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Pharmacology > Ocular Drugs > Flashcards

Ocular Drugs Flashcards

1
Q

Peri-ocular injections

A

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

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2
Q

Intraocular injection types

A

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

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3
Q

Ophthalmic medication

A

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

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4
Q

Glaucoma

A

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

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5
Q

Cholinergic agonists

A

pilocarpine, carbachol

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6
Q

Cholinergic agonist MOA

A

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

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7
Q

Cholinergic clinical uses

A

miosis, glaucoma, usually second or third line

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8
Q

Cholinergic ADRs

A

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

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9
Q

Anticholinergic agents

A

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

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10
Q

Anticholinergic agents MOA

A

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

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11
Q

Anticholinergic clinical uses

A

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

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12
Q

Anticholinergic agents ADRs

A

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

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13
Q

Sympathomimetics

A

epinephrine, brimonidine (Alphagan), TID drug

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14
Q

Sympathomimetics MOA

A

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

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15
Q

Sympathomimetics Clinical use

A

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

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16
Q

Sympathomimetcs ADRs

A

fatigue, conjunctival blanching, mydriasis, VERY well tolerated

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17
Q

Beta blockers

A

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

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18
Q

Beta blockers MOA

A

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

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19
Q

Beta blockers use

20
Q

Beta blocker ADR

A

stinging, rarely systemic

21
Q

Carbonic anhydrous inhibitors

A

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

22
Q

Carbonic anhydrous inhibitors MOA

A

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

23
Q

Carbonic anhydrous inhibitors Use

A

ocular HTN, glaucoma

24
Q

Carbonic anhydrous inhibitors ADR

A

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

25
Q

Prostaglandin analogues

A

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

26
Q

Prostaglandin analogues MOA

A

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

27
Q

Prostaglandin analogues use

A

ocular HTN and glaucoma

28
Q

Prostaglandin analogues ADRs

A

local irritation, iris pigmentation

29
Q

Prostaglandin Pearls

A

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

30
Q

Suspected pathogens of eye infections

A

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

31
Q

Anti infective ophthalmic agents

A

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

32
Q

Anti infective ophthamic agents Pearls

A

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

33
Q

Intraocular decongestants

A

tetrahydrozoline (visine), oxymeazoline (Visine LR)

34
Q

Intraocular decongestants MOA

A

sympathomimetic activity, promote constriction to result in clearing red eyes

35
Q

Intraocular decongestant Pearls

A

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

36
Q

Artificial tears

A

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

37
Q

Intraocular NSAIDs

A

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

38
Q

Intraocular NSAIDs MOA

A

inhibit COX I and II resulting in production of inflammatory mediaters

39
Q

Intraocular NSAID uses

A

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

40
Q

Ocular antihistamines

A

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

41
Q

Ocular antihistamines MOA and use and ADR

A

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

42
Q

Ocular antihistamine Pearls

A

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

43
Q

Corticosteroids

A

Fluorometholone, prednisolone, dexamethoasone, hydrocortisone

44
Q

Corticosteroids MOA

A

inhibition of arachadonic acid release from phospholipids by inhibiting prospholipase A2

45
Q

Corticosteroids clinical use

A

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

46
Q

Corticosteroids ADR

A

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

47
Q

Ocular complications associated with systemic drugs

A

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

Pharmacology (61 decks)

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