ocular pharmocology

Question 1

drug delivery to eye

Answer 1

Most drugs are available as ophthalmic solutions. . Prolonging the time in the cul-de-sac with gels, ointments and solid inserts facilitates drug absorption into the eye.

Question 2

how does drug get to aqueous humor

Answer 2

passive diffusion through cornea

Question 3

Systemic absorption possible via

Answer 3

nasolacrimal drainage

Question 4

topical drugs and systemic side effects

Answer 4

•1st pass effect is avoided and systemic side effects are possible with topically administered drugs

Question 5

list guidelines for administration of ophthalmic drops in glaucoma

Answer 5

1 drop per dose, If > 1 topical drug required, separate instillation by 5-10 minutes for optimal ocular contact
1 drop per dose, If > 1 topical drug required, separate instillation by 5-10 minutes for optimal ocular contact

Question 6

proper topical administration

Answer 6

make pocket with lower eyelid, place single drop in eye. Close eyelid for 1-3 minutes and put index finger over nasolacrimal drainage system to maximize local effect and minimize systemic effects

Question 7

open angle gluacoma

Answer 7

decreased outflow, increased production, increased intraocular pressures leads to nerve damage

Question 8

Prostaglandin analogs:

Answer 8

Primary agent in open glaucoma treatment. Latanoprost (Xalatanâ)- increase outflow

Question 9

Prostaglandin analogs:

Answer 9

Brown discoloration of iris, Eyelash lengthening, Ocular irritation

Question 10

Alpha2-adrenergic agonists:

Answer 10

secondary agent for open glaucoma. Brimonidine (Alphaganâ). Decreases production

Question 11

Alpha2-adrenergic agonists side effects

Answer 11

Red eye and ocular irritation, CNS depression and apnea (neonates)

Question 12

Beta-adrenergic antagonists.

Answer 12

Timolol (Timopticâ)- secondary agent or tertiary agent for open glaucoma. Decreases production

Question 13

Beta-adrenergic antagonists side effects

Answer 13

depression, fatigue, bradycardia, respiratory depression, masking hypoglycemia, avoid in patients with asthma, bradycardia, COPD

Question 14

Carbonic anhydrase inhibitors:

Answer 14

Dorzolamide (Trusoptâ)- secondary or tertiary agent for open glaucoma. Decreases production. Useful if beta blocker not tolerated as tertiary agent

Question 15

Carbonic anhydrase inhibitors side effects

Answer 15

Fatigue-depression, paresthesias, kidney stones, bitter taste

Question 16

Cholinomimetics:

Answer 16

Pilocarpine (Ocusertâ). Initial treatment of closed glaucoma- induces miosis and removes trabecular space block.

Question 17

Cholinomimetics side effects

Answer 17

ciliary spasm (headache), myopia, dim vision

Question 18

Closed (narrow-angle) glaucoma cause

Answer 18

mechanical blockage of trabecular meshwork by peripheral iris

Question 19

treatment of closed glaucoma

Answer 19

intially: pilocarpine to remove block. Acetazolamide to decrease aqueous humor production and mannitol to produce intraocular dehydration. Definitive: laser peripheral iridotomy

Question 20

what meds should you avoid while waiting for closed angle glaucoma

Answer 20

decongestants and anticholinergic agents

Question 21

bacterial conjunctivitis treatment

Answer 21

Empiric therapy usually initiated with erythromycin or polymixin-trimethoprim