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Ophthalmology > Ocular Pharm > Flashcards

Ocular Pharm Flashcards

1
Q

Artificial Tears/ocular lubricants

A

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

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2
Q

Topical Immunosuppressant

A

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

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3
Q

Sulfacetamide sodium

A

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

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4
Q

Erythromycin ointment

A 
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
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5
Q

Ciprofloxacin

A

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

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6
Q

Gentamicin

A

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

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7
Q

Anti-cholinergic Mydriatic

A

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

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8
Q

Phenylephrine

A

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

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9
Q

Topical NSAIDS

A

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

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10
Q

Topical Corticosteroids

A

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,

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11
Q

Beta-blockers for topical glaucoma

A

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

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12
Q

Carbonic anhydrase inhibitors for glaucoma

A

Dorzolamide, Brinzolamide (common)
MOA: Reduce aqueous production
Potential Systemic Effects: Ocular burning, bitter taste, Sulfa allergy (ask about allergy hx)

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13
Q

Alpha-2 agonists for glaucoma

A

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

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14
Q

Cholinergics for glaucoma

A

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

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15
Q

Topical ophthalmic med application

A
  1. Pt tilt head back and look up
  2. Pull lower lid down/forward
  3. Apply drop/ointment to lower fornix
  4. Give pt a tissue
  5. Nasal punctual occlusion
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16
Q

gtts

A

drops

17
Q

ung

A

ointment

18
Q

Proparacaine

A

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

19
Q

Tetracaine

A

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

20
Q

Fluorescein Strip

A

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

21
Q

Anticholinergic Mydriatics

A

Atropine (7-14 days)
Cyclopentolate (12 hours)
Tropicamide (4-6 hours)

22
Q

Mydriatic for routine dilated exam

A

Phenylephrine (2.5%) OR
Tropicamide (0.5 or 1%)

Kids: Cyclopentolate (1%)

23
Q

Considerations before dilating pupil

A

Consult an ophthalmologist?
Pupils: Rule out RAPD (relative afferent pupillary defect)
IOP: Avoid inducing acute angle-closure glaucoma

24
Q

Pharm that stops aqueous humor production

A

Beta-blockers
Alpha-2 agonists
CAI’s

25
Q

Pharm that increases trabecular meshwork outflow

A

Prostaglandins

Pilocarpine

26
Q

Topical Prostaglandins for glaucoma

A

Latanoprost, Bimatoprost, Travoprost common
MOA: Increase aqueous outflow
Potential systemic SE: Ocular burning/redness, darkening of the iris, Myalgia, Hypertrichosis (eyelash growth)

27
Q

Topical corticosteroids for eyes

A

prednisolone acetate
durezol
dexamethasone

28
Q

Topical NSAIDS for eyes

A

Voltaren

Acular

29
Q

Ocular Abx

A

Class: Abx
Indication: corneal/conjunctival/eyelid infections, postoperative prophylaxis
ROA: ointment vs. drop based on comfort

30
Q

Abx for CL wearers

A

Need to use fluoroquinolone DROPS for pseudomonas coverage

Quinolones are concentration dependent killing

31
Q

Systemic steroids ocular SE

A

Glaucoma
Cataracts
Diabetic problems
NEEDS CLOSE FOLLOW-UP

32
Q

Systemic Plaquenil ocular SE

A

It’s an anti-malarial/immunomodulator

SE: retinal toxicity

NEEDS ANNUAL EYE EXAM

33
Q

Systemic Tamoxifen ocular SE

A

It’s an estrogen receptor antagonist

SE: retinal toxicity

NEEDS ANNUAL EYE EXAM

34
Q

Amiodarone ocular SE

A

It’s an anti-arrythmic

SE: corneal deposits, optic neuritis

35
Q

Systemic anticholinergic ocular SE

A

Blurry vision

36
Q

Systemic TB treatment ocular SE

A

Ethambutol (and isoniazid, rifamprin) SE: optic neuritis

Rifamprin - turn tears orange, stain contact lenses

Ophthalmology (9 decks)

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