eye drugs Flashcards
what is the drug name for fluorescein dye
sodium fluorescien
why do we use fluorescein dye
to detect abrasions on the cornea (must remove contacts before using)
name two ocular anesthetics
proparacaine hydrochloride 0.5%
tetracaine 0.5%
what should you NOT do with ocular anesthetics
prescribe for repeated use
also do not rub eye for 10 min after use
what are the two types of dilating agents (mydriatics)
- cholinergic blocking
2. adrenergic stimuating
name 3 types of cholinergic blocking dilating agents/ mydriatics
- tropicamide 0.5% or 1%
- cyclopentolate hydrochloride 0.5%, 1%, 2%
- homatropine hydrobromide 2% or 5%
name one type of adrenergic stimulating dilating agents/ mydriatics
phenylephrine hydrochloride 2.5-10%
how do the cholinergic blocking dilating agents work
dilation by paralyzing the iris sphincter
referred to as cycloplegics –> produce paralysis of accommodation
can also be used for pain relief as it paralyzes the ciliary spasm during iritis etc
how do adrenergic stimulating dilating agents work
stimulates the pupillary dilator muscles
no effect on accommodation
dilatory effect is not as strong
mydriatic but NOT cycloplegic
how should you introduce drops to the eye
avoid dropping them directly on cornea as it is the most sensitive part of the eye
what do you use if maximum mydriasis is required
phenylephrine and tropicamide in combo
in peds, use cyclopentolate and phenylephrine
what drug should never be used by a primary care physician
topical ocular corticosteroids
what drug should you use to treat ophthalmic herpes SIMPLEX viral infection
topical trifluridine (viroptic)
use only under direction of ophtho
what should you never use to dilate the pupil for a fundus exam
atropine or scopolamine
the dilatory effects can last up to 1-2 weeks
what side effects are associated with regular beta blockers?
how does this differ for betaxolol?
regular beta blockers have pulmonary SEs and are thus contraindicated in asthma and COPD
betaxolol is cardioselective so less pulm SEs
what is tamsulosin
alpha 1a antagonist for BPH
what are the ocular ramifications of tamsulosin
can cause intraoperative floppy iris syndrome
flaccid iris–> prolapse from surgical wounds and poor pupillary dilation
higher risk of intraoperative complications for example during cataract surgery
what are the ocular ramifications of thioridazine
pigment retinopathy at high doses
list the types/classes of glaucoma meds
- beta blockers
- cholinergic stimulating
- alpha 2 agonists
- adrenergic stimulating
- prostaglandin inhibitors
- carbonic anhydrase inhibitors
name beta blockers used to treat glaucoma
topical timolol, levobunolol, metipranolol, carteolol
name a cholinergic stimulating drug used to treat glaucoma
pilocarpine
how does pilocarpine work
increases aqueous flow through the trabecular meshwork
unpleasant SEs in eye and thus unpopular–> often less systemic PNS side effects
name 2 alpha-2 agonist drugs used to treat glaucoma
brimonidine tartrate
apraclonidine
how does apraclonidine work
decreases aqueous formation and increases outflow
used in critical situations in pressure spikes
what drug is used in critical situations of pressure spikes in glaucoma
apraclonidine –> used in ER for temporary control of IOP
who should you not give apraclonidine to
infants due to risk of severe hypotension and apnea
SEs of apraclonidine
orthostatic hypotension
fairly high sensitivity reactions
name two adrenergic stimualting drugs used to treat glaucoma
epinephrine
dipivefrine
how are prostaglandin analogues used to treat glaucoma
increase aqueous outflow through the uveoscleral pathway
have no major systemic toxicities
have more unique local effects like iris darkening, eyelash lengthening, inflammation/ swelling of eye
name two PO carbonic anhydrase inhibitors used to treat glaucoma
PO acetazolamide and methazolamide
used for chronic glaucoma management, limited by side effects
side effects of PO carbonic anhydrase inhibitors used to treat glaucoma
paresthesia
anorexia
renal calculi/bone marrow
name two intraocular carbonic anhydrase inhibitors used to treat glaucoma
IO dorzolamide, brinzolamide
what is the benefit to IO carbonic anhydrase inhibitors to treat glaucoma
similar therapeutic effect but less systemic SEs
altered taste is main adverse reaction
what ocular effect can the following drug have:
amiodarone
optic neuropathy–>
mildly decreased vision, visual field defects, bilateral optic disc swelling
produces WHORL SHAPED pigmented deposits on the corneal epithelium
what should you think of if you see whorl shaped pigmented deposits on the corneal epithelium
amiodarone side effect
what is amiodarone
cardiac anti arrhythmic
what ocular effect can the following drug have:
bisphosphonates
associated with conjunctivitis, scleritis, uveitis
symptoms are red eye, photophobia, decreased vision, deep eye pain
what do bisphosphonates treat
osteoporosis
what ocular effect can the following drug have:
chloroquine
can produce corneal deposits and retinopathy
retinal damage is insidious, slowly progressive and usually irreversible
BULLS EYE macular lesions when damage has already occurred
all patients on chloroquine should be referred to ophtho to determine baseline and f/u intervals
what should you think of if you see bulls eye lesions on the macula
damage from chloroquine drug
what is chloroquine used to treat
rheumatoid
what ocular effect can the following drug have:
chlorpromazine
produces punctate opacities in the corneal epithelium after long term use
reversible with discontinuation
what ocular effect can the following drug have:
corticosteroids
long term use can cause POSTERIOR SUBCAPSULAR CATARACTS
also may cause central serous retinopathy and related macular edema
what ocular effect can the following drug have:
digitalis
blurred vision
abnormally coloured vision
objects can appear frosted or have white halo
what is digitalis used for
cardiac–arrhythmias etc
what ocular effect can the following drug have:
diphenyhydantoin
can cause dosage related cerebellar-vestibular effects (nystagmus)
what ocular effect can the following drug have:
ethambutol
dosage related optic neuropathy
what is ethambutol used for
chemo of TB
what ocular effect can the following drug have:
statins
associated with cataracts when given in excessive doses (not proven)
what ocular effect can the following drug have:
rifabutin
uveitis
what is rifabutin used for
MAC infections
what ocular effect can the following drug have:
viagra
at peak plasma levels may experience transient impairment of colour discrimination (blue colour tinge)
rare at normal dose
what ocular effect can the following drug have:
tamoxifen
high doses can cause whorl-shaped opacities, retinal crystalline deposits, macular edema, cataracts, optic neuritis
rare at normal dose
what ocular effect can the following drug have:
topiramate
shown to induce acute bilateral angle closure glaucoma
what is topiramate used for
treatment of seizure
define epiphora
chronic tearing
define amblyopia
loss of visual acuity not correctable by glasses in an otherwise healthy eye
define photopsias
flashes of light
