pharm Flashcards
Fluorescein
Orange dye used to detect foreign bodies in the eye as well as abrasions, ulcers and infection, herpatic dendrites
. Any problems on the surface of the cornea will be stained by the dye and appear green under the blue light.
Topical Anesthetics
Proparacaine (Alcaine), Oxybuprocaine AKA Benoxinate (Novesin, Novesine)
Very short acting
Tetracaine (Pontocaine, AK-T Caine PF)
Longer acting
Topical Anesthetics SE
Stinging, irritation
Hypersensitivity reaction
Prolonged use may retard wound healing.
Must protect the eye from irritants until it wears off.
Topical Anesthetics CI
any hypersensitivity to anesthetics, liver disease, taking anticholiesterases*, dry eye, perforating eye injury
NSAIDS Indications
analgesia, antipyretics, anti-inflammatory.
NSAIDS
Diclofenac (Voltaren), Suprofen (Profenal), Brofenac (Xibrom), Flurbiprofen (Ocufen), Nepafenac (Nevanac) are all used for post-op pain/inflammation after cataract surgery, some used for photophobia (Voltaren) and some used for prevention of intraoperative mioisis (Ocufen and Profenal)
Ketorlac tromethamine O.5% soln (Acular)
Relief of ocular inflammation due to seasonal allergic conjunctivitis.
NSAIDS
Have no effect on IOP
May cause burning and stinging
1 drop to the affected eye QID
Don’t use for longer then 2 weeks or can cause corneal injury
Corticosteroid Indications
Treatment of steroid responsive inflammatory conditions. Some examples are: Acute iritis Stromal keratitis Chemical burns Episleritis/Scleritis
Corticosteroids
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
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)
Corticosteroids SE
Mydriasis, ptosis, inhibition of corneal epitheliem or stromal healing
Repeated use or long term use hazards:
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
Corticosteroids CI
Viral disease of the cornea or conjunctiva (herpes simplex keratitis)
Mycobacterial or fungal infections of the eye
Decongestants MOA
Cause pupil dilation
Increase in outflow of aqueous humor
Vasoconstriction
Decongestants Indications
Allergic conjunctivitis Redness of the conjunctiva Increased tearing Itchiness Burning sensation Blurred vision due to the increase in tearing
Decongestants
Naphazoline/Pheniramine maleate (Visine A, Naphcon-A, Opcon-A, etc.) Naphazoline hydrochloride (Murine
Decongestants SE
Burning, blurred vision, pupil dilation
Individuals should be informed that overuse of ophthalmic decongestants can lead to rebound congestion of the conjunctiva. Don’t use longer then 2 weeks.
Patients with narrow anterior chamber angles or narrow-angle glaucoma should not use these products.
Antihistamines
Prescription Olopatadine (Patanol, Pataday) Bepotastine (Bepreve) Alcaftadine (Lastacraft) OTC Azelastine (Optivar) Epinastine (Elestat) Pemirolast (Alamast Ketotifen *generic and most commonly found OTC
Antihistamines SE
Most can be used in contact lens wearers *
Take contacts out and leave out for at least 10 minutes after medication
Side effects:
Eye irritation, stinging upon instillation of drops
Mast cell stabilizer
Cromolyn Sodium (Opticrom)
Inhibits mast cell degranulation
Need to take QID and takes 1-2 weeks to work
Indications: Allergic conjunctivitis
Side effects:
Burning
Dry eyes
Sulfonamides
MOA
Inhibits synthesis of folic acid
Indications: Lid infections Conjunctivitis Corneal abrasion, ulcer Prevent infections after removing foreign bodies
Sulfonamides
Sulfacetamide (Bleph-10, Ocu-Sul, Sodium Sulamyd, Sulf-10)
Drops $30-$56, Ointment $66
Ok for kids at least 2 mo old
Oint ½” Q2-3 h & hs X 7-10 d, disp 3.5 g
Drops 1-2 gtts Q2-3 h & hs X 7-10 d, disp 5 ml
Side effects:
Local irritation, stinging, burning
Fluoroquinolones
MOA:
Inhibits DNA synthesis
Indications:
Lid infections
Conjunctivitis (not for use as 1st line therapy)
Corneal abrasion, ulcer
Prevent infections after removing foreign bodies
Should be used for sure if a pseudomonas infection is suspected.
Fluoroquinolones
Ciprofloxacin (Ciloxan) Solution or ointment Ofloxacin (Ocuflox) solution Levofloxacin (Quixin) solution Gatifloxacin (Zymar) solution Moxifloxacin (Vigamox) Solution
Side effects:
Burning, stinging, foreign body sensation, photophobia
Aminoglycosides
MOA:
Bind to ribosomes and inhibit tRNA synthesis
Indications: Lid infections Conjunctivitis Corneal abrasion, ulcer Prevent infections after removing foreign bodies
Aminoglycosides
Gentamycin (Garamycin) Soln, ointment Tobramycin (Tobrex) Soln, ointment Neomycin High incidence of allergy to neomycin in the general population.
Side effects:
Burning, itching, erythema
These can be toxic to the corneal epithelium and can cause a reactive keratoconjunctivits after several days of use. Best to reserve these for the specialists
Macrolides
Erythomycin ointment ($10-$15) MOA: Inhibits tRNA synthesis Indications: Lid infections Conjunctivitis Corneal abrasions, ulcer Prevent infections after removing foreign bodies Also used as prophylaxis of Gonococcal Ophthalmia Neonatroeum
Azithromycin drops
$116
Bacitracin ointment
Indications: Lid infections Conjunctivitis Corneal abrasion, ulcer Prevent infections after removing foreign bodies
Trimethoprim Sulfate - Polymyxin B Sulfate (Polytrim)
Indications: Lid infections Conjunctivitis Corneal abrasions, ulcer Prevent infections after removing foreign bodies
Antivirals Idoxuridine (Dendrid)
Used for herpes simplex keratitis Blocks reproduction of HSV May cause irritation, pain photophobia Recurrence may be seen If no lessening of fluorescein staining in 14 days, start different therapy with Trifluridine (Viroptic)
Antivirals
Trifuridine (Viroptic)
Used for keratoconjnctivitis, keratitis
May cause burning, stinging
Used if Vidarabine is ineffective
Vidarabine (Vira-a)
Used for ketatoconjunctivitis, superficial karatitis
May cause temp visual haze, foreign body sensation and burning
Use if Viroptic is ineffective
Cycloplegics
MOA:
paralyze the ciliary muscles and cause dilatation of the pupil.
Indications:
Dilation before eye examinations.
Before and after eye surgery.
Provide pain relief to patient with corneal abrasions and iritis/uveitis
Cycloplegics
Atropine (Isopto Atropine)
Scopolamine (Isopto Hyoscine)
Cyclopentolate (Cyclogyl)
Mydriacyl (Tropicamide)
Cycloplegics CI
Angle closure glaucoma
People with narrow angles
Caution:
Children and elderly patients
Cycloplegics SE
Blurred vision Burning or stinging Eye irritation Increased sensitivity of eyes to light Swelling of the eyelids
Agents for Glaucoma
(1st line) Prostaglandin Analogs (2nd line) Beta Blockers Alpha adrenergic agonists * Cholinergic agonists * Carbonic Anhydrous Inhibitors *
Prostaglandin analogs
MOA:
Increase uveoscleral outflow of the aqueous.
Latanoprost (Xalatan) $95-$131
Bimatoprost (Lumigan) $251
Tafluprost (Zioptan) $125
Side effects: Decreased visual acuity Eye discomfort Dry eye Foreign body sensation
Beta Blockers MOA
May decrease aqueous humor formation or increase outflow
Beta Blockers
Betaxolol (Betoptic)
Selectively blocks beta1-adrenergic receptors with little or no effect on beta2-receptors.
Timolol maleate (Timoptic) Nonselective beta-adrenergic blocking agent Levobunolol (Betagan, AKBeta) Nonselective beta-adrenergic blocking agent
Beta Blockers
Adverse effects of the beta-blockers are due to systemic absorption of the drug: Decreased cardiac output Bronchial constriction/Bronchospasm Bradycardia Heart block Hypotension
Beta Blockers
Contraindications: Asthma Severe chronic obstructive pulmonary disease Sinus bradycardia Second- and third-degree AV block Overt cardiac failure
Alpha Adrenergic Agonists
MOA:
Reduce intraocular pressure (IOP) by increasing outflow and reducing production of aqueous humor
Brimonidine (Alphagan P)
Selective alpha2-receptor
$32-$200
Apraclonidine (Iopidine) 0.5%, 1%
Potent alpha-adrenergic agent selective for alpha2-receptors with minimal cross-reactivity to alpha1-receptors.
Side effects:
Dry mouth, allergic conjunctivitis, redness, ocular pruritis
Cholinergic agonists
MOA:
Contract ciliary muscle, tightening the trabecular meshwork and allowing increased outflow of the aqueous.
Miosis results from action of these drugs on pupillary sphincter.
Pilocarpine (Pilocar, Pilagan)
Mimics muscarinic effects of acetylcholine at postganglionic parasympathetic nerves.
Directly stimulates cholinergic receptors in the eye, decreasing resistance to aqueous humor outflow.
Side effects:
brow ache
induced myopia
decreased vision in low light
Carbonic anhydrase inhibitors
MOA:
Reduce secretion of aqueous humor by inhibiting carbonic anhydrase in ciliary body
Duration of action is shorter than many other classes of drugs.
Used concomitantly with other topical ophthalmics
Dorzolamide HCl (Trusopt) 2% Brinzolamide (Azopt) 1%
Side effects:
Rare, but include
superficial punctate keratitis
nausea, depression, and fatigue
