Ophthalmology Medications Flashcards
tx and prevention of opthalmia neonatorum
- form of neonatal conjunctivitis
- prevention: erythromycin ointment
- thin ribbon on each eye within 1 hour of birth
- tx: cefotaxime IM/IV BID x 7 days
tx of allergic conjunctivitis
slow or stop release of cytokine
1st line = topical antihistamine + decongestant
topical decongestants : alleviate erythema (redness, burning, stinging)
Keep Allergens Near Other People
- ketotifen (H1 receptor antagonist/ mast cell stabilizer/ eosinphil inhib.)
- azelastine (H1 receptor antagonist/ mast cell stabilizer)
- nedocromil (H1 receptor antagonist/ mast cell stabilizer)
- olopatadine (H1 receptor antagonist/ mast cell stabilizer)
- pemirolast (Mast cell stabilizer)
Red Flag Symptoms of the Eye
- reduction of visual acuity
- ciliary flush (redness at the cornea and sclera, and limbus)
- photophobia
- severe foreign body sensatiion
- corneal opacity
- fixed pupil
- severe headache with nausea
General Treatment for acute bacterial conjunctivitis
(List 1-5)
- Macrolides(erythromycin) (first line)
- Combo (TMP-Polymyxin B, polymyxin B with Bacitracin) (first line)
- Quinolones (Ciprofloxacin, moxifloxacin, ofloxacin, gatifloxacin) Expensive (reserved for recurrent infections
- Sulfa (TMP, sulfacetamide)
- Aminoglycosides (gentamicin, tobramycin, neomycin)
tx of hyperacute bacterial conjunctivitis
ceftriaxone 1g IM x1 + topical abx
refer to ophthalmologist
tx of viral conjunctivitis
- artificial tears
- the “Refresh” eye drops
- no preservatives and active ingredients are CMV, Glycerin, Mineral Oil, and PVA
- the “Refresh” eye drops
- Topical decongestants
- phenylephrine (alpha-agonists)
- tetrahydrozoline (Visine)
- **Be careful with long term use ⇒ rebound congestion
- NO longer than 10 days
Bacterial keratitis
bacterial infection of the cornea
- common pathogens: pseudomonas, gram - rods; strep; staph
- if left untreated can lead to corneal scarring and loss of vision
tx of bacterial keratitis
start with broad spectrum abx empirically
- start with: cefazolin & tobramycin or fluoroquinolones
- gram + cocci:
- cefazoline or vancomycin or bacitracin or moxifloxacin
- gram - rods:
- tobramycin, gentamycin, ceftazidime or fluoroquinolones
- gram - cocci:
- ceftriaxone or ceftazidime (3rd gen ceph) or fluoroquinolones
- Nontubercuolosis mycobacteria:
- amikacin or clarithromycin
Risk factors for Dry Eye
- older age
- female
- connective tissue disease
- vitamin A deficiency
- Androgen deficiency
- estrogen replacement therapy
Tx for Severe Dry Eye
- Systemic Treatments:
- stimulat muscarinic receptors:
- pilocarpine or cevimeline
- stimulat muscarinic receptors:
- Topical:
- immunomodulator that increases tear production
- cyclosporine ophthalmic emulsion
- xiidra (lifitegrast)
- immunomodulator that increases tear production
Drainage of Aqueous Humor
- 8% through the trabecular meshwork and the Canal of Schlemm
- 20% through the ciliary muscle
- modulated by:
- adrenoreceptors
- prostanoid receptors
- prostamide (porstaglandin ethenolamide) receptors
- modulated by:
What is the name of the angle that determines whether is is open angle glaucoma or closed angle glaucoma
irido-corneal angle
Intraocular Pressure
- Normal: 10-21 mmHg
- Optic nerve Damage over Several Years: 21-30mmHg
- Rapid Optic Nerve Damage: 40-50mmHg
- Emergency!
Open Angle Glaucoma
- Asymptomatic
- slow, insidious loss of vision
- may take 13-16 years
- 4-8% progress to legal blindless
- peripheral vision is most susceptible
- central vision preserved until advanced disease
What IOPs to refer primary open angle glaucoma?
IOP> 40mmHg = EMERGENT REFERRAL
IOP = 30-40mmHG: urgent referral (within 24 hours)
IOP = 25-29mmHg: referral within 1 week
IOP =23-24mmHg: repeat measurement to confirm
Aqueous Humor Inflow is controlled by:
- Alpha-2 adrenergic receptor agonists
- Beta-blockers
- Carbonoic anhydrase inhibitors
Aqueous humor outflow is controlled by:
- Trabecular Outflow
- muscarinic agonists
- Uveoscelral outflow
- prostaglandin agonists
1st line glaucoma treatment
- beta blockers
- reduce aqueous humor production
- Timoptic
- Monotx = tachyphylaxis in 20-50%
- SEs:
- systemic absorption via nasolacrimal duct = bronchospasm, bradycardia, hypotension, CHF exacerbation
- Local: stinging, conjuctivitis, keratitis, dry eyes, uveitis,
- due to preservatives
1st line glaucoma treatment (not beta-blockers)
- Prostaglandin analogs (ocular hypotensive lipids) once daily
- end in “prost”
- latanoprost
- keep in fridge until open, 6weeks at RT
- travoprost
- tafluprost
- bimaprost
- latanoprost
- increase aqueous humor outflow
- end in “prost”
- Contraindications:
- macular edema
- history of herpetic keratitis
- SEs:
- HA, stinging
- hyperpigmentation of iris, hypertrichosis (increased eyelash growth), darkening of eyelashes
- conjunctival hyperemia (enlargement of blood vessels in the conjunctiva)
Alpha-2 Agonists and Glaucoma
- decrease aqueous humor production (inflow)
- “idine”
- Brimonidine
-
Apraclonidine
- long term = tachyphylaxis
- SEs:
- HA, dry mouth, fatigue
- eyelid retraction
- foreign body sensation
- used to prevent increased IOP after surgery
Carbonic Anhydrase Inhibitors and Glaucoma
- carbonic anhydrase is an important step in aqueous humor production
- “zolamide”
- Dorzolamide
- Brinzolamide
-
Acetazolamide
-
CI:
- significant liver impairment, cirrhosis
-
CI:
- methazolamide
- SEs:
- burning, stinging, itching, foreign body sensation, dry eyes, conjuctivitis
- AVOID USE if Crcl <30
-
Contraindication:
- do NOT use if pt has sulfonamide allergy
Direct Acting Cholinergic Agents and Glaucoma
-
pilocarpine 3rd line
- stimulates M3 receptors
- ciliary muscle contraction = widening of spaces in trabecular network
- Se:
- pupillary spasm, myopia, increased risk of retinal detachment
- N/V/D and bradycardia
- stimulates M3 receptors
-
Carbachol
- stimulates M3 and inhibits AchE
- more potent than pilocarpine but more SEs
Indirect Acting Cholinergic Agents and Glaucoma
- echothiophate iodine
- SE:
- similar to pilocarpine
- can deplete systemic cholinesterases and pseudocholinesterases → cataracts
- should d/c 1 week before general surgical procedures
- DDI: toxic accumulation of echothiophate because succinulcholine is metabolized by pseudocholinesterases
Hyperosmotics and Glaucoma
- Glycerin
- isosorbide
- mannitol 20%
- SE:
- HA, thirst
- Caution: CNS dehydration can lead to coma; renal & CV diseases
- HA, thirst
- SE:
Non-selective adrenergic agonists and glaucoma
- rarely used
- epinephrine
- dipivefrin (prodrug that is metabolized to epinephrine)
- stimulation of alpha and beta receptors leads ot increased outflow through trabecular meshwork and uveoscleral pathway
- also reduces the production of aqueous humor
- SEs:
- mydriasis, conjunctival hyperemia
- palpitation, HTN, arrhythmias
- Cautions: CV disease, hyperthyroidism
- CIs: narrow angles can lead to acute angle closure
loteprednol
used for allergic conjunctivits
- Steroid
- not very popular due to SEs:
-
increased risk of IOP/risk of cataracts
- reserved for very severe cases
-
increased risk of IOP/risk of cataracts
Allergic conjunctivitis and Mast Cell Stabilizers
typically used for chronic allergic conjunctivitis because it takes 4-6 weeks to reach maximal effect
**not helpful for acute AC**
- cromolyn
- lodoxamine
- nedocromil
Ketorolac
- allergic conjuctivitis
- only NSAID used for itching but may take up to 2 weeks for full efffects and short duration of therapy
- 5 days on, 5 days off
- SEs:
- GI Side effects
