Common Conditions of the eyes and ears Flashcards
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
The eyes are more sensitive than the ears. Eye drops can be used in the ears, but _
Never use an ear drop in the eye! The ear drops may not have the appropriate pH, may not be isotonic and may not be sterile.
These abbreviations can be mistaken (interchanged) for each other and can mean other things; know how to interpret them, but its safer to write them out. (Use right eye, instead of OD).
AD =
AS =
AU =
OD =
OS =
OU =
AD = right ear
AS = left ear
AU = each ear
OD = right eye
OS = left eye
OU = each eye
A is from the Latin for ear (auris)
O is for eye (oculus)
Eye and ear formulations:
1 drop = _________
suspensions: shake well
ointments: _____
Gels: _______________________
0.05 mL
apply to the conjunctival sac or over lid margins (for blepharitis). Ointments can make vision blurry. Do Not Use with contact lenses.
with cap on, invert and shake once to get the medicine into the tip before instilling into the eye.
Glaucoma:
is a disease of the eye that results in damage to the optic nerve and loss of the visual field (the vision straight ahead and the peripheral vision, measured by the visual filed test). the vision gets narrower as damage progresses.
With Glaucoma, in most cases, the ____________ is above the normal range.
(IOP) Intraocular pressure
normal range: 12-22 mmHg
-this increase in pressure of the eye is due to the fluid building up.
The goal of treatment with glaucoma is to _________
reduce the IOP
There are two main forms of glaucoma:
Which is the most common?
Open-angle glaucoma (most common)
-usually presents without symptoms and is treated with eye drops or surgery
Closed angle glaucoma also called Angle closure glaucoma.
-Is a sharp, sudden increase in IOP due to a blockage. This type of glaucoma usually presents with eye pain, headaches and decreased vision AND is a MEDICAL EMERGENCY that is treated surgically.
Key Drugs that can increase intraocular pressure (IOP):
-anticholinergics (antihistamines, oxybutynin, tolterodine, benztropine, scopolamine, trihexyphenidyl, tricyclic antidepressants)
- decongestants
-chronic steroids
-topiramate
Drug treatment:
Glaucoma treatments decrease IOP by targeting __________
the aqueous humor (fluid in the eye) in 2 main ways.
1) reduce aqueous humor production (make less fluid)
2) increase aqueous humor outflow (move fluid out)
Which drugs classes will reduce aqueous humor production (make less fluid)?
- Adrenergic alpha-2 agonists
- Beta blockers
- Carbonic anhydrase inhibitors
Which drugs classes increase aqueous humor outflow (move fluid out)?
- prostaglandin analogs
- cholinergics (Miotics)
- rho kinase inhibitors
- adrenergic alpha-2 agonists
____________ are used commonly as initial treatment. They are the most effective drugs at decreasing IOP ~30%; they are safe and used once daily.
prostaglandin analogs
a _______ is preferable if the pressure is high in one eye only because the darkening of the iris and eyelash thickening seen with prostaglandin analogs is not desirable in only one eye.
beta-blockers, reduce IOP ~22%
If monotherapy does not sufficiently decrease IOP, consider switching to a different medication or using combination therapy.
Counseling on proper administration technique and the importance of adherence is critical.
Which eye drops should be stored in the refrigerator before opening but once opened can be stored at room temperature?
latanoprost
latanoprostene bunod
tafluprost
Which prostaglandin analogs DO NOT contain the BAK preservative?
Travatan Z (travoprost) - uses alternative
Xelpros (latanoprost) - uses alternative
Zioptan (tafluprost) - preservative free
Which prostaglandin analog is NOT indicated for glaucoma?
Latisse
Which prostaglandin analog eye drop comes preservative free?
Zioptan (tafluprost)
Which eye drops come as a gel?
timolol
when do administer eye ointments?
usually at night so ointment stays in the eye
Lumigan
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
bimatoprost
class: Prostaglandin analog = -prost
Indications: Open angle glaucoma
MOA: increase aqueous humor outflow
Dosage forms:
Dosing: 1 drop into the eye at bedtime
Max dose: 1 drop into each eye daily at bedtime
Warnings:
*Ocular effects: *darkening of the iris, eyelid skin and eyelashes; *eyelash length and number can increase, contamination of multiple-dose ophthalmic solutions can cause bacterial keratitis
Side Effects:
*Blurred vision, stinging, increased pigmentation of the iris/eyelashes, eyelash growth/thickening, foreign body sensation
Pearls/Notes:
*Do Not exceed once daily dosing; can decrease efficacy
*Wait 5-10 minutes in between drops of 2 different medications
*Apply gels last. Wait 10 minutes after the last eye drop before use.
*Remove contact lenses prior to using eye drops. Wait 15 minutes to reinsert.
* Do not use with Latisse (bimatoprost). Can reduce the effectiveness of other prostaglandins.
* Products contain the preservative (BAK) benzalkonium chloride, remove contact lenses prior to use, then wait 15 minutes to reinsert.
Drug-Drug/Food interactions:
Xalatan
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
latanoprost
class: Prostaglandin analog = -prost
Indications: Open angle glaucoma
MOA: increase aqueous humor outflow
Dosage forms:
Dosing: 1 drop into the eye at bedtime
Max dose: 1 drop into each eye daily at bedtime
Warnings:
*Ocular effects: *darkening of the iris, eyelid skin and eyelashes; *eyelash length and number can increase, contamination of multiple-dose ophthalmic solutions can cause bacterial keratitis
Side Effects:
*Blurred vision, stinging, increased pigmentation of the iris/eyelashes, eyelash growth/thickening, foreign body sensation
Pearls/Notes:
* *Store in the refrigerator before opening; once opened, store at room temp**
*Do Not exceed once daily dosing; can decrease efficacy
*Wait 5-10 minutes in between drops of 2 different medications
*Apply gels last. Wait 10 minutes after the last eye drop before use.
*Remove contact lenses prior to using eye drops. Wait 15 minutes to reinsert.
* Do not use with Latisse (bimatoprost). Can reduce the effectiveness of other prostaglandins.
* Products contain the preservative (BAK) benzalkonium chloride, remove contact lenses prior to use, then wait 15 minutes to reinsert.
Drug-Drug/Food interactions:
Xelpros
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
latanoprost
class: Prostaglandin analog = -prost
Indications: Open angle glaucoma
MOA: increase aqueous humor outflow
Dosage forms:
Dosing: 1 drop into the eye at bedtime
Max dose: 1 drop into each eye daily at bedtime
Warnings:
*Ocular effects: *darkening of the iris, eyelid skin and eyelashes; *eyelash length and number can increase, contamination of multiple-dose ophthalmic solutions can cause bacterial keratitis
Side Effects:
*Blurred vision, stinging, increased pigmentation of the iris/eyelashes, eyelash growth/thickening, foreign body sensation
Pearls/Notes:
* *Store in the refrigerator before opening; once opened, store at room temp**
** Does NOT have BAK preservative**
*Do Not exceed once daily dosing; can decrease efficacy
*Wait 5-10 minutes in between drops of 2 different medications
*Apply gels last. Wait 10 minutes after the last eye drop before use.
*Remove contact lenses prior to using eye drops. Wait 15 minutes to reinsert.
* Do not use with Latisse (bimatoprost). Can reduce the effectiveness of other prostaglandins.
Drug-Drug/Food interactions:
Travatan Z
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
travoprost
class: Prostaglandin analog = -prost
Indications: Open angle glaucoma
MOA: increase aqueous humor outflow
Dosage forms:
Dosing: 1 drop into the eye at bedtime
Max dose: 1 drop into each eye daily at bedtime
Warnings:
*Ocular effects: *darkening of the iris, eyelid skin and eyelashes; *eyelash length and number can increase, contamination of multiple-dose ophthalmic solutions can cause bacterial keratitis
Side Effects:
*Blurred vision, stinging, increased pigmentation of the iris/eyelashes, eyelash growth/thickening, foreign body sensation
Pearls/Notes:
** Does NOT contain BAK preservative**
*Do Not exceed once daily dosing; can decrease efficacy
*Wait 5-10 minutes in between drops of 2 different medications
*Apply gels last. Wait 10 minutes after the last eye drop before use.
*Remove contact lenses prior to using eye drops. Wait 15 minutes to reinsert.
* Do not use with Latisse (bimatoprost). Can reduce the effectiveness of other prostaglandins.
Drug-Drug/Food interactions:
Vyzulta
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
latanoprostene bunod
class: Prostaglandin analog = -prost
Indications: Open angle glaucoma
MOA: increase aqueous humor outflow
Dosage forms:
Dosing: 1 drop into the eye at bedtime
Max dose: 1 drop into each eye daily at bedtime
Warnings:
*Ocular effects: *darkening of the iris, eyelid skin and eyelashes; *eyelash length and number can increase, contamination of multiple-dose ophthalmic solutions can cause bacterial keratitis
Side Effects:
*Blurred vision, stinging, increased pigmentation of the iris/eyelashes, eyelash growth/thickening, foreign body sensation
Pearls/Notes:
* *Store in the refrigerator before opening; once opened, store at room temp**
*Do Not exceed once daily dosing; can decrease efficacy
*Wait 5-10 minutes in between drops of 2 different medications
*Apply gels last. Wait 10 minutes after the last eye drop before use.
*Remove contact lenses prior to using eye drops. Wait 15 minutes to reinsert.
* Do not use with Latisse (bimatoprost). Can reduce the effectiveness of other prostaglandins.
* Products contain the preservative (BAK) benzalkonium chloride, remove contact lenses prior to use, then wait 15 minutes to reinsert.
Drug-Drug/Food interactions:
Latisse
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
bimatoprost
class: Prostaglandin analog = -prost
Indications: For eyelash hypotrichosis
MOA:
Dosage forms:
Dosing: 1 drop into the eye at bedtime
Max dose: 1 drop into each eye daily at bedtime
Warnings:
*Ocular effects: *darkening of the iris, eyelid skin and eyelashes; *eyelash length and number can increase, contamination of multiple-dose ophthalmic solutions can cause bacterial keratitis
Side Effects:
*Blurred vision, stinging, increased pigmentation of the iris/eyelashes, eyelash growth/thickening, foreign body sensation
Pearls/Notes:
*Do Not exceed once daily dosing; can decrease efficacy
*Wait 5-10 minutes in between drops of 2 different medications
*Apply gels last. Wait 10 minutes after the last eye drop before use.
*Remove contact lenses prior to using eye drops. Wait 15 minutes to reinsert.
* Do not use with Latisse (bimatoprost). Can reduce the effectiveness of other prostaglandins.
* Products contain the preservative (BAK) benzalkonium chloride, remove contact lenses prior to use, then wait 15 minutes to reinsert.
Drug-Drug/Food interactions:
Zioptan
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
tafluprost
class: Prostaglandin analog = -prost
Indications: Open angle glaucoma
MOA: increase aqueous humor outflow
Dosage forms:
Dosing: 1 drop into the eye at bedtime
Max dose: 1 drop into each eye daily at bedtime
Warnings:
*Ocular effects: *darkening of the iris, eyelid skin and eyelashes; *eyelash length and number can increase, contamination of multiple-dose ophthalmic solutions can cause bacterial keratitis
Side Effects:
*Blurred vision, stinging, increased pigmentation of the iris/eyelashes, eyelash growth/thickening, foreign body sensation
Pearls/Notes:
** comes as 10 single use, preservative free containers in a foil pouch; discard each container after use**
* *Store in the refrigerator before opening; once opened, store at room temp**
*Do Not exceed once daily dosing; can decrease efficacy
*Wait 5-10 minutes in between drops of 2 different medications
*Apply gels last. Wait 10 minutes after the last eye drop before use.
*Remove contact lenses prior to using eye drops. Wait 15 minutes to reinsert.
* Do not use with Latisse (bimatoprost). Can reduce the effectiveness of other prostaglandins.
Drug-Drug/Food interactions:
which beta-blocker eye drop comes as a preservative free option?
Cosopt PF (timolol + dorzolamide)
Timoptic Ocudose (single dose vials)
“Preservative Free”
which beta-blocker eye drop formulations are available in a gel formulation?
Timoptic-XE
“Timolol GFS gel-forming solution”
Counseling tip on gel formulations:
Gels: shake once before use; wait 10 minutes after administering other eye drops before inserting gel
Betimol
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
timolol
class: non-selective beta blocker
Indications: open angle glaucoma
MOA: reduces aqueous humor production
Dosage forms:
Dosing: 1 drop daily or BID
Max dose:
Contraindications:
sinus bradycardia; heart block > 1st degree (except in patients with a pacemaker); cardiogenic shock; uncompensated heart failure; bronchospastic disease
Warnings:
-cardiac
-pulmonary
-BAK warnings
Side Effects:
burning, stinging, bradycardia/fatigue, bronchospasm with non-selective agents, itching of the eyes or eyelids, changes in vision, increased light sensitivity.
Monitoring:
Pearls/Notes:
-All are non-selective beta-blockers EXCEPT betaxolol; betaxolol is less likely to cause pulmonary adverse effects in patients with chronic lung disease (asthma/COPD)
- some products contain sulfites, which can cause allergic reactions
-select products contain the preservative BAK; remove contact lenses before use
Drug-Drug/Food interactions:
Timoptic
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
timolol
class: non-selective beta blocker
Indications: open angle glaucoma
MOA: reduces aqueous humor production
Dosage forms:
Dosing: 1 drop daily or BID
Max dose:
Contraindications:
sinus bradycardia; heart block > 1st degree (except in patients with a pacemaker); cardiogenic shock; uncompensated heart failure; bronchospastic disease
Warnings:
-cardiac
-pulmonary
-BAK warnings
Side Effects:
burning, stinging, bradycardia/fatigue, bronchospasm with non-selective agents, itching of the eyes or eyelids, changes in vision, increased light sensitivity.
Monitoring:
Pearls/Notes:
-All are non-selective beta-blockers EXCEPT betaxolol; betaxolol is less likely to cause pulmonary adverse effects in patients with chronic lung disease (asthma/COPD)
- some products contain sulfites, which can cause allergic reactions
-select products contain the preservative BAK; remove contact lenses before use
Drug-Drug/Food interactions:
Timoptic-XE
class:
Indications:
MOA:
Dosage forms: gel
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
timolol
class: non-selective beta blocker
Indications: open angle glaucoma
MOA: reduces aqueous humor production
Dosage forms:
Dosing: 1 drop daily or BID
Max dose:
Contraindications:
sinus bradycardia; heart block > 1st degree (except in patients with a pacemaker); cardiogenic shock; uncompensated heart failure; bronchospastic disease
Warnings:
-cardiac
-pulmonary
-BAK warnings
Side Effects:
burning, stinging, bradycardia/fatigue, bronchospasm with non-selective agents, itching of the eyes or eyelids, changes in vision, increased light sensitivity.
Monitoring:
Pearls/Notes:
-All are non-selective beta-blockers EXCEPT betaxolol; betaxolol is less likely to cause pulmonary adverse effects in patients with chronic lung disease (asthma/COPD)
- some products contain sulfites, which can cause allergic reactions
-select products contain the preservative BAK; remove contact lenses before use
Drug-Drug/Food interactions:
Istalol
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
timolol
class: non-selective beta blocker
Indications: open angle glaucoma
MOA: reduces aqueous humor production
Dosage forms:
Dosing: 1 drop daily or BID
Max dose:
Contraindications:
sinus bradycardia; heart block > 1st degree (except in patients with a pacemaker); cardiogenic shock; uncompensated heart failure; bronchospastic disease
Warnings:
-cardiac
-pulmonary
-BAK warnings
Side Effects:
burning, stinging, bradycardia/fatigue, bronchospasm with non-selective agents, itching of the eyes or eyelids, changes in vision, increased light sensitivity.
Monitoring:
Pearls/Notes:
-All are non-selective beta-blockers EXCEPT betaxolol; betaxolol is less likely to cause pulmonary adverse effects in patients with chronic lung disease (asthma/COPD)
- some products contain sulfites, which can cause allergic reactions
-select products contain the preservative BAK; remove contact lenses before use
Drug-Drug/Food interactions:
Cosopt Co- = combination product
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
timolol + dorzolamide
Combigan Co- = combination product
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
timolol + brimonidine
Betoptic S
class: selective beta-blocker
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
betaxolol
class: selective beta blocker
Indications: open angle glaucoma
MOA: reduces aqueous humor production
Dosage forms:
Dosing: 1 drop daily or BID
Max dose:
Contraindications:
sinus bradycardia; heart block > 1st degree (except in patients with a pacemaker); cardiogenic shock; uncompensated heart failure; bronchospastic disease
Warnings:
-cardiac
-pulmonary
-BAK warnings
Side Effects:
burning, stinging, bradycardia/fatigue, bronchospasm with non-selective agents, itching of the eyes or eyelids, changes in vision, increased light sensitivity.
Monitoring:
Pearls/Notes:
-All are non-selective beta-blockers EXCEPT betaxolol; betaxolol is less likely to cause pulmonary adverse effects in patients with chronic lung disease (asthma/COPD)
- some products contain sulfites, which can cause allergic reactions
-select products contain the preservative BAK; remove contact lenses before use
Drug-Drug/Food interactions:
Betagan
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
levobunolol
class: non-selective beta blocker
Indications: open angle glaucoma
MOA: reduces aqueous humor production
Dosage forms:
Dosing: 1 drop daily or BID
Max dose:
Contraindications:
sinus bradycardia; heart block > 1st degree (except in patients with a pacemaker); cardiogenic shock; uncompensated heart failure; bronchospastic disease
Warnings:
-cardiac
-pulmonary
-BAK warnings
Side Effects:
burning, stinging, bradycardia/fatigue, bronchospasm with non-selective agents, itching of the eyes or eyelids, changes in vision, increased light sensitivity.
Monitoring:
Pearls/Notes:
-All are non-selective beta-blockers EXCEPT betaxolol; betaxolol is less likely to cause pulmonary adverse effects in patients with chronic lung disease (asthma/COPD)
- some products contain sulfites, which can cause allergic reactions
-select products contain the preservative BAK; remove contact lenses before use
Drug-Drug/Food interactions:
Miostat
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
carbachol
class: cholinergic (miotic)
Indications: open angle glaucoma
MOA: increase aqueous humor outflow
Dosage forms:
Dosing: 1-2 drops up to TID
Max dose:
Contraindications:
Warnings:
Side Effects: poor vision at night (due to pupil constriction), corneal clouding, burning (transient= lasts for short time), hypotension, bronchospasm, abdominal cramps/GI distress
Monitoring:
Pearls/Notes:
-Use with caution in patients with a history of renal detachment or corneal abrasion.
-select products contain BAK preservative; remove contact lenses before use
Drug-Drug/Food interactions:
Isopto Carpine
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
pilocarpine
class: cholinergic (miotic)
Indications: open angle glaucoma
MOA: increase aqueous humor outflow
Dosage forms:
Dosing: 1-2 drops up to 4 times daily
Max dose:
Contraindications:
Warnings:
Side Effects: poor vision at night (due to pupil constriction), corneal clouding, burning (transient= lasts for short time), hypotension, bronchospasm, abdominal cramps/GI distress
Monitoring:
Pearls/Notes:
-Use with caution in patients with a history of renal detachment or corneal abrasion.
-select products contain BAK preservative; remove contact lenses before use
Drug-Drug/Food interactions:
_________ is used infrequently for glaucoma; it is used for the prevention and treatment of acute mountain (altitude) sickness.
acetazolamide
methazolamide
Trusopt
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
dorzolamide
-zolamide = Can cause Sulfonamide allergy
class: carbonic anhydrase inhibitor
Indications: open angle glaucoma
MOA: reduces aqueous humor production
Dosage forms:
Dosing: 1drop TID
Max dose:
Contraindications:
Warnings:
**Sulfonamide allergy: caution due to the risk of systemic exposure and cross reactivity (especially with oral formulations)
Side Effects:
** eye drops: burning, blurred vision, blepharitis, dry eye**
Monitoring:
Pearls/Notes:
** select ophthalmic products contain the preservative BAK; remove contact lenses before use**
Drug-Drug/Food interactions:
Azopt
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
brinzolamide
-zolamide = Can cause Sulfonamide allergy
class: carbonic anhydrase inhibitor
Indications: open angle glaucoma
MOA: reduces aqueous humor production
Dosage forms:
Dosing: 1 drop TID
Max dose:
Contraindications:
Warnings:
**Sulfonamide allergy: caution due to the risk of systemic exposure and cross reactivity (especially with oral formulations)
Side Effects:
** eye drops: burning, blurred vision, blepharitis, dry eye**
Monitoring:
Pearls/Notes:
** select ophthalmic products contain the preservative BAK; remove contact lenses before use**
Drug-Drug/Food interactions:
Simbrinza
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
brinzolamide + brimonidine
Alphagan P
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
brimonidine
class: adrenergic alpha-2 agonist
Indications: open angle glaucoma
MOA: increases aqueous humor outflow & reduces aqueous humor production
Dosage forms:
Dosing: TID
Max dose:
Contraindications:
Warnings: CNS depression: caution with heavy machinery & driving
Side Effects:
sedation, dry mouth, dry nose
Monitoring:
Pearls/Notes:
select products contain the preservative BAK; remove contact lenses before use
remember “clonidine” -nidine
Drug-Drug/Food interactions:
Iopidine
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
apraclonidine
class: adrenergic alpha-2 agonist
Indications: open angle glaucoma
MOA: increases aqueous humor outflow & reduces aqueous humor production
Dosage forms:
Dosing: TID
Max dose:
Contraindications:
Warnings: CNS depression: caution with heavy machinery & driving
Side Effects:
sedation, dry mouth, dry nose
Monitoring:
Pearls/Notes:
select products contain the preservative BAK; remove contact lenses before use
remember “clonidine” -nidine
Drug-Drug/Food interactions:
Lumify
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
brimonidine
class: adrenergic alpha-2 agonist
Indications: open angle glaucoma, is indicated for ocular redness
MOA: increases aqueous humor outflow & reduces aqueous humor production
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings: CNS depression: caution with heavy machinery & driving
Side Effects:
sedation, dry mouth, dry nose
Monitoring:
Pearls/Notes:
select products contain the preservative BAK; remove contact lenses before use
OTC
remember “clonidine” -nidine
Drug-Drug/Food interactions:
Rhopressa
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
netarsudil
class: rho kinase inhibitor
Indications: open angle glaucoma
MOA: increases aqueous humor outflow
Dosage forms:
Dosing: 1 drop daily in the evening
Max dose:
Contraindications:
Warnings:
Side Effects:
burning/eye pain, corneal disease, conjunctival hemorrhage and conjunctival hyperemia (excess blood vessels)
Monitoring:
Pearls/Notes:
Contains the preservative BAK; remove contact lenses prior to use
Store in the refrigerator before opening; once opened, store at room temperature for < than or equal to 6 weeks
Drug-Drug/Food interactions:
Rocklatan
netarsudil + latanoprost
Conjunctivitis:
pink eye
conjunctivitis can be caused by:
virus, bacterial, allergic or an irritant
-viral & bacterial highly contagious
The most common bacterial cause of conjunctivitis is ________
staphylococcus aureus
but
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
are also common culprits.
More severe cases are caused by
Neisseria gonorrhoeae
Chlamydia
which these will require systemic treatment.
Most of the time conjunctivitis is _______.
The most common pathogen being _____________________
viral
adenovirus
Antibiotic eye drops used for treatment include:
(Vigamox) moxifloxacin
(Moxeza) moxifloxacin
(Maxitrol) Neomycin/Polymyxin B/Dexamethasone
(Ocufox) ofloxacin
(Polytrim) Trimethoprim/Polymyxin B
(AzaSite) azithromycin - store in the refrigerator, stable for 14 days at room temp
Blepharitis:
eyelid inflammation
What is the preferred treatment for Blepharitis:
- application of a warm compress over the eye for a few minutes to loosen the crusty deposits, then use of a warm, moist washcloth (water plus a few drops of baby shampoo) to wipe away the debris.
inflammation of blepharitis can be reduced with a ____________ and either ___________ (if mild) or a __________ (if severe)
cold compress
NSAID eye drop
Steroid eye drop
NSAID eye drops
Acular (ketorolac)
Acuvail (ketorolac)
diclofenac
brofenac
llevro (nepafenac)
Nevanac (nepafenac)
= For inflammation
Steroid eye drops
Pred Forte (prednisolone)
Pred Mild (prednisolone)
Omnipred* (prednisolone)
Maxidex (dexamethasone)
Ozurdex (dexamethasone)
Alrex (loteprednol)
**Lotemax (loteprednol)
Flarex (fluorometholone)
FML Forte (fluorometholone)
= For inflammation
For Chronic Dry eye:
Restasis (cyclosporine) - emulsion eye drop - is indicated for keratoconjunctivitis sicca (severe, chronic dry eye syndrome)
Xiidra (lifitgrast)
**Eysuvis (loteprednol)
Tyrvaya (varenicline nasal spray)
For Redness of eye:
Clear eyes Redness Relief = naphazoline
Naphcon A = naphazoline/pheniramine
Visine A = naphazoline/pheniramine
Visine = tetrahydrozoline
Preservatives are toxic to bacteria and are irritating to the sensitive tissues of the eyes, which leads to burning/stinging after administration.
Common drugs known to cause vision changes or damage:
Retinal changes/retinopathy
Optic neuropathy
Intraoperative floppy iris syndrome (IFIS); causes difficulty in cataract surgery
Color discrimination
Vision loss/abnormal vision
Retinal changes/retinopathy
- chloroquine
- hydroxychloroquine
Optic neuropathy
- amiodarone (+ corneal deposits)
- ethambutol
- linezolid
Intraoperative floppy iris syndrome (IFIS); causes difficulty in cataract surgery
- alpha blockers (tamsulosin)
Color discrimination
- digoxin (with toxicity)- yellow/green vision
- PDE-5 inhibitors (sildenafil) - greenish tinge around objects
- voriconazole - color vision changes
Vision loss/abnormal vision
- digoxin (with toxicity)- blurry, halos
- PDE-5 inhibitors - vision loss
- isotretinoin - decreased night vision
- vigabatrin - permanent
- voriconazole - photophobia
