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Ocular Pharm > Ocular Pharm: L8: Drugs for Managing Ocular Allergy > Flashcards

Ocular Pharm: L8: Drugs for Managing Ocular Allergy Flashcards

1
Q

Non-Pharmaceutical Management

  1. Goal is to do what?
  2. What are good things to do?
    (START WITH NON DRUG TXs!)
  3. What sets Allergies apart from dry eyes?
A
  1. soothe eye and/or get rid of antigens
  2. ATs, Cold compresses, Wash Hair before going to bed; Wash Pets (2x’s/wk for dogs)
    * If associated w/CL Wear: Switch to DAILY DISPOSABLE LENSES or use HYDROGEN PEROXIDE CLEANER!
  3. Usually ITCHING
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2
Q

Pharmaceutical Tx?

A
  1. Mast Cell Stabilizers
  2. Antihistamines
  3. Combined Antihistamine/Mast Cell Stabilizers
  4. Steroids (NSAIDs)
  5. Immune System Suppressants
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3
Q

Topical Mast Cell Stabilizers

  1. What is needed to get them?
    a. How long does it take for them to work?
  2. 4 of them
  3. What will they do with Mast Cells?
A
  1. Rx
    a. 7-14 days to work (Best if given before allergic response starts)
  2. a. Lodaxamide Tomethamine
    * 1 gtt QID >2yo

b. Nedocromyl Sodium
* 1 gtt BID, >3yo

c. Perimolast Potassium
* 1gtt QID >3yo

d. Cromolyn Sodium
* 1 gtt QID >4yo

  1. Turn off symptoms and Mast Cells are saved!
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4
Q

Topical Antihistamines

  1. Emedastine Difumerate: drops?
A
  1. 1 gtt QID, >3yo, Rx NEEDED
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5
Q

Oral Antihistamines: First Gen

  1. Rx needed?
  2. Diphenhydramine
  3. Chlorpheniramine
  4. Also can cause what?
A
  1. OTC or BTC
  2. 25-50 mg q4-6h, No children’s formulation
  3. 4 mg, q4-6h >6yo
  4. Drowsiness
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6
Q

Oral Antihistamine: Second Gen

  1. Less effect of what?
  2. Certirizine Hydrochloride
  3. Loratadine
  4. Fenfoxadine Hydrochloride
A
  1. Less Anticholinergic Effects (Less Drowsiness)
  2. 10 mg QD (2yo)
  3. Non-Drowsy, 10 mg QD (2 yo)
  4. Non-Drowsy, Up to 180 mg daily (6 yo)
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7
Q

Oral Antihistamine: Newest in Class

  1. Desloratadine
  2. Levocetirizine
A
  1. Active form of Loratadine (Claritin)
    Faster Action. (1 yo for liquid form)
  2. Active Form of CERTIRIZIN (Zyrtec
    More Effective, Fewer Side effects
    Non-Drowsy
    (6 months for liquid form)
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8
Q

Topical AH’s (MCS’s)

  1. Ketotifen Fumerate
  2. Olopatadine Hydrochloride
A
  1. OTC (0.025%)
  2. Patanol: 0.1%, 1gtt, BID >3yo

Pataday: 0.2%, 1gtt, BD, >3yo

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9
Q

Topical AH’s/MCS’s-2

  1. Azelastine Hydrochloride
  2. Bepotastine Besolate
  3. Epinastine Hydrochloride
  4. Alcaftadine
A
  1. 1 gtt BID >3yo
  2. 1 gtt BID >2yo
  3. 1 gtt BID >3yo
  4. 1gtt QD >2yo; Reduces Itching in 3 minutes, Lasts for 16 hrs
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10
Q

Topical Corticosteroids

  1. Rx needed?
  2. Ocular: (already discussed..)
  3. Non-ocular
    a. Hydrocortisone

b. Triamcinolone

A
  1. Yes. Usually
  2. Fluorometholone, Loteprednol
  3. a. 1% ung or cream; OTC; BID to TID 5-10 Days, use with CAUTION on children

b. by Rx; BID to TID 5-10 Days, use with caution on children
(0. 025 to 0.5% ung or cream)

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11
Q

Nasal Spray Corticosteroids

  1. Nasal Steroids can also reduce what?
  2. Rx Needed?
  3. How do you administer it?
  4. 5 of them
A
  1. Ocular Allergy Symptoms
  2. Yes
  3. 2 Sprays Each nostril, QD
  4. a. Triamcinolone
    b. Fluticonasone
    c. Fluticonasone Propionate
    d. Budesonide
    e. Beclomethasone
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12
Q

Topical NSAIDs

  1. DO NOT Block what receptors?
  2. Do not completely inhibit what?
  3. GOOD for Tx of what 2 ocular symptoms?
  4. Not as effective as other drugs for what symptoms?
A
  1. Histamine receptors
  2. Immune System
  3. of Itching and Redness
  4. for Burning, Conjunctival Chemosis, Eyelid Swelling, Photophobia, and FBS
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13
Q

If you really just want to get the RED out, prescribe what?

  1. Long-term Tx?
  2. Three of them?
A
  1. Decongestant Vasoconstrictor
  2. NO. If you do, then stop using them, you will get issues…
  3. Naphazoline HCL
    b. Phenylephrine HCL
    c. Tetrahydrozoline HCL, Oxymetazoline HCL
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14
Q

Major Types of Ocular Allergy

A
  1. Acute Allergic (rhino) conjunctivitis
    a. Seasonal and Perennial Allergic
  2. Vernal Keratoconj. (VKC)
    a. W/LIMBAL and CORNEAL INVOLVEMENT
  3. Atopic Keratoconjunctivitis
  4. Giant Papillary Conjunctivitis
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15
Q

Acute Allergic conjunctivitis

  1. Can be what?
  2. Symptoms?
  3. Signs
A
  1. Seasonal or Year-round, depends on when allergens are present
  2. Itching, burning, tearing, HYPEREMIA
  3. CONJUNCTIVAL HYPEREMIA and Chemosis, Eyelid Edema
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16
Q

Acute Allergic conjunctivitis Tx

  1. Mild (2 things)
  2. Moderate to Severe
    a. first step
    b. Prophylaxis control
    c. Combo?
    d. For RhinoConjunctivitis

e. Severe Cases?

A
  1. Cold Compresses and ATs (chilled)
  2. a. Topical or oral Antihistamines
    b. Topical Mast Cell Stabilizers (prophylaxis or Control RATHER than RAPID RESPONSE)

c. Topical Antihistamine/Mast Cell Stabilizer Combination
d. Topical NSAID or Steroid Nasal Spray (RHINOCONJUNCTIVITIS)
e. Topical Corticosteroids (SEVERE CASES)

17
Q

Vernal Keratoconjunctivitis (VKC)

  1. Usually affects whom?
  2. Peak incidence?
  3. % of patients have associated ATOPY?
  4. Symptoms?
  5. 3 forms?
  6. Can develop what?
A
  1. Young Boys
  2. Spring
  3. 90%
  4. Intense Bilateral Itching, Stringy mucous DISCHARGE, FBS, VA may be affected
  5. Limbal, Palpebral, Mixed
  6. Keratopathy can develop d/t inflammatory mediators or trauma from palpebral papillae
18
Q

Treatment of VKC

  1. Supportive Therapy (Mild Disease)
  2. What is used in 85% of PATIENTS?
  3. Chronic Cases?
  4. What is used for EXCESS MUCOUS?
  5. What is used in Severe Cases?
A
  1. Cold Compresses, ATs, Maintain cool and Moist environment
  2. Topical Corticosteroids
  3. Topical Mast Cell Stabilizers w/or w/o Antihistamine (for chronic cases)
  4. Acetylcysteine 10% (mycolytic)
  5. Cyclosporine, Mitomycin-C 0.01%, Periocular Corticosteroids for severe cases, or even systemic
19
Q

Atopic Keratoconjunctivitis

  1. Symptoms
  2. Signs
A
  • in men more than women. Bilateral, symmetric
    1. Itching and tearing, reduced VA late in disease possible
    2. Ropy mucous discharge, Tarsal Papillae, Trantas Dots, Fornix foreshortening, symblepharon
20
Q

Atopic Keratoconjunctivitis Tx:

  1. Mild Disease?
  2. ACUTE OCULAR Symptoms?
  3. Chronic Symptoms
  4. Eyelid Eczema
  5. Blepharitis/Meibomianitis
  6. Excessive Mucous Production
  7. Refractory Disease
A
  1. Supportive: Cool compresses, ATs, maintain cool and moist environment, Warm compresses for Blepharitis
  2. Topical Antihistamine, Antihistamine/Mast Cell Stabilizer, NSAID, or Corticosteroid
  3. Topical Mast Cell STabilizer w/or w/o antihistamine
  4. Topical Corticosteroid (non-ocular)
  5. Topical Antibiotic, Topical Corticosteroid/Antibioitc, Oral Antibiotic
  6. Acetylcysteine
  7. Topical or Oral Cyclosporine
21
Q

GPC

  1. In whom?
  2. Symptoms?
  3. Signs
A
  1. CL patient, ocular prostheses
  2. itching, burning, chafing, mucous discharge (eyelids stick together), BILATERAL
  3. Conj Hyperemia, mucus discharge, Giant papillae on Upper tarsal conj, CL coated with grayish-white film
22
Q

GPC Tx

  1. Mild:
  2. Long term Maintenance?
  3. If CL Related?
A
  1. Mild Topical Corticosteroid: QID 2wks then BID for 2 more weeks.
  2. Topical mast cell stabilizer
  3. D/C CL wear for about 4 wks

and re-fit w/DAILY Lens or switch to Hydrogen peroxide cleaning system

Ocular Pharm (13 decks)

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