NE 7.09 Ophthalmic Pharmacology

Question 1

Name 3 Classes of drugs (and examples of each) used in the Normal Eye Exam

Answer 1

1. Anticholinergics: Tropicamide-adults, Cyclopentolate-peds, Atropine
2. Alpha Agonist: Phenylephrine
3. Anesthetics: Proparacaine, Tetracaine

Question 2

Name 5 classes of drugs (and examples of each) used in the treatment of Glaucoma

Answer 2

1. B-Blockers: Timolol
2. A-2 Adrenergic agonsists: Brimonidine (not in my objectives list)
3. Carbonic Anhydrase inhibitors: Dorzolamide
4. Prostaglandins: Bimatoprost, Latanaprost)
5. Cholinergics: Pilocarpine-for CAG

Question 3

Name 2 drugs used in the treatment of bacterial infections of the eye.

Answer 3

Moxiflxacin and Gatifloxacin

Question 4

What is 1 cholinergic drug uses in ophthalmic pharmacology?

Answer 4

Pilocarpine.

Question 5

Describe the MOA and Indication for the use of Pilocarpine

Answer 5

a. MOA: Miosis to help open the angle of outflow in closed angle glaucoma.
b. Indication: closed angle glaucoma

Question 6

What are the side effects of Pilocarpine?

Answer 6

Nausea, vomiting, diarrhea, sweating, hypotension.

Question 7

Name 3 examples of Anticholinergics used in eye Tx

Answer 7

(Tropicamide-adults, Cyclopentolate-peds, Atropine)

Question 8

Describe the MOA and Indications (including populations) for Tropicamide, Cyclopentolate, and Atropine

Answer 8

a. MOA: Blocks muscarinic receptors (parasympathetic) on sphincter muscles of the eye
b. Indications: Dilation and Cycloplegia. Most commonly used drug for dilation.
(1) Peds: Cyclopentolate
(2) For adult dilation tropicamide is often used in combination with phenylephrine.
(3) Atropine used to break or avoid synechia following eye trauma, also used in surgery.

Question 9

Describe side effects for the anticholinergic drugs

Answer 9

(1) Can cause increased IOP for patients that have Closed angle glaucoma Can exacerbate this issue.
(2) They can reduce lacrimal secretion causing dry eye.
(3) Tropicamide can have CNS side-effects in children, so cyclopentolate more commonly used in pediatric dilation.
(4) For adults, often used with Phenylephrine for best dilation.
Atropine has super long half life so not used for clinical visits

Question 10

Name 1 alpha agonist used in ophthalmologic treatment

Answer 10

Phenylephrine

Question 11

Describe the MOA and Indication Phenylephrine

Answer 11

a. MOA: α-1&raquo_space; α-2 selective α-adrenergic agonists. Acitvates adrenergic receptors on the radial muscles of th eye.
b. Indication: Dilation. (will not affect accomodation)

Question 12

What are the contraindications for Phenylephrine

Answer 12

patients with HTN, pediatrics or geriatric populations.

Question 13

Name 1 Beta Blocker used in ophthalmologic treatment

Answer 13

Timolol

Question 14

Describe the MOA and indication for Timolol

Answer 14

a. MOA: decreased aqueous secretion from the ciliary epithelium.

Indication: Glaucoma

Question 15

What are the contraindications for use of Timolol?

Answer 15

avoid in patients with asthma, COPD, CHF and bradycardia

Question 16

Name 2 Prostaglandins used in ophthalmologic treatment

Answer 16

Bimatoprost and Latanaprost

Question 17

Describe the MOA and indications for Bimatoprost and Latanaprost

Answer 17

1. MOA: MAO-Stimulate matrix metalloproteinases which cause break down in the fibrous tissue connecting the longitudinal muscle bundles in the ciliary body. This opens up the space, allowing the aqueous humour to flow out more easily
2. Indications: 1st line treatment for open angle glaucoma.

Question 18

What are the side effects of Bimatoprost and Latanaprost?

Answer 18

a. Eye lash growth (Latrisse)
b. Herpes Simplex keratitis
c. Headaches
d. Increased iris pigmentation

Question 19

Name 1 Carbonic Anhydrase inhibitor used in Ophthalmologic treatment

Answer 19

Dorzolamide

Question 20

Describe the MOA and indication for Dorzolamide

Answer 20

1. MOA: blocks CA and decreases the formation of aqueous humor.
2. Indication: Glaucoma

Question 21

What are the side effects for Dorzolamide?

Answer 21

avoid in sulfa allergy, avoid in sickle cell patients (can induce sickling in anterior chamber if they have hyphema-blood in anterior chamber)

Question 22

What are 2 anesthetics used in ophthalmologic treatment?

Answer 22

Proparacaine, Tetracaine

Question 23

Describe the MOA and Indications for Proparacaine and Tetracaine

Answer 23

1. MOA- Sodium Channel Blockers, block nerve conduction.
2. Indications: Used for tonometry (checking IOP), and temporary relief of pain so an examination can be performed. Can be mixed with fluorescein to help identify corneal tears and abrasions (using a blue light).

Question 24

What are the ADME and side effects of Proparacaine and Tetracaine

Answer 24

1. Side-effects- Stinging, burning, redness, hypersensitivity, long-term use can cause corneal ulcerations.
2. ADME- 1-2 drops usually last 10-30 minutes.

Question 25

Name 2 antimicrobials used in treatment of bacterial eye infections. What drug class?

Answer 25

A. 4th Generation Fluoroquinolones (Moxifloxacin, Gatifloxacin)

Question 26

Describe the MOA and indication for Moxifloxacin or Gatifloxacin

Answer 26

1. MOA: act by inhibiting DNA gyrase and topoisomerase IV. Strong and help fight resistance but have toxicities. Work fairly well with topical treatment of eye infections.
2. Indication: bacterial infections of the eye. Often Staph. Aureus, Strep. Pneumoniae, Pseudomonas-contacts.