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Ocular Pharmacology > 1691 Final Material > Flashcards

1691 Final Material Flashcards

1
Q

Brimonidine tartrate 0.025%

A

Alpha-2 adrenergic agonist for ocular redness, 1gtt QD

Lumify brand name

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2
Q

Mast cell stabilizers

A

For allergies, take 7-14 days to work so used prophylactically or chronically, rx required

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3
Q

Lodoxamide tromethamine 0.1% (Alomide)

A

mast cell stabilizer

1gtt QID , >2yo

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4
Q

Nedocromil sodium 2% (Alocril)

A

mast cell stabilizer

1gtt BID , 3yo

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5
Q

Pemirolast potassium (Alamast)

A

mast cell stabilizer

1gtt QID , >3yo

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6
Q

Cromolyn sodium 4% (Crolom)

A

mast cell stabilizer

1gtt, QID , >4yo

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7
Q

Antihistamines

A

Rapid response for allergic reactions, more used for moderate to severe cases, rx required, can be drops or oral med (some oral meds OTC)

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8
Q

Emedastine difumarate 0.05% (Emadine)

A

antihistamine eye drop

1gtt QID , >3yo

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9
Q

Cetirizine 0.24% (Zerviate)

A

antihistamine eye drop with Hydrella vehicle

1gtt BID , >2yo

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10
Q

Diphenhydramine (Benadryl)

A

1st gen oral antihistamine, causes drowsiness

25-50mg q4-6h

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11
Q

Chlorpheniramine (Chlor-Trimeton)

A

1st gen oral antihistamine, causes drowsiness

4mg q4-6h , >6 yo

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12
Q

Cetirizine hydrochloride (Zyrtec)

A

2nd gen oral antihistamine, less drowsy

10mg QD , >2 yo

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13
Q

Loratadine (Claritin, Alavert)

A

2nd gen oral antihistamine, less drowsy

10mg QD , >2 yo

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14
Q

Fexofenadine hydrochloride (Allegra)

A

2nd gen oral antihistamine, less drowsy

up to 180mg QD, >6 yo

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15
Q

Desloratadine (Clarinex)

A

3rd gen oral antihistamine, faster action loratadine

BID or QD , >1yo for liquid

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16
Q

Levocetirizine (Xyzal)

A

3rd gen oral antihistamine, more effective cetirizine and fewer side effects
QD, >6 mo for liquid

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17
Q

Hydrocortisone 1% ung or cream

A

non-ocular topical corticosteroid, OTC
BID to TID, 5-10 days
for eczema symptoms in allergies, used on skin not in eyes

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18
Q

Triamcinolone 0.0025-0.5% ung or cream

A

non-ocular topical corticosteroid, rx required

BID to TID, 5-10days

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19
Q 
Triamcinolone (Nasacort AQ)
Fluticasone furoate (Veramyst)
Fluticasone propionate (Flonase) 
Budesonide (Rhinocort Aqua)
Beclomethasone (Beconase AQ)
A

nasal spray corticosteroids, can be used for rhinoconjunctivitis symptoms, rx required
2 sprays each nostril QD

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20
Q

Ketotifen fumarate 0.025%

A

combined antihistamine/mast cell stabilizer, generally BID

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21
Q

Olopatadine hydrochloride

A

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%)

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22
Q

Azelastine hydrochloride 0.05% (Optivar)

A

Combined antihistamine/mast cell stabilizer

1gtt BID, >3yo

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23
Q

Epinastine hydrochloride 0.05% (Elestat)

A

Combined antihistamine/mast cell stabilizer

1gtt BID, >3y

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24
Q

Bepotastine besolate 1.5% (Bepreve)

A

Combined antihistamine/mast cell stabilizer

1gtt BID, >2yo

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25
Q

Alcaftadine 0.25% (Lastacaft)

A

Combined antihistamine/mast cell stabilizer

1gtt QD, >2yo

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26
Q

Loteprednol etabonate

A

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

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27
Q

Difluprednate (Durezol 0.05%)

A

Topical corticosteroid emulsion

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28
Q

Dexamethasone

A

Corticosteroid, topical Maxidex 0.1% solution, 10 or 13 day DexPak, Ozurdex insert, or injections

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29
Q

Rimexolone (Vexol 1.0% suspension)

A

Topical corticosteroid

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30
Q

Prednisolone acetate

A

Strong corticosteroid, Pred Forte 1.0% suspension, Pred Mild 0.12% suspension, Six-day Medrol po

be careful using generic Pred

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31
Q

Fluorometholone

A

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

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32
Q

Which medication interferes with the development and activity of T cells, and is used to treat inflammation in DED?

A

Cyclosporine

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33
Q

Diclofenac 0.1% (Voltaren)

A

Topical NSAID, older type, approved for more txs, stings, cheaper, QID

34
Q

Ketorolac tromethane

A

Topical NSAID, less stinging, more expensive, 0.5% for generic QID

  1. 4% Acular LS, QID
  2. 45% Acuvail BID, preservative free
35
Q

Nepafenac

A

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

36
Q

Bromfenac

A

Topical NSAID, 0.09% for generic BID

  1. 7% Prolensa QD, better corneal permeability
  2. 9% Xibrom, 0.9% Bromday, 0.075% Bromsite
37
Q

What groups of meds do DMARDs (biological agents) include?

A

TNFa inhibitors, IL-6, and Type I interferons

38
Q

Ilevro

A

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

39
Q

Tobradex

A

Combo drop - tobramycin + dexamethasone

1-2gtts TID to QID

40
Q

Zylet

A

Combo drop - tobramycin + loteprednol

1-2gtts TID to QID

41
Q

Maxitrol

A

Combo drop - neomycin + Polymyxin B + dexamethasone

1-2gtts TID to QID

42
Q

FML-S Liquifilm

A

Combo drop - sulfacetamide + fluorometholone

1gtt QID

43
Q

Palliative ocular pain drugs

A

Artificial tears, cycloplegics, topical steroids

44
Q

Analgesics for ocular pain

A

Topical NSAIDs, topical anesthetics, oral pain relievers, opioids, etc.

45
Q

Cycloplegics - for ocular pain

A

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

46
Q

Topical anesthetics

A

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%)

47
Q

Naproxen sodium (Aleve)

A

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!

48
Q

Ibuprofen (Advil, Motrin)

A

Oral pain reliever, stomach upset, GI toxicity

200mg-800mg q4h, max daily dose of 3200mg!

49
Q

Acetylsalicylic acid (Aspirin)

A

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!

50
Q

Acetaminophen (Tylenol)

A

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

51
Q

Orphengesic forte and Dyloject

A

New oral pain relievers, 1st one has orphenadrine citrate (anticholinergic), aspirin (NSAID) and caffeine
And dyloject is IV diclofenac

52
Q

Schedule I drugs

A

high potential for abuse, not used medically in USA

-heroin, LSD, marijuana, GHB

53
Q

Schedule II drugs

A

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
54
Q

Schedule III drugs

A

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)
55
Q

Vicodin

A

Pain reliever; 5-10mg hydrocodone + 300mg acetaminophen 1-2 tablets q4-6h, max daily dose of 8 tablets

56
Q

Schedule IV drugs

A

accepted medical tx

-benzodiazepine, long-acting barbiturates, certain opiates or opiate-like drugs (tramadol, pentazocine)

57
Q

Schedule V drugs

A

Lower potential for abuse

-cough suppressants, anticonvulsants, drugs containing small amounts of opiates

58
Q

Tramadol

A

Oral pain reliever, avoid in pts w/hx of seizures

50-100mg q4-6h, max daily dose of 400mg/day

59
Q

Ultracet

A

Oral pain reliever, 37.5mg tramadol + 325mg acetaminophen 1-2 tablets q4-5h

60
Q

Tylenol 3, 2, 4 components?

A

Tylenol 3: 30mg codeine, 300mg acetaminophen
Tylenol 2: 15mg codeine, 300mg acetaminophen
Tylenol 4: 60mg codeine, 300mg acetaminophen

61
Q

Empirin w/codeine 3 and 4

A

Same as Tylenol 3 and 4 but with 325mg acetylsalicylic acid

3 - 30mg codeine, 4 - 60mg codeine

62
Q

Dosing for Tylenol 3,2,4 and empirin 3,4

A

0.5 to 2 tablets q4-6h

Max dose of 360mg for codeine, 4000mg for acetaminophen/acetylsalicylic acid

63
Q

Which fluoroscein drop is not absorbed by soft CLs? (Contacts can be worn immediately after IOP check)

A

Flura-Safe

  1. 35% fluorexon disodium
  2. 4% benoxinate hydrochloride + 0.5% chlorobutanol (preservative)
64
Q

Cholinergic antagonists drugs

A

Atropine, Scopolamine, Homatropine, Cyclopentolate, Tropicamide

65
Q

Adrenergic agonist drops

A

Phenylephrine 2.5% or 10%
Hydroxyamphetamine 1%
CV side effects (HTN, tachy)

66
Q

Use low dose tropicamide only for dilation in patients such as:

A

Elderly >80yo, Down’s syndrome, pt’s w/CV disease, pt’s w/borderline narrow angles

67
Q

Mydriolytics

A

Dapiprazole, pilocarpine, nyxol (faster acting than dapiprazole)

68
Q

Tx for pingueculitis

A

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

69
Q

Tx for chalazion

A

Warm compresses and massage
Sx to remove (oculoplastics) if not resolved <3-4wks
Corticosteroid injection 0.2-1.0mL (w/2% lidocaine +epinephrine)

70
Q

Tx for phlyctenulosis

A

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

71
Q

Tx for marginal keratitis

A

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

72
Q

Tx for Thygeson’s SPK

A

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

73
Q

Tx of disciform keratitis or necrotizing interstitial keratitis

A

Pred Forte (prednisolone 1%) q1-6h
Antiviral cover
Tx of underlying systemic disease if applicable (Kawasaki, TB, etc)

74
Q

Tx of SEIs

A

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

75
Q

Tx for episcleritis

A

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

76
Q

Tx for contact dermatitis

A

ATs, avoid allergen, topical antihistamine, mild steroid cream (avoid getting in eyes) fluorometholone 0.1% ung BID to TID for 5d

77
Q

Tx for GPC

A

No CLs, mast cell stabilizer for long term

Topical steroid QID for 2wks then BID for 2 more wks

78
Q

Tx for anterior uveitis

A

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.

79
Q

Tx for allergic conjunctivitis

A

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%

80
Q

Tx of diffuse or nodular scleritis

A 
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
81
Q

Tx of necrotizing scleritis

A

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)

Ocular Pharmacology (10 decks)

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