Eye Meds

Question 1

Key Factors in Ophthalmic Drugs

Answer 1

• effectiveness
• toxicity
• propensity to cause allergic reactions
• availability in ointment or solution form
• cost

Question 2

Aminoglycosides MOA

Answer 2

inhibit bacterial protein synthesis

Question 3

Examples of Aminoglycosides

Answer 3

Tobramycin (Tobrex)
Gentamicin (high ocular toxicity)
Neomycin (high ocular toxicity)

Question 4

Aminoglycoside Uses

Answer 4

• most effective against G- (esp Pseudomonas)

- also synergy against some G+

Question 5

Aminoglycoside AEs

Answer 5

• localized ocular toxicity and hypersensitivity
• lid itching, lid swelling, conjunctival erythema
• bacterial/fungal corneal ulcers
• nonspecific conjunctivitis
• conjunctival epithelial defects
• conjunctival hyperemia
• superficial punctate keratitis

Question 6

Fluoroquinolone MOA

Answer 6

inhibit bacterial DNA gyrase

Question 7

Fluoroquinolone Uses

Answer 7

• corneal infections/ulcers

- severe conjunctivitis

Question 8

Fluoroquinolone AEs

Answer 8

• white crystalline precipitates, lid margin crusting, crystals/scales
• FB sensation, corneal infiltrates
• conjunctival hyperemia
• bad/bitter taste
• corneal staining, keratopathy/keratitis, allergic reactions
• lid edema, tearing, photophobia, decreased vision
• nausea, chemosis

Question 9

Can Fluoroquinolones be used for conjunctivitis?

Answer 9

not used first line due to poor Strep coverage, expense, resistance concern

Question 10

Trimethoprim/Polymyxin B Uses

Answer 10

• Gram pos and neg (except Pseudo, but polymyxin covers pseudomonas)
• very effective against H flu, S pneumo

Question 11

Trimethoprim/Polymyxin B Overall Comments

Answer 11

• first line tx for conjunctivitis
• low toxicity
• good for kids
• cost effective

Question 12

Erythromycin Ointment

Answer 12

• first line treatment for conjunctivitis
• very gentle on the cornea
• cost-effective

Question 13

Bacitracin Ointment Use

Answer 13

• first line for conjunctivitis

- use for blepharitis

Question 14

Bacitracin Ointment Cautions

Answer 14

-avoid long term use due to resistance development

Question 15

Trifluridine/Viroptic Class and Use

Answer 15

• topical antiviral

- dendritic HSV keratitis

Question 16

Famciclovir/Famvir Class and Use

Answer 16

• oral antiviral
• safe for kids
• effective with HSV and Varicella zoster

Question 17

What is the gold standard ophthalmic medication?

Answer 17

prednisolone acetate (Pred Forte)

Question 18

Corticosteroid AEs

Answer 18

• cataracts (long-term)
• elevated IOP
• optic nerve damage
• papilledema assoc w/ pseudotumor cerebri

Question 19

What must be monitored with corticosteroids and when?

Answer 19

• IOP at baseline and qweek until therapy stopped

- taper corticosteroid if therapy duration prolonged

Question 20

What is the downfall of corticosteroid treatment?

Answer 20

can mask infx –> turn into more severe infx

Question 21

Which corticosteroid forms provide better penetration?

Answer 21

acetate corticosteroids better than EtOH

Question 22

NSAID Uses

Answer 22

tx of eye pain or itching

Question 23

NSAID AEs

Answer 23

• transient burning or stinging upon instillation

- other minor sxs of ocular irritation

Question 24

Treatment of Allergic Conjunctivitis (steps)

Answer 24

1. remove/avoid allergen
2. artificial tears
3. topical antihistamine
4. mast cell stabilizer or MCS/antihistamine
5. trial of topical NSAID
6. short term topical corticosteroid and immunotherapy

Question 25

Cycloplegics MOA

Answer 25

anticholinergic agents block the responses of the sphincter muscle of the iris and muscle of ciliary body --> produces pupillary dilation and paralysis of accommodation

Question 26

Cycloplegic Examples

Answer 26

- atropine - homatropine - cyclopentolate - tropicamide

Question 27

Cycloplegic Use

Answer 27

for reduction of inflammation and pain

Question 28

Cycloplegic AEs

Answer 28

- increase IOP - transient stinging/burning - irritation w/ prolonged use: allergic lid rxns, hyperemia, follicular conjunctivitis, blepharoconjunctivitis, vascular congestion, edema, exudate

Question 29

Cycloplegic Special Info

Answer 29

all of them have red caps

Question 30

Bimatoprost Use

Answer 30

-increasing eyelash growth

Question 31

Bimatoprost MOA

Answer 31

adverse effect of prostaglandin analog eye drops

Question 32

Bimatoprost Trade Name

Answer 32

Latisse

Question 33

Bimatoprost AEs

Answer 33

- may darken iris and skin around eyes - skin effects can be reversible - iris effects usually permanent

Question 34

Bimatoprost Cautions

Answer 34

- with use in pts getting prostaglandin eyedrops for glaucoma - prostaglandin exposure > qd can decrease efficacy

Question 35

AREDS Vitamin Supplements

Answer 35

- vitamin A, C, E - zinc - copper

Question 36

Use of Vitamin Supplements

Answer 36

-does not prevent age-related macular degeneration but does slow rate of progression

Question 37

Cautions for Vitamin Supplements

Answer 37

vitamins A, D, E, K are fat soluble and can accumulate to toxic levels