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RUSVM Pharmacology > Ophthalmic Drugs > Flashcards

Ophthalmic Drugs Flashcards

1
Q

What are routes of administration of ophthalmic drugs?

A

Topical

Systemic - must overcome blood-ocular barrier

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2
Q

Why are topical preparations usually preferred for ophthalmic medications

A

High local concentration with low systemic absorption

Reach anterior chamber of the eye

Systemic drugs may not reach part of the eye in sufficient concentrations

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3
Q

The dog/cat eye can hold ________________ amount of fluid and excess will drain into the __________________

A

One drop; nasolacrimal duct

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4
Q

How long should you wait between administration of ocular drops? Why?

A

5mins

Wait for first medication to be absorbed
Adding one drop after another will wash out the first/overflow into the nasolacrimal duct

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5
Q

What are adverse effects of using topical ophthalmic medications

A

Irritating to eye
Effects of drug if it is systemically absorbed or swallowed (usually little concern)
Alteration of function or diagnostic tests
Difficult to administer repeatedly and frequently

Short acting at site -> washing by tears

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6
Q

What is used commonly in equines to administer ophthalmic drugs frequently?

A

Subpalpebral lavage system

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7
Q

The __________________ nervous system will cause miosis and contraction of the ciliary body

A

Parasympathetic

Constriction of the iris sphincter

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8
Q

Contraction of the ciliary body will cause lens accommodation for __________ vision

A

Near

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9
Q

What effect will the PSNS have on aqueous outflow ?

A

Lifts the iris away from the trabecular meshwork and increases the uveoscleral angle => increased outflow

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10
Q

The ______________ nervous system will cause relaxation of the ciliary body and mydriasis

A

Sympathetic

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11
Q

The sympathetic nervous system will cause lens accommodation for ______ vision

A

Far

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12
Q

What effect with the SNS have on aqueous humor?

A

Ciliary body relaxation causes decreased angle of the uveoscleral angle -> accumulation of aqueous humor

This is why SNS drugs are contraindicated in glaucoma (increase IOP)

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13
Q

What effects will mitotic drugs have?

A

Pupil contraction

Open drainage angle => improved aqueous outflow

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14
Q

When should mitotic not be used?

A

Direct and indirect acting parasympathomimetics

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15
Q

What is the MOA of pilocarpine

A

Direct acting parasympathomimetic

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16
Q

What is the duration of pilocarpine?

A

Miosis lasting 2-6 hours

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17
Q

What is the main clinical use of pilocarpine

A

Diagnosis of parasympathetic lesions

Uncommonly used to treat glaucoma and keratoconjunctivitis sicca ‘dry eye’ (KCS)

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18
Q

What is the MOA of atropine?

A

Direct acting parasympathoLYTIC

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19
Q

What effect will atropine have on the eye and what is its main indication?

A

Mydriasis
Cycloplegia (paralysis of ciliary muscle)

Reduced pain associated with corneal or iris disease
Break up synechiae in uveitis (ciliary body attached to lens-> ciliary body relax/dilate pupil to detach from the lens)

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20
Q

When is topical ophthalmic atropine contraindicated

A

Primary glaucoma!

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21
Q

What are precautions to using atropine topically in the eye?

A

Cycloplegia -> horse may panic

Very bitter taste -> cat will froth at the mouth

Generally minimal systemic absorption but in some cases may see increased heart rate

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22
Q

What is the MOA of tropicamide?

A

Direct acting parasympathoLYTIC

Causing mydriasis and cycloplegia

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23
Q

How does the duration of tropicamide compare to atropine?

A

Tropicamide (onset 15mins; duration 6hrs) has faster onset and shorter action than atropine (onset 1hr; duration 120+ hrs)

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24
Q

What are the indications for tropicamide?

A

Dilate pupil for ophthalmic exam

Prevent adhesions after cataract surgery

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25
Q

What are precautions to using tropicamide?

A

Bitch better not be using this in glaucoma patients

Less effective pain control than atropine
Less bitter but can still cause hypersalivation in catto
Alter Schirmers tear test (as any drop in the eye would do)

26
Q

What is the MOA of ophthalmic phenyleprhine

A

Direct acting sympatoMIMETIC - A1 agonist

Causes mydriasis through contraction of the iris dilator muscle

27
Q

What is phenylephrine most commonly used for in the eyeball?

A

Diagnosis and localization of Horner’s syndrome

28
Q

What is a side effect to using ophthalmic phenylephrine ?

A

Cardiovascular side effects (esp in small patients -> increases systolic BP)

Cats and horses-> need to be used in combo with another agent to cause adequate mydriasis

29
Q

What are two ways that drugs can treat/manage glaucoma ?

A

Decreased aqueous humor formation

OR

Increased aqueous humor drainage

30
Q

What is used to decrease aqueous humor formation and prevent glaucoma?

A

Timolol

31
Q

What is the MOA of Timolol

A

Non selective B-antagonist

Miosis and decreased aqueous humor formation

32
Q

What are the topical carbonic anhydrase inhibitors

A

Dorzolamide

Brinzolamide

Sulfonamides derivatives

33
Q

What is the MOA of dorzolamide?

A

Reversible inhibitor of carbonic anhydrase (CA)

34
Q

What effect will dorzolamide have?

A

Decrease aqueous humor production -> reduce IOP

35
Q

What are precautions to using Sulfonamide derivatives

A

Hypersensitivity to sulfa

36
Q

What is the main effect of topical prostaglandin analogs (ophthalmic)

A

Increase uveoscleral outflow by stimulating FP (prostaglandin ) receptors in the eye

37
Q

T/F: we can not use prostaglandin analogs to treat glaucoma in dogs

A

F

We can use in doggo, but not in cat and horse

38
Q

What are the prostaglandin analogs that can be used to reduce IOP

A

Latanoprost
Travoprost
Bimatoprost

39
Q

_________________ agents provide lubrication to do not perfectly replicate natural tears

A

Lacromomimetic

40
Q

What is the difference between drops and ointments?

A

Ointments will have prolonged contact time

  • > less dilution
  • > slower breakdown by tears/enzymes
  • > less drainage via nasolacrimal duct
41
Q

What topical immunomodulators are used for tear production

A

Cyclosporine

Tacrolimus

42
Q

What is the main effect of cyclosporine?

A

Treatment of canine KCS (keratoconjucntivitis sicca)

43
Q

When do we used tracolimus and what is a precaution to using it?

A

Alternative to cyclosporine when they are not responsive to this -> tear production

Link to cancer in patients -> Wear your gloves (as you should in all medical procedures)

44
Q

What do we use to manage inflammatory and immune mediated eyeball conditions like non-infectious keratitis, uveitis.

A

Topical glucocorticoids

45
Q

When are topical glucocorticoids contraindicated?

A

Corneal ulcers, infection, or diabetes

46
Q

How do you treat conditions involving the back of the eye (retina/optic nerve)

A

Systemic steroids

47
Q

What are the topical glucocorticoids ?

A

Dexmethasone
Prednisolone
Etc, etc, etc….

48
Q

_____________ is used in the management of inflammation associated with uveitis and some keratitis

A

NSAIDS

49
Q

Do we use NSAIDS with glucocorticoids

A

How about NO

50
Q

When is the use of NSAID in the eye contraindicated

A

Corneal ulceration, glaucoma, or coagulopathies

Can cause burning/stinging

51
Q

What are the topical NSAIDS

A

Flurbiproven

Diclofenac

52
Q

What is an opthalamic topical anesthetic

A

Proparacaine

Used for diagnostic evaluation ad minor procedures

53
Q

What is the MOA of proparacaine

A

Block Na+ channels to stop depolarization

54
Q

When do we most commonly used opthalamic antiviral agents

A

Manage feline viral infections and only in severe cases

55
Q

What are adverse effects of using opthalamic antivirals?

A

Bone marrow, hepatic, and renal toxicity

56
Q

What is the topical ophthalmic antivirals

A

Gancyclovir

57
Q

What is the systemic ophthalmic antiviral

A

Famcyclovir

58
Q

What is used to treat fungal keratitis/conjunctivitis ?

A

Antifungals

Natamycin (human labeled)

59
Q

T/F: both topical and systemic antimicrobial drugs are used to treat ophthalmic conditions

A

T

60
Q

Infections within the globe require (topical/systemic) antimicrobial therapy

A

Systemic

61
Q

What are precautions to using topical antibiotics?

A

Damaging to epithelial cells
Inhibitory to keratocytes
Impair corneal healing or worsen corneal ulcers

62
Q

What species can have a rare reaction to Polymixin or Bacitracin in opthalamic treatments

A

Cats… of course, who else.

RUSVM Pharmacology (18 decks)

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