Ophthamology: Ocular Pharm Flashcards
How many mg of atropine are in 5cc of a 1% solution?
50mg
1% = 1 gram/ 100cc
1 gram/ 100cc x 5 grams = 0.05 grams = 50mg
Tetracaine
Topical Anesthetic (Eye Drop)
MOA: blocks sodium channels
Toxicity: corneal toxicity, never prescribe for home use (corneal melting)
Epinephrine
Glaucoma treatment
MOA: non-selective adrenergic agonist
-increases trabecular outflow from anterior chamber to decrease IOP
Phenylephrine
Treatment for glaucoma
MOA: direct-acting alpha agonist
-Mydriasis with NO EFFECT ON THE CILIARY MUSCLE
Contraindicated: INFANTS (do not use)
Aproclonidine
Treats glaucoma
MOA: alpha 2 agonist
-suppresses aqueous humor production
Adverse effects: somnolence in children (doesn’t cross BBB in adults)
Brimonidine
Treats Glaucoma
MOA: alpha 2 agonist
-suppresses aqueous humor production
Adver effects: causes sedation by binding to alpha 2 receptors in the CNS, somnolence in children
Timolol
Treats Glaucoma
MOA: blocks Beta 1 and Beta 2
- suppresses aqueous humor production
- NO EFFECT ON OPTIC NERVE BLOOD FLOW
Adverse Effects: may exacerbate Myasthenia Gravis
Betaxolol
Treats Glaucoma
MOA: selective Beta 1 blocker
- decreases aqueous humor production
- SAFE TO USE ON PATIENTS WITH LUNG DISEASE
Carteolol
Treats Glaucoma
MOA: blocks Beta 1 and Beta 2
- suppresses aqueous humor production
- NO EFFECT ON OPTIC NERVE BLOOD FLOW
Adverse Effects: may exacerbate Myasthenia Gravis
What is an intracameral injection?
Injection into the anterior chamber of the eye
Acetylcholine
Used during cataract suergy to induce miosis.
MOA: binds to muscarinic receptors on the iris.
Must be injected intracameral to avoid corneal cholinesterases
Methacholine
Used topically to cause miosis. Used to diagnose Adie’s Tonic Pupil
MOA: binds to muscarinic receptors on the iris
Resistant to corneal cholinesterases so it can be administered as eye drops
Carbachol
Glaucoma treatment
MOA: combo of ACh and Physostigmine (AChase inhibitor)
Causes miosis and increases trabecular flow for reabsorption of aqueous humor.
Side Effects: Accommodative spasms, conjunctival hyperemia
Pilocarpine
Used for angle closure glaucoma or to reverse pupil dilation
MOA: muscarinic agonist
Causes miosis, myopia, increases trabecular outflow, but decreases uveoscleral outflow.
Side Effects: Salivatio, Lacrimation, Sweating nausea, vomitting, diarrhea, Bronchiolar spasm/ pulmonary edema
Physostigmine
Used for anticholinergic overdose
MOA: AChase inhibitor
Atropine
Used for iritis: relaxes ciliary body
Amblyopia: alternative to patching
Hyphema
Reverses oculocardiac reflex
MOA: competitive ACh antagonist
In what populations are carbonic anhydrase inhibitor drugs contraindicated.
Patients with sulfa drug allergies
Sickle Cell disease patients (causes increased sickling of RBCs)
Renal or Liver failure
Addison’s Disease
What drug class if the 1st line for glaucoma treatment?
Prostaglandin Analogs
Latanoprost
Glaucoma Treatment
MOA: prostaglandin analog
Increases uveoscleral outflow of aqueous humor, relaxes the ciliary muscle
Side Effects: irreversible darkening of the iris, hypertrichosis (long lashes)
Travoprost
Glaucoma Treatment
MOA: prostaglandin analog
Increases uveoscleral outflow of aqueous humor, relaxes the ciliary muscle
Side Effects: irreversible darkening of the iris, hypertrichosis (long lashes)
Bimatoprost
Glaucoma Treatment
MOA: prostaglandin analog
Increases uveoscleral outflow of aqueous humor, relaxes the ciliary muscle
Side Effects: irreversible darkening of the iris, hypertrichosis (long lashes)
5 major uses of corticosteroids in ophthamology.
- Uveitis
- Conjunctivitis
- Macular Edema
- Corneal Edema
- Hyperemia
Contraindications for using corticosteroids.
Herpes Simplex Infections
Fungal infections
Side Effects of corticosteroids used in the eye.
- Delayed Healing
- Bacterial Proliferation
- Cataracts
- Increased IOP
Levocabastine
Treats allergic conjunctivitis
MOA: H1 receptor antagonist
Contraindications: do not use with contact lens wearers
Olopaditine
Treats allergic conjunctivitis
MOA: H1 receptor antagonist and Mast cell stabilizer
Fluoroquinolones
-oxacins
Antiobiotic eye drops useful in contact lens wearers to cover pseudomonas infection
MOA: inhibits DNA gyrase
Aminoglycosides
gentamicin, tobramycin
-used to treat mostly gram (-) eye infections
MOA: binds 30S ribosomal subunit
Side Effects: vestibular, renal, and auditory toxicity
Macrolides
Erythromycin
-coverage of gram (+) eye infections, not effective against pseudomonas
MOA: binds 50S ribosomal subunit
Most common cause of bacterial conjunctivitis.
Staph Aureus
usually use macrolides to treat, need fluoroquinolones if the patient wears contact lenses
Trifluridine
Treats viral eye infections (HSV)
MOA: fluorine nucleoside analog
Digitalis
Systemic ocular medication
Side Effects: changes visual perception, snowy white, green, yellow
Estrogen Progesterone contraceptives
Systemic ocular medication
Side Effects: optic neuritis, papilledema, contact lens intolerance
Tamsulosin
Systemic ocular medication
Side Effects: floppy iris syndrome
Amiodarone
Systemic ocular medication
Side Effects: Vortex Keratopathy (corneal deposits in the epithelium) after 1 month.
Hydroxychloroquine
Systemic ocular medication
Side Effects: drug binds to melanin causing bulls-eye maculopathy
Topamax
Systemic ocular medication
Side Effects: myopia, bilateral angle closure, ciliary body swelling
Sildenafil
Systemic ocular medication
Side Effects: blue haze in vision, light sensitivity, pupil sparing 3rd nerve palsy
