1691 Final Material Flashcards
Brimonidine tartrate 0.025%
Alpha-2 adrenergic agonist for ocular redness, 1gtt QD
Lumify brand name
Mast cell stabilizers
For allergies, take 7-14 days to work so used prophylactically or chronically, rx required
Lodoxamide tromethamine 0.1% (Alomide)
mast cell stabilizer
1gtt QID , >2yo
Nedocromil sodium 2% (Alocril)
mast cell stabilizer
1gtt BID , 3yo
Pemirolast potassium (Alamast)
mast cell stabilizer
1gtt QID , >3yo
Cromolyn sodium 4% (Crolom)
mast cell stabilizer
1gtt, QID , >4yo
Antihistamines
Rapid response for allergic reactions, more used for moderate to severe cases, rx required, can be drops or oral med (some oral meds OTC)
Emedastine difumarate 0.05% (Emadine)
antihistamine eye drop
1gtt QID , >3yo
Cetirizine 0.24% (Zerviate)
antihistamine eye drop with Hydrella vehicle
1gtt BID , >2yo
Diphenhydramine (Benadryl)
1st gen oral antihistamine, causes drowsiness
25-50mg q4-6h
Chlorpheniramine (Chlor-Trimeton)
1st gen oral antihistamine, causes drowsiness
4mg q4-6h , >6 yo
Cetirizine hydrochloride (Zyrtec)
2nd gen oral antihistamine, less drowsy
10mg QD , >2 yo
Loratadine (Claritin, Alavert)
2nd gen oral antihistamine, less drowsy
10mg QD , >2 yo
Fexofenadine hydrochloride (Allegra)
2nd gen oral antihistamine, less drowsy
up to 180mg QD, >6 yo
Desloratadine (Clarinex)
3rd gen oral antihistamine, faster action loratadine
BID or QD , >1yo for liquid
Levocetirizine (Xyzal)
3rd gen oral antihistamine, more effective cetirizine and fewer side effects
QD, >6 mo for liquid
Hydrocortisone 1% ung or cream
non-ocular topical corticosteroid, OTC
BID to TID, 5-10 days
for eczema symptoms in allergies, used on skin not in eyes
Triamcinolone 0.0025-0.5% ung or cream
non-ocular topical corticosteroid, rx required
BID to TID, 5-10days
Triamcinolone (Nasacort AQ) Fluticasone furoate (Veramyst) Fluticasone propionate (Flonase) Budesonide (Rhinocort Aqua) Beclomethasone (Beconase AQ)
nasal spray corticosteroids, can be used for rhinoconjunctivitis symptoms, rx required
2 sprays each nostril QD
Ketotifen fumarate 0.025%
combined antihistamine/mast cell stabilizer, generally BID
Olopatadine hydrochloride
Combined antihistamine/mast cell stabilizer
Pataday Twice daily relief (replaces Patanol 0.1%), once daily relief (replaces Pataday 0.2%), once daily relief extra strength (replaces Pazeo 0.7%)
Azelastine hydrochloride 0.05% (Optivar)
Combined antihistamine/mast cell stabilizer
1gtt BID, >3yo
Epinastine hydrochloride 0.05% (Elestat)
Combined antihistamine/mast cell stabilizer
1gtt BID, >3y
Bepotastine besolate 1.5% (Bepreve)
Combined antihistamine/mast cell stabilizer
1gtt BID, >2yo
Alcaftadine 0.25% (Lastacaft)
Combined antihistamine/mast cell stabilizer
1gtt QD, >2yo
Loteprednol etabonate
Topical corticosteroid drop, requires its ester group for activity, rapid de-esterification in tissues causes quick inactivation and very little systemic effect
Lotemax 0.5% suspension ung QID
Inveltys 1.0% suspension, nanoparticle formula BID
Lotemax SM 0.38% gel, submicron formula TID
Difluprednate (Durezol 0.05%)
Topical corticosteroid emulsion
Dexamethasone
Corticosteroid, topical Maxidex 0.1% solution, 10 or 13 day DexPak, Ozurdex insert, or injections
Rimexolone (Vexol 1.0% suspension)
Topical corticosteroid
Prednisolone acetate
Strong corticosteroid, Pred Forte 1.0% suspension, Pred Mild 0.12% suspension, Six-day Medrol po
be careful using generic Pred
Fluorometholone
Topical corticosteroid, weaker than Pred, used for more mild reactions
FML Forte 0.25% suspension, FML Liquifilm/Flarex 0.1% suspension, FML ophthalmic 0.1% ung
Which medication interferes with the development and activity of T cells, and is used to treat inflammation in DED?
Cyclosporine
Diclofenac 0.1% (Voltaren)
Topical NSAID, older type, approved for more txs, stings, cheaper, QID
Ketorolac tromethane
Topical NSAID, less stinging, more expensive, 0.5% for generic QID
- 4% Acular LS, QID
- 45% Acuvail BID, preservative free
Nepafenac
Topical NSAID, 0.1% for generic QD
0.3% Ilevro QD
1% Nevanac TID, has better bioavailability for getting to the back of the eye
Bromfenac
Topical NSAID, 0.09% for generic BID
- 7% Prolensa QD, better corneal permeability
- 9% Xibrom, 0.9% Bromday, 0.075% Bromsite
What groups of meds do DMARDs (biological agents) include?
TNFa inhibitors, IL-6, and Type I interferons
Ilevro
Nepafenac NSAID, 2x concentration of the active drug, lower pH (6.8 vs 7.4), reduced molecule size so better penetrability, faster dissolution when on ocular surface, and guar gum may increase time on ocular surface, better availability
Tobradex
Combo drop - tobramycin + dexamethasone
1-2gtts TID to QID
Zylet
Combo drop - tobramycin + loteprednol
1-2gtts TID to QID
Maxitrol
Combo drop - neomycin + Polymyxin B + dexamethasone
1-2gtts TID to QID
FML-S Liquifilm
Combo drop - sulfacetamide + fluorometholone
1gtt QID
Palliative ocular pain drugs
Artificial tears, cycloplegics, topical steroids
Analgesics for ocular pain
Topical NSAIDs, topical anesthetics, oral pain relievers, opioids, etc.
Cycloplegics - for ocular pain
Atropine for most sustained effect, duration up to 12 days, can be 0.5%, 1%, 2% gtts or 1% ung BID to TID
Homatropine for acute conditions, but not immobilizing iris completely so better if risk of synechiae, uveitis cases, duration 1-3 days and can be 2% or 5% gtt
Cyclopentolate, short duration, use in office until stronger cyclo agent available. Can be 0.5%, 1%, 2% gtt
Topical anesthetics
Proparacaine 0.5% or tetracaine 0.5% used for acute pain relief, abuse/overuse can cause delayed healing of corneal epithelium and neurotrophic keratitis
diluted forms can be used without injury (0.05 or 0.1%)
Naproxen sodium (Aleve)
Oral pain reliever, 220mg q8-12h, give two pills as loading dose then 3 in the rest of the 24hr period. max daily dose of 1500mg!
Ibuprofen (Advil, Motrin)
Oral pain reliever, stomach upset, GI toxicity
200mg-800mg q4h, max daily dose of 3200mg!
Acetylsalicylic acid (Aspirin)
Oral pain reliever, contraindicated in pts w/hx of stomach ulcers, bleeding disorders, are pregnant, under 18yo or have viral illness (Reye’s syndrome)
650mg-975mg q4h, max daily dose of 4000mg!
Acetaminophen (Tylenol)
Oral pain reliever, inhibits COX but not an NSAID, doesn’t have peripheral anti-inflammatory properties
650-975mg q4h, max daily dose of 4000mg! Liver toxicity! Contraindicated in pt’s w/liver problems
Orphengesic forte and Dyloject
New oral pain relievers, 1st one has orphenadrine citrate (anticholinergic), aspirin (NSAID) and caffeine
And dyloject is IV diclofenac
Schedule I drugs
high potential for abuse, not used medically in USA
-heroin, LSD, marijuana, GHB
Schedule II drugs
high potential for abuse, accepted for medical tx w/severe restrictions
- hydrocodone compounded with other agents (ex. Vicodin) used to be III
- methadone, oxycodone, oxymorphine, amphetamines, short-acting barbiturates
Schedule III drugs
potential for abuse but less than I&II, accepted medical use
- codeine compounded w/NSAID
- buprenorphine, ketamine, anabolic steroids, intermediate-acting barbiturates, sodium oxybate (Xyrem), Marinol (THC analog), paragoric, ergine (LSD precursor)
Vicodin
Pain reliever; 5-10mg hydrocodone + 300mg acetaminophen 1-2 tablets q4-6h, max daily dose of 8 tablets
Schedule IV drugs
accepted medical tx
-benzodiazepine, long-acting barbiturates, certain opiates or opiate-like drugs (tramadol, pentazocine)
Schedule V drugs
Lower potential for abuse
-cough suppressants, anticonvulsants, drugs containing small amounts of opiates
Tramadol
Oral pain reliever, avoid in pts w/hx of seizures
50-100mg q4-6h, max daily dose of 400mg/day
Ultracet
Oral pain reliever, 37.5mg tramadol + 325mg acetaminophen 1-2 tablets q4-5h
Tylenol 3, 2, 4 components?
Tylenol 3: 30mg codeine, 300mg acetaminophen
Tylenol 2: 15mg codeine, 300mg acetaminophen
Tylenol 4: 60mg codeine, 300mg acetaminophen
Empirin w/codeine 3 and 4
Same as Tylenol 3 and 4 but with 325mg acetylsalicylic acid
3 - 30mg codeine, 4 - 60mg codeine
Dosing for Tylenol 3,2,4 and empirin 3,4
0.5 to 2 tablets q4-6h
Max dose of 360mg for codeine, 4000mg for acetaminophen/acetylsalicylic acid
Which fluoroscein drop is not absorbed by soft CLs? (Contacts can be worn immediately after IOP check)
Flura-Safe
- 35% fluorexon disodium
- 4% benoxinate hydrochloride + 0.5% chlorobutanol (preservative)
Cholinergic antagonists drugs
Atropine, Scopolamine, Homatropine, Cyclopentolate, Tropicamide
Adrenergic agonist drops
Phenylephrine 2.5% or 10%
Hydroxyamphetamine 1%
CV side effects (HTN, tachy)
Use low dose tropicamide only for dilation in patients such as:
Elderly >80yo, Down’s syndrome, pt’s w/CV disease, pt’s w/borderline narrow angles
Mydriolytics
Dapiprazole, pilocarpine, nyxol (faster acting than dapiprazole)
Tx for pingueculitis
ATs 4-8x/d
Mild topical steroid like fluorometholone 0.1% or loteprednol 0.2% (or 0.5%) QID
NSAID - ketorolac 0.5% gtts BID to QID
Tx for chalazion
Warm compresses and massage
Sx to remove (oculoplastics) if not resolved <3-4wks
Corticosteroid injection 0.2-1.0mL (w/2% lidocaine +epinephrine)
Tx for phlyctenulosis
Topical steroid like loteprednol 0.5% gtts QID if mild or prednisolone 1% gtts QID if severe
Topical antibiotic to reduce bacterial load or manage overlying ulcer: tobramycin or fluoroquinolone QID
Doxycycline 100mg po QID 2wks then BID 2wk then QD 1mo to treat chronic or recurrent cases
Azithromycin also effective
Antibiotic/steroid combination drop
Manage blepharitis as necessary
Tx for marginal keratitis
Topical steroid like loteprednol 0.5% gtts QID if mild or prednisolone 1% gtts QID if severe
Topical antibiotic to reduce bacterial load or manage overlying ulcer: tobramycin or fluoroquinolone QID
Doxycycline 100mg po QID 2wks then BID 2wk then QD 1mo to treat chronic or recurrent cases
Azithromycin also effective
Antibiotic/steroid combination drop
Manage blepharitis as necessary
Tx for Thygeson’s SPK
Mild topical steroid like fluorometholone 0.1% (FML) BID or loteprednol 0.2% or 0.5% gtts QID
Cyclosporine 2% gtts or 0.5% ung 3-5x/d up to 6mo
Tacrolimus 0.02% (T-cell inhibitor) BID 1-42wks
Tx of disciform keratitis or necrotizing interstitial keratitis
Pred Forte (prednisolone 1%) q1-6h
Antiviral cover
Tx of underlying systemic disease if applicable (Kawasaki, TB, etc)
Tx of SEIs
Usually self-resolving
Can use steroids- FML Forte BID to QID, Loteprednol QID, Pred Forte BId to QID - during first 2wks of EKC up to 1mo for CL/blepharitis associated cases
Consider antibacterial cover if there is an epithelial defect
Tx for episcleritis
ATs if mild, Diclofenac 0.1% gtts QID, Loteprednol 0.5% gtts QID
Oral NSAID: Flurbiprofen 100mg po TID or if no response try indomethacin 100mg QD then 75mg
Tx for contact dermatitis
ATs, avoid allergen, topical antihistamine, mild steroid cream (avoid getting in eyes) fluorometholone 0.1% ung BID to TID for 5d
Tx for GPC
No CLs, mast cell stabilizer for long term
Topical steroid QID for 2wks then BID for 2 more wks
Tx for anterior uveitis
Topical steroid- Pred forte gtt q1-2h then q1-6h or Durezol (difluprenate) emulsion q2h the QID (faster at clearing AC cells)
Add fluorometholone ung 0.5” ribbon at night
Can supplement with oral 6day Medrol dose pack or periocular steroid injection of 20-40mg triamcinolone
Cycloplegic, manage secondary glaucoma, consider bloodwork, TNFa inhibitors, etc.
Tx for allergic conjunctivitis
Mild - cool compress and chilled ATs
Moderate - antihistamines and mast cell stabilizers
Severe - add a mild steroid like fluorometholone 0.1% QID 1-2wks or loteprednol 0.2% QID 1-2wks
Consider topical NSAID, steroid nasal sprays, topical corticosteroid creams for eczema symptoms (AKC)
Acetylcysteine 10% for mucus in VKC/AKC, cyclosporine, mitomycin-C 0.01%
Tx of diffuse or nodular scleritis
Oral NSAIDs (may need 2+ in succession), oral steroid if NSAIDs not effective, if still not effective try immunosuppressive drugs like methotrexate (antimetabolite), cyclosporine (T cell suppressant), or cyclophosphamide (alkylating agent), in case of therapeutic failure try infliximab (TNFa inhibitor) IV and subconj injections of steroids may also be used
Tx of necrotizing scleritis
Oral immunosuppressive drugs supplemented with corticosteroids (periocular steroid injections should NOT be used)
Cyclophosphamide for pts w/underlying systemic vasculitis and urgent cases (IV pulse)
