Ocular Pharm Flashcards
Artificial Tears/ocular lubricants
Class: artificial tear solution/optical lubricant
Indication: dry eye syndrome
Contraindication: contact lens wearers (remove before using)
MOA: protect and lubricate mucus membrane and relieve dryness/irritation
Pharmacokinetics:
ROA: drops
Common Adverse Effects: blurred vision, crusting of eyelids, mild stinging of eyes
Topical Immunosuppressant
Class: topical immunosuppressant (cycloflorine)
Indication: dry eye syndrome
Contraindication: contact lens wearers (remove 15 minutes before using)
MOA:
Pharmacokinetics:
ROA: drops
Common Adverse Effects: eye pain, burning sensation, foreign body sensation of eye, HA
Sulfacetamide sodium
Class:
Indication: corneal/conjunctival/eyelid infections, post-operative prophylaxis
Contraindication: CrCl <15, warfarin interaction, SULFA ALLERGY
MOA: inhibits folic acid synthesis
Pharmacokinetics:
ROA: drops/ointment
Common Adverse Effects: photosensitivity, GI, thrombocytopenia, leukopenia, hyperkalemia, SJS, rash
Erythromycin ointment
Ilotycin, romycin Class: erythromicin ointment Indication: corneal/conjunctival/eyelid infection, post-operative prophylaxis Contraindication: n/a MOA: inhibits RNA protein synthesis Pharmacokinetics: macrolide, bacteriostatic, 50s ribosomal subunit, CYP34A inducer ROA: drops/ointment Common Adverse Effects: GI, NV
Ciprofloxacin
Class: fluoroquinolone
Indication: corneal/conjunctival/eyelid infections, post-operative prophylaxis
Contraindication: warfarin, kidney disease or dysfunction
MOA: inhibits DNA gyrase, nucleic acid synthesis
Pharmacokinetics:
ROA: drops or ointment
Common Adverse Effects: GI, NV, seizures, prolong QT interval, photosensitivity, BLACK BOX for tendonitis, tendon rupture, neuropathies
Gentamicin
Class: aminoglycoside
Indication: corneal/conjunctival/eyelid infections, post-operative prophylaxis
Contraindication: n/a
MOA: inhibits bacterial protein synthesis by binding 30s
Pharmacokinetics: drops or ointment
ROA: drops or ointment
Common Adverse Effects: burning sensation of eyes, irritation, may prolong corneal healing
Anti-cholinergic Mydriatic
Class: Anticholinergics
Indication: Pupil Dilation, Treatment of uveitis, cyloplegic refraction in kids
Contraindication: Glaucoma or suspicion of acute-angle (check IOP first)
MOA: Paralysis of Iris sphincter by inhibition of parasympathetic innervation; cycloplegia by paralyzing ciliary muscle (loss accommodation = blurred near vision)
Pharmacokinetics:
ROA: eye drops
Common Adverse Effects: Topical SE are rare. Neuro problems (ataxia, confusion, psychosis), anti-cholinergic effects (tachy, dry mouth, urinary retention, constipation), very rarely precipitates angle-closure glaucoma
Phenylephrine
Class: Sympathomimetic Mydriatic
Indication: Pupil dilation
Contraindication: Infants (cardiac complications)
MOA: Stimulates iris dilator muscle (alpha-1 adrenergic), Iris dilation only (no cycloplegia)
Pharmacokinetics:
ROA: Drops (3-5 hours)
Common Adverse Effects: HTN
Topical NSAIDS
Class: anti-inflammatory
Indication: Pain, inflammation, macular edema, pre/post-operative
Contraindication:
MOA: COX inhibition
Pharmacokinetics:
ROA: drops
Common Adverse Effects: epithelial toxicity, GI bleeding/ulceration, thrombocytopenia, interacts w/ aspirin, nephrotoxic
Topical Corticosteroids
Class:anti-inflammatory
Indication: corneal injury, mild/moderate inflammation of lid/conjunctiva, cornea/sclera
Contraindication: Corneal abrasion, herpes, immunocompromised pt, do not prescribe w/ abx
MOA: reduces inflammation
Pharmacokinetics:
ROA: eye drops, milky suspension so shake before using
Common Adverse Effects: IOP, cataracts, scleral melting, exacerbation of viral and/or bacterial infection,
Beta-blockers for topical glaucoma
Timolol (nonselective beta-1 and beta-2)*
Betaxolol (mainly blocks beta-1)
MOA: Reduce aqueous production and IOP
Potential Systemic Effects: cardiac (arrhythmia, bradycardia, hypotension), respiratory (asthma, bronchospasm), Neuro/psych (HA, depression, confusion, dizziness), Block diabetic hypoglycemic response, nausea, impotence
Carbonic anhydrase inhibitors for glaucoma
Dorzolamide, Brinzolamide (common)
MOA: Reduce aqueous production
Potential Systemic Effects: Ocular burning, bitter taste, Sulfa allergy (ask about allergy hx)
Alpha-2 agonists for glaucoma
Brimonidine common
MOA: Reduce aqueous production
Potential Systemic Effects: AVOID IN KIDS <2yo, HA, syncope, fatigue, muscle pain, dry nose and mouth, taste alteration, GI sx
Cholinergics for glaucoma
Pilocarpine common
MOA: Increase aqueous outflow and induce miosis (stretch trabecular meshwork)
Potential Systemic Effects: neurologic problems, HA, confusion, depression, tremor, Parasymp effects diarrhea, bradycardia, HoTN, bronchospasm, ass w/ higher rate retinal detachment
Topical ophthalmic med application
- Pt tilt head back and look up
- Pull lower lid down/forward
- Apply drop/ointment to lower fornix
- Give pt a tissue
- Nasal punctual occlusion
gtts
drops
ung
ointment
Proparacaine
Anesthetic
Lasts about 20 min
Clinical use: Pain relief to ease exam, for IOP checks, surgical procedures
SE: tremor, restlessness
CHRONIC USE IS TOXIC TO CORNEA! (hide bottle from pt so they don’t take it)
Warn pt of initial sting
Tetracaine
Anesthetic
Lasts about 30 min
Clinical use: Pain relief to ease exam, for IOP checks, surgical procedures
SE: tremor, restlessness
CHRONIC USE IS TOXIC TO CORNEA! (hide bottle from pt so they don’t take it)
Warn pt of initial sting
Fluorescein Strip
Wet tip of strip w/ proparacaine
Apply to inner lower lid (do NOT touch cornea)
Use cobalt blue light. Dye appears green
Clinical uses: Corneal abrasion/ulcers/epithelial path, red painful eyes, IOP pressure check
Anticholinergic Mydriatics
Atropine (7-14 days)
Cyclopentolate (12 hours)
Tropicamide (4-6 hours)
Mydriatic for routine dilated exam
Phenylephrine (2.5%) OR
Tropicamide (0.5 or 1%)
Kids: Cyclopentolate (1%)
Considerations before dilating pupil
Consult an ophthalmologist?
Pupils: Rule out RAPD (relative afferent pupillary defect)
IOP: Avoid inducing acute angle-closure glaucoma
Pharm that stops aqueous humor production
Beta-blockers
Alpha-2 agonists
CAI’s
Pharm that increases trabecular meshwork outflow
Prostaglandins
Pilocarpine
Topical Prostaglandins for glaucoma
Latanoprost, Bimatoprost, Travoprost common
MOA: Increase aqueous outflow
Potential systemic SE: Ocular burning/redness, darkening of the iris, Myalgia, Hypertrichosis (eyelash growth)
Topical corticosteroids for eyes
prednisolone acetate
durezol
dexamethasone
Topical NSAIDS for eyes
Voltaren
Acular
Ocular Abx
Class: Abx
Indication: corneal/conjunctival/eyelid infections, postoperative prophylaxis
ROA: ointment vs. drop based on comfort
Abx for CL wearers
Need to use fluoroquinolone DROPS for pseudomonas coverage
Quinolones are concentration dependent killing
Systemic steroids ocular SE
Glaucoma
Cataracts
Diabetic problems
NEEDS CLOSE FOLLOW-UP
Systemic Plaquenil ocular SE
It’s an anti-malarial/immunomodulator
SE: retinal toxicity
NEEDS ANNUAL EYE EXAM
Systemic Tamoxifen ocular SE
It’s an estrogen receptor antagonist
SE: retinal toxicity
NEEDS ANNUAL EYE EXAM
Amiodarone ocular SE
It’s an anti-arrythmic
SE: corneal deposits, optic neuritis
Systemic anticholinergic ocular SE
Blurry vision
Systemic TB treatment ocular SE
Ethambutol (and isoniazid, rifamprin) SE: optic neuritis
Rifamprin - turn tears orange, stain contact lenses
