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Opthalmology > pharm > Flashcards

pharm Flashcards

1
Q

Fluorescein

A

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.

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2
Q

Topical Anesthetics

A

Proparacaine (Alcaine), Oxybuprocaine AKA Benoxinate (Novesin, Novesine)
Very short acting

Tetracaine (Pontocaine, AK-T Caine PF)
Longer acting

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3
Q

Topical Anesthetics SE

A

Stinging, irritation
Hypersensitivity reaction
Prolonged use may retard wound healing.
Must protect the eye from irritants until it wears off.

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4
Q

Topical Anesthetics CI

A

any hypersensitivity to anesthetics, liver disease, taking anticholiesterases*, dry eye, perforating eye injury

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5
Q

NSAIDS Indications

A

analgesia, antipyretics, anti-inflammatory.

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6
Q

NSAIDS

A

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.

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7
Q

NSAIDS

A

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

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8
Q

Corticosteroid Indications

A 
Treatment of steroid responsive inflammatory conditions. Some examples are:
Acute iritis
Stromal keratitis
Chemical burns
Episleritis/Scleritis
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9
Q

Corticosteroids

A

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)

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10
Q

Corticosteroids SE

A

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

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11
Q

Corticosteroids CI

A

Viral disease of the cornea or conjunctiva (herpes simplex keratitis)
Mycobacterial or fungal infections of the eye

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12
Q

Decongestants MOA

A

Cause pupil dilation
Increase in outflow of aqueous humor
Vasoconstriction

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13
Q

Decongestants Indications

A 
Allergic conjunctivitis
Redness of the conjunctiva 
Increased tearing 
Itchiness 
Burning sensation 
Blurred vision due to the increase in tearing
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14
Q

Decongestants

A 
Naphazoline/Pheniramine maleate (Visine A, Naphcon-A, Opcon-A, etc.)
Naphazoline hydrochloride (Murine
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15
Q

Decongestants SE

A

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.

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16
Q

Antihistamines

A 
Prescription
Olopatadine (Patanol, Pataday) 
Bepotastine (Bepreve)
Alcaftadine (Lastacraft)
OTC
Azelastine (Optivar)
Epinastine (Elestat)
Pemirolast (Alamast
Ketotifen *generic and most commonly found OTC
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17
Q

Antihistamines SE

A

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

18
Q

Mast cell stabilizer

A

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

19
Q

Sulfonamides

A

MOA
Inhibits synthesis of folic acid

Indications:
Lid infections
Conjunctivitis
Corneal abrasion, ulcer
Prevent infections after removing foreign bodies
20
Q

Sulfonamides

A

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

21
Q

Fluoroquinolones

A

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.

22
Q

Fluoroquinolones

A 
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

23
Q

Aminoglycosides

A

MOA:
Bind to ribosomes and inhibit tRNA synthesis

Indications:
Lid infections
Conjunctivitis
Corneal abrasion, ulcer
Prevent infections after removing foreign bodies
24
Q

Aminoglycosides

A 
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

25
Q

Macrolides

A 
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

26
Q

Bacitracin ointment

A 
Indications:
Lid infections
Conjunctivitis
Corneal abrasion, ulcer
Prevent infections after removing foreign bodies
27
Q

Trimethoprim Sulfate - Polymyxin B Sulfate (Polytrim)

A 
Indications:
Lid infections
Conjunctivitis
Corneal abrasions, ulcer
Prevent infections after removing foreign bodies
28
Q

Antivirals Idoxuridine (Dendrid)

A 
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)
29
Q

Antivirals

A

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

30
Q

Cycloplegics

A

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

31
Q

Cycloplegics

A

Atropine (Isopto Atropine)
Scopolamine (Isopto Hyoscine)
Cyclopentolate (Cyclogyl)
Mydriacyl (Tropicamide)

32
Q

Cycloplegics CI

A

Angle closure glaucoma
People with narrow angles

Caution:
Children and elderly patients

33
Q

Cycloplegics SE

A 
Blurred vision 
Burning or stinging 
Eye irritation 
Increased sensitivity of eyes to light 
Swelling of the eyelids
34
Q

Agents for Glaucoma

A 
(1st line) Prostaglandin Analogs
(2nd line) Beta Blockers
Alpha adrenergic agonists *
Cholinergic agonists *
Carbonic Anhydrous Inhibitors *
35
Q

Prostaglandin analogs

A

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
36
Q

Beta Blockers MOA

A

May decrease aqueous humor formation or increase outflow

37
Q

Beta Blockers

A

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
38
Q

Beta Blockers

A 
Adverse effects of the beta-blockers are due to systemic absorption of the drug:
Decreased cardiac output
Bronchial constriction/Bronchospasm
Bradycardia
Heart block
Hypotension
39
Q

Beta Blockers

A 
Contraindications:
Asthma
Severe chronic obstructive pulmonary disease
Sinus bradycardia
Second- and third-degree AV block
Overt cardiac failure
40
Q

Alpha Adrenergic Agonists

A

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

41
Q

Cholinergic agonists

A

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

42
Q

Carbonic anhydrase inhibitors

A

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

Opthalmology (6 decks)

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