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Ocular Pharmacology > Anti-Infective Medications Used in Eyecare Part 2 > Flashcards

Anti-Infective Medications Used in Eyecare Part 2 Flashcards

Exam 2

1
Q

What are the common viruses encountered in eye care?

A 
Adenovirus
Herpes Virus (Simplex/Zoster/CMV)
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2
Q

What does adenovirus cause?

A

Conjunctivitis and EKC (Epidemic Keratoconjunctivitis)

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3
Q

What are the most common serotypes of adenovirus that cause EKC?

A

8, 19, 37

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4
Q

What medications are approved for the treatment of adenovirus?

A

None currently

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5
Q

What is the effect of topical corticosteroids on EKC?

A

It delays viral shedding and enhances adenovirus replications. This makes things worse

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6
Q

What is the rule of 8’s for adenovirus infection?

A

First 8 days: White and quiet, virus is replicating and the patient is contagious
Second 8 days: Patient is miserable, eyes are often not symmetrical and pseudomembranes are formed
Third 8 days: Infiltrates are present confirming EKC

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7
Q

What is a common treatment for EKC? When is it most effective?

A

Off label use of Povidone-iodine (Betadine)
It is most effective when the virus is replicating. This is a problem because patients are asymptomatic while the virus replicates! (First 8 days!)

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8
Q

What is the Melton and Thomas protocol for Betadine usage to treat EKC?

A
  1. Anesthetize both eyes with proparacaine
  2. Instill 2-3 drops betadine and have patient roll eyes around to enhance distribution
  3. Rub lid margins to kill any resident virus
  4. Flush betadine out (Irrigate, Irrigate, Irrigate)
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9
Q

What is the MOA of anti-herpetic drugs?

A

Inhibit cellular metabolism in infected cells

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10
Q

When are anti-herpetic drugs most effective?

A

When the virus is replicating (first 3 days)

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11
Q

What are the topical anti-herpetic drugs?

A

Trifluridine 0.1% solution

Zirgan 0.15% gel

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12
Q

What are the oral anti-herpetic drugs?

A

Acyclovir
Valacyclovir
Famciclovir

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13
Q

How do oral anti-herpetic drugs differ from one another?

A

Acyclovir has been the drug of choice for a long period of time, but it has poor bioavailability and short half-life.
Valacyclovir is a prodrug of acyclovir and has a bioavailability that is 3-5 times higher than acyclovir
Famciclovir is 100x less potent than acyclovir but has a better half-life than acyclovir.

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14
Q

What are the adverse effects of anti-herpetic medications?

A

Burning/redness/blur (topical (blur specific to ointment))

Headache/nausea

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15
Q

Which anti-herpetic drug should be used with caution in patients with HIV? Why?

A

Valacyclovir, due to risk of vascular issues

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16
Q

What was the HEDs 1 study about? What were the results?

A

HEDs 1 dealt with more severe herpetic disease like stromal keratitis.

Outcome 1:
Using corticosteroids with a topical antiviral resulted in fewer treatment failures and faster resolution of stromal keratitis.
Outcome 2:
No benefit of the addition of oral acyclovir to a current regimen consisting of a topical steroid and topical antiviral
Outcome 3:
Adding oral acyclovir to topical steroid and trifluridine has a benefit when treating iridocyclitis

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17
Q

What was the HEDs 2 study about? What were the results?

A

HEDs 2 delt with epithelial keratitis and recurrence of HSV epithelial keratitis.

Outcome 1:
No benefit of oral acyclovir to topical trifluridine in preventing the development of stromal keratitis from epithelial keratitis
Outcome 2:
Oral acyclovir reduced the incidence of epithelial keratitis and stromal keratitis by 41% and 50% reduction in the return rate of more severe forms of keratitis while taking oral acyclovir
Outcome 3:
No significant behavioral factors associated with recurrence of HSV

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18
Q

Explain how to treat HSV epithelial keratitis.

A

When active replication is occurring, a dendritic lesion may be apparent. Antiviral medication should be used to reduce replication and spread of the virus. Avoid topical steroids!

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19
Q

Explain how to treat HSV stromal keratitis.

A

Use topical steroid with oral antiviral to balance immune response reduction with antiviral therapy

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20
Q

Explain how to treats HSV endothelial keratitis.

A

A topical steroid with oral antiviral is preferred.

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21
Q

What are some scenarios that would warrant the use of antivirals for prophylaxis? (4)

A
  1. Multiple recurrences of any type, especially stromal
  2. Recurrent inflammation approaching visual axis
  3. More than one episode of HSV with ulceration
  4. History of ocular HSV during immunosuppressive treatment
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22
Q

What are three prophylaxis treatment options with antivirals?

A
  1. Acyclovir 400mg BID x 1 year +
  2. Valacyclovir 500mg QD x 1 year +
  3. Famciclovir 250mg BID x 1 year+
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23
Q

What is the treatment of choice for CMV retinitis?

A

CMV retinitis is the most common opportunistic eye infection in persons with AIDs/Immunocompromised transplant patients

Treat with Ganciclovir Insert
Valganciclovir
Foscarnet

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24
Q

What are the indications for Viroptic (trifluridine)?

A

HSV keratoconjunctivitis

HSV epithelial keratitis

25
Q

What is the adult dose of Viroptic (trifluridine)?

A

1gtt q2h while awake until reepithelization

1gtt q4h while awake x 7 days

26
Q

What is the minimum dose of Viroptic (trifluridine) after reepithelization in adults? What is the max dose of Viroptic after reepithelialization in adults? ?

A

Min: 5 gtt/eye/day
Max: 9gtt/eye/day x 21 days
Dosage is same in kids

27
Q

What is the age limit for Viroptic (trifluridine)?

A

Must be >6 years

28
Q

What is the preservative of Viroptic (trifluridine)?

A

Thimerosal, which is toxic to the cornea

29
Q

What is the indication for Zirgan (gancyclovir)?

A

Acute HSV keratitis

30
Q

What is the adult dose of Zirgan (gancyclovir)?

A

5x/day until reepithelization

TID x 7 days after reepithelization

31
Q

What is the age limit for Zirgan (gancyclovir)?

A

2 years

same dose as adults

32
Q

What is the preservative of Zirgan (gancyclovir)?

A

BAK, less toxic than Viroptic (trifluridine)

33
Q

What are the indications for Zovirax (acyclovir)?

A

HSV keratitis
HSV prophylaxis
HZO

34
Q

What are the adult dosages of Zovirax (acyclovir) for HSV? HZO?

A

HSV: 400mg 5 times per day x 7-10 days
HZO: 800mg 5 times per day x 7-10 days

35
Q

What is the dosage of Zovirax (acyclovir) for HSV prophylaxis?

A

400mg BID x 12 months

36
Q

When must you administer Zovirax (acyclovir) when treating zoster?

A

Within 72 hours of rash onset

37
Q

What are the indications for Valtrex (valacyclovir)?

A

HSV keratitis
HSV prophylaxis
HZO

38
Q

What are the adult dosages for Valtrex (valacyclovir) when treating HSV? HZO?

A

HSV: 500mg TID x 7-10 days
HZO: 1000mg TID x 7-10 days

39
Q

What is the HSV prophylaxis dosage of Valtrex (valacyclovir)?

A

500-1000mg daily

40
Q

What are the indications for Famvir (famciclovir)?

A

HSV keratitis
HSV prophylaxis
HZO

41
Q

What are the dosages of Famvir (famciclovir) for HSV? HZO?

A

HSV: 250mg TID x 7-10 days
HZO: 500mg TID x 7-10 days

42
Q

What is the prophylaxis dosage of Famvir (famciclovir)?

A

125-250mg BID

43
Q

What are the indications for Valcyte (valganciclovir)?

A

CMV retinitis (AIDS-Association)

44
Q

What is the dosage of Valcyte (valganciclovir)?

A

900mg BID for a week and then 900mg daily

45
Q

What is the age limit for Valcyte (valganciclovir)?

A

1 month and older depending on condition

46
Q

What are the indications of Foscavir (foscarnet)?

A

Acyclovir resistant mucocutaneous HSV/HZO/CMV retinitis, AIDS-association

47
Q

What is the dosage for Foscavir (foscarnet)?

A

90mg BID for a week and then 90-120 mg/kg daily (through IV)

48
Q

What are the fungi that are encountered in eye care?

A

Yeast: Candida
Molds: Aspergillus, Fusarium, Curvularia

49
Q

What are a few predisposing factors for fungal infection?

A

CL wear
Topical steroids
Trauma
Immunocompromised

50
Q

What are the specific antifungal drugs we need to know?

A

Natamycin
Amphotericin B
Ketoconazole tabs
Fluconazole tabs

51
Q

What is the MOA for natamycin?

A

Creates pores in cell membranes

52
Q

What are the indications of natamycin?

A

Fungal keratitis
Fungal blepharitis
Fungal conjunctivitis

53
Q

What is the only approved topical antifungal agent?

A

Natamycin 5%

54
Q

What is Ketoconazole used for?

A

Severe fungal corneal ulcers

55
Q

What is Fluconazole used for?

A

Severe fungal corneal ulcers?

56
Q

What is the most common protozoa encountered in eye care?

A

Acanthamoeba

57
Q

What medications are approved to treat acanthamoeba?

A

None, you must treat with compounded drugs

58
Q

What are the three treatments for acanthamoeba?

A

PHMB: Pool cleaner
Chlorohexidine: Surgical scrub
Propamidine isethionate: Disinfectant

All are disinfectants

Ocular Pharmacology (8 decks)

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