Ocular Drugs

Question 1

Peri-ocular injections

Answer 1

less common, reach behind iris-lens diaphragm, bypasses conjunctiva and corneal epithelium which is good for drugs with low lipid solubility

Question 2

Intraocular injection types

Answer 2

intracameral or intravitreal, intravitreal anti-VEGF- macular degeneration, intrav steroid- macular edema, intrav antibiotics- endophthalmitis, intraocular acetylcholine- cataract surgery

Question 3

Ophthalmic medication

Answer 3

Cholinergic agonists, sympathomimetics, BBs, carbonic anhydrous inhibitors, prostaglandin analogues, intraocular decongestants, anticholinergic agents, NSAIDs, corticosteroids, antihistamines, antiinfectives

Question 4

Glaucoma

Answer 4

intraocular pressure> 30 mmHg, open is chronic and closed is severe and acute, goal is to prevent vision loss, multiple agents give at least 10 mins apart

Question 5

Cholinergic agonists

Answer 5

pilocarpine, carbachol

Question 6

Cholinergic agonist MOA

Answer 6

cause miosis by contraction of the iris sphincter muscle which increases aqueous humor flow through the trabecular meshwork by longitudinal cilliary muscle contraction, accommodation

Question 7

Cholinergic clinical uses

Answer 7

miosis, glaucoma, usually second or third line

Question 8

Cholinergic ADRs

Answer 8

HA from accomadative spasm, retinal detachment (rare), systemic cholinergic effects are rare

Question 9

Anticholinergic agents

Answer 9

atropine, cyclopentolate, phenylephrine (Cyclomydril), Tropicamide (Midriacyl)

Question 10

Anticholinergic agents MOA

Answer 10

causes mydriasis by paralyzing the sphincter muscle and also causes cycloplegia by paralyzing the cilliary muscle

Question 11

Anticholinergic clinical uses

Answer 11

eye exams where dilation is needed to facilitate exam of retina, fundoscopy, cycloplegic refraction, sublingual use of atropine drops for terminal secretions

Question 12

Anticholinergic agents ADRs

Answer 12

blurred vision, nausea, vomiting, pallor, constipation, urinary retention

Question 13

Sympathomimetics

Answer 13

epinephrine, brimonidine (Alphagan), TID drug

Question 14

Sympathomimetics MOA

Answer 14

a2 agonist that reduces IOP by reducing the production of aqueous humor and improving drainage

Question 15

Sympathomimetics Clinical use

Answer 15

open angle glaucoma, ocular HTN, can be used to prevent IOP post op

Question 16

Sympathomimetcs ADRs

Answer 16

fatigue, conjunctival blanching, mydriasis, VERY well tolerated

Question 17

Beta blockers

Answer 17

Timolol (Timoptic), Levobunolol (Betagan), Betaxolol (Betoptic)

Question 18

Beta blockers MOA

Answer 18

reduce intraocular pressure by blocking B2 in ciliary epithelium, reduces production of aqueous humor, given BID except Timoptic

Question 19

Beta blockers use

Answer 19

glaucoma

Question 20

Beta blocker ADR

Answer 20

stinging, rarely systemic

Question 21

Carbonic anhydrous inhibitors

Answer 21

Acetazolamide (diamox) (rare), Dorzolamide (Trusopt) (TID, Brinzolamide (Azopt) (TID)

Question 22

Carbonic anhydrous inhibitors MOA

Answer 22

reduce IOP by buffering an acid residue which may be present in secretory cells as a result of production of aqueous humor

Question 23

Carbonic anhydrous inhibitors Use

Answer 23

ocular HTN, glaucoma

Question 24

Carbonic anhydrous inhibitors ADR

Answer 24

stinging, burning, bitter taste, Dorzolamide known for systemic absorption

Question 25

Prostaglandin analogues

Answer 25

Bimatoprost (Lumigan), Latanoprost (Xalatan) generic available, Travoprost (Travatan)

Question 26

Prostaglandin analogues MOA

Answer 26

reduce IOP by increasing aqueous humor drainage via a process not previously targeted

Question 27

Prostaglandin analogues use

Answer 27

ocular HTN and glaucoma

Question 28

Prostaglandin analogues ADRs

Answer 28

local irritation, iris pigmentation

Question 29

Prostaglandin Pearls

Answer 29

first line, most efficacious, once daily dosing, combo available

Question 30

Suspected pathogens of eye infections

Answer 30

str, pneumoniae, staph aureus, hemophilus sp, proteus sp, Klebsiella sp

Question 31

Anti infective ophthalmic agents

Answer 31

Bacitracin, neomycin, sulfa (first line, cheap); erythromycin (all infants), tobramycin, Gentamicin (gram - bac), Cipro (gram -, cheap), levofloxacin (broad spectrum, $$), Moxifloxacin (recurrent infections, $$)

Question 32

Anti infective ophthamic agents Pearls

Answer 32

similar to other infections, cultures not always obtained, response in few days, change to broad spectrum if no improvement

Question 33

Intraocular decongestants

Answer 33

tetrahydrozoline (visine), oxymeazoline (Visine LR)

Question 34

Intraocular decongestants MOA

Answer 34

sympathomimetic activity, promote constriction to result in clearing red eyes

Question 35

Intraocular decongestant Pearls

Answer 35

red eyes, no ADR, risk of dependency (no more than 72 hrs)

Question 36

Artificial tears

Answer 36

Many products available, balance salt solutions with viscosity inducing agents to prolong contact time, for dry eyes, may temporarily blur vision, very cheap

Question 37

Intraocular NSAIDs

Answer 37

Diclofenac (Voltaren), Ketorolac (Acular), $$$

Question 38

Intraocular NSAIDs MOA

Answer 38

inhibit COX I and II resulting in production of inflammatory mediaters

Question 39

Intraocular NSAID uses

Answer 39

intraoperative miosis, inflammation post op, seasonal conjuctivitis, macular edema

Question 40

Ocular antihistamines

Answer 40

Olopatadine (Patanol), Ketotifen (Zaditor), Azelastine (Optivar)

Question 41

Ocular antihistamines MOA and use and ADR

Answer 41

histamine receptor blockers and mast cell stabilizers; for allergic conjuctivitis, mostly for prevention, burning, stinging

Question 42

Ocular antihistamine Pearls

Answer 42

$$$, limit use to pt with ocular sx not controlled with systemic therapy or GLAUCOMA pts

Question 43

Corticosteroids

Answer 43

Fluorometholone, prednisolone, dexamethoasone, hydrocortisone

Question 44

Corticosteroids MOA

Answer 44

inhibition of arachadonic acid release from phospholipids by inhibiting prospholipase A2

Question 45

Corticosteroids clinical use

Answer 45

postop, anterior uveitis, sever allergic conjuctivitis, vernal keratoconjunctivitis, prevention and suppression of corneal graft rejection, episcleritis, scleritis

Question 46

Corticosteroids ADR

Answer 46

increased susceptibility to infections, glaucoma, cataract, mydriasis, scleral melting

Question 47

Ocular complications associated with systemic drugs

Answer 47

ibuprofen, lovastatin, CCB, allopurinol (form cataract), amiodarone