Supplemental Knowledge

  • Eylea-  is a drug used to treat wet age-related macular degeneration (AMD). It is also used to treat diabetic eye disease and other problems of the retina. It is injected into the eye to help slow vision loss from these and certain other diseases.

  • Eylea - is the brand name for the drug, which is called aflibercept. It blocks the growth and leaking of fluid from abnormal blood vessels in the back of the eye. Those blood vessels can leak and affect vision, causing vision loss from wet AMD and diabetic eye disease.

  • Avastin (bevacizumab) - is another drug like Eylea. Avastin was first approved by the Food and Drug Administration (FDA) to treat different types of cancer. Its use to treat eye disease is considered “off-label.”  The FDA allows “off- label” drug use if doctors are well informed about the product and studies prove the drug is helpful. Eylea may also be used off-label for some retinal conditions. Many studies have shown Avastin as safe and effective for eye disease since it was first used in 2005.

  • Hyperosmolar hyperglycemic state (HHS) -  is a serious complication of diabetes that happens when blood sugar levels are very high for a long period of time. Symptoms of HHS can include extreme thirst, frequent urination and confusion.

  • Thrombocytopenia - is a condition that occurs when the platelet count in your blood is too low. Platelets are tiny blood cells that are made in the bone marrow from larger cells. When you are injured, platelets stick together to form a plug to seal your wound.

  • Agranulocytosis - refers to having severely low neutrophil levels. Neutrophils are a type of white blood cell. They fight germs that make you sick. Untreated agranulocytosis can lead to life-threatening infections.


The following are the medications commonly involved with agranulocytosis:

  • Cancer chemotherapies.

  • Analgesic - and anti-inflammatory (gold, naproxen, and penicillamine)

  • Anti-thyroid (carbimazole, propylthiouracil)

  • Anti-arrhythmics (quinidine, procainamide)

  • Anti-hypertensives (captopril, enalapril, nifedipine)


  • Polycythemia vera (PV) - is a condition where the bone marrow goes into “overdrive” and makes too many red blood cells, along with too many white blood cells and platelets. This can put you at risk for life-threatening blood clots, bleeding, and certain blood cancers.

  • Cholestyramine - is used to lower high cholesterol levels in the blood. This may help prevent medical problems caused by cholesterol clogging the blood vessels. Cholestyramine is also used to remove substances called bile acids from your body.

  • Conn's syndrome - also known as primary aldosteronism, is a condition that causes resistant high blood pressure. It is caused by excess production of a hormone called aldosterone. Aldosterone is secreted by the adrenal glands to stimulate excretion of potassium by the kidneys.

  • Cholesteatoma - is a skin-lined cyst that begins at the margin of the eardrum and invades the middle ear and mastoid.

  • Glaucoma - is a disease that damages your eye’s optic nerve. It usually happens when fluid builds up in the front part of your eye. That extra fluid increases the pressure in your eye, damaging the optic nerve.

  • There are two main types of laser surgery to treat glaucoma. They help aqueous drain from the eye. These procedures are usually done in the ophthalmologist’s office or an outpatient surgery center.

    • Trabeculoplasty - This surgery is for people who have open-angle glaucoma and can be used instead of or in addition to medications. The eye surgeon uses a laser to make the drainage angle work better. That way fluid flows out properly and eye pressure is reduced.

    • Iridotomy - This is for people who have angle-closure glaucoma. The ophthalmologist uses a laser to create a tiny hole in the iris. This hole helps fluid flow to the drainage angle.

  • Cushing reflex -is a physiological nervous system response to acute elevations of intracranial pressure (ICP), resulting in the Cushing triad of widened pulse pressure (increasing systolic, decreasing diastolic) bradycardia, and irregular respirations.

  • Cushing's triad - refers to a set of signs that are indicative of increased intracranial pressure, or increased pressure in the brain. Cushing's triad consists of bradycardia, irregular respirations, and a widened pulse pressure.

  • Treatment of Cushing's triad

    • Treatment is aimed at decreasing the ICP, reversing the cause, and restoring cerebral blood flow. Intravenous mannitol, hyperventilation, and elevation of the head are all effective in decreasing the ICP. Some individuals may also benefit from additional medications such as methylprednisolone, propofol, or furosemide.

  • Interventions to lower or stabilize ICP include elevating the head of the bed to thirty degrees, keeping the neck in a neutral position, maintaining a normal body temperature, and preventing volume overload.

  • What fluids reduce ICP?

    • Mannitol, a hypertonic crystalloid solution, is commonly used to decrease brain water content and reduce intracranial pressure (ICP). Hypertonic saline solutions also decrease brain water and ICP while temporarily increasing systolic blood pressure and cardiac output.

  • Dawn phenomenon - happens when hormones your body naturally makes in the early morning (including cortisol and growth hormone) increase your blood sugar. The Somogyi effect also involves a surge of hormones, but it's due to a low blood sugar episode overnight. Dawn phenomenon doesn't happen because of low blood sugar.

  • Phantom limb pain - is the perception of pain or discomfort in a limb that is no longer there. PLP most commonly presents as a sequel of amputation. The underlying pathophysiology remains poorly understood. A patient may experience phantom pain soon after your amputation or even in the weeks or months afterward. The pain in the missing limb may be ongoing or unpredictable. It is often worse at night when your thoughts turn inward as outside distractions subside.

  • Insulin resistance - is when cells in your muscles, fat, and liver don't respond well to insulin and can't easily take up glucose from your blood. As a result, your pancreas makes more insulin to help glucose enter your cells.

    • It isn't clear exactly what causes insulin resistance, but a family history of type 2 diabetes, being overweight (especially around the waist), and being inactive all can raise the risk

  • Meniere's disease - is an inner ear problem that can cause dizzy spells, also called vertigo, and hearing loss. Most of the time, Meniere's disease affects only one ear. Meniere's disease can happen at any age. But it usually starts between the ages of 40 to 60.

    • Some researchers think that Ménière's disease is the result of constrictions in blood vessels similar to those that cause migraine headaches. Others think Ménière's disease could be a consequence of viral infections, allergies, or autoimmune reactions.

    • Meniere syndrome – The symptomatic triad of episodic vertigo, tinnitus, and hearing loss occurring secondary to other inner ear disorders.