Clinic: Medication Regimes (dosage, frequency) Flashcards
Seasonal conjunctivitis (2)
Topical AH/MCS: Patanol 0.1% BiD or Zatiden 1% BiD
if that doesn’t work:
FML iBD-iQiD for 2 weeks (iBD 1st week, iQD 2nd)
GPC (2)
Topical AH/MCS: Patanol BiD or Zatiden BiD for several months
if that doesn’t work:
FML iBD-iQD in short term for more severe cases
VKC (2)
Topical AH/MCS: Patanol BiD or Zatiden BiD
FML/Flarex iBD-iQiD
AKC (2)
Topical AH/MCS: Patanol BiD or Zatiden BiD
Flarex/Maxidex iTDS-Q2h with aggressive taper (3x day to every 3 hours)
Bacterial conjunctivitis (non-GC) (3)
Update: this should be chlorsig 0.5% gtt or 1% ung QID for 5 days then rev on 5th day.
Generally self limiting/monitor.
Faster with antibiotics (Chlorsig 0.5% NOCTE 7-10 days, or aminoglycoside - e.g. neomycin)
Follow up 3-5 days, then 7-10 days
GC conjunctivitis (3)
REFER: Often systemic so IM Cephalosporin and/or oral fluoroquinolone
Adjunct tx z topical fortified aminoglycoside or fluoroquinolone (e.g. ofloxacin)
Oral azithromycin for co-existing chlamydia if present
EKC (viral, no resp, haemorrhagic, fine spk, epi opacities @ 7 days, SEI) (2)
If infectious: supportive (vasoconstrictors, cold compress, povidine-iodine, possibly steroids if severe enough)
If non-infectious: Flarex 0.1% Bd to QiD z slow taper
PCF (viral, URTI, may have keratitis) (4)
Optom hygiene + educate px
GP referral to stay home
Supportive (povidone-iodine, cold compress, lubricants, nurofen)
Steroid if sever infl [Flarex 0.1% BD to QiD z slow taper]
AIC (chlamydia D-K. Follicles, superior pannus, chemosis) (4)
Px + partner sex clinic lab tests
Identify co-existing infections
Topical tetracyclin (won’t tx full extent)
Oral azithromycin 1gm PO or Erythromycin 250mg QiD 2-6 weeks
Trachoma (chlamydia A-C)
ID source of exposure
Lab tests
Sx for trichiasis
Topical lubricants + dry eye mx for scarring
Hygiene
Tx active infection: oral macrolide (azithromycin 1gm PO), tetracycline (doxycycline)
Anterior Blepharitis (4)
Lid therapy + warm compress + lid masage Tear supplements for ocular surface problems Follow up 2-4 weeks If no improvement, consider: Mild topical steroids Tetracyclin ointment
Posterior Blepharitis (5)
Oral tetracyclines (Oral Doxy 250mg)
Lid therapy + warm compress + lid massage
Tear supps
Antibiotic ointments (for coexisting anterior)
Mild topical steroids
Ocular Rosacea
Topical antibiotic: metronidazole gel for skin rash
Oral tetracyclines (doxy) or macrolides - mainstay
Lid therapy for bleph
Tear supps
Mild topical steroids (tx of conj infl + keratitis)
OAG 1st choice
Xalatan 0.005% NOCTE
OAG when 1st PGA doesn’t work
Swap to another PGA: Travatan 0.004% NOCTE (binds better to PGF2alpha)
Or add adjunct if small change needed (e.g. CAI drop)
Possible Glaucoma medications
PGA: Xalatan 0.005% NOCTE or Travant 0.004% NOCTE
BB: Timolol 0.5% qD (once daily) or BiD, Betaxolol 0.5% BiD instead if asthmatic as its the safer bb for asthmatics out of the two
CAI drops: Trusopt 2% BiD, Brinzolamide 1% BiD (adjunct)
AAs: Alphagan 0.2% TiD (max) or BiD (adjunct)
Apraclonidine (for IOP spikes) 0.5% TiD
Muscarinics: Pilocarpine gtt 2% qiD (good for low dose PDS/PDG, where miosis + reduced iris movement is desired)
Possible glaucoma medications (oral)
Oral diamox 2 x 250mg + 500mg KCl: initial dose for AACG patient
AACG first aid:
1 drop each of BB + AA + CAI + pilo (pilo 2% to reverse dilation from tropicamide)
Oral diamox 2 x 250mg + 500mg KCl if kidneys ok
1 Steroid drop if inflammation
Diamox contraindications (3)
Kidney diseease
Allergy to it
COPD (get GP advice)
CAI drop benefits (4)
Reduces diurnal fluctuations
Good vascular + nocturnal profile
Fast effect (1 hr)
Good adjunct to PGAs (b/c PGAs secondarily promote CA)
CAI drop contraindications (1)
Corneal graft (b/c cornea needs CA to pump)
Are beta blockers effective at night?
No
Beta blocker contraindications (6)
LTG Bradycardia (<50bpm) Asthma/COPD (use betaxalol with caution) MG (can worsen) Diabetes Depression (B blockers reduce melatonin = sleep + mood disorders)
NB: Caution with – asthma, concurrent calcium channel blocking drugs (heart meds)
Alpha agonist contraindications (4)
Tricyclic anti-depressants
MAO inhibitors
Severe cardiovascular disease
Don’t use while driving/machinery
CMO (3)
NSAIDS (500mg ibuprofen PO) can be good for some (give as 4 week trial)
IV steroid (aVEGF)
Scatter/Grid photocoagulation around macula
Anterior Uveitis (4)
Pred Forte 1% q1h
Tropicamide 1% TiD (to break synechiae)
Can add cyclosporin if severe
IOP medication considered if raised
Episcleritis (3)
Often self limiting:
Hot compress q3-4h for several days + lubricants and vasoconstrictors for symptomatic relief
If necessary:
Mild topical steroid (pulsed) (e.g. FML qid, Flarex qid)
Oral NSAID (ibuprofen)
More severe cases:
Try Prednisolone 1% qid for short duration
Scleritis
REFER
+ Similar mx plan to more severe episcleritis as well
Conjunctival abrasion (3)
Generally self limiting (2 weeks)
Lubricants
Could try antibiotic ointment (e.g. erythromyin) perhaps if huge (but generally we just leave it
Corneal abrasion
Debride edges
Topical antibiotic: Broad spectrum Chlrosig QiD (consider loading dose to get to therapeutic level faster)
For CL wearers/related: Broad spectrum Ciprofloxacin, Ofloxacin or Tobramcyin
Use antibiotic for 2 weeks, continue 3 days after healed
Symptomatic: Oral analgesic (panadol), ocular lubricant q1-2h, mydriatic if severe AC reaction and discomfort (atropine 1% in office tx)
Soft bandage CL if loose tissue
Should you patch abrasians? Why/why not?
NEVER patch abrasions because it slows epithelial healing and increases pain
RCEs (3)
Preservative free lubricant ointment (esp @ night, but also frequently in day) (@ night for many months to stop recurrence) Bandage CL (+ prophylactic chlorsig) (3 months) Oral pain relief e.g. ibuprofen (can help during acute episodes) + also ice packs to tx pain too.
Chemical injury
Immediate 30 minute irrigation
Topical anaesthesia (also during irrigation): 2-3 drops through and ON lids (b/c lids can be hard to open) +_ makes consult easier
Prophylactic topical broad antibiotic (chlorsig 0.5 qid or tetracycline qiD)
Cycloplegia (1% cyclopentolate) for pain and AC reaction (homatropine qID)
Analgesia + artificial tears
Topical steroid for more severe damage if AC reaction present (Flarex q2h)
Manage IOP (timolol 0.5% biD)
If grade 3-4, need to REFER.
Bacterial keratitis
Empirical monotherapy with fluoroquinolones e.g. ofloxacin or ciprofloxacin. – ciprofloxacin 0.3%
1-2-3 guideline:
1 = if 1+ or less AC response
2 = if infiltrate <2mm in diameter
3 = if ulcer >/= 3mm from visual axis
Ciprofloxacin dosage scheme for keratitis
The recommended dosage regimen for the treatment of corneal ulcers is: Two drops into the affected
eye every 15 minutes for the first six hours and then two drops into the affected eye every 30 minutes
for the remainder of the first day.
On the second day, instill two drops in the affected eye hourly.
On the third through to the fourteenth day, place two drops in the affected eye every four hours.
Treatment may be continued after 14 days if corneal re-epithelialization has not occurred.
https://www.medsafe.govt.nz/profs/Datasheet/c/ciprofloxacintevadrops.pdf
Epithelial HSV keratitis
Topical acyclovir ung 3% 5xdaily for 1-2 weeks
List 4 different options for prostaglandin analogues, including their dosage percentages
Latanaprost [Xalatan 0.005% NOCTE]
Travaprost [Travatan 0.004% NOCTE]
Bimatoprost [Lumigan 0.03% NOCTE]
Tafluprost [Zioptan 0.0015% NOCTE]
List 2 topical CAI options for reducing IOP
Dorzolamide [Trusopt 2% TiD]
Brinzolamide [Azopt 1% BiD]
List 2 options for beta-blockers to reduce IOP
Timolol 0.5% QD (once daily) or BiD (BiD proven more effective)
Betaxolol 0.5% sol BiD [safest b-blocker for asthmatics[
List 2 alpha agonist options for treating glaucoma
Alphagan [Brimonidine 0.2% Tid (max) or BiD (adjunct)]
Apraclonidine [Iopidine 0.5% Tid (max) or BiD (adjunct)]
