B.M.		bowel movement
bol.	bolus	as a large single dose (usually intravenously)
B.S.		blood sugar
B.S.A		body surface areas
cap., caps.	capsula	capsule
c	cum	with (usually written with a bar on top of the "c")
c	cibos	food
cc	cum cibos	with food, (but also cubic centimetre)
cf		with food
comp.		compound
cr., crm		cream
D5W		dextrose 5% solution (sometimes written as D5W)
D5NS		dextrose 5% in normal saline (0.9%)
D.A.W.		dispense as written
dc, D/C, disc		discontinue
dieb. alt.	diebus alternis	every other day
dil.		dilute
disp.		dispense
div.		divide
d.t.d.	dentur tales doses	give of such doses
D.W.		distilled water
elix.		elixir
e.m.p.	ex modo prescripto	as directed
emuls.	emulsum	emulsion
et	et	and
ex aq	ex aqua	in water
fl., fld.		fluid
ft.	fiat	make; let it be made
g		gram
gr		grain
gtt(s)	gutta(e)	drop(s)
H		hypodermic
h, hr	hora	hour
h.s.	hora somni	at bedtime
ID		intradermal
IM		intramuscular (with respect to injections)
inj.	injectio	injection
IP		intraperitoneal
IV		intravenous
IVP		intravenous push
IVPB		intravenous piggyback
L.A.S.		label as such
LCD		coal tar solution
lin	linimentum	liniment
liq	liquor	solution
lot.		lotion
M.	misce	mix
m, min	minimum	a minimum
mcg		microgram
mEq		milliequivalent
mg		milligram
mist.	mistura	mix
mitte	mitte	send
mL		millilitre
nebul	nebula	a spray
N.M.T.		not more than
noct.	nocte	at night
non rep.	non repetatur	no repeats
NS		normal saline (0.9%)
1/2NS		half normal saline (0.45%)
N.T.E.		not to exceed
o_2		both eyes, sometimes written as o2
o.d.	oculus dexter	right eye
o.s.	oculus sinister	left eye
o.u.	oculus uterque	both eyes
oz		ounce
per	per	by or through
p.c.	post cibum	after meals
p.m.	post meridiem	evening or afternoon
prn	pro re nata	as needed
p.o.	per os	by mouth or orally
p.r.		by rectum
pulv.	pulvis	powder
q	quaque	every
q.a.d.	quoque alternis die	every other day
q.a.m.	quaque die ante meridiem	every day before noon
q.h.	quaque hora	every hour
q.1h	quaque 1 hora	every 1 hour; (can replace "1" with other numbers)
q.d.	quaque die	every day
q.i.d.	quater in die	four times a day
q.o.d.		every other day
qqh	quater quaque hora	every four hours
q.s.	quantum sufficiat	a sufficient quantity
R		rectal
rep., rept.	repetatur	repeats
RL, R/L		Ringer's lactate
s	sine	without (usually written with a bar on top of the "s")
s.a.	secundum artum	use your judgement
SC, subc, subq, subcut		subcutaneous
sig		write on label
SL		sublingually, under the tongue
sol	solutio	solution
s.o.s., si op. sit	si opus sit	if there is a need
ss	semis	one half
stat	statim	immediately
supp	suppositorium	suppository
susp		suspension
syr	syrupus	syrup
tab	tabella	tablet
tal., t	talus	such
tbsp		tablespoon
troche	trochiscus	lozenge
tsp		teaspoon
t.i.d.	ter in die	three times a day
t.d.s.	ter die sumendum	three times a day
t.i.w.		three times a week
top.		topical
T.P.N.		total parenteral nutrition
tr, tinc., tinct.		tincture
u.d., ut. dict.	ut dictum	as directed
ung.	unguentum	ointment
U.S.P.		United States Pharmacopoeia
vag		vaginally
w		with
w/o		without
X		times
Y.O.		years old

(source: Wikipedia)

The above prescription codes should help during co-management of disease conditions with other health care providers, objectifying our respect in the medical world and developing Optometry in Nigeria into a truly medical eye care profession in line with the dreams of our founding fathers...
I am all for the 21st century trend of Optometry, but I believe we have to earn it; we have to expand, grow and redefine our place in the medical world!
Long live Nigerian Optometrists,
Long live Optometry!
Compliments of the season!

A discussion session in Pan-OJ Clinic and Diagnostic services limited... My presentation!

Below is the original copy of my presentation during one of the clinic's health education meetings. Read on:

Topic: Clinical Optometry Practice in Eye care

Discussion:

·         Introduction- an Optometrist is an eye care professional who specializes in using refraction and other form of eye tests within the scope of their practice to diagnose, treat & manage conditions of the eye as a functional part of the human system.

 

·         Brief History- The profession Optometry became popular in the early 19^th century. Prior to this time, it was unregulated and was made up of mainly opticians (one who fits glasses) for the commercial purpose of providing spectacles for their clients. Today, the profession has gradually evolved into a medical eye care provider. [In some states in the USA, Optometrists are trained to perform laser surgeries and other invasive procedures on the eyes.]

 

 

·         The Organogram of eye care- The eye care is a sub-sector of the health care sector. There are three different types of care in eye care sub-sector, viz primary, secondary and tertiary eye care.

Primary eye care involves preventive eye care procedures like ocular hygiene, vision screening, education etc.

 Secondary eye care involves treating eye conditions with glasses, drugs or surgery. 

 Tertiary eye care involves using low vision aids to improve vision, post surgical care, glass prescription follow-up for children below 9 years, managing chronic eye conditions e.g. glaucoma.

There are three different types of eye care providers:

1) The optician (those who fix glasses prescribed by a refractionist.),

2) The Optometrist (those who use refraction and other eye tests to non-invasively diagnose and treat/manage/refer patients with eye medical conditions.) and

3) The Ophthalmologist (Eye care specialists who use various invasive procedures to manage eye medical conditions).   

 

The practice of Optometry- The practice of Optometry today has evolved beyond managing ocular conditions with glasses alone into a medical eye care profession as is been witnessed in our clinic. There are currently six sub-units represented in Pan-OJ Clinic and Diagnostic Services Limited.  The practice of optometry in the clinic been able to touch various units in the clinic as highlighted by the following illustrations:

a)    The drug dispensing/nurses unit-

 *The nurses provide the optometrist with auxiliary services in the form of taking Blood pressure(B.P.) , Visual acuity (V.A.), dilating of the eyes with mydriatics etc 

* They educate patients on how to apply their eye drops/ointments.

* The nurses help patients in making choices for frames in the clinic.

 

b)   The administrative unit-  [The receptionist and the PRO]

* The Receptionist registers our patients and directs them to the eye examination room.

 * She informs the patients about their glasses and ensures that the patients pay up before final dispensing of glasses and drugs.

* She communicates follow-up information to the patients.

* She assists the patients in choosing their frames in absence of the nurses.

* Sorts out patient’s folders when needed in the eye care unit.

* The public relation officer (the P.R.O.) helps in creating eye care awareness and set seminars/workshops in schools, hospitals, churches etc

* The PRO can assist patients in choosing glasses.

 

The following three clinical co-managed cases highlight the relationship between Optometry practice and general health care practice in Pan-OJ Clinic and Diagnostic Services Limited.

Case History (By the Head Laboratorist) 1:

 Px, 29, A complained of poor and deteriorating vision for the past 5 years especially on the right eye.

 Her visual acuity (V.A.) @ 6 meters was

 

RE: 6/4

LE: 1/60

Refraction was

RE: +0.50 DS (Dioptre Sphere) [6/4]

LE: +0.50 DS (Dioptre Sphere) [1/60]

Both eyes were dilated using Gutt: Mydriacyl 1% one drop every 5 minutes until maximum dilation was achieved.

Ocular fundus examination with the slit lamp and the Ophthalmoscope revealed a macular scar on the Left eye and a coeco-central choroido-retinal scar on the right eye. A laboratory test was requested to rule out toxoplasma gondii as a causative agent.

A laboratory microbial analysis of the blood collected around 12.00 noon for ova/egg of Toxoplasma gondii was carried out which showed the presence of the parasitic egg.

Case History 2 (By Doctor Giwa):

Px B, 33, presents to the clinic with a painful vesicobullous dermatitis on patient’s left side of the face. He complained of photophobia, epiphora, chronic redness and loss of vision on the ipsilateral eye. Patient has variously used over the counter eye drops without much improvement.

His visual acuity @ 6 meters was

RE: 6/5

LE: LP

External examination revealed a neovascularized cornea, corneal ulcer, anterior synechia and associated blepheritis. There is no corneal sensitivity on the left eye.   RVS test was requested and it came out positive. Clinical observation of the red eye with the RVS result confirmed the presence of Herpes Zoaster Ophthalmicus (HZO). He has since been co-managed with a general practitioner. On his last visit, prognosis has improved drastically.

His visual acuity on the Left eye has improved to 6/60!

Case history 3 (By Mr Moses):

Px C, 38, is a known chronic hyperglycaemic patient who presented with sudden reduced vision even with her habitual prescribed glasses. Her presenting visual acuity 6 meters [with her glasses] was

RE: 6/18

LE: 6/12

Her visual acuity @25 cm was N8.

Refraction was

RE:-1.50-1.00 x 30 [6/9]

LE:-1.25-1.00 x 150 [6/9]

     Add 2.25 [N5]

She was given the glasses. 3 months later she returned to the clinic with same complaint that her glasses do not allow her see. Her presenting Fasting Blood Sugar (FBS) was 20 mmol/l. Her visual acuity was

RE: 6/12

LE: 6/12

Refraction was:

RE: +1.00-1.00 x 30 [6/5]

LE: +1.25-1.00 x 150 [6/5]

Add 2.00 [N5]

She was given the new glasses but was told to that her blood sugar level change will affect this new refractive status. Last week, she reported back to the clinic with improved blood sugar value of 9mmol/l. She cannot see with her last glass prescription. Her visual acuity was

RE: Plano-0.75 x 30 [6/4]

LE: -0.25-0.75 x 150 [6/4]

Add 2.00 [N5].

This is a typical case of fluctuating refractive errors in adults associated with DM. the new glasses has since been given to her while a General practitioner manages her hyperglycemia.

 

In conclusion of our session, it cannot be over-emphasised the role of clinical optometry in health care practice. It is no longer the practice of lens prescription. It involves using both topical and non-topical drug agents to treat/manage the condition of the eyes.

Thank You.

Dr Victor Ezebuiroh Okwudiri (OD)

 

Hope you enjoyed it... Compliments of the season!

Hypertension and the Eye... What the Primary Eye care Optometrist Should Know.

Hypertension is a chronic cardiovascular condition characterized by elevated blood pressure.
The normal blood pressure is a function of two measurements: the diastolic and the systolic blood pressure measurements. The diastolic is measured in between two systolic beats, when the heart muscles are relaxed. The normal diastolic value ranges from 60-90mmHg. The systolic is measured when the heart muscle contracts followed by a beat. The normal systolic value ranges from 100-140 mmHg. A ratio=

Systolic/Diastolic (mmHg) defines the arbitrary blood pressure.

An indivudual is said to be hypertensive when his systolic is consistently equal to and/or above 140 mmHg with a consistent diastolic reading of 90 mmHg and above.
Like other cardiovascular conditions, hypertension has strong affinity for blood vessels especially the capillaries. Arterisclerosis and arteriolosclerosis are major cardiovascular changes that is associated with chronically elevated blood pressure.
The eye is surrounded by end blood vessels, i.e. blood vessel with terminal roots in the eye. The retina, the uvea and the optic nerve areas are vascularized areas of the posterior eyeball. They are made-up of tiny arterioles susceptible to chronic hypertension. The chronicity and management of systemic hypertension determines how most ocular symptoms of the disease manifest. And the vascularized parts of the eyes are frequently affected more often than the non-vascular portions of the eyes. For instance, the retina is more affected in systemic hypertension than by the non-vascularized cornea.
The retina and the choroid are the earliest to start showing signs of systemic hypertension. Thinning of retinal vasculature, nicking of retinal vessels, deep seated choroidal vascular changes and oftentimes background hypertensive retinopathies. This patient complains of reduced visual acuity both far and near especially in the adult population. The resulting refractive error is often a hyperopic shift. One will expect increased crystalline lens sclerosis in adult hypertensive patients.
Poorly managed or unmanaged systemic hypertension causes more dramatic ocular complications. The retina, the choroid, the optic nerve and the surrounding vitreous body casts varying signs and symptoms that complicates visual acuity. The retinal sensitivity is severely reduced in cases of proliferative hypertensive rethinopathy. Retinal haemorrahge is not uncommon in very poorly managed systemic hypertension. Chronic and unmanaged hypertension could cause serious choroidal vascular complications which often results in low vision or even blindness.
As a primary health care specialist, it is required of us to always place emphasis on the rouine BP check for our patients even without complementary ocular symptoms.Every patient with hypertension should be periodially visually examined to rule out potentially blinding signs associated with long standing hypertension. Refer every hypertention patient you come in contact with to the nearest medical centre while encouraging healthy living viz exercises, dieting and periodic medical check-ups etc...