Ophthalmic Pharmacology Flashcards
anesthetic agent drug ex?
opthane
staining agent? what could you use it for diagnostically?
fluorescein dye
can use to see dendritic figure of herpes keratitis
mydriatic and cycloplegic drug?
homatropine
mitotic drug?
pilocarpine
6 ways to administer drugs to have their end action on the eye?
intravitreal intracameral topical suprachoroidal systemic periocular
other names of dry eyes? MC cause? what can happen if left untreated
keratoconjunctivitis sicca
xerophthalmia
MC cause: contact lenses, but can also be caused by dry and windy environments
if left untreated can lead to corneal ulceration or ocular infection
non-pharm interventions for dry eyes?
avoid anticholinergics
no smoking
warm compresses
take breaks from reading/looking at electronic devices
pharm interventions for dry eyes?
artificial tears
topical cyclosporine solution (SE: stinging, redness)
oral omega-6 FAs
causes of conjunctivitis? how each presents?
allergic: itchy, mild redness, watery eyes w/some lid swelling
viral: often assoc w/URI; watery d/c, itch, usu involving both eyes
bacterial: dt common pyogenic bacteria such as staph; causes marked irritation and grey or yellowish d/c
ways to tx allergic conjunctivitis?
avoid allergens: pollen, gust, animal dander, mold, cosmetics, etc
mild tx: cool compress + antihistamine/decongestant + lubricant
moderate tx: cool compress + antihistamine/decongestant + lubricant + mast cell stabilizer
severe tx: cool compress + antihistamine/decongestant + lubricant + steroid + NSAID + mast cell stabilizer
how does a decongestant work to help w/allergic conjunctivitis? examples?
constricts the dilated arterioles assoc w/conjunctiva
ex: tetrahydrozoline, naphazoline, phenylephrine
what are 2 decongestant/antihistamine combos?
antazoline/naphazoline
pheniramine/naphazoline
how do antihistamines work? 3 examples?
work by blocking H1 receptor sites
ex: azelastine hydrochloride, emedastine, olopatadine
3 examples of mast cell stabilizers?
ketotifen, cromolyn sodium, nedocromil sodium
4 NSAIDs?
ketorolac, diclofenac sodium, flurbiprofin, suprofen
drug of choice to tx bacterial conjunctivitis?
0.3% tobramycin solution or ointment, polymyxin B/Trimethoprim
drug of choice to tx a more severe bacterial conjunctivitis?
0.3% ofloxacin solution or 0.3% ciproflaxcin solution or ointment
if you don’t see improvement in bacterial conjunctivitis w/treatment, what is your next course of action?
suspect microbial resistance, incorrect drug or incorrect dx
how many times a day and for how many days are most anti-bacterial conjunctivitis drugs used?
usually applied every 2-4 hrs for a total of 7-10 days
2 options of topical antibiotic therapy for conjunctivitis? IV abx used when? what ointment can be used to tx s. pneumonia, h. flu resistance and is reserved primarily for prophylactic use in neonates against GC/CT?
aminoglycosides (gentamicin, neomycin, tobramycin drops)
flurorquinolones (broad spectrum; ciprofloxacin, ofloxacin, gatifloxacin, moxifloxacin)
IV abx for confirmed gonococcal or chlamydial dz
erythromycin ointment can be used to tx s. pneumonia, h. flu resistance; reserved primarily for prophylaxis of neonatal gonococcal and chlamydial infxn
ssxs of herpes simplex keratitis?
redness, sensation of a foreign body in the eye, blurred vision, pain, photophobia, watery
drug of choice to tx herpes simplex keratitis?
trifluridine topical solution
cytomegalovirus keratoconjunctivitis is mostly sees in what population? 3 tx options? if retinal lesions are life-threatening where and what do you inject?
immunosuppressed pts
ganciclovir, cidofovir, foscarnet
if life-threatening lesions inject ganciclovir or foscarnet intravitreally
what is glaucoma? two types?
ocular d/o involving optic neuropathy w/changes in optic disc and loss of visual sensitivity and field; may or may not involve increased intraocular pressure
leads to damaged optic nerve = visual loss and can lead to blindness
2 types: primary open-angle glaucome (MC), primary closed-angle glaucoma
first line tx of primary open-angle glaucoma?
beta blockers
prostaglandin analogs
adjunctive agents to use in the tx of open-angle glaucoma?
brimonidine, topical carbonic anhydrase inhibitors
second line tx for open-angle glaucoma?
pilocarpine, diprivefrin or ephinephrine, apraclonidine
what categories of drugs decrease aqueous production?
beta blockers
Alpha-2-adrenergic agonists
topical carbonic anhydrase inhibitors
what categories of drugs increase aqueous outflow?
prostaglandin analogs
parasympathomimetics
sympathomimetics
nonspecific beta blockers that can help with open-angle glaucoma?
timolol, levobunolol, metipranolol
relatively specific B-1 blocker?
betaxolol
nonspecific open-angle glaucoma tx w/partial beta agonist activity?
carteolol
which two open-angle glaucoma txs are more effective at lowering IOP?
timolol and levobunolol
which two open-angle glaucoma tx options have lower risks of systemic SEs?
betaxolol and carteolol
which category of open-angle glaucoma txs have lower risk of systemic SEs?
prostaglandin analogs have lower risk of systemic SEs than beta blockers
when do you administer prostaglandin analogs?
at bed
what is the #1 prescribed prostaglandin analog? SEs?
latanoprost
SEs: iris pigmentation, ocular irritation
alpha-2 adrenergic agonists can be used as adjunctive therapy with what other drugs?
beta blockers
prostaglandin analogs
CAIs
1 used alpha-2 adrenergic agonist? systemic SEs? cautions?
brimonidine
systemic SEs: dizziness, somnolence, dry mouth, decreased BP, decreased pulse
cautions: CVD, renal compromise, cerebrovascular dz, DM, pts taking anti-HTN, CAD drugs, MAO inhibitors, tricyclic antidepressants
what tx for open-angle glaucoma is rarely used as initial tx?
topical carbonic anhydrase inhibitors (CAIs)
what 2 CAIs are we most likely to see used?
dorzolamide, brinzolamide
how do CAIs work? SEs?
reduce IOP by decreasing bicarbonate production resulting in 40-60% decrease in aqueous humor secretion
generally well tolerated but can have local SEs such as ocular burning, stinging, discomfort and allergic reactions, bitter taste
