Ophthalmic Agents

Question 1

Dendritic figure seen on a fluorescein exam is indicative of what pathology?

Answer 1

Herpes keratitis (ocular herpes simplex)

Question 2

Fluorescein dye

Answer 2

dye found to be an excellent culture for pseudomonas aeruginosa.
MC use in staining eye with paper held against lower lid.
(paper may first be moistened with saline/Opthane
(will stain contact lenses!!)

Question 3

Dry Eye syndrome

Answer 3

AKA keratoconjunctivits sicca
MC due to contact lens wear
Also dt dry and windy environments, decreased tear production with age, autoimmune disease
may cause corneal abrasion, infx.
OTC lubricants available

Question 4

Cyclosporine/ Restasis

Answer 4

Class: initially marketed to prevent tissue rejection after transplant.
MOA: T-cell inhibition diminishes inflammation, allows for increased lacrimation
Indic: chronic dry-eye
Char: 0.05% solution
SE: local irrigation, very limited systemic absorption

Question 5

Some causes of conjunctivitis:

Answer 5

allergy (typically itchy with lid swelling)
viral (usu accompanied with URI Sxs, watery eyes)
bacterial (usu dt pyogenic Staphylococcus- will usu have irritation, stringy grey/yellow discharge)
Also thermal, UV burns, chemical toxin exposure, contact lens overuse

Question 6

Tetrahydrozoline/ Visine

Answer 6

Class: ocular astringent, redness reliever
MOA: vasoconstriction (tetrahydrozoline) and astringent (Zinc sulfate additive)
Indication: “gets the red out”, allergies
Char: solution
SE: local irritation, rebound vasodilation

Question 7

Azelastine/ Optivar

Answer 7

Class: ocular antihistamine
MOA: blocks HI receptor sites
Indication: allergic conjunctivitis
Char: solution
SE: local irritation, limited systemic absorption

Question 8

Ketorolac/ Acular

Answer 8

Class: ocular NSAID
MOA: COX inhibitor
Indic: ocular discomfort from swelling
Char: solution
SE: local irritation, limited systemic absorption,
no increased risk of cataracts, drug-induced glaucoma associated with ocular steroids

Question 9

What are some options for ocular antibiotics/antimicrobials?

Answer 9

Sulfonamides
Macrolides
Amino glycosides
Fluoroquinolones
Bacitracin/Polymyxin

Question 10

Bacitracin-Polymyxin B/ Polysporin Ophthalmic suspension

Answer 10

Class: antibiotic
Indic: bacterial conjunctivitis, blepharitis, corneal ulcers, styes, infected tear ducts, prophylactic use after corneal abrasion
MOA: inhibits bacterial protein synthesis
Char: solutions, ointments, applied in varying time schedules
SE: local irritation (esp from preservatives), systemic absorption limited

Question 11

Vidarabine/ Ara-A

Answer 11

Class: antiviral, HSV specific
Indic: HSV keratoconjunctivitis
MOA: inhibits viral DNA synthesis
Char: ointment, solution for ophthalmic use. IV for systemic use. not as effective for ophthalmic herpes zoster, as these info are deeper in cornea.
SE: local irrigation, systemic abs limited

Question 12

Common drugs used in glaucoma:

Answer 12

Beta-blockers
Prostaglandin analogs
Miotic agents
Alpha agonists
Carbonic anhydrase inhibitors

Question 13

Timolol/ Timoptic

Answer 13

Class: ocular beta-adrenergic agonist
Indic: glaucoma
MOA: blocks ocular effects of epinephrine–> reduced aqueous humor production
Char: solution, gels, BID dosing
SE: systemis absorption may cause worsening asthma, emphysema, low BP, fatigue, impotence

Question 14

Latanoprost/ Xalatan

Answer 14

Class: selective prostaglandin receptor agonist
MOA: increases uveoscleral outflow, thus reducing intraocular pressure
SE: few, local irritation, darkening of the iris (heterochromia), lengthening/thickening/darkening or eyelashes

Question 15

Pilocarpine

Answer 15

Class: cholinergic agonist (parasympathomimetics)
miotic agent indicated in glaucoma
causes ciliary muscle contraction–> tightened trabecular meshwork and increased outflow of aqueous humor