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Pharm I - Eye > Eye > Flashcards

Eye Flashcards

1
Q

T/F topical drugs for eye can be used for systemic absorption like on the skin.

A

False; local absorption only

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2
Q

How should the dose of topical eye medications be increased?

A

increased concentration (not volume)

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3
Q

what are the two mediums eye medications come in?

A

ointment and drops

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4
Q

what are the disadvantages of drops?

A
  • hard to hold eye open
  • less duration of effect
  • need to use more frequently
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5
Q

what are the advantages and disadvantages of ointments?

A

Advantages:

  • better adherence to eye
  • better exposure to drug
  • less leakage down nasolacrimal duct
  • less frequent application

Disadvantage:
- blurry vision for longer time

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6
Q

when should ointments for the eye be applied?

A

night

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7
Q

You have prescribed drops and an ointment. What order should they be applied in?

A

drops than ointment

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8
Q

What is the most common dosage form for eyes?

A

Liquid eye drops

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9
Q

How many drops should you prescribe?

A

1 is all that is needed, 2 are prescribed incase some rolls out of eye

more than 2 increases toxicity and cost without benefit

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10
Q

what is 1 drop equivalent to?

A

1 drop = 1 ggt = 1/20 cc = 0.05 cc

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11
Q

How do you put eye drops in?

A
  • wash hands
  • shake if suspension
  • hold lower lid down to hold pouch between eyelid and ball
  • brace hand against cheek or nose
  • look at sky
  • apply drops into pouch (or apply 1/2 in. of ointment here)
  • don’t touch tip of applicator on anything
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12
Q

What is the mechanism of absorption of the eye?

A

local effect of drug on the eye is by diffusion into the eye

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13
Q

where does systemic absorption of eye medications occur? what do they cause?

A

nasolacrimal duct

S/E

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14
Q

how can you prevent systemic absorption?

A

nasolacrimal occlusion

  • put drops in the eye, close the eye, apply gentle pressure on the inner cants for 1-2 minutes
  • this decreases the exposure to the nasolacrimal apparatus & systemic absorption
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15
Q

what are ocular inserts?

A
  • patient applies
  • prolonged exposure
  • often only need to apply weekly
  • CL with drug implanted for LT drug use
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16
Q

What are the 6 major groups of drugs used in the eye?

A
  • glaucoma medications
  • lubricants
  • vasoconstrictors (decongestants)
  • antihistamines
  • ocular corticosteroids
  • ocular antibiotics
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17
Q

What is glaucoma?

A

elevated IOP due to increased aqueous humor and decreased drainage that kills optic nerve causing blindness

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18
Q

Compare and contrast open-angle glaucoma and closed/narrow-angle glaucoma.

A

open:

  • slow
  • chronic loss of vision
  • topically tx fairly easily

closed:

  • rapid loss of vision
  • surgery required
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19
Q

How do glaucoma drugs work (2 ways)?

A
  • decreased production of fluid

- change anatomy of eye so more fluid is drained

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20
Q

First line drugs for glaucoma?

A
  • prostaglandin analogs
  • beta blockers
  • alpha agonists
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21
Q

second line drugs for glaucoma?

A
  • carbonic anhydrase inhibitors

- cholinomimetics

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22
Q

MOA of prostaglandin analogs?

A

increase drainage of aqueous humor; most effective groups

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23
Q

S/E of prostaglandin analogs?

A
  • hyperemia (redness)
  • punctate erosions
  • blurred vision
  • change the color of iris permanently
  • hypertrichosis (increased hair)
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24
Q

What are the different types of prostaglandin analogs available?

A
  • latanoprost
  • bimatoprost
  • travoprost
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25
Q

what is the MOA of beta blockers?

A

decreased secretions of aqueous humor

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26
Q

S/E of beta blockers?

A

Local:

  • stinging
  • blepharitis
  • blurred vision

Systemic:

  • hypotension
  • low HR
  • heart failure
  • worsening asthma
27
Q

What are the beta blockers used in glaucoma?

A
  • timolol
  • carteolol
  • levobunolol
28
Q

what is the MOA of alpha agonists?

A
  1. decrease production

2. increases outflow of aqueous humor

29
Q

What are the S/E of alpha agonists?

A

Local:
- allergic rxn

Systemic:

  • dizziness
  • fatigue
  • sleepy
  • dry mouth
  • decreased BP
30
Q

What are the alpha agonists used for glaucoma?

A
  • apraclonidine

- brimonidine

31
Q

What is the MOA of carbonic anhydrase inhibitors?

A

reduce the production of aqueous humor

32
Q

S/E of carbonic anhydrase inhibitors?

A

Local:

  • stinging
  • tearing
  • blurred vision
33
Q

What are the two types of carbonic anhydrase inhibitors available?

A 
Topical
- dorzolamide
- brinzolamide
Oral
- acetazolamide
34
Q

MOA of cholinomimetics for glaucoma?

A

stimulate contraction of ciliary muscle which pulls open the trabecular meshwork and relieves IOP (increases drainage of humor)

35
Q

S/E of cholinomimetics?

A

Local:

  • miosis (decreased night vision)
  • HA
  • periorbital pain
36
Q

Examples of cholinomimetics for glaucoma?

A

pilocarpine; has to be used several times a day (2nd line)

37
Q

What is used to treat dry eyes?

A

lubricants

38
Q

what are the 3 types of lubricants available?

A
  • artificial tears
  • lubricating ointments
  • restasis
39
Q

MOA of artificial tears?

A
  • stimulate tears

- decrease evaporation of tears

40
Q

S/E of artificial tears?

A

irritation if preservative present in preparation

41
Q

Disadvantages of artificial tears?

A
  • short duration of action

- need to be used a lot

42
Q

Tx with artificial tears?

A

2x/day and increase

can use every hour if needed

OTC
available in single dose (preservative free)
or multi dose with preservative

43
Q

MOA of lubricating ointments?

A
  • stimulate tears

- decrease evaporation of tears

44
Q

Advantages and disadvantages of ointments?

A
  • more occlusive

- blurry vision

45
Q

cyclosporine (restasis) MOA?

A

immunosuppressant used topically for chronic dry eye

it working suggests chronic inflammatory process in dry eyes

46
Q

S/E of cyclosporine?

A

Local:

  • stinging
  • increased infections
47
Q

Disadvantages to cyclosporine?

A
  • takes a long time to work
  • need to keep using to get effect
  • expensive
  • only Rx for dry eyes
48
Q

Vasoconstrictor MOA?

A

alpha agonist that decreases redness by temporarily constricting blood vessels (eye decongestant)

49
Q

S/E of vasoconstrictors?

A

Local:

  • rebound
  • increased IOP
  • local irritation

Systemic:
- adrenergic agonist effects

50
Q

Vasoconstrictors on the market for the eye?

A
  • naphazoline
  • tetrahydrozoline
  • oxymetazoline
51
Q

MOA of ocular antihistamines?

A

inhibit release of histamine from mast cells

52
Q

examples of anthistamines?

A
  • alcaftadine
  • azelastine
  • bepotastine
  • olopatadine
  • emedastine
  • epinastine
  • ketotifen
53
Q

MOA of ocular antibiotics?

A

kill bacteria

54
Q

uses for ocular antibiotics?

A
  • conjunctivitis
  • blepharitis
  • keratitis
  • styes
  • prophylactically
  • pre/post op
55
Q

examples of ocular antibiotics?

A
  • besifloxaxin
  • moxifloxacin
  • gatifloxacin
  • erthromycin
  • gentamycin
  • suflacetamide
  • tobramycin
56
Q

MOA of ocular corticosteroids?

A

decreases inflammation in inflammatory eye conditions

57
Q

S/E of ocular steroids?

A 
Local:
- increases IOP
- infections
- cataracts
- scleral thinning
- corneal melting
Systemic:
- the usual
58
Q

Examples of ocular corticosteroids?

A
  • prednisolone
  • dexamethasone
  • difluprednate
  • fluoromethalone
  • loteprednol
59
Q

What drugs are given systemically that cause adverse affects to eye?

A
  • hydroxychloroquine
  • chloroquine
  • sildenafil
  • corticosteroids
60
Q

How does hydroxychloroquine and chloroquine affect the eye?

A

immunomodulator that deposits pigment in back of eye, can cause blindness with LT use

used for malaria

61
Q

How does sildenafil (viagra) affect the eye?

A

a phosphodiesterase inhibitor may rarely cause blindness, more commonly can see color changes with its use

62
Q

how do corticosteroids affect the eye?

A

increase IOP and cause cataracts

63
Q

what drugs increase the risk of glaucoma?

A
  • corticosteroids (eye or oral)

- anticholinergics (topical)

64
Q

what drugs increase the risk of closed-angle glaucoma?

A
  • anticholinergics (topical or oral)
  • sympathomimetics (topical)
  • anti-histamines
  • anti-depressants
  • topiramate
  • phenothiazines

Pharm I - Eye (5 decks)

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