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3. Clin Pharm 3 > Ocular Pharmacology pt 3 > Flashcards

Ocular Pharmacology pt 3 Flashcards

1
Q

parasympatholytics are not used in what cases?

A
  • we avoid using parasympatholytics in cases of glaucoma as the pupillary dilation and
    relaxation of the ciliary body can increase the intraocular pressure in patients with glaucoma or at risk of glaucoma
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2
Q

mydriatics

A

dilate the pupil

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3
Q

cycloplegics

A

paralyze the pupillary sphincter and ciliary muscle

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4
Q

Phenylephrine
- what is it?
- use
- cats?
- adverse effect?

A
  • direct acting alpha agonist sympathomimetic
  • lesion localization in Horner’s syndrome
  • will only dilate cats with a postganglionic lesion
    > no effect on other cats
  • can increase blood pressure
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5
Q

Atropine
- what is it?
- duration
- use
- concentration

A
  • parasympatholytic drug with both mydriatic and cycloplegic properties
  • duration of action can last 4-5 days
  • commonly used in patients with uveitis
  • most common concentration used in practice is 1%
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6
Q

atropine adverse effects

A
  • transient decrease in tear production
  • hypersalivation if drainage through the nasolacrimal system enters the mouth
  • tachycardia, decreased gastrointestinal motility and photophobia
    <><>
    Long-term topical administration of atropine in young cats can result in smaller resting pupils
    following cessation of therapy
    <><>
    canine patients may react paradoxically to atropine (or tropicamide) topical administration with miosis
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7
Q

Tropicamide
- what is it?
- duration
- adverse effect

A
  • parasympatholytic drug that is commonly used prior to examination of the fundus
  • short duration (6-12h)
  • weak cycloplegic
    <><><><>
    in young cats, IOP can significantly
    increase to above the normal range
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8
Q

types of drugs used for glaucoma

A
  • Prostaglandin analogues
  • Carbonic anhydrase inhibitors
  • Beta-adrenergic drugs
  • Parasympathomimetics
  • Diuretics
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9
Q

Prostaglandin analogues
- mechanism
- uses
- onset
- adverse effects

A
  • effective topical anti-glaucoma drugs
  • decrease IOP by increasing the uveal-scleral outflow in dogs
  • NOT effective in cats
  • canine primary glaucoma
  • effects seen in 30-60 min
    <><><><>
  • side effect: severe miosis lasting 12-18 hour
  • patients at risk for lens luxation should not be prescribed this medication
  • pateints with glaucoma secondary to severe uveitis should not be prescribed this medication (breaks down blood-aqueous barrier)
    <><><><>
    -prost
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10
Q

Carbonic anhydrase inhibitors
- mechanism
- use
- speed of effect

A
  • decrease IOP by lowering the production of aqueous humour
  • not as rapid as prostaglandin analogues or osmotic diuretics (~1-2 hours)
  • adjunct therapy for primary and secondary glaucoma in both dogs and cats
    <><><><>
    -zolamide
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11
Q

Carbonic anhydrase inhibitors - disadvantages of systemic (ie. why we prefer topical)

A
  • systemic acidosis
  • vomiting
  • diarrhea
  • general malaise
  • anorexia
  • panting
  • lameness due to paresthesia and ataxia (cats especially)
    <><><><>
  • Long-term supplementation with potassium is also needed due to the diuresis that induces hypokalemia
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12
Q

Beta-adrenergic drugs
- mechanism
- synergy
- adverse effects

A
  • decrease IOP by lowering the production of
    aqueous humour
  • A positive additive effect is seen with combinations of beta-blockers and carbonic anhydrase inhibitors
    <><><><>
  • Mild miosis
  • bradycardia
  • NOT to be used in cats with asthma
    <><><><>
    -olol
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13
Q

Parasympathomimetics
- mechanism
- use
- adverse effects

A
  • decrease IOP by opening the aqueous outflow channels due to contraction of the ciliary body
  • decrease IOP by causing a break in the blood aqueous barrier and therefore increasing vascular permeability
  • replaced in practice by prostaglandin analogues
    <><><><>
  • Conjunctival inflammation and miosis
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14
Q

Diuretics
- mechanism
- onset time
- contraindications

A
  • lowering IOP by reducing the aqueous and vitreous volumes within the eye
  • as early as 10 minutes
    <><><><>
  • contraindicated in patients with congestive heart failure, systemic hypertension, renal
    insufficiency, and diabetes mellitus
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15
Q

Tear stimulants and corneal lubricating formulations
- when are they needed?

A
  • needed in cases of tear deficiency and poor tear quality
  • Keratoconjunctivitis sicca in dogs
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16
Q

Cyclosporine use
- what it does
- schedule of application
- use with schirmer tear test
- onset of action
- caution

A
  • Topical cyclosporine has been shown to be an effective treatment for canine KCS
  • Increased lacrimation is seen in normal and most deficient dogs after application of cyclosporine, but not in cats
  • 2x daily, life-long
  • It is imperative that cyclosporine be given the morning of the recheck Schirmer Tear Test appointment to adequately evaluate response to treatment
  • 2-3 months for onset
    of action
    <><><><>
    Optimmune, 0.2% cyclosporine ointment, is the
    only licensed veterinary product for canine KCS
    <><><><>
  • handling of cyclosporine should be done with
    gloves, as it is an immunosuppressive drug
17
Q

Tacrolimus
- use
- adverse effects and instructions for use

A
  • increase lacrimation
  • alternative to topical cyclosporine
  • potential link to cancer
  • prescription of this medication in patients that are non-responsive to cyclosporine, use of gloves when manipulating the drug, and avoid contact with children
18
Q

Pilocarpine
- use
- adverse effects
- time to onset

A
  • Topical pilocarpine 1-2% can also be used orally to stimulate tear production in neurogenic
    cases of KCS
  • toxicity can occur quickly > vomiting and
    diarrhea
  • increase in schrimer tear test after 3 weeks
19
Q

Artificial tear supplements
- use

A

important adjunct therapy for tear deficiencies

20
Q

Sodium chloride 5% use for ophtho

A
  • helps reduce corneal oedema
  • endothelial dystrophy or degeneration, bullous keratopathy and superficial corneal ulceration may benefit
  • oitment q 6 hours
21
Q

Sodium fluorescein

A
  • corneal ulcers
  • nasolacrimal patency (Jones)
  • tear break up time
  • aqueous fluid leaks following corneal perforation (Seidel)
22
Q

Topical anesthesia for the eye
- what drug
- adverse effects

A
  • 0.5% proparacaine
  • onset of action is rapid
    <><><><>
  • toxicity to corneal and conjunctival epithelium
  • decreased epithelial healing rates due to inhibited mitosis and cellular migration
    <><><><>
  • collect culture samples prior to instillation
23
Q

preferred germicide for prepping of
ophthalmic surgical patients
- adverse effects?

A
  • Diluted povidone-iodine solution (1:50)
  • bactericidal, virucidal and fungicidal
    <><><><>
    chemosis and conjunctivitis

3. Clin Pharm 3 (12 decks)

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