Pharm 3 Topical Agents pt2 Flashcards
Combination Antiinfectives
Examples (2)
Indication
Combinations have a wide range of antibacterial action.
Example: Neomycin and polymyxin B sulfates and gramicidin (Neosporin)
A wide range of antibacterial action is provided by the overlapping spectra of these agents
Indicated for the treatment of ocular bacterial infections caused by susceptible bacterial strains, esp. S. aureus, S. pneumonia, E. coli, H. flu, Klebsiella sp., Enterobacter sp., Neisseria sp., and P. aeruginosa
Combination antiinfective’s caveats
Topical antibiotics, especially neomycin, can cause SENSITIZATION
Antivirals
Example, indication
Example: trifluridine (Viroptic)
Indicated for the treatment of ocular primary and secondary keratoconjunctivitis caused by herpes simplex virus types 1 and 2
What medication is used principally for Herpes simplex 1 and 2?
Used principally for Herpes simplex virus types 1 and 2
How does Herpes present in the eye?
Key sign: dendritic lesions. Seen by staining the eye with fluorescein stain and looking it with a cobalt blue light.
Antiviral’s caveats (3)
Do not give steroids to patient with eye herpes. They’ll lose their eye.
Patients with lesions suspicious for herpes should always be evaluated by an ophthalmologist emergently
Always store under refrigeration
Antiinflammatory and antiinfective combinations
Example (4), indications
Example: Neomycin, polymyxin B sulfates, bacitracin zinc, hydrocortisone (Cortisporin)
Indicated for use in steroid-responsive inflammatory occular conditions for which a corticosteroid is indicated and where a bacterial infection, or risk of a bacterial infection, exists (e.g., chronic anterior uveitis, corneal injury from chemical, radiation or thermal burns
Steroid’s caveats
Steroid eye drops, even with antiinfectives, should be ordered only by experienced clinicians
Do not give steroids to patient with eye herpes. They’ll lose their eye.
Ocular Antihistamines/Mast Cell Wall Stabilizers 2 examples indication helpful instruction preganancy category
Azelastine (Optivar) Olopatadine (Patanol) Indicated for ocular pruritis, allergic conjunctivitis in adults and children 3 years of age and older Avoid contact lenses for 10 minutes Pregnancy Category C
Ocular NSAIDs Example Indication Mechanism of action The efficacy beyond \_\_\_ has not been established.
Example: ketoralac (Acular)
Indicated for the relief of ocular itching caused by seasonal allergic conjunctivitis
Mechanism of action is thought to be due in part to its ability to inhibit prostaglandin biosynthesis
The efficacy beyond 1 week administration has not been established
Ocular NSAIDs Caveats (3)
Ketoralac is contraindicated in soft contact lens wearers and in any patient with NSAID hypersensitivity
NSAIDS applied to the eye may cause increased bleeding of ocular tissues, including hyphemas
Use with caution in patients with bleeding tendancies or taking anticoagulants
Mast Cell Wall Stabilizers
Example
Indication
Example: lodoxamide tromethamine (Alomide)
Indicated for the treatment of vernal keratoconjunctivitis, conjunctivitis and keratitis
UV bilateral burning of the cornea.
Keratoconjunctivitis
Ophthalmic Steroids
Example
Indication
Example: prednisolone acetate (Pred-Forte)
Indicated for steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea, anterior segment of the globe, including allergic conjunctivitis, acne rosacea, superficial punctate keratitis, iritis
Sympathomemetic agents
Example
Indication
When is this given?
Example: phenylephrine hydrochloride (Neo-synephrine)
Indicated to dilate the eyes
This is the stuff given at the end of eye exams. The eye not being able to constrict is similar to Glaucoma.
Vasoconstrictors
Example
Indication (1 by itself, 1 with a combination)
Example: Naphazoline hydrochloride (Naphcon)
When pheniramine maleate (antihistamine) is added, the combination is used for ocular irritation and/or congestion
Indicated for the temporary relief of redness and itching due to pollen or animal hair
Vasoconstrictors Caveats
When are they contraindicated?
Vasoconstrictors are contraindicated in narrow-angle glaucoma, contact lens wearers, concurrent MAOI (Monoamine oxidase inhibitor) use
Eye-irrigation solutions
Example
Indication
This product is not to be used as:
Example: balanced salt solution (Dacriose)
Indications: a sterile and stable irrigating solution designed and packaged for use in the eyes
Closely approximates human tears
This product is not to be used as a rinsing and/or soaking solution for soft contact lenses
Anesthetics (for the eyes)
Example
What they do
Example: Proparicane hydrochloride (Alcaine)
Used to numb the eye for ophthalmic procedures including removal of superficial foreign bodies
Anesthetics names end in:
–caine (ex: Alcaine)
Anesthetic Caveats
It burns off a layer of epithelials every time they use it.
Topical anesthetics should be used only when eye pain makes it difficult or impossible to examine the eye
Never give this drug to patients to self-administer
Diagnostics
Example
What it does
Example: Fluorescein sodium (Fluorocaine) aka Fluorescein dye.
Fluorescein-containing compounds contain the disclosing agent for use when visualization of corneal integrity is necessary (e.g., corneal abrasion, f/b, etc.)
Eye Preparation Patient Education (6)
Avoid touching eye, surrounding structure w/ the tip of the dispensing container
Whenever possible, administer ointments before bed to reduce blurring of vision
Avoid administering immediately prior to driving
Discontinue use if side effects occur, esp. conjunctivitis or lid reactions
Benzalkonium chloride, a preservative used in some products may be absorbed by soft contact lenses; do not administer while wearing contacts
Keep products tightly closed, away from children
