Pharm Week 2

Question 1

NSAIDS Drugs

Answer 1

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.

Question 2

NSAID indications

Answer 2

Used for analgesia, antipyretics and anti-inflammatory effects.

Question 3

NSAIDS facts

Answer 3

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

Question 4

Corticosteroids Indications

Answer 4

Treatment of steroid responsive inflammatory conditions:
Acute iritis
Stromal keratitis
Chemical burns
Episleritis/Scleritis

Question 5

Corticosteroids MOA

Answer 5

Reduce inflammation

Decrease edema

Question 6

Corticosteroids Drugs

Answer 6

**Prednisolone acetate (Pred Forte) most commonly used
Prednisolone sodium phosphate (Inflamase Forte, Metreton)

Dexamethasone/Tobramycin oint/susp (Tobradex)
Steroid/antibiotic combo
Dexamethsone oint/soln
Topical dexamethasone preparations are also potent agents.

Fluorometholone 0.1% soln (Flarex)
Fluorometholone 0.25% susp. (FML-Forte)

Question 7

Corticosteroids Side Effects

Answer 7

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
Keratitis

Question 8

Corticosteroids CI

Answer 8

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

Question 9

Agents for Glaucoma

Answer 9

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

Question 10

Prostaglandin Analogs MOA

Answer 10

Increase uveoscleral outflow of the aqueous.

Question 11

Prostaglandin Analogs Drugs

Answer 11

Latanoprost (Xalatan) $95-$131
Bimatoprost (Lumigan) $251
Tafluprost (Zioptan) $125

Question 12

Prostaglandin Analogs SE

Answer 12

Decreased visual acuity
Eye discomfort
Dry eye
Foreign body sensation
Can change eye color

May interact with systemic NSAIDs by decreasing or increasing the ophthalmic effects

Question 13

Beta Blockers MOA

Answer 13

May decrease aqueous humor formation or increase outflow

Question 14

Beta Blockers Drugs

Answer 14

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

Question 15

Beta Blockers Side Effects

Answer 15

Decreased cardiac output
Bronchial constriction/Bronchospasm
Bradycardia
Heart block
Hypotension 

Pulse rate and blood pressure should be monitored in patients receiving topical beta-blocker therapy.

Question 16

Beta Blockers CI

Answer 16

Asthma
Severe chronic obstructive pulmonary disease
Sinus bradycardia
Second- and third-degree AV block
Overt cardiac failure

Question 17

Alpha Adrenergic Agonists MOA

Answer 17

Reduce intraocular pressure (IOP) by increasing outflow and reducing production of aqueous humor

Question 18

Alpha Adrenergic Agonists Drugs

Answer 18

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

Question 19

Alpha Adrenergic Agonists Side Effects

Answer 19

Dry mouth, allergic conjunctivitis, redness, ocular pruritus

Effective but not commonly used due to side effects. Many drug interactions.

Question 20

Cholinergic Agonists MOA

Answer 20

Contract ciliary muscle, tightening the trabecular meshwork and allowing increased outflow of the aqueous.
Miosis results from action of these drugs on pupillary sphincter.

Question 21

Cholinergic Agonists Side Effects

Answer 21

brow ache
induced myopia
decreased vision in low light

Question 22

Cholinergic Agonists Drugs

Answer 22

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.

Question 23

Carbonic Anhydrase Inhibitors MOA

Answer 23

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

Question 24

Carbonic Anhydrase Inhibitors Drugs

Answer 24

Dorzolamide HCl (Trusopt) 2% 
Brinzolamide (Azopt) 1%

Question 25

Carbonic Anhydrase Inhibitors Side Effects

Answer 25

Rare, but include
superficial punctate keratitis
nausea, depression, and fatigue