Pharm Week 2 Flashcards
NSAIDS Drugs
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.
NSAID indications
Used for analgesia, antipyretics and anti-inflammatory effects.
NSAIDS facts
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
Corticosteroids Indications
Treatment of steroid responsive inflammatory conditions: Acute iritis Stromal keratitis Chemical burns Episleritis/Scleritis
Corticosteroids MOA
Reduce inflammation
Decrease edema
Corticosteroids Drugs
**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)
Corticosteroids Side Effects
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
Corticosteroids CI
Viral disease of the cornea or conjunctiva (herpes simplex keratitis)
Mycobacterial or fungal infections of the eye
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.
Prostaglandin Analogs Drugs
Latanoprost (Xalatan) $95-$131
Bimatoprost (Lumigan) $251
Tafluprost (Zioptan) $125
Prostaglandin Analogs SE
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
Beta Blockers MOA
May decrease aqueous humor formation or increase outflow
Beta Blockers Drugs
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 Side Effects
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.
Beta Blockers CI
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
Alpha Adrenergic Agonists Drugs
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
Alpha Adrenergic Agonists Side Effects
Dry mouth, allergic conjunctivitis, redness, ocular pruritus
Effective but not commonly used due to side effects. Many drug interactions.
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.
Cholinergic Agonists Side Effects
brow ache
induced myopia
decreased vision in low light
Cholinergic Agonists Drugs
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.
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
Carbonic Anhydrase Inhibitors Drugs
Dorzolamide HCl (Trusopt) 2% Brinzolamide (Azopt) 1%
