Ophtho Pharm Flashcards
Wait how long between different ocular medications?
10minutes
When applying drops and ointment to the eyes which comes first?
apply drops first and then ointment.
How long can you keep preservative and preservative free eye medication?
Preservative- 1 mo after opening
Preservative free- 1wk after opening
Flurescein
- indications
- how to use
- detect foerign bodies in the eye, abrasions, ulcers, infection, herpatic dendrites
- a piece of blotting paper w/ dye is touched to surface of eye. Dye coats tear film. Blue woods lamp, any problems on the surface of the cornrea will be stained by the dye and appear green under the blue light.
What are the types of combo anesthetic and fluoroscein medications?
- flluoroscein/Benoxinate
- -eyeflur, fluress, flurox
- Fluorescein/Proparacaine
- -flucaine
Indications for topical anesthetics
- measurement of IOP
- removal of foreign bodies and sutures from the cornea
- facilitate exam of the eye
- for anesthesia for surgical procedures
- temporary pain relief
Types of Topical Anesthetics and MOA
- Proparacaine (Alcaine)
- Oxybuprocaine AKA Benoxinate(Novesin, Novesine)
- Tetracaine (altacaine, Tetcaine, TetraVisc)
MOA:
-block initiation and conduction of nerve impulses by decreasing the neuronal membranes permeability to NA, K, and other ions resulting in inhibition of depolarization»> blockade of conduction.
Topical Anesthetics
- duration to onset
- duration
-very short acting, within seconds
-10-20 minutes
except Tetracaine 30mins
SE & CI of Topical Anesthetics
-stinging SE -irritation -hypersensitivity rxn -prolonged use may slow healing
CI
- any hypersensitivity to anesthetics
- liver disease
- dry eye
- perforating eye( of globe) injury
- if pt taking anticholinesterases, specifically drugs to treat myasthenia gravis, alzheimers, and glaucoma. * can make your eyes more dry
What will you never do with ocular topical anesthetics?
-write a Rx, because you lose the protective pain reflex and may continue to damage the cornea.
Clyclopegics
- what are they?
- what are they used for?
- MOA
- Atropine (Isopto Atropine)
- Scopolamine (Isopto Hyoscine)
- Homatropine
- Clyclopenolate (Cyclogyl)
- Mydriacyl (Tropicamide)
- this one is mixed with amphetamine causing vasoconstriction, will have longer duration of action.
-used to dilate the eye
-Moa:
block action of Ach resulting in paralysis of the ciliary muscles» dilation of the pupil
*anticholinergic or antimuscarinic drugs
Clycloplegic indications of use
- dilation before eye examinations*
- before and after eye surgery
- provide pain relief to patient with corneal abrasion and iritis/uveitis. (every time the eye constricts or dilates this causes pain, this drug takes away vasoconstriction reducing their pain)
CI of Clycloplegics
Cautions of Cycloplegics
- angle closure glaucoma
- people with narrow angles
- these angles are where the canal of schlemm resides, if this becomes blocked fluid is unable to drain causing increased intraocular pressure.
Caution:
-children and elderly patients.
What is the most potent cycloplegic? How long is it duration of action?
Atropine
- 12days
Scopolamine duration?
wears off within 3 days
Homatropine duration
-wears off in 1-3 days
Tropicamide and Cyclopentolate
- use
- duration
used only for diagnostic testing
-duration of 6hrs
SE of Cycloplegics
- blurred vision
- burning or stinging
- eye irritation
- increased sensitivity of eyes to light
- swelling of the eyelids
Systemic side effects: (if too much medication is used)
- clumsiness
- confusion
- dryness of skin
- fast/irregular HR
- fever
- skin rash
- slurred speech
- thirst or unusual dryness of mouth
- drowsiness
Medications for Allergic Conjunctivitis
- decongestants
- antihistamines
- NSAIDS
- Mast Cell stabalizers
Decongestants
- MOA
- indications
- OTC drugs, SE, & CI
MOA: cause pupil dilation, increase outflow of aqueous humor and vasoconstriction
Indications:
-allergic conjunctivitis: redness of conjunctiva, increased tearing, itchiness, burning sensation, blurred vision
-OTC:
Naphazoline/Pheniramines maleate (Visine A, Naphcon-A, Opcon-A)
Naphazoline Hydrochloride (Murine)
-SE: burning, blurred vision, pupil dilation
-CI: use longer than 2weeks, pt w/ narrow anterior chamber angles or narrow-angle glaucoma
Antihistamines
- Prescription and OTC
- SE
- Can contact wearers use these?
-Prescription:
olopatadine (pantanol, pataday)
bepotastine (Bepreve)
Alcaftadine (Lastacraft)
OTC: Aselastine (Optivar) Epinastine (Elastat) Pemirolast (Alamast) Ketotifen
- SE: Eye irritation, stinging* (sting the most) upon instillation of drops
- yes, they just need to take out their contacts when applying the medication and wait at least 10minutes after medication to wear contacts.
Mast Cell Stabalizer
- medication name
- indication
- SE
- Comolyn Sodium (Opticrom)
- allergic conjunctivitis
- SE:
- burning, dry eyes
- not many systemic SE, good for children
Antihistamine/Mast Cell Stabilizer Combo
Azelastine (optivar)
Epinastine (Elestat)
Ketotifen (Zaditor, Claritin Eye, Zyrtec Itchy Eye)
Oloptadine (Pantanol, Pataday)
MOA of Antihistamine/Mast Cell Stabalizer
competes with histamine for H1 receptor sites on effector cells and inhibits the release of histamine and other mediators involved in the allergic response.
SE of Mast Cell/Antihistamine combos
burning, stinging, dry eye, HA, blurred vision
NSAIDs for allergic conjunctivitis
- MOA
- use
-inhibits the synthesis of prostaglandin by decreasing the activity of the enzyme cyclooxygenase
-UNIQUE!! You normally dont think about using NSAID in allergy but in this case we do.
decrease inflamm and itching associated with allergic conjunctivitis.
Antibiotic Classes
sulfonamides fluoroquinolones aminoglycosides macrolides polypeptides
Sulfonamides
- MOA
- Indications
- effective against what type of bacteria?
- SE
- drug name
MOA- inhibits synthesis of folic acid, folic acid important for bacterial cell wall membranes
Bacteriostatic: it inhibits the further reproduction of more bacteria.
Indications:
- lid infections
- conjunctivitis
- corneal abrasion, ulcer
- prevent infection after removing foreign bodies
Effective: gram-negative bacteria–pneuomocystitis carinii and some gram-positive bacteria (Staph aureus)
SE:
-local irritation, stinging, burning
CI- sulfa allergy
Drug name: sulfacetamide
Fluoroquinolones
- MOA
- Indications
- Protects against what type of bacteria?
- SE
MOA- inhibits DNA synthesis & is bactericidal
Indications;
- lid infections
- conjunctivitis (not 1st line)
- corneal abrasion, ulcer
- prevent infection after removing foreign bodies
- if pseudomonas infection is suspected
-Protects against gram-negative organisms:
H. flu, P. aeruginosa, Neisseria gonorrheoa, chlamydia
SE:
burning, stinging, foreign body sensation, photophobia
What patients need to be protected against pseudomonas especially?
-If you are thinking corneal ulcer this is your go to for those who wear contacts. It kills pseudomonas, this is the bug you are trying to catch in contact lens wearers. Pseudomonas is water loving and the contact lens cleaner may inhabit pseudomonas.
Name the broadest and narrowest coverage of bugs in the flouroquinolone class.
Narrowist: ciprofloxacin (Ciloxan)
Broadest: Moxifloxacin Vigamox)
Aminoglycosides
- MOA
- General recommendation
- Indications
- Types
- SE
MOA-Bind to ribosomes and inhibit RNA synthesis
Recommendation-Don’t use these in primary care! they can cause toxiticty and these patients probably need a higher level or care.
Indications
- Lid infections
- conjunctivitis
- corneal abrasion, ulcer
- prevent infections after removing foreign bodies
- usually used in combination with a bata-lactam antibiotic due to resistance
Types
- Gentamycin (Garamycin)
- Tobramycin (tobrex)
- Neomycin *high incidence of allergy to neomycin in the general population
SE
- burning, itching, erythema
- can be toxic to corneal epithelium and can cause a reactive keratoconjunctivits after several days of use. Refer!
Macrolides
- MOA
- Indications
- Types
MOA
- inhibits tRNA synthesis
- bacterostatic (it inhibits the further reproduction of more bacteria. )
Indications:
- lid infections
- conjunctivitis
- corneal abrasion, ulcer
- prevents infections after removing foreign bodies
- used as prophylaxis of gonococcal ophthalmia Neonatroeum*** (unique)
- given to babies to cover for eye infections after vaginal birth, ok for any age group
Types:
erythromycin ointment (cheaper)
azithromycin drop
Polypeptides: Bacitracin Ointment
- MOA
- indications
MOA- inhibits bacterial cell wall synthesis (s. aureaus, streptococcus pneuomoniae, H. flu)
Indications:
- lid infections
- conjunctivitis
- corneal abrasion, ulcer
- prevent infections after removing foreign bodies
Polypeptide: Trimethoprim Sulfate & Polymyxin B Sulfate (Polytrim)
- MOA
- indications
MOA- bactericidal
IIndications:
- lid infections
- conjuncitivits
- corneal abrasions, ulcer
- prevent infection after removing foreign bodies
- ** can cover pseudomonas
- not as good as cipro, if pt has lenses then use cipro.
Ophthalmic Abx Tx:
- how to prescribe?
- what is the drug of choice for corneal ulcers or for contact lens users to treat pseudomonas?
- avoid _____ d/t toxicity to the corneal epithelium, this may cause what?
start w/ cheapest drug w/ best coverage: erythromycin or polytrim
- FLUOROQUINOLONES**
- aminoglycosides, reactive keratoconjuncitvitis
ointment or drops have a higher frequency of application?
drops
Herpes of the Eye
- tx
- drugs
- what does this look like?
-always refer to Ophtho
- idoxuridne (Dendrid)
- Trifuridine (Viroptic)
- Vidarabine (Vira-a)
-fern. alien, dendrite
Antivirals:
-what medications might you see on a med list that would lead you to believe the pt has herpetic infection of the eye.
SE of these drugs.
Idoxuridine (dendrid)
Trifuridine (Viroptic)
Vidarabine (Vira-a)
- all cause burning stinging sensation
