Eyes- Quiz 1 Flashcards

1
Q

What is the most common cause of conjunctivitis?

A

Bacteria!

H influenza OR Strep pneumoniae

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2
Q

What types of eye problems will a primary care prescriber treat?

A

Conjunctivitis

Blepharitis

Hordeolums (Stye)

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3
Q

What types of issues should always be referred to an ophthalmologist?

What medications should only be prescribed by ophthalmologists?

A

HSV
Keratitis
Corneal ulcers

Tobramycin & Gentamycin & steroids
–carry high risk for life altering complications

Generally antiviral agents are only specialists as well

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4
Q

Bacitracin

MOA
Effective Against

A

-Bacteriostatic
-Inhibits incorporation of
amino acids & nucleotides
into the cell

-Active against gram+
Staph, Strep, Clostridia,
Corynebacterium and
anaerobes
-Active against gram
gonococci, meningococci
& fusobacteria

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5
Q

Erythromycin (EES)

MOA
Effective Against

A

-Bacteriostatic
-Macrolide that binds to 50S
ribosomal subunit; inhibits
bacterial protein synthesis

-Active against gram +
Staph aureus, Strep
pyogenes, Strep
pneumoniae, Strep viridians
& Corynebacterium
diptheriae
-Limited gram –coverage
-not active against Chlamydia trachomatis

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6
Q

Sulfacetamide

MOA
Active Against

A

MOA
-Sulfonamide; inhibits
bacterial dihydrofolate
synthetase

Active against
-Step, Staph, E coli, Klebsiella,
Pseudomonas
pyocynea, Neisseria
gonorrhea and
Chlamydia

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7
Q

Tobramycin

Class
MOA
Active Against

A

-Aminoglycoside

-MOA is unknown

-Active against Staph,
Strep,
Corynebacterium,
Klebsiella, Moraxella,
Proteus, beta-hemolytic
Strep, Haemophilus
influenzae

-Not active against
Neisseria or Chlamydia

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8
Q

Gentamycin

Class
MOA
Active Against

A

-Aminoglycoside

-Active against gram +
and gram –pathogens

-MOA unknown

-Covers Staph, Strep
pneumonia, beta
hemolytic strep, E coli,
H flu, N. gonorrhoeae &
Enterobacter

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9
Q

Azithromax

Active against

A

Gets 88% of gram +
and 92% of gram -
bacteria in RCTs—
including 93% of H
flu

We don’t use it because it’s 10x more expensive than bacitracin

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10
Q

Fluoroquinolones

MOA
Active Against

A

-Bactericidal via
inhibition of DNA
gyrase

-Active against Staph,
Strep, H flu,
Klebsiella, Proteus,
Enterobacter and
Pseudomonas
aeruginosa

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11
Q

Polytrim
(Polymyxin B & trimethoprim)

MOA for each
Coverage for each

A

-Polymyxin B binds to cell
membranes,
specifically the phospholipids
in the cell wall [increases cell
permeability]
—Active against gram –E coli,
Pseudomonas and H flu

-Trimethoprim inhibits bacterial
dihydrofolate reductase
–Covers gram + and gram
bacteria; active against Staph,
Strep and Strep pyogenes

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12
Q

Polysporin

What two meds
Active Against

A

Polymyxin B + Bacitracin

Active against gram + and gram -

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13
Q

Gancyclovir (Zirgan)

MOA
Active Against

A

inhibits replication of HSV by inhibiting
synthesis of viral DNA

HSV

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14
Q

Vidarabine (Vira A)

MOA
Active Against

A

MOA unknown

HSV1
HSV2
VZV
CMV
Vaccinia
Hep B

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15
Q

Trifluridine (Viroptic)

MOA
Active against

A

MOA unknown

HSV1
HSV2
Adenovirus
Vaccinia

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16
Q

When is an ophthalmic ointment contraindicated? Why?

A

After corneal trauma or surgery

Ointment decreases corneal healing

In these cases use drops

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17
Q

What ocular symptom would contraindicate the use of sulfacetamide?

A

Exudate

Inactivated by para-aminobenzoic acid.

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18
Q

What are the Category C pregnancy eye drugs?

A

Gentamycin
Cipro
Gatifloxin
Levofloxin
Moxifloxin
Norfloxacin
Ofloxacin
Polymyxin B
Suflacetamide

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19
Q

What eye drops are contraindicated with lactation?

A

Sulfacetamide
Fluoroquinolones

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20
Q

What eye drops/ointments are safe in children?

A

Safe: Erythromycin & tobramycin (though don’t give it, send to ophthalmologist)

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21
Q

Which eye drops need to be avoided in children less than 1 year?

<2 months?

A

Contraindicated in children less than 1 year:

Fluoroquinolones [Besifloxin, Cipro,
Gatifloxin, Moxifloxin [Vigamox],
Levofloxin, Norfloxin, Ofloxin] &
Azithromax

Contraindicated in <2 mo

Sulfacetamide
Polymyxin B
Bacitracin

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22
Q

What eye drops can be used in children > 4 months?

A

> 4 mo
Moxifloxacin (Moxeza)

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23
Q

Common drug reactions of all eye drops?

A

Local irritation (usually transient)

Superinfection possible with repeated or prolonged use

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24
Q

Common drug reaction for opthalmic bacitracin?

A

Blurred vision- transient

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25
Q

Common drug reactions for sulfacetamide?

A

Hypersensitivity with Sulfa
30% can cause burning & stinging, try to use lower concentrations for better tolerance

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26
Q

Common drug reactions for aminoglycosides?

A

localized
ocular toxicity & hypersensitivity

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27
Q

Common drug reactions for fluoroquinolones?

A

-a white
crystal precipitate in superficial cornea
[17% with Cipro];

lid crusting; crystals,
scales & sense of foreign body in the eye;
dysgeusia

Can also cause photophobia, tearing, nausea,
decreased vision, conjunctival hyperemia &
corneal staining

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28
Q

Common drug reactions with antivirals?

Gancyclovir?
Vidarabine?
Trifluridine?

A

burning, irritation
when instilling

-Gancyclovir can cause blurred vision,
punctate keratitis, conjunctival hyperemia

-Vidarabine—photophobia, itching, erythema,
ocular pain, increased tears; punctate
keratitis if exposed to UV light MUST WEAR SUNGLASSES

-Trifluridine reactions similar to Vidarabine
and increased IOP

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29
Q

Which eye preparations have no drug/drug interactions?

A

Bacitracin
Gentamycin
Tobramycin
Polymyxin B
Azithromycin
Erythromycin

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30
Q

What drugs are incompatible with Sulfacetamide?

A

Silver preparations
Zinc preparations will form precipitate

Sulfacetamide antagonized by:
Benzocaine
Chloroprocain
Cocaine
Procaine
Popoxycaine
Tetracaine

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31
Q

What drugs are incompatible with fluoroquinoles?

A

Theophylline, increases level and INR

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32
Q

Eye infection in the newborn is likely?

What is the standard treatment?

When can you not give the standard? What do you give instead?

A

Chlamydia

IM Ceftriaxone (50mg/kg max 125mg) once

IF there are extraocular symptoms 7 days of IM or IV is needed.

If baby has hyperbilirubinemia no ceftriaxone.
Give Cefotaxime 50-100mg/kg/day bid x 7 days

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33
Q

What is given within one hour of birth to prevent eye infection of the newborn?

What does it NOT prevent?

A

Erythromycin

Prevention of ophthalmia neonatorum

Chlamydia! Therefore any mucopurulent discharge in the first few weeks of life, check for chlamydia.

Prevents gonorrhea infection of the eye

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34
Q

In children 3 months to 8 years, what are the likely infective eye agents?

A

Staph, Strep or Haemophilis (h. Flu)

In children > 7 H flu most common

Side note: warm climates H flu, colder strep pneumoniae

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35
Q

In adults >70 what is the most likely infective eye agents?

A

Staph aureus and pseudomonoas

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36
Q

Bacterial conjunctivitis with dacryostenosis (excess tearing) is most commonly what infective agent? What are the best treatments?

A

Strep pneumonia
H flu

Erythromycin
tobramycin (but don’t)
fluoroquinolone

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37
Q

Conjunctivitis-Otitis Syndrome

Likely organism?
Treatment?

A

Seen in those <6 yo

H flu

PO Augmentin, no additional eye drops
–make sure amoxicillin dose is 80-90mgkg/day

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38
Q

Gonococcal Conjunctivitis

Identification?
Treatment?
Side note?

A

Purulent bacterial conjunctivitis

Rocephin (cephtriaxone) 1g IMx1
Use NS irrigations to clear exudate

UNLESS in a newborn with “sexually promiscuous parent” then do gram stain and culture of eye discharge

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39
Q

Blepharitis

What is it?
Treatment?

A

-Acute or chronic inflammation of the lash
follicles and Meibomian glands of the lashes

-Treat with warm compresses 5-10” BID
QID; scrub lashes with gentle no-tear
shampoo;

-EES (erythromycin) ointment .25” ribbon to both
eyes BID until symptoms resolve, THEN for
another 7 days OINTMENT IS PREFERRED
or
Zithromax 1% solution BID for 4 weeks

-No contacts during therapy—then sterilize
before re-inserting
-Discard ALL eye make-up and get new

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40
Q

Hordeolum

What is it?
Causing agent?
Treatment?

A

-Stye—infection of sebaceous gland of
lashes or lid

-Cause—Staph aureus

-Treatment—warm moist compresses QID
for 15” each time

—Sulfacetamide 10% or Polytrim gtts or
—EES ointment 0.5% QID until sx are gone the for
another 3 days

The stye will usually rupture on its own—if
it does not—refer to the ophthalmologist, it needs to be lanced and drained

41
Q

Viral Conjunctivitis

Causing agents?
Treatment?

A

-Causes—adenovirus, HSV or VZV

–Treat adenovirus with 10% Sulfacetamide
[sol. or oint.] QID or Tobramycin to
prevent bacteria superinfection for 12-15
days [until the conjunctivitis runs its
course]

-HSV—herpes keratitis can be a
complication—refer to ophthalmologist

-Viral conjunctivitis can be treated with
Gancyclovir, Trifluridine or Vidarabine

42
Q

What is the drug of choice for eye infection of the infant?

A

Erythromycin (EES)

43
Q

What education do you need to provide to the patient with an eye infection for

Prevent spread to others?

Prevent re-infection?

A

Control Spread
-Wash hands when touching infected
eyes & before instilling gtts
-Those with eye infections do not share
hand towels with other family members

Prevent re-infection
-Eye make-up has to be tossed after
the eye infection—mascara & other
make-up can harbor bacteria/viruses
-Remove purulent discharge with a
cotton ball moistened with water;
wipe from interior to exterior
canthus; use clean cotton ball for
each wipe

44
Q

What education do you need to provide to the patient to use the prescribed medication, both drops or ointment?

A

General
-Administration—keep tip of dropper
or tube from touching eyes, fingers
-Do not share eye medications

Ointment
-Transfer ointments to moistened
cotton, then roll into each
conjunctival sac

Drops
-Self-administer eye gtts by holding
bottle in dominant had & use index
finger of other hand to pull down
lower lid to form a pocket
-School aged children—they can help
by pulling down their lower lid while
parent or HCP instills the gtts into the
pocket
-Alternative method—have child lie down on
their back, close eyes & hold head still; the
parent drops antibiotic or antiviral gtts into
inner canthus; child should then open their
eyes without moving their head
-Younger children may require
immobilization to instill gtts or ointments
into the eyes—2 adults are needed

45
Q

What 5 categories of medications are used to treat glaucoma?

A
  1. Beta blockers
  2. Miotics
  3. Carbonic anhydrase inhibitors
  4. sympathomimetics/ Adrenergic agonists
  5. Prostaglandin agonists
46
Q

*****Miotics/ Cholinesterase Inhibitor

MOA
-Two types

A

MOA
Indirect acting agents that inhibit cholinesterase
- Cause intense miosis
& muscle contraction;
IOP is decreased by a
decrease resistance to
aqueous outflow (constict pupil that increases the outflow of aqueous humor)

Type 1: reversible (shorter acting)
physostigmine
& demecarium combined
with cholinesterase
[resulting union is
hydrolyzed]

Type 2: Irreversible (longer acting, but has risk of iris cystitis)
echothiophate
iodide [Phospholine] binds
to cholinesterase into a co
valent bond that does not
hydrolyze; cholinesterase
must be obtained from
other parts of the body for
eye action to normalize

47
Q

Carbonic Anhydrase Inhibitors

MOA

A

Decrease aqueous
humor secretion by
decreasing the
formation of
bicarbonate ions; this
decrease in Na+ and
fluid transport leads
to less aqueous
humor production

48
Q

Sympathomimetics

MOA

A

-Cause
vasoconstriction,
pupillary dilation and
decrease the IOP

-These drugs decrease
IOP by reducing
production of
aqueous humor & by
increasing aqueous
humor outflow

49
Q

Alpha Adrenergic Agonists

MOA
Peak level time
Elimination

A

Decreases IOP by
reducing the
production of
aqueous humor by
increasing uveoscleral
outflow

Peak in 1-4hrs

Metabolized in liver, eliminated in urine

50
Q

Prostaglandin Agonists

MOA

A

selective agonist of a prostaglandin
receptor-FP

Increases outflow of aqueous humor by
acting on this receptor and thus decreases
IOP

51
Q

What are the Prostaglandin Agonists?
Protoype?

A

“Prost” = Prostaglandin

Lantanoprost (Xalantan)-PROTOYPE

Bimatoprost (Lumigan)= synthetic prostaglandin

Unoprostone (Rescula)/Travaprost (Travatan)

Bimatoprost (Latisse)

52
Q

Beta Blockers

MOA
Half life
Note

A

Unknown

12-24 hrs

DOES have systemic effect, see heart and lungs

53
Q

Cholinesterase Inhibitor

MOA
Half Life

A

Unknown

6-8hrs

54
Q

Carbonic Anhydrase Inhibitors

Examples (3)
Caution
Elimination

A

-Brinzolamide [Azopt] absorbed systemically;
widely distributed, including in breast milk [& may cross placenta]; metabolized and excreted
in urine

-Dorzolamide [Trusopt] some systemic
absorption; primarily excreted unchanged in
urine

-Methazolamide [Neptazane]—oral carbonic
anhydrase inhibitor—absorbed from GI tract—
distributed throughout [plasma, CSF, aqueous humor, RBC, bile, extracellular fluid];

excreted by kidney; 25% unchanged in urine

55
Q

Prostaglandin Analogues

Examples (4)
Caution
Elimination

A

-Latanoprost [Xalantan] absorbed through
cornea—hydrolyzed to active form; not
known if it crosses placenta; in animal
studies—ADVERSE FETAL EFFECTS DID OCCUR;
metabolized in the urine

-Bimatoprost—absorbed & reaches steady
state in plasma; metabolized by oxidation & excreted in urine [mostly] and feces

-Travaprost absorbed from cornea and
peaks in plasma within 30”; hydrolyzed
in cornea and rapidly cleared within 60”

-Unoprostone rapidly absorbed from
cornea and hydrolyzed into unoprostone
free acid; rapidly eliminated in urine

-prost = PROSTaglandin

-PROSTate ok, no pregnancy

56
Q

Beta Blockers
Caution/
Contraindication

A

-contraindicated in
those with asthma, COPD and other
pulmonary diseases

-Decrease conduction
through AV node

-Topical BB are
contraindicated in
those with
bradycardia or AV
block & those with
SBP <100

-Use with caution in
those with poorly
controlled DM [as BB
prolong & enhance
hypoglycemia]

-Also CI in those with
Raynaud’s, PAOD or
cerebral-vascular
disease

-Pregnancy category C

-Topical BB excreted
in breast milk
[contraindicated in
breast feeding]

57
Q

Miotics
Caution/ Contraindications

A

-CI with eye
inflammation

-CI when
constriction no
wanted—iritis,
uveitis,
secondary
glaucoma

58
Q

Carbonic Anhydrase Inhibitors

Caution/ Contraindications

A

-Dorzolamide and Brinzolamide
contain Sulfacetamide and are
absorbed in amounts great enough to
cause hypersensitivity in those with
Sulfa allergies

-Pregnancy Category C, CI in lactation; safety in children is
NOT known

-Methazolamide—CI in those with low
Na+, low K+, renal disease, liver
disease, supra-renal gland disease &
severe COPD; not recommended for
children; Pregnancy Category C

59
Q

Sympathomimetics

Cautions/ Contraindications

A

-Apraclonidine
[Lopidine] Ci in those
allergic to Clonidine;
Pregnancy Category C

-Dipivefrin [Akpro;
Propine] is CI in those
with narrow angle
glaucoma; pregnancy
Category B

Not recommended for
children or nursing moms

60
Q

Alpha Adrenergic Agonists

Cautions/ Contraindications

A

-Brimonidine is CI in
those on MAOIs

-Do not instill with
contact lens in—wait
15” after use before
putting contacts

-Pregnancy Category C

61
Q

Prostaglandin Agonists

Cautions/ Contraindications

A

-Latanoprost—do not instill with contacts
in; use with caution in those with iritis

-Pregnancy Category C; not for use in
children or lactating moms

-Brimatoprost—Pregnancy Category C

62
Q

Adverse Drug effects common to all meds that treat glaucoma

A

All anti-glaucoma drugs may cause
transient discomfort/tearing; blurred
vision, photophobia and hyperemia
may occur

63
Q

Beta Blocker

Adverse Drug Effect

A

headache, dizziness
and systemic BB effects—bradycardia,
hypotension, bronchospasm

64
Q

Miotics

Adverse Drug Effect

A

Corneal clouding,
headache, retinal
detachment; may
have systemic
anticholinergic
effects—headache,
HTN, salivation,
sweating, nausea,
vomiting

65
Q

Carbonic Anhydrase Inhibitors

Adverse Drug Effect

A

-25% report
dysgeusia (change in taste); 10-15%
can have punctate
keratosis

-Oral: Neptazane
can cause melena, GI
upset, glycosuria,
urinary frequency,
renal stones and
nephrotoxicity

66
Q

Sympathomimetics

Adverse Drug Effects

A

-Conjunctival and or
corneal pigmentation
-Systemic effects—HA,
HTN, elevated HR,
cardiac arrhythmias

67
Q

Alpha Agonists

Adverse Drug Effects

A

-10-30% feel like they
have a foreign body
in the eye and have
pain

-Systemic effects—dry
mouth, drowsiness,
HA

68
Q

Prostaglandin Agonists

Adverse Drug Effects

A

-10-15% have foreign body sensations

-Keratopathy, iris discoloration [gradual
increase in amount of brown pigment from
increase in number of melanosomes in
melanocytes] which is usually permanent

-Bimatoprost [Latisse] can cause
permanent brown iris pigment and hair
growth outside of the treatment area—
must only be applied to upper lashes

69
Q

Beta Blocker

Drug Interactions

A

-Use with systemic BB can cause additive
effects—adding Timolol can cause
bradycardia and asystole

-Betaxolol/ Caretolol/ Metipranol—interacts
with BB, other pressors, CCB, Digoxin,
Amiodarone and Beta agonists

-Levobunolol—interacts with other BB and
Beta agonists

-Timolol—interacts with BB, pressors, CCB,
Digoxin, Amiodarone, Quinidine and Beta
agonists

70
Q

Miotics

Drug Interactions

A

-Echothiophate can
have additive effects
with systemic
anticholinesterases
[drugs used to treat
Myesthenia gravis]

71
Q

Carbonic Anhydrase Inhibitors

Drug Interactions

A

-Concurrent use of
CAI and high dose
salicylates may cause
metabolic acidosis &
salicylate toxicity

-Methazolamide and
Topamax increases
risk of renal stones

72
Q

Sympathomimetics

Drug Interactions

A

-No known drug
interactions

-Apraclonidine—do
not used with
MAOIs because of
potential HTN
crisis

73
Q

Alpha Adrenergic Agonists

Drug Interactions

A

-Do not use with MAOIs

-Additive effects if used
with CNS depressants

-Drugs that can lower HR
[BB, pressors, Dig.] may
have additive effects of
depressing HR and BP if
Brimonidine used with
alpha adrenergic
agonists

74
Q

Prostaglandin Agonists

Drug Interactions

A

Interacts with Thimerosal; wait 5
minutes between the two different gtts
[if one contains Thimerosal]

75
Q

What follow up is needed for all patients being treated for glaucoma?

A

CV and BP monitoring 2-3 times per year

76
Q

What are the mast cell Stabilizers?

A

 Iodoxamide [Alomide]
 Nedocromil [Alocril]
 Cromolyn Na+
[Cromolon]

77
Q

What are the ocular antihistamines?

A

-Histamine= Hisat “STINE”
 Levocabastine [Livostin]
 Antazoline [Vascon-A]
 Azelastine [Optivar]
 Bepotastine [Bepreve]
 Epinastine [Elestat]
 Emedastine [Emadine]
 Ketotifen [Zaditor]
 Olopatadine [Patanol; Pataday]
 Pheniramine [Naphcon-A]

78
Q

What are the ocular NSAIDS?

A

Fluriprofen [Ocufen]
Suprofen [Profenal]
Diclofenac [Voltaren]
Nepafenac [Nevanac]
Ketorolac [Acular]

-These should only ever be prescribed by an ophthalmologist!!

79
Q

Mast Cell Stabilizer

MOA

A

Mast cell stabilizers—
decrease sensitivity
reactions by inhibiting
degranulation of
sensitized mast cells
[that have been
exposed to antigens];
also inhibit histamine
& slow reacting
substance of
anaphylaxis [SRS-A]

80
Q

Ocular Antihistamines

MOA

A

Ocular
antihistamines—
selective for H1
receptor; block
histamine receptor
& inhibit histamine
stimulated vascular
permeability in the
conjunctiva;
decrease ocular
itching

81
Q

Ocular NSAIDS

MOA

A

Have analgesic,
antipyretic and anti
inflammatory
activity

NSAIDs—decrease
prostaglandin E2 in
aqueous humor by
inhibiting
prostaglandin
biosynthesis

82
Q

Ocular Topical Steroids

MOA

A

the
anti-inflammatory
MOA is not known;
thought to induce
phospholipase A2
inhibitory proteins;
these can increase
IOP—mechanism is
not known

Metabolism and excretion not known

DO NOT PRESCRIBE THESE!

83
Q

Ocular NSAID

Contraindications

A

If patient is allergic to acetylsalicylic
acid—use caution when prescribing
NSAIDs

NSAIDs are Pregnancy Category C—as are
corticosteroids

84
Q

Ocular Steroids

Contraindications
Cautions
Black Box

A

Pregnancy Category C

Those that need steroids should be referred for
slit-lamp to rule out HSV keratitis [steroids can
cause blindness if this is present]

Can increase intraocular pressure!

Steroids should be prescribed by an OPHTHALOMOLOGIST

85
Q

Ocular Antiallergics

Cautions/ Contraindications

A

Emedastine, Cromolyn, Lodoxamide—PREGNANCY CATEGORY B

Antazoline, Ketotifen,
Levocabastine—
PREGNANCY CATEGORY C, DO NOT USE IN LACTATION

Lodoxamide is safe in those 2 years and older;
Cromolyn safe in those >4 years;
Emedastine/Ketotifen can be used in those 3
and older; Nepanfenac can be used in those 10
and older

86
Q

Ocular Antiallergics

Education

A

Those that use Ketotifen or Emadastine can use
soft lenses 10-15” after they have used the gtts

Avoid wearing soft contacts when using
gtts with benzalkonium chloride [can
resume use a few hours after gtts are
finished]—Cromolyn Na+, Lodoxamide,
Ketotifen, Emedastine, Levocabastine

87
Q

Ocular Antiallergic

Adverse Drug Effects

A

-Anti-allergics and anti-inflammatories
can cause transient discomfort or
tearing

Naphazoline can precipitate narrow
angle glaucoma, mydriasis, increased
IOP, allergic dermatitis

-1-5% using Lodoxamide—dry eyes,
foreign body sensation, itching of the
eyes and crystalline deposits

-Cromolyn—itching eyes, dryness,
puffiness and styes

-Antihistamines—headaches; 10-25%
have conjunctival injections and rhinitis

88
Q

Ocular Anti-inflammatories

Adverse Drug Effects

A

NSAIDs may cause minor ocular
irritation and can contribute to
superficial ocular infection, superficial
keratitis, superficial inflammation,
corneal edema, iritis

Steroids can cause severe ADRs—
glaucoma, optic nerve damage, field
defects and decreased vision,
cataract formation, secondary
infection and perforated globe

DON’T PRESCRIBE THESE, LEAVE IT TO OPHTHALMOLOGISTS

89
Q

Allergic Conjunctivitis

Treatments
Which can be used in children?

A

Many allergens can cause this condition—mast cell
stabilizers [Lodoxamide; Cromolyn] used and can be
continued for 90 days

H1 Blockers—Ketotifen used for conjunctivitis +
tearing [in adults and those >3 years] 1 gtt to
affected eye every 8-12 hours; Levocabastine 1 gtt
to affected eye QID

OTC products are decongestants + antihistamines—
Antazoline & Naphazoline [Vasacon A] or
Naphazoline + Pheniramine [Opcon A, Naphcon A]

CONSULT OPHTHALMOLOGIST MUST RULE OUT HSV KERATITS FIRST

90
Q

Antiallergy

Safe Population

A

Mast cell stabilizers are safe in adults,
children and pregnancy women

Antihistamines are safe and can be
used in children as young as 2
[Lodoxamide]

H1 Blockers are safe in adults;
Ketotifen is safe for children as young
as 3 years

91
Q

Ocular Lubricant

MOA
Condition
Dosage

A

These products
contain balanced
solution of salts to
maintain ocular
tonicity, buffers to
adjust pH, viscosity
to prolong eye
contact time and
preservatives

They are not
absorbed

used to treat dry eyes
& ocular irritation; can also be used as
lubricants for artificial eyes

-1-2 gtts to each eye QID prn

92
Q

Cyclosporine (Restasis)

MOA
Use

A

Immune modulator/anti
inflammatory—cyclosporine [Restasis]

is used to treat dry eyes and is usually prescribed by an ophthalmologist

93
Q

Ocular Lubricants

Contraindications

A

-No true contraindications

-Products that contain benzalkonium
chloride—do not use with soft contacts
[Puralube Tears, comfort Tears, Dry
Eyes, Hypo Tears, Ultra Tears, Isopto
Tears, Just Tears, LubriTears, Murine,
Nature’s Tears, Nu-Tears, Nu-Tears II,
OcuCoat, Tears Naturale]

IF they need them, educate them to use them before bed when they already have their contact lenses out for the evening.

94
Q

Ocular lubricant

Adverse drug effects

A

Mild stinging and blurred vision, should be transient

95
Q

Ophthalmic Vasoconstrictors

MOA
Uses

A

Sympathomimetic
agents that
constrict the
conjunctival
vessels—weak
sympathomimetic
drugs

No data available
on the
pharmacokinetics

Used for temporary relief of red eye
from minor irritants

used by
ophthalmologic specialists—to dilate
pupils [2.5% hydroxyamphetamine;
10% phenylephrine]

96
Q

Ophthalmic Vasoconstrictors

Contraindications/ Cautions

A

Pregnancy Category C

Contraindicated if patient has
Narrow angle glaucoma
sensitivity

Generally not for use in children

97
Q

Ophthalmic Vasoconstrictors

Adverse drug effects/ Drug Interactions

A

-Transient stinging/burning with
instillation

-Mydriasis; increased tearing, irritation
and discomfort

-Most serious side effect—increased
IOP

-Rebound congestion can develop with
extended use

-TCAs and Maprotiline [Ludiomil]
increases pressor effect of Naphazoline

NO MAOIs WITHIN 21 DAYS of ophthalmologic sympathomimetics

98
Q

What are the ophthalmic vasconstrictors?

A

Tetrahydrolazine 0.012%,
Oxmetazoline 0.02%, Naphazoline
0.03% and Phenylephrine 0.12% is
available OTC

-Naphazoline 0.1% is prescription
-Phenylephrine 2.5% and 10% are
used by eye specialists for dilation

99
Q

Topical Fluorscein Sodium

Use
MOA
Caution/ Precaution

A

Dye used to detect corneal epithelial defects or abrasions

-Fluorescein is a yellow water soluble
dibasic acid xanthine dye

-It produces intense green color in
alkaline [pH of 5.0] solution

-Corneal defect will uptake dye and
will appear bright green under UV or
Wood’s lamp

-Pharmacokinetically—not absorbed

-Do not use with soft contacts in—they
get stained; can re-insert after eyes
are flushed with saline and patient
waits one hour

-Pregnancy Category C