Ophthalmology Pharm Week 2 Flashcards
Indications for NSAIDs?
3
Used for analgesia, antipyretics and anti-inflammatory effects.
Five NSAIDs used for post op pain after surgery?
Diclofenac (Voltaren), Suprofen (Profenal), Brofenac (Xibrom), Flurbiprofen (Ocufen), Nepafenac (Nevanac)
What NSAID is used for photophobia?
Voltaren
What NSAIDs are used for prevention of intraoperative myosis?
2
(Ocufen and Profenal)
What NSAID is used for relief of ocular inflammation due to seasonal allergic conjunctivitis?
Ketorlac tromethamine O.5% soln (Acular)
Downsides to NSAIDs?
3
- Have no effect on IOP
- May cause burning and stinging
- Don’t use for longer then 2 weeks or can cause corneal injury
Should we as PAs every prescribe corticosteroids?
never, only ophthomalogist
Mechanism of action for corticosteriods for the eye?
2
reduce inflammation and decrease edema
Indications for corticosteroids?
4
Treatment of steroid responsive inflammatory conditions. Some examples are: Acute iritis Stromal keratitis Chemical burns Episleritis/Scleritis
Types of corticosteriods for eye treatment? 6
And what is the most commonly used one?
- Prednisolone acetate 1% soln (Pred Forte) most commonly used
- Prednisolone sodium phosphate 1% or 0.125% soln (Inflamase Forte, Metreton)
- Dexamethasone/Tobramycin oint/susp (Tobradex)
Steroid/antibiotic combo (STAY AWAY FROM THIS) - Dexamethsone 0.05%, 0.1% oint/soln
Topical dexamethasone preparations are also potent agents. - Fluorometholone 0.1% soln (Flarex)
- Fluorometholone 0.25% susp. (FML-Forte)
Side effects of corticosteriod treatment?
3
- Mydriasis,
- ptosis,
- inhibition of corneal epitheliem/stromal healing
Repeated use or long term use hazards of corticosteroids?
5
- Cataracts
- Corneal thinning and/or rupture
- Glaucoma leading to optic neuritis
- Immunosuppression: increased incidence of eye infections, mask acute (fungal) infections, prolong or exacerbate viral infections
- Keratitis
Contraindications for corticosteriod treatment?
2
- Viral disease of the cornea or conjunctiva (herpes simplex keratitis)
- Mycobacterial or fungal infections of the eye
Agents for glaucoma?
(whats 1st line?)
(whats 2nd line?)
5
(1st line) Prostaglandin Analogs (2nd line) Beta Blockers Alpha adrenergic agonists * Cholinergic agonists * Carbonic Anhydrous Inhibitors *
Mechanism of action for prostaglandin analogs?
Increase uveoscleral outflow of the aqueous.
giving it another way to drain other than through the trabecular meshwork
Medications that are prostaglandin analogs?
3
Latanoprost (Xalatan) $95-$131
Bimatoprost (Lumigan) $251
Tafluprost (Zioptan) $125
Side effects of prostaglandin analongs?
5
Decreased visual acuity Eye discomfort Dry eye Foreign body sensation Could change the color of the iris
What should we not mix with prostaglandin analogs due to drug interactions?
NSAIDs
Mechanism of action of beta bockers?
2 ways it could help
May decrease aqueous humor formation or increase outflow
Types of beta blockers?
3
Betaxolol (Betoptic)
Timolol maleate (Timoptic)
Levobunolol (Betagan, AKBeta)
MOA of Betaxolol (Betoptic)?
Selectively blocks beta1-adrenergic receptors with little or no effect on beta2-receptors.
(affects heart not lungs)
MOA of Timolol maleate (Timoptic)?
Nonselective beta-adrenergic blocking agent
MOA of Levobunolol (Betagan, AKBeta)?
Nonselective beta-adrenergic blocking agent
If you have an asthmatic patient what will you decide to treat with (which drug?)
Betaxolol (Betoptic)
Because its selective for B1 which only affects the heart. Timolol maleate and Levobunolol are nonselective and affect both the heart and the lungs
Both will decrease HR