Ocular Pharmacology

Question 1

Carboxymethylcellulose (Refresh)

Answer 1

OTC for dry eye

Question 2

Polyvinyl alcohol (Artificial Tears)

Answer 2

OTC for dry eye

Question 3

White petrolatum (Artificial Tears Ointment)

Answer 3

OTC for dry eye

Question 4

What treatments increase risk of dry eye?

Answer 4

Prolonged surgery
Oxygen therapy
Anticholinergic drugs

Question 5

Cyclosporin ophthalmic (Restasis)

Answer 5

Reduces inflammation in lacrimal gland
Increases tear production
Contraindications: ophthalmic infx, hx of herpes keratitis, age under 17

Question 6

Increased fungal infection risk

Answer 6

trauma, chronic ocular surface diseases, immunosuppression (including ophthalmic steroids)

Question 7

Increased Acanthamoeba risk

Answer 7

Poor contact lens hygiene, wearing contacts in pool or hot tub

Question 8

Natamycin

Answer 8

Treat fungal eye infection

Question 9

Topical Herpes zoster or simplex agents

Answer 9

Trifluridine

Vidarabine

Question 10

Systemic Herpes zoster or simplex agents

Answer 10

Acyclovir
Valacyclovir
Famciclovir

Question 11

Cytomegalovirus antivirals

Answer 11

IV, intravitreal, oral: Ganciclovir

IV and/or intravitreal: Foscarnet, formivirsen, cidofovir

Question 12

Increased CMV risk

Answer 12

Advanced immunosuppression (transplant and AIDS pts)

Question 13

Ophthalmic Corticosteroids (info)

Answer 13

AE: increased IOP in 90% with family hx of open angle glaucoma

Question 14

Ophthalmic Corticosteroids

Answer 14

Low potency: dexamethasone
Intermediate: fluorometholone
High: prednisone acetate

Question 15

Ophthalmic NSAIDs - counter unwanted intraoperative miosis

Answer 15

Flurbiprofen
Diclofenac
Ketorolac

Question 16

Ophthalmic NSAIDs

Answer 16

AE: Corneal deposits, increased IOP, ocular inflammation

Question 17

Ophthalmic Antihistamines: H1 blockers

Answer 17

Pheniramine, olopatadine

Question 18

Ophthalmic Antihistamines: Mast Cell Stabilizers

Answer 18

Cromolyn, Iodoxamide

Question 19

Ophthalmic alpha 1 agonists

Answer 19

Tetrahydrozoline
Naphazoline
Phenylephrine

Question 20

Ophthalmic alpha 1 agonists (info)

Answer 20

Gets the red out
Phenylephrine also used as mydriatic
Caution: Cardiovascular disease including HTN & CAD; diabetes and hyperthyroidism
AE: dry eye, rebound congestion, allergic conjunctivitis, SYSTEMIC EFFECTS

Question 21

Open Angle Glaucoma

Answer 21

Most common

Corticosteroids can cause secondary open angle glaucoma

Question 22

Narrow (angle closure) Glaucoma

Answer 22

Emergency!

Drugs implicated: anticholinergic, adrenergic, ganglionic blockers

Question 23

Treatment: open angle glaucoma

Answer 23

Reduce aqueous formation: alpha 2 agonists, beta blockers, mixed alpha agonists, carbonic anhydrase inhibitors
Increase outflow: cholinergics, prostaglandins

Question 24

Treatment: narrow angle glaucoma

Answer 24

Iridoplasty

Acute & perioperative meds: cholinergics, carbonic anhydrase inhibitors, corticosteroids, hyperosmotics

Question 25

Adrenergics for glaucoma

Answer 25

Mixed agonists: epinephrine, dipivefrin
AE: dry eye, tachycardia, hypertension

Alpha 2 agonists: apraclonidine, brimonidine
AE: dry eyes, sedation, fatigue, tachyphylaxis

AE for both: corneal melanin deposits, hyperemia, headache

Question 26

Beta 2 blockers for Glaucoma

Answer 26

Timolol, betaxolol, levobunolol, carteolol
Betaxolol is beta 1 selective
Reduce aqueous humor production
Contraindications: decompensated heart failure
AE: bradycardia, hypotension, bronchospasm, hypoglycemic unawareness

Question 27

Cholinomimetics for Glaucoma

Answer 27

Direct acting: pilocarpine

AE: myopia, night blindness

Question 28

Carbonic Anhydrase Inhibitors

Answer 28

Dorzolamide, brinzolamide, acetazolamide

Carbonic anhydrase type II responsible for aqueous formation; inhibitors decrease aqueous formation

AE: irritation, conjunctivitis

Question 29

Prostaglandin (PGF-2) analogs

Answer 29

Latanoprost, travoprost, bimatoprost

Lower IOP by facilitating aqueous outflow thorugh accessory uveoscleral outflow pathway

Once daily dosing, low systemic side effects, potent IOP lowering effect

Question 30

Hyperosmotics

Answer 30

Used for acute & perioperative reduction in IOP

Mannitol IV, Glycerine oral

AE: headache, diuresis, dehydration, rapid increase in extracellular volume & preload may precipitate or aggravate CHF!

Question 31

Mydriatcs and Cycloplegics

Answer 31

Mydriatic only: phenlyephrine

Mydriatic & cycloplegic:
Atropine, homatropine, tropicamide, scopolamine

Question 32

Fluoroscein

Answer 32

Dye that reveals epithelial defects of cornea/conjunctiva & aqueous humor leakage post-trauma

Question 33

Ophthalmic local anesthetics

Answer 33

Tetracaine, properacaine

Question 34

Cocaine

Answer 34

Combination decongestant and local anesthetic

Question 35

Drugs that cause Miosis

Answer 35

Cholinergics, opiates, sympatholytics, alpha2 agonists

Question 36

Drugs that cause Mydriasis, photophobia

Answer 36

Anticholinergics, meperidine, TCA, fluoxetine, sympathomimetics

Question 37

Drugs that cause color perception

Answer 37

Digitalis, PDE5 inhibitors, ethambutol

Question 38

Drugs that cause floppy iris

Answer 38

Alpha 1 blockers

Question 39

Drugs that cause pigment deposits

Answer 39

Antipsychotics, PG analogs, adrenergics

Question 40

Ophthalmic drops

Answer 40

Greater drug solubility

Faster penetration

Question 41

Ophthalmic ointment

Answer 41

Prolong time a drug remains on eye
Generally blurs vision
Poor corneal bioavailability

Question 42

Drugs that cause cataracts

Answer 42

Steroids, allopurinol