Opthalmic Meds

Question 1

Drug classes to tx Opthalmic problems

Answer 1

ABx
antivirals
corticosteroids
abx/coritco combo
NSAIDs
allergy meds
cycloplegics
lubricants
vitamin supplements

Question 2

Aminoglycosides info for opthalmic

Answer 2

MOA: inhibit bacterial synthesis
Most common drug used:Tobramycin (Tobrex)
Used for: G - (esp. pseudomonas); also synergy against some G+
AE: ocular toxicity, hypersensitivity, lid itching, swelling, and erythema, corneal ulcers, conjunctivitis, superficial punctate keratitis
Other comments: less expensive than FQs, alt. for bact. conjunctivitis

Question 3

Fluoroquinolones info for ophthalmic

Answer 3

MOA: inhibits bacterial DNA gyrase
Products: Cipro (solution and ointment), Ofloxacin (solution only), levo, moxi, gatifloxacin, besifloxacin
Used for: Corneal infections and severe conjunctivitis
AE: white precipitates, lid margin crusting, crystals, FB sensation, conjunctival hyperemia, bad taste in mouth, corneal staining, keratitis, allergic rxns, edema, tearing, photophobia, N, decreased vision
Comments: Not used first line for conjunctivitis d/t poor strep coverage, expensive, and resistance concern

Question 4

Miscellaneous Abx

Answer 4

MOA: inhibits folic acid synthesis
Products: Trimethoprim + Polymyxin B
Used for: G+, G- (except pseudomonas but the polmyxin covers that); very effective against H.flu and S.pneumo
AE: low toxicity
Comments: good for kids, cost effective; first line tx for conjunctivitis

Question 5

Abx ointments

Answer 5

Cipro
Erythromyacin: inhibits bact protein synthesis; first line for conjunctivitis
Bacitracin: inhibits cell wall synthesis; used for Blepharitis and first line tx for conjunctivitis

Question 6

Antiviral topical

Answer 6

Trifluridine: inhibits DNA synthesis; used for dendritic HSV keratitis
Vidarabine: only avilable ung; worry about blurred vision

Question 7

Antiviral oral

Answer 7

Acyclovir (cheapest), Valacyclovir, Famiciclovir: as effectvie as topicals, safe for children, effective for HSV an Varicella zoster

Question 8

Corticosteroids

Answer 8

Prednisone is the gold standard
Rimexolone, Prednisolone, Loteprednol
AE: cataracts, IOP, opti nerve damage, papilledema assoc with pseudomotor cerebri
Comments: can mask infection, acetate forms will provide better penetration than alcohol forms
*need to monitor IOP: get a baseline, monitor weekly and taper CS if prolonged use

Question 9

Abx/corticosteoir combos

Answer 9

Used if you want redness to go away immediately
Dexamethasone/Tobramycin
Loteprednol/tobramycin
prednisolone/sulfa
prednisolone/gentamicin
prednisolone/neomcin
prednisolone/neomycin ung

Question 10

NSAIDs

Answer 10

MOA: reduce pgs production via cyclo-oxygenase
Products: Ketorolax, DIclofenac
Uses: tx of ete pain or itching
AE: transient burning and stinging upon instillation, ocular irritation

Question 11

Allergic Conjunctivitis Tx Steps

Answer 11

1. remove allergen (no shit)
2. artificial tears
3. topical antihisitimine
4. mast cell stabilizer (response may take 4-6 wks)
5. trial of topical NSAID
6. short term topical corticosteroid

Question 12

Cycloplegics

Answer 12

MOA: anticholinergic agents block the responses of the sphincter muscle of the iris and the muscle of the ciliary body to the cholinergic stimulation, thus producing pupillary dilation (mydriasis) and paralysis of accomodation
Products: atropine, homatropine, cyclopentolate, tropicamide
Use: for reduction of inflamm and pain
AE: increased IOP, transient burning, irritation with prolonged use
Comments: all cycloplegics have red caps, like putting the eye in a cast

Question 13

Vitamins

Answer 13

Lutein

AREDS: vitamin A, C, E, and zinc and copper may slow progression of age related macular degeneration

Question 14

Cosmetic agent

Answer 14

Bimatoprost
MOA AE of prostaglandin eye drops, makes eyelashes grow
AE: may darken the iris and skin around the eyes, skin effects can be reversible, iris is usually permanent