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Pharmacology 1 choefsho > Ophthalmic drugs > Flashcards

Ophthalmic drugs Flashcards

1
Q

How well do you remember your eye anatomy?

A

REVIEW

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2
Q

Why would you use ophthalmic drugs to DILATE (mydriasis) or CONSTRICT (miosis) the pupil?

A
  • Treat glaucoma (build up of pressure in the eye that can lead to blindness)
  • Treat uveitis (inflammation of the middle layer of the eye)
  • Diagnostic testing/retinal exam
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3
Q

Why would you want to use ophthalmic drugs to decrease the production of aqueous fluid or intraocular pressure?

A

Treat glaucoma

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4
Q

What types of drugs would you use to increase the production of tears?

A
  • Artificial tears
  • Immunosuppressive therapy
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5
Q

Why are topical ophthalmic preparations preferred over systemic drugs?

A
  • Topicals ave high local concentrations and low systemic absorption
  • Topicals typically reach the anterior chamber and less get into the posterior chamber
  • Systemic drugs may not reach parts of the eye in sufficient concentrations
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6
Q

Typically, how many drops can one eye hold?

A

1 drop

  • When a drop is instilled in the conjunctival sac, blinking distributes it over the corneal surface diluted in tears
  • Excess spills over or drains through nasolacrimal duct (absorbed by mucous membranes or swallowed)
  • Ideally wait 5 minutes between drops
  • Slower elimination achieved with ointments
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7
Q

T or F. Miosis is a feature of the parasympathetic nervous system where the iris sphincter muscle and the ciliary body contracts.

A

True

  • Contraction of the ciliary body allows the lens to accommodate for near vision and lifts the iris away from the trabecular meshwork and increases uveoscleral aqueous outflow
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8
Q

T or F. Mydriasis is a feature of the sympathetic nervous system which relaxes the ciliary body and contracts the iris dilator muscles.

A

True

  • Relaxation of the ciliary body allows the lens to accommodate for far vision
  • Aqueous humor is also formed with the sympathetic nervous system
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9
Q

Miotics generally cause pupil ____________________ (constriction/relaxation) which ______________ (opens/closes) the drainage angle.

A

Miotics generally cause pupil constriction which opens the drainage angle.

  • Contraction of the ciliary body also lifts the iris away from the trabecular meshwork and improves aqueous outflow
  • Generally do not use if anterior uveitis or anterior lens luxation
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10
Q

What do pilocarpine (Pilostat), physostigmine and demecarium (Humorsol), and echothiophate (phospholine iodide) all have in common?

A

They are parasympathomimetic miotics (not used much)

(I saw a pile of cars (pilocarpine) in front of me so I threw my fist (physostigmine) at them (demecarium) and echo‘ed (echothiophate) _P_lease _M_ove’)

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11
Q

Which parasympathomimetic drug would you use to treat glaucoma and also to diagnose parasympathetic lesions (e.g. CN III)?

  1. Pilocarpine (Pilostat)
  2. Physostigmine and Demecarium (Humorsol)
  3. Echothiophate (phospholine iodide)
A
  1. Pilocarpine (Pilostat)
  • Direct acting parasympathomimetic
  • Lasts 2-6 hours (not as long as indirect acting PMs
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12
Q

Which parasympathomimetic drug has a very long duration of miosis (>12 hours)?

  1. Pilocarpine (Pilostat)
  2. Physostigmine and Demecarium (Humorsol)
  3. Echothiophate (phospholine iodide)
A
  1. Echothiophate (phospholine iodide)
    * Indirect acting parasympathomimetic (irreversible cholinesterase inhibitor)
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13
Q

Which parasympathomimetic drug increases uveoscleral drainage (up to 48 hours) and is usually used as a preventative for glaucoma in other other eye?

  1. Pilocarpine (Pilostat)
  2. Physostigmine
  3. Demecarium (Humorsol)
  4. Echothiophate (phospholine iodide)
A
  1. Demecarium (Humorsol)
    * Indirect acting parasympathomimetic (reversible cholinesterase inhibitor)
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14
Q

Which parasympathomimetic increases uveoscleral drainage (up to 48 hours) and readily crosses the BBB (systemic absorption may cause seizures) so must be used with caution in small patients?

  1. Pilocarpine (Pilostat)
  2. Physostigmine
  3. Demecarium (Humorsol)
  4. Echothiophate (phospholine iodide)
A
  1. Physostigmine
  2. Indirect acting parasympathomimetic (reversible cholinesterase inhibitor)
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15
Q

Which long lasting (>120 hours) ophthalmic drug causes mydriasis and also cycloplegia, which relieves pain associated with corneal or iris diseases (uveitis)?

  1. Tropicamide (Mydriacyl)
  2. Atropine (Atrophate)
  3. Phenylephrine (ophthalmic)
A
  1. Atropine
  • Direct acting parasympatholytic (anticholinergic)
  • Onset 1 hours, lasts 120+ hours!
  • Can break up synechiae (adhesions) in uveitis
  • DO NOT USE IN PRIMARY GLAUCOMA
  • Generally minimal systemic absorption
  • Cycloplegia can causes horses to freak out
  • Bitter taste, especially in cats (frothy ass mouth when drops used)
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16
Q

Which ophthalmic drug is similar to atropine, but has a faster onset and shorter duration, which is good for ophthalmic (funduscopic) exams?

  1. Tropicamide (Mydriacyl)
  2. Atropine (Atrophate) PLEASE DON’T CHOOSE THIS ANSWER
  3. Phenylephrine (ophthalmic)
A
  1. Tropicamide (Mydriacyl)
  • Direct acting parasympatholytic
  • Causes mydriasis and cycloplegia (like atropine)
  • Onset 15-30 minutes, duration 6-12 hours
  • Used to dilate the pupil for ophthalmic (funduscopic) exam
  • Used to prevent adhesions after cataract surgery (pain control by doing cycloplegia)
  • Less effective pain control than atropine
  • Less bitter but cats still hypersalivate
  • AVOID IN GLAUCOMA
  • May alter Schirmer’s tear tests (cats and horses) so usually do this test first before any other eye exams
17
Q

Which ophthalmic drug causes mydriasis through the contraction of the iris DILATOR muscle (alpha-1 agonist) and is more commonly used to diagnose Horner’s syndrome?

  1. Tropicamide (Mydriacyl)
  2. Atropine (Atrophate)
  3. Phenylephrine (ophthalmic)
A
  1. Phenylephrine (ophthalmic)
  • Peioperative use in cataract surgery (reduction of posterior synechiae formation)
  • More often used to help in diagnosis and treatment of Horner’s syndrome (localize the lesion) than as a primary mydriatic
  • Can cause cardiovascular side effects (esp in small patients > increased systolic BP)
  • Cats and horses unlikely to cause adequate mydriasis alone (used in combination with another agent)
18
Q

Which of the following drugs DO NOT reduce aqueous humor formation and/or improve aqueous outflow?

  1. Prostaglandin analogs (latanoprost)
  2. Parasympatholytic (tropicamide)
  3. Beta-antagonists (timolol)
  4. Alpha-agonists (brimonidine)
  5. Carbonic anhydrase inhibitors (dorzolamide, brinzolamide)
A
  1. Parasympatholytic (tropicamide)
19
Q

Which ophthalmic drug is a topical carbonic anhydrase inhibitor which decreases aqueous humor production?

  1. Brimonidine (Alphagen)
  2. Timolol (Timoptic)
  3. Dorzolamide (Trusopt) and Brinzolamide (Azopt)
  4. Latanoprost (Xalatan)
A
  1. Dorzolamide (Trusopt) and Brinzolamide (Azopt) [common]
  • *Covered under diuretics
  • Reversible inhibition of carbonic anhydrase which decreases aqueous humor production
  • Sulfonamide derivatives (caution if hypersensitivity to sulfa)
  • Dorzolamide may sting more than brinzolamide
  • Dorzolamide + timolol = Cosopt
20
Q

Which ophthalmic alpha-agonist is sometimes used in dogs to treat glaucoma by decreasing aqueous humor formation/flow, but can cause mydriasis?

  1. Brimonidine (Alphagen)
  2. Timolol (Timoptic)
  3. Dorzolamide (Trusopt) and Brinzolamide (Azopt)
  4. Latanoprost (Xalatan)
A
  1. Brimonidine (Alphagen)
    * Mydriasis may occur (alpha-1 receptors) so other drug are preferred
21
Q

Which ophthalmic drug is a nonselective beta-antagonist (beta-blocker) used in glaucoma management by preventing glaucoma in the contralateral eye?

  1. Brimonidine (Alphagen)
  2. Timolol (Timoptic)
  3. Dorzolamide (Trusopt) and Brinzolamide (Azopt)
  4. Latanoprost (Xalatan)
A
  1. Timolol (Timoptic)
  • Decreases aqueous formation
  • May cause some miosis
  • Timolol + dorzolamide = Cosopt
22
Q

Which ophthalmic drug is a topical prostaglandin analog that treats glaucoma and reduces IOP by increasing uveoscleral outlfow by stimulating FP receptors in the eye?

  1. Brimonidine (Alphagen)
  2. Timolol (Timoptic)
  3. Dorzolamide (Trusopt) and Brinzolamide (Azopt)
  4. Latanoprost (Xalatan)
A
  1. Latanoprost (Xalatan), very effective but $$$
  • Topical
  • Travoprost (Travatan) and Brimatoprost (Lumigan) also used
23
Q

What makes up the 3 layers in natural tear film?

A

Water, lipid film, and mucin

24
Q

_________________ agents provide lubrication but do not perfectly replicate natural tears.

A

Lacrimomimetic agents

  • Usually used temporarily, unless KCS (dry eye) which might have to be used long term
25
Q

Which lasts longer, drops or ointments?

A

Ointments

  • Less dilution
  • Slower breakdown by tears/enzymes
  • Less drainage via nasolacrimal duct
26
Q

________________ agents increases the production of natural tears.

A

Lacrimogenic agents

  • Cyclosporine (Optimmune)
  • Tacrolimus (Protopic)
27
Q

Which lacrimogenic agent is the first drug used in the treatment of canine Keratoconjunctivitis Sicca (KCS) by causing local immunosuppression?

  1. Cyclosporine (Optimmune)
  2. Tacrolimus
A
  1. Cyclosporine (Optimmune)
  • Not effective in felines
  • BID topical
  • May be lifelong
  • Monitor by measuring tear production (Schirmer Tear Test)
  • Local immunosuppression (caution if infection, wear gloves to administer)
28
Q

Which lacrimogenic agent is usually the 2nd tear drug that decreases T-cell activation and may be a potential carcinogen?

  1. Cyclosporine (Optimmune)
  2. Tacrolimus (Protopic)
A
  1. Tacrolimus (Protopic)
  • Alternative to cyclosporine (works on different receptors), works on some patients that are not responsive to cyclosporine
  • Used more for perianal fistulas
  • Also immunosuppressive
  • Wear gloves!
29
Q

Which anti-inflammatory ophthalmic drug would you use on a diabetic patient with non-infectious keratitis, uveitis?

  1. Topical corticosteroids (dexamethasone, prednisolone)
  2. Topical NSAIDs (flurbiprofen, diclofenac)
A
  1. Topical NSAIDs (flurbiprofen, diclofenac)
  • Similar to topical steroids in that it gives higher local concentrations and lower systemic concentrations
  • Used to manage uveitis and some keratitis
  • For extraocular inflammation would use systemic NSAIDs
  • May be used to manage inflammation associated with cataracts (e.g. diabetic patients)
  • Contraindicated if corneal ulcers, glaucoma or coagulopathies
  • Can be irritating and cause buring/stinging
30
Q

Which anti-inflammatory ophthalmic drugs is used to manage inflammatory and immune-mediated conditions (NON-INFECTIOUS keratitis, uveitis), but not on patients with diabetes or infections?

  1. Topical corticosteroids (dexamethasone, prednisolone)
  2. Topical NSAIDs (flurbiprofen, diclofenac)
A
  1. Topical corticosteroids (dexamethasone, prednisolone)
  • We want to make sure there is no existing infection there because we are immunosuppressing for the reason that there is an inflammation for no good reason (we want our immunity to fight infections first)
  • Local vs. systemic (even with local, there is some systemic absorption)
    • May not be enought to show systemic ‘corticosteroid’ signs, but may be enough to alter adrenal function tests
  • Contraindicated if corneal ulcers (less healing), infection, or diabetes
  • Systemic steroids needed to treat conditions involving the BACK of they eye (retina, optic nerve)
31
Q

T or F. Both topical and systemic antimicrobial drugs are used to treat ophthalmic conditions.

A

True

  • Use of topical therapies can circumvent systemic toxicity issues (e.g. aminoglycosides, polymyxin)
  • Typically used to treat conjunctival and corneal infectious diseases (infections within the globe likely require systemic therapy; caution of corneal ulcers)
  • May be combine products (>1 antibiotic, with or without an anti-inflammatory agent)
  • Typically require frequent administration (QID)
  • Antibiotics, antifungals, antivirals
32
Q

Why should we be cautious when using antibiotics as an ophthalmic route?

A

Some can be damaging to epithelial cells (epitheliotoxic) or inhibitory to keratocytes and could impair corneal healing or worsen deep corneal ulcers

  • Select based on suspected organism, gram stain or culture/sensitivity (usually going to be a secondary infection)
  • Frequently used as an adjunct/preventative therapy)
  • Aminoglycosides (gentmicin, neomycin, tobramycin)
  • Fluoroquinolones (ciprofloxacin, moxifloxacin, ofloxacin)
  • Chloramphenicol (Chloromycetin)
  • Bacitracin/Polymyxin B. Neomycin (‘triple’ antibiotic oint.)
  • Oxytetracycline (Terramycin)
33
Q

What are antiviral ophthalmic agents commonly going to be used for?

A

Feline viral infections (e.g. herpes)

  • Generally reserved for more severe cases; will probably not use in chronic cases
  • Potential adverse effects- bone marrow, hepatic and renal toxicity (greater risk with systemic antivirals)
  • Can be irritating
  • Topical: Gancyclovir (Zirgan)
  • Systemic: Famcyclovir (Famvir)
  • L-lysine oral supplementation (nutritional amino acid)
34
Q

What are antifungal ophthalmic agents usually used for?

A

Fungal keratitis, conjunctivitis

  • Less frequently used than antibiotics
  • Natamycin (Natacyn)- human labeled product
  • Numerous compounded or extra-label products used
  • Will probably want to be in contact with an ophthalmologist at this point
35
Q

What ophthalmic local/topical anesthetic is used to decrease corneal sensation to allow diagnostic evalulation (e.g. tonometry)?

A

Proparacaine (Alcaine)

  • MOA same as other local anesthetics by blocking sodium channels to prevent axonal depolarization

Pharmacology 1 choefsho (13 decks)

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