Eyes- Quiz 1 Flashcards
What is the most common cause of conjunctivitis?
Bacteria!
H influenza OR Strep pneumoniae
What types of eye problems will a primary care prescriber treat?
Conjunctivitis
Blepharitis
Hordeolums (Stye)
What types of issues should always be referred to an ophthalmologist?
What medications should only be prescribed by ophthalmologists?
HSV
Keratitis
Corneal ulcers
Tobramycin & Gentamycin & steroids
–carry high risk for life altering complications
Generally antiviral agents are only specialists as well
Bacitracin
MOA
Effective Against
-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
Erythromycin (EES)
MOA
Effective Against
-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
Sulfacetamide
MOA
Active Against
MOA
-Sulfonamide; inhibits
bacterial dihydrofolate
synthetase
Active against
-Step, Staph, E coli, Klebsiella,
Pseudomonas
pyocynea, Neisseria
gonorrhea and
Chlamydia
Tobramycin
Class
MOA
Active Against
-Aminoglycoside
-MOA is unknown
-Active against Staph,
Strep,
Corynebacterium,
Klebsiella, Moraxella,
Proteus, beta-hemolytic
Strep, Haemophilus
influenzae
-Not active against
Neisseria or Chlamydia
Gentamycin
Class
MOA
Active Against
-Aminoglycoside
-Active against gram +
and gram –pathogens
-MOA unknown
-Covers Staph, Strep
pneumonia, beta
hemolytic strep, E coli,
H flu, N. gonorrhoeae &
Enterobacter
Azithromax
Active against
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
Fluoroquinolones
MOA
Active Against
-Bactericidal via
inhibition of DNA
gyrase
-Active against Staph,
Strep, H flu,
Klebsiella, Proteus,
Enterobacter and
Pseudomonas
aeruginosa
Polytrim
(Polymyxin B & trimethoprim)
MOA for each
Coverage for each
-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
Polysporin
What two meds
Active Against
Polymyxin B + Bacitracin
Active against gram + and gram -
Gancyclovir (Zirgan)
MOA
Active Against
inhibits replication of HSV by inhibiting
synthesis of viral DNA
HSV
Vidarabine (Vira A)
MOA
Active Against
MOA unknown
HSV1
HSV2
VZV
CMV
Vaccinia
Hep B
Trifluridine (Viroptic)
MOA
Active against
MOA unknown
HSV1
HSV2
Adenovirus
Vaccinia
When is an ophthalmic ointment contraindicated? Why?
After corneal trauma or surgery
Ointment decreases corneal healing
In these cases use drops
What ocular symptom would contraindicate the use of sulfacetamide?
Exudate
Inactivated by para-aminobenzoic acid.
What are the Category C pregnancy eye drugs?
Gentamycin
Cipro
Gatifloxin
Levofloxin
Moxifloxin
Norfloxacin
Ofloxacin
Polymyxin B
Suflacetamide
What eye drops are contraindicated with lactation?
Sulfacetamide
Fluoroquinolones
What eye drops/ointments are safe in children?
Safe: Erythromycin & tobramycin (though don’t give it, send to ophthalmologist)
Which eye drops need to be avoided in children less than 1 year?
<2 months?
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
What eye drops can be used in children > 4 months?
> 4 mo
Moxifloxacin (Moxeza)
Common drug reactions of all eye drops?
Local irritation (usually transient)
Superinfection possible with repeated or prolonged use
Common drug reaction for opthalmic bacitracin?
Blurred vision- transient
Common drug reactions for sulfacetamide?
Hypersensitivity with Sulfa
30% can cause burning & stinging, try to use lower concentrations for better tolerance
Common drug reactions for aminoglycosides?
localized
ocular toxicity & hypersensitivity
Common drug reactions for fluoroquinolones?
-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
Common drug reactions with antivirals?
Gancyclovir?
Vidarabine?
Trifluridine?
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
Which eye preparations have no drug/drug interactions?
Bacitracin
Gentamycin
Tobramycin
Polymyxin B
Azithromycin
Erythromycin
What drugs are incompatible with Sulfacetamide?
Silver preparations
Zinc preparations will form precipitate
Sulfacetamide antagonized by:
Benzocaine
Chloroprocain
Cocaine
Procaine
Popoxycaine
Tetracaine
What drugs are incompatible with fluoroquinoles?
Theophylline, increases level and INR
Eye infection in the newborn is likely?
What is the standard treatment?
When can you not give the standard? What do you give instead?
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
What is given within one hour of birth to prevent eye infection of the newborn?
What does it NOT prevent?
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
In children 3 months to 8 years, what are the likely infective eye agents?
Staph, Strep or Haemophilis (h. Flu)
In children > 7 H flu most common
Side note: warm climates H flu, colder strep pneumoniae
In adults >70 what is the most likely infective eye agents?
Staph aureus and pseudomonoas
Bacterial conjunctivitis with dacryostenosis (excess tearing) is most commonly what infective agent? What are the best treatments?
Strep pneumonia
H flu
Erythromycin
tobramycin (but don’t)
fluoroquinolone
Conjunctivitis-Otitis Syndrome
Likely organism?
Treatment?
Seen in those <6 yo
H flu
PO Augmentin, no additional eye drops
–make sure amoxicillin dose is 80-90mgkg/day
Gonococcal Conjunctivitis
Identification?
Treatment?
Side note?
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
Blepharitis
What is it?
Treatment?
-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