Med classes Ocular- Quiz 1 Flashcards
Aminoglycosides (EYE ABX)
- If you can, you should something be”SIDES” this abx because its harsh
-Tobramycin and Gentamycin
-Effective against Gram - AND +
-ADE: Ocular tox +hypersnesitivty
Fluoroquinolones (EYE ABX)
ADE
Effective against
-This standa”LONE” abx class can make your tendon rupture
-Ex. Ciprofloxacin, Ofloxacin, Moxifloxacin, Levofloxacin
-Effective against Gram - AND +
-ADE: Crystal precipitate in eyes/ crusting/ foreign body feel/corneal stain
-Do NOT give with theophylline (INR)
Macrolides (EYE ABX)
-Ex. Erythromycin, Azithromycin
-Effective against Gram +
-EES Given within 1 hour of birth (doesn’t prevent chlamydia but DOES prevent opthalmia neonatorum/ gonorrhea)
Sulfonamides (EYE ABX)
Effective against
-Ex. Sulfacetamide
-Effective against Gram - AND +
-NOT compatible with zinc + silver (forms precipitate)
-Antagonized by the “caines”
Polypeptides ABX
(USUALLY COMBO EYE ABX)
-Ex. Polymyxin B, Bacitracin
-Often combined with other abx (ex polysporin, polytrim)
-Effective against Gram -
-NOTE* Straight polypeptide abx are only gram -, combo is often Gram - AND+*
Nucleoside Analogues (EYE ANTIVIRALS)
-“analogues” are too old to go viral
-WE DONT PRESCRIBE THESE
(critical care ophthalmologist does ;)
-Ex. Gancyclovir, Vidarabine,
Trifluridine
-Mainly treat: HSV, VZV, CMV
-Can cause burning/ irritation/ blurry
What do I actually need to know about ocular agents absorption?
-Abx/ antivirals penetrate only ocular fluid & tissues
-Limited systemic absorption so limited ADE EXCEPT Sulfacetamide (also dont use with ocular exudate, sulfa may be inactivated)
-Local irritation—usually transient
-Superinfection can occur with prolonged/repeated use
When should you not use ointments in the eyes and why?
-After trauma or surgery, ointments may decrease corneal healing
Which ocular med classes are Category C in pregnancy?
-Polypeptide (abx)
-Macrolides (abx)
-Nucleoside analogues (antivirals)
-Sulfonamides (abx)
-
Which ocular med classes should not be used in lactation?
-Sulfacetamide & Fluoroquinolones (harmful to infant)
-NOTE* EES and tobra safe in children*
Common Conjunctivitis per age
-Most common cause: H ifluenza or Strep Pneumoniae (Bacterial)
-Preschoolers: usually bacterial
-School aged: Viral w adenovirus
-Sexually active teens/adults—check
for Neisseria gonorrhea
-Adults—viral or bacterial
Ophthalmia Neonatorum- what to know
-Seen in infants <1 month of age
-Chlamydia most common pathogen
-GC is most serious—Ceftriaxone
-Cannot give Rocephin to those with elevated bilirubin—give Cefotaxime
-Prevention—proph abx to eye
within 1 hour of delivery (EES)
Neonatal Chlamydia
-Chlamydia—systemic ABX for 2-3 weeks OR Zithromax for 3 days
-Chlamydia conjunctivitis NOT prevented with EES at birth
-Any mucopurulent discharge in 1st few weeks of life—check for chlamydia
Bacterial Conjunctivitis Children V elderly common causes
-Children (3 mo to 8 years):
Staph, Strep or Haemophilis
- >7 years—H flu most common
-Elderly—Staph aureus and Pseudomonas (those >70 years)
-Usually self limiting but abx can speed up recovery
Bacterial Conjunctivitis Tx
-Uncomplicated disease can be treated with: Polypeptides, sulfonamides, aminoglycosides, macrolides, fluroquinolones
(sulfa stings and doesnt cover H flu)
Conjunctivitis-Otitis Syndrome
-Seen in those under 6
-Usually caused by H . Flu
-Treat with Augmentin PO
(No specific eye therapy)
Gonococcal conjunctivitis (GC)
-SEVERE infection by Neisseria gonorrhoeae.
-Purulent bacterial conjunctivitis
usually responds to topicals
(except hyperpurulent in a newborn in which need gram stain)
-Adults: acquired through direct contact w infected genital secretions
-Neonates: Passed from an infected mother to the baby during childbirth (known as ophthalmia neonatorum).
-Treat with Rocephin IM and NS irrigations to clear exudate
Blepharitis
-Acute/ chronic inflammation of the lash follicles and Meibomian glands
-Treat with: warm compresses, scrub lashes with no-tear shampoo, EES ointment until symptoms resolve, THEN for another 7 days OR Zithromax solution for 4 weeks
-NOTE* No contacts during tx and discard all eye make up*
Hordeolum (Stye)
-Infection of sebaceous gland of lashes or lid
-Cause—Staph aureus
-Treatment—warm moist compress, Sulfacetamide Polytrim gtts or EES
ointment until sx are gone then for
another 3 days
-Stye will usually rupture on its own—if not—refer to ophthalmologist
Extra shit for eyes that’s good to know
-H. flu high on your list of causes (do not use Sulfacetamide d/t poor coverage—Polysporin or Polytrim have good coverage)
-In infants—EES is DOC
-NOTE* Zithromax/ Fluoroquinolones are 10x the cost of EES
Glaucoma
-Leading cause of blindness
-Therapies for glaucoma are aimed at decreasing production of aqueous humor and increasing outflow of this fluid from the angle structures
-Mandatory Ophthalmology consult
What are the 6 main categories of anti-glaucoma agents?
- Beta blockers
- Adrenergic agonists
- Miotics (Inhibit cholinesterase)
- Carbonic anhydrase inhibitors (CAI’s)
- Sympathomimetics
- Prostaglandin agonists
Beta Blockers for Glaucoma
MOA
ADE
Interactions
- MOA:—decrease IOP by
interfering with production of aqueous humor and IOP is decreased (Exact MOA unknown)
2.Pharmacokinetics: Little is known (Duration is 12-24 hours)
-Systemic absorption DOES occur and can be seen w lungs and heart - Precautions/ CI:
-Topical BB are contraindicated with
bradycardia/AV block or SBP <100
-Also contraindicated with Raynaud’s, PAOD or vascular disease
-Use with caution with poorly controlled DM (can prolong & enhance hypoglycemia
-Pregnancy category C
-Topical BB excreted in breast milk (contraindicated in breast feeding) - ADE: HA, dizziness and systemic BB effects, bradycardia, hypotension, bronchospasm
5: Drug/drug inter: Use w systemic BB- worry about bradycardia/ ASYSTOLE
-Interacts with: other BB, pressors, CCB, Digoxin, Amio, Beta agonists
Adrenergic Agonists for Glaucoma
1.MOA: Decreases IOP by reducing the production of aqueous humor by increasing uveoscleral outflow
2. Pharmacokinetics: peak levels in 1-4 hours; metabolized in liver/ eliminated in urine
3. Precautions/ CI: Brimonidine is CI in those on MAOIs
-Do not instill with contact lens in—wait 15” after use before contacts
-Pregnancy Category C
4. ADE: feel like they have a foreign body in the eye/ pain
-Systemic effects—dry mouth, drowsiness, HA
5. Drug-drug inter: Do not use with MAOIs
-Additive effects w CNS depressants
-Drugs that can lower HR may have additive effects of depressing HR/ BP
brimonidine (Alphagan P) and apraclonidine (Iopidine)
