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Ocular Pharm > Ocular Pharm: L9: Drugs for Managing Ocular Pain > Flashcards

Ocular Pharm: L9: Drugs for Managing Ocular Pain Flashcards

1
Q

Drugs for Ocular Pain

  1. Palliative/Adjunctive Agens (3)
  2. Analgesics (4)
A
  1. AT’s, Cycloplegics, Topical Steroids

2. Topical NSAIDs, Topical Anesthetics, OTC Pain Relievers, Narcotics

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2
Q

Artificial Tears (1)

  1. Lubricate Ocular surface, and Decrease Mechanical Irritation
    a. Use for what?
    b. Can be used with what?
  2. Gels or Ointments may provide MORE sustained Relief
    a. What 3? (GRE)
  3. Can be used with other drugs like what?
    a. Why would we use them with these drugs?
    b. Allow at least how much time b/w Instillation of Drops?
A
  1. a. Mild Chemical Burn or Post FB
    b. with BCL
  2. a. Genteal Gel
    b. Refresh PM ung
    c. Erythromycin ung
  3. things like Topical Antivirals
    a. because some of these drugs can CAUSE DRYNESS or IRRITATION (like Viroptic use 9x’s day)

b. at least 15 minutes b/w instillation of drops.

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3
Q

Cycloplegics

  1. For Ocular Pain due to what?
    a. So if a patient complains of pain with what? (think UVEITIS)
    b. Look for what in the AC?
  2. What other 3 things are they used for?
A
  1. due to an Internal Inflammatory Condition
    a. an inflamed muscle (so moving their eye)
    b. Cells and Flare
  2. a. Uveitis
    b. Traumatic Uveitis
    c. FB on Corneal Epithelium that INDUCES Iritis!
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4
Q

Common Cycloplegics (Stop ACH)

  1. Scopolamine
    a. % of Drop?
    b. Used how often?
  2. Atropine
    a. Duration of Action?
    b. % drops?
    c. Ointment?
    d. How often do you use them?
    e. Why would you want to use something that Cycloplege’s for up to 12 days more than once a day?
  3. CYCLOPENTOLATE

a. How long does it last?
b. Use until when?
c. Drop %’s?

  1. Homatropine
    a. Use for what condition types?
    b. % drop?
  2. Type of drug used, concentration, and DOSING are based on what?
A
  1. a. 0.25% drop
    b. BID
  2. a. MOST POTENT CYCLOPLEGIC; up to 12 days
    b. 0.5%, 1% and 2% drops
    c. 1% ung
    d. BID to TID
    e. Because you want just a little movement so Synechiae DOESNT FORM!. (Trying to keep a little bit of movement, but minimal…to minimize pain)
  3. a. SHORT ACTING
    b. Use until Stronger Cycloplegic Agent is available
    c. 0.5%, 1%, 2% Drop
  4. a. for ACUTE CONDITIONS; Effect Lasts 1-3 DAYS
    b. 2% and 5% drop
  5. on Severity of AC RxN!
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5
Q

Topical Steroids

  1. Kind of Pain Modulators?
  2. How do they work?
  3. Should be considered Short Term/Long Term Option because of Side Effects?
    a. Measure IOP how often?
  4. SO if a PATIENT COMES in WITH ACUTE PAIN or CHRONIC PAIN, should these be USED?
A
  1. “Adjunctive” Pain modulators.
  2. by Treating the Inflammation that PRODUCES PAIN
  3. Short Term Option
    a. Bi-Weekly (if using for more than two weeks)
  4. NO! Use something else!
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6
Q

Topical NSAIDs

  1. Do these have an Analgesic Effect?
  2. Approved for treatment of what 2 things?
    a. Related to what?
    b. What else could they be used for?

c. What if a patient comes in with a CORNEAL ULCER?
3. Also useful for PAIN due to what 2 things?
4. Can also be used for what other type of pain?

A
  1. YES!
  2. of Pain and Inflammation related to CATARACT SURGERY (this is the ONLY ocular use for Topical use, but have been used for other situations)

a. to CATARACT SURGERY
b. Mild eye pain due to FB, injury, NSAID is not a bad choice.

c. He doesn’t recommend using a topical NSAID in that situation
3. Allergy or Medicamentosa
4. ACUTE PAIN

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7
Q

Common Topical NSAIDs

  1. DICLOFENAC 0.1%
    a. Requires what KIND of DOSING?
    b. Does it sting upon instillation?
    c. Older drug, generic available. How expensive?
  2. KETORALOC TROMETHANE 0.4%
    a. Same as DICLOFENAC, but…?
  3. Ketoraloc Tromethane 0.45%
    a. Dosing type?
    b. Are there preservatives?
    c. Price?
  4. NEPAFENAC 0.1%
    a. Dosing?
    b. Type of Drug?
    c. Ilevro (why is this better?) (just been approved for surgery…or after surgery…)
    d. Expensive/Inexpensive?
  5. BROMFENAC 0.09%
    a. Dosing?
    b. Prolensa (newer one for cataracts) has more what?
    c. Expensive?
  6. If you have a homeless patient or a cash pay patient, what would you not prescribe to them?
A
  1. a. QID dosing
    b. YES!
    c. Inexpensive ($26/5 ml)
  2. a. but more expensive ($76/5ml)
  3. a. BID Dosing
    b. NO. Preservative Free (Less stinging)
    c. EXPENSIVE (about $150/30 vials)
  4. a. TID dosing
    b. Prodrug (Less Sting)
    c. 2x’s concentration of the Active Drug; Lower pH; Reduced Molecule Size (better penetrability); Faster Dissolution when on the Ocular Surface (better availability); Guar gum may increase time on Ocular Surface (better availability)

d. EXPENSIVE
5. a. QD Dosing (Bromday)
b. More physiological pH and Better Corneal Permeability
c. Expensive!
6. Probably not the Nepafenac or Bromfenac because they are EXPENSIVE!

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8
Q

Topical Anesthetics

  1. Major one we use?
    a. Useful for what?
  2. Major use can DELAY what?
  3. What can be used prn W/o Coreal Injury?
A
  1. Proparacaine 0.5% drop is the Topical Anesthetic of CHOICE
    a. For ACUTE Pain Relief (can allow ocular examination or treatment)
  2. healing of Corneal Epithelium
  3. Dilute Proparacaine (0.05%)
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9
Q

OTC Analgesics

  1. For management of what?
  2. Price?
  3. Risk of Addiction or abuse?
  4. CONTRAINDICATED in cases with what 3 things?
A
  1. of MILD PAIN
  2. Inexpensive
  3. None
  4. with GI Bleeding, Alcohol Use, and Pregnancy
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10
Q

Common OTC Analgesics

  1. Acetylsalicyclic Acid
    a. What is it?
    b. Normal Dosage?
    c. CI in patients with what?
  2. ACETAMINOPHEN
    a. Normal dosage?
    b. Max Daily dose?
    c. Problem if Max dose is Exceeded?
    d. CI in Pts with what?
  3. IBUPROFEN
    a. Normal Dosage?
    b. Max Daily Dose?
    c. 2 issues it can CAUSE?
  4. NAPROXEN SODIUM
    a. Dosage?
    b. Max Daily dose?
    c. Can give how much as a LOADING DOSE? Then how much over the rest of the 24 hr period?
A
  1. a. ASPIRIN!
    b. 650 mg to 975 mg q4h
    c. w/H/o of Stomach Ulcers or Bleeding Disorders, Pts that are PREGNANT, Pts under 18 yo or with Viral Illness (Reye’s Syndrome)
  2. a. 650 to 975 mg q4h
    b. 3000 mg
    c. Liver Toxicity
    d. in pts with LIVER PROBLEMS
  3. a. 200-800 mg q4h
    b. 2400 mg
    c. Upset Stomach and GI Toxicity
  4. a. 220 mg q8-12h
    b. 1500 mg
    c. 2 pills as a loading dose. Then 3 in the REST of the 24 hr PERIOD.
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11
Q

Scheduled Drugs

  1. Created by what?
  2. Regulated the Manufacture, importation, possession, use and what of certain substances?
  3. Number of Schedules of the drugs?
  4. Classification decisions are based on what?
A
  1. CONTROLLED SUBSTANCES ACT (CSA)
  2. and Distribution of Certain Substances
  3. 5 Schedules (classifications), with varying qualifications for a substance to be included in each.
  4. on Potential for Abuse, currently accepted medical use in treatment in the US, and international treaties
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12
Q

Schedule 1 Drugs

  1. Drug or other substance has what potential for abuse?
  2. Drug or other substance has any current accepted medical use in treatment in the US?
  3. Can they be prescribed?
  4. Use then?
  5. Examples?
A
  1. HIGH Potential for Abuse
  2. NONE currently.
  3. No.
  4. Production quotas, e.g. for research use.
  5. Heroin, LSD, marijuana, GHB (date rape…also a Schedule 3 under trade nam Xyrem)
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13
Q

Schedule II Drugs

  1. Drug or other substance has what potential for abuse?
  2. Can they be used for medical use in treatment in the US?
  3. Abuse of the drug or other substances may lead to what?
  4. Is a Prescription required?
    a. Can refills be prescribed?
  5. Examples?
A
  1. HIGH
  2. Yes. (but w/severe restrictions)
  3. may lead to severe Psychological or Physical Dependence
  4. YES.
    a. NO
  5. certain opiates not in Schedule 1 (Methadone, Oxycodone, Oxymorphine, amphetamines, short-acting barbituates)
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14
Q

Schedule III Drugs

  1. Drug or other substance has what potential for abuse?
  2. Drug or other substance has a currently accepted medical use in treatment in US?
  3. Abuse of the drug or other substance may lead to what?
  4. Prescription needed?
    a. Duration length?
    b. Number of refills?
  5. Example?
A
  1. Abuse is less than those in Schedule 1 or 2
  2. Yes.
  3. to Moderate or Low Physical Dependence or High Psychological Dependence
  4. Yes
    a. 6 month duration
    b. up to 5 refills
  5. Anabolic Steroids, Certain opiates not in Schedules I or II
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15
Q

Schedule 3 Drugs….Some that were listed….?

A
  1. Buprephenone
  2. Dihydrocodeine when compounded w/other substances to a certain dosage and concentration
  3. Hydrocodone/Codeine when compounded w/an NSAID
  4. Ketamine
  5. Anabolic Steroids
  6. Intermediate-acting Barbituates
  7. Sodium Oxybate (Tx of Narcolepsy)
  8. Marinol (THC Analog)
  9. Paragoric (small amt of opium)
  10. Ergine (LSA; LSD Precursor, Hallucinogen)
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16
Q

Schedule 4 Drugs

  1. Drug or other substances has what potential for abuse?
  2. Have a current accepted medical use in Tx in the US?
  3. Abuse of drug may lead to what?
  4. Prescription needed?
    a. Duration length?
    b. Max refill limit?
  5. Examples?
A
  1. Low potential for abuse relative to the drugs or other substances in schedule IV
  2. Yes
  3. May lead to LIMITED Physical Dependence or Psychological Dependence relative to the drugs or other substances in Schedule III
  4. Yes.
    a. 6 months
    b. max of 5 refills
  5. Benzodiazepine, Long-acting barbituates, certain opiates or opiate-like drugs (tramadol in some states , Pentazocine)
17
Q

Schedule V Drugs

  1. Abuse Potential?
  2. current medical use?
  3. Abuse of drug or other substances may lead to what?
  4. Prescription needed?
  5. Examples?
A
  1. LOW
  2. Yes.
  3. limited physical dependence or psychological dependence relative to the drugs or other substances in Schedule IV
  4. YES
  5. Cough suppressants, anticonvulsants, drugs containing small amts of opiates (e.g. Anti-diarrhea drugs)
18
Q

Arizona Law

  1. Optometrist may prescribe, dispense, and administer what types of drug?
    a. Examples?
  2. What schedule drugs can we NOT PRESCRIBE?
  3. can we prescribe a controlled substance to yourself or a family member?
A
  1. a Schedule 3 Controlled substance ONLY if it IS AN ANALGESIC!!

a. Buprephenone
b. Dihydrocodeine when compounded w/other substances to a certain dosage and concentration
c. Hydrocodone or Codeine, when compounded w/an NSAID
d. Ketamine

  1. 1,2,4, or 5 controlled substance
  2. No. It’s considered unprofessional conduct
19
Q

Changes in US Law

  1. What drug is being reclassified to SCHEDULE II?
  2. What is AZ legislature doing about it?
A
  1. Hydrocodon

2. they’re considering changes to allow Optometrists to continue to prescribe these drugs

20
Q

Narcotics

  1. Use?
  2. Often Prescribed with what?
  3. Side effects?
  4. Addiction and Abuse Potential?
  5. How can they be prescribed?
  6. What do you have to indicate on the prescription?
A
  1. Mild to Moderate Pain Relief
  2. with an NSAID
  3. Drowsiness, Respiratory Depression, Liver Toxicity, Renal Failure, Urinary retention, Nausea, Vomiting
  4. SIGNIFICANT
  5. 1 day at a time w/NO REFILL
  6. Number of Pills prescribed as a NUMERAL and in Writing (like a check)
21
Q

Common Narcotics

  1. Codeine
    a. Tylenol #3 refers to what?
    b. Tylenol #1?
    c. Tylenol #4?

d. Empirin with what?
e. Dosing level?
f. Max dosing?

  1. Hydrocodone
    a. Vicodin: what is it?
    b. Dosing?
  2. TRAMADOL:
    a. Dosing?
    b. Max per day?
    c. Abuse and Addiction potential?
    d. AVOID in PT with a HISTORY of what?
    e. Ultracet: What is it? and Dosing?
    f. What SCHEDULE is it in ARIZONA LAW?
A
  1. a. 30 mg Codeine, 300 mg Acetaminophen
    b. 15 mg Codeine, 300 mg acetaminophen
    c. 60 mg Codeine, 300 mg acetaminophen
    d. with Codeine #3 and #4: Same as above only Acetaminophen is Replaced with 325 mg Acetylsalicylic Acid (Aspirin)
    e. 1 Tablet, q4-6h
    f. Max dose of 360mg Codeine, and 4000mg Acetaminophen
  2. a. 5 mg Hydrocodone with 500 mg Acetaminophen
    b. 1-2 Tablets q4-6h; MAX 8 TABLETS per day!
  3. a. 50-100 mg q4-6h
    b. Max 400mg per day
    c. LOW!
    d. History of SEIZURES

e. 37.5 mg Tamadol w/325 mg Acetaminophen; 1-2 tablets q4-5h
f. SCHEDULE 4 in AZ LAW (but NOT US LAW)

22
Q

Guidelines for Pain Medication Rx

  1. Know what you are…?
  2. Gauge what?
  3. For mild Pain, use what?
  4. For Moderate pain, use what?
  5. In moderate to Severe cases, use what?
  6. If stronger pain relief is needed?
A
  1. treating
  2. quality of pain (10 point scale)
  3. use Topical Drugs or OTC Analgesics
  4. use Tylenol #3 1-2 tablets, q4-6h
  5. use 1-2 tablets Vicodin q4-6h
  6. Refer out

Ocular Pharm (13 decks)

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