pharmacology Flashcards
What is fluorescein and indications for it?
Orange dye used to detect foreign bodies in the eye as well as abrasions, ulcers and infection, herpatic dendrites
How does fluorescein work?
A piece of blotting paper containing the dye is touched to the surface of the eye. Blinking spreads the dye and coats the “tear film” covering the surface of the cornea. A blue light (woods lamp) is then directed at the eye. Any problems on the surface of the cornea will be stained by the dye and appear green under the blue light.
What are uses of local anesthesia (topical anesthestics)?
measurement of intraocular pressure.removal of foreign bodies and sutures from the cornea. conjunctival scraping and gonioscopic examination.
prior to surgical operations such as cataract extraction.
What is the MOA of topical anesthetics?
stabilizes neuronal membranes inhibiting nerve impulses
What are some short acting anesthetics?
Proparacaine (Alcaine), Oxybuprocaine AKA Benoxinate (Novesin, Novesine)
What is a long acting anesthetic?
Tetracaine (Pontocaine, AK-T Caine PF)
What local anesthetic comes in combo with fluroescin (Flurox)?
benoxinate
What is the most commonly used topical anesthetic and why?
Proparacaine because it has less stinging/burning associated with instillation of drops
What are SE of topical anesthetics?
Stinging, irritation. Hypersensitivity reaction. Prolonged use may retard wound healing. Must protect the eye from irritants until it wears off.
What are contraindications to topical anesthetics?
any hypersensitivity to anesthetics, liver disease, taking anticholiesterases*, dry eye, perforating eye injury
What are indications for NSAIDs?
Used for analgesia, antipyretics and anti-inflammatory effects.
What are some NSAIDs used for post-op pain/inflammation after cataract surgery?
Diclofenac (Voltaren), Suprofen (Profenal), Brofenac (Xibrom), Flurbiprofen (Ocufen), Nepafenac (Nevanac)
What NSAIDs are used for photophobia?
Diclofenac (Voltaren)
What NSAIDs are used for prevention of intraoperative mioisis?
Flurbiprofen (Ocufen) and Suprofen (Profenal)
What NSAID is used for relief of ocular inflammation due to seasonal allergic conjunctivitis?
Ketorlac tromethamine O.5% soln (Acular)
How are NSAIDs dosed?
1 drop to the affected eye QID. Don’t use for longer then 2 weeks or can cause corneal injury
Who should prescribe opthalmic corticosteroids?
ophthalmologists
What is the MOA of opthalmic corticosteroids?
Reduce inflammation. Decrease edema
What are indications for opthalmic corticosteroids?
Treatment of steroid responsive inflammatory conditions: Acute iritis, Stromal keratitis, Chemical burns, Episleritis/Scleritis
What is the most commonly used opthalmic corticosteroid?
Prednisolone acetate 1% soln (Pred Forte)
Why shouldn’t you use dexamethasone/tobramycin (Tobradex)?
Tobramycin is an aminoglycoside that can be toxic to cornea and cause ulceration
What are SE of corticosteroids?
Mydriasis, ptosis, inhibition of corneal epitheliem or stromal healing
What can repeated use of opthalamic corticosteroids lead to?
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
What are CI of opthalmic corticosteroids?
Viral disease of the cornea or conjunctiva (herpes simplex keratitis). Mycobacterial or fungal infections of the eye
What is the MOA of opthalmic decongestants?
Cause pupil dilation. Increase in outflow of aqueous humor. Vasoconstriction
What are indications for opthalmic decongestants?
Allergic conjunctivitis
What are the opthalmic OTC decongestants?
Naphazoline/Pheniramine maleate (Visine A, Naphcon-A, Opcon-A, etc.).Naphazoline hydrochloride (Murine)
What are SE of opthalmic OTC decongestants?
Burning, blurred vision, pupil dilation
What can happen as a result of overuse of opthalmic decongestants?
can lead to rebound congestion of the conjunctiva. Don’t use longer then 2 weeks.
Who should avoid opthalmic decongestants?
Patients with narrow anterior chamber angles or narrow-angle glaucoma
What are some prescription topical antihistamines with mast cell stabilizing properties?
Olopatadine (Patanol, Pataday), Bepotastine (Bepreve), Alcaftadine (Lastacraft
What are some OTC topical antihistamines with mast cells stabilizing properties?
Azelastine (Optivar), Epinastine (Elestat), Pemirolast (Alamast), Ketotifen *generic and most commonly found OTC
What are guidelines for contact wearers using opthalmic antihistamines?
Most can be used in contact lens wearers. Take contacts out and leave out for at least 10 minutes after medication
What are SE of opthalmic antihistamines?
Eye irritation, stinging upon instillation of drops
What ingredient found in some antihistamines can’t be used with contacts?
Benzalkonium chloride
What is an opthalamic mast cell stabilizer and its dosage?
cromoly sodium (Opticrom), Need to take QID and takes 1-2 weeks to work
What are indications for opthalmic mast cell stabilizer?
Allergic conjunctivitis
What are SE of mast cell stabilizer?
Burning, Dry eyes
What are some general antibiotic categories?
Sulfonamides, Fluoroquinolones, Aminoglycosides
What is the MOA of sulfonamides?
Inhibits synthesis of folic acid
What are the indications of sulfonamides?
Lid infections, Conjunctivitis, Corneal abrasion, ulcer, Prevent infections after removing foreign bodies
Name an opthalmic sulfonamide
Sulfacetamide (Bleph-10, Ocu-Sul, Sodium Sulamyd, Sulf-10)
What is the dosage of sulfacetamide?
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
What are SE of sulfonamides?
Local irritation, stinging, burning
What is the MOA of fluoroquinolones?
Inhibits DNA synthesis
What are indications of fluoroquinolones?
Lid infections,Conjunctivitis (not for use as 1st line therapy), Corneal abrasion, ulcer,Prevent infections after removing foreign bodies. pseudomonas infection
What patient needs to be protected against pseudomonas especially
contact lens wearers
What are the fluoroquinolone opthalmic medications?
Ciprofloxacin (Ciloxan), Ofloxacin (Ocuflox), Levofloxacin (Quixin), Gatifloxacin (Zymar), Moxifloxacin (Vigamox)
What are SE of fluoroquinolones?
Burning, stinging, foreign body sensation, photophobia
What is the MOA of aminoglycosides?
Bind to ribosomes and inhibit tRNA synthesis
What are indications of aminoglycosides?
Lid infections, Conjunctivitis,Corneal abrasion, ulcer, Prevent infections after removing foreign bodies
What are aminoglycoside opthalmic medications?
Gentamycin (Garamycin), Tobramycin (Tobrex), Neomycin
WHy is neomycin generally avoided?
High incidence of allergy to neomycin in the general population. Due to use of neosporin, ppl are developing allergies
What are SE of neomycin?
Burning, itching, erythema. can be toxic to the corneal epithelium and cause a reactive keratoconjunctivits after several days of use. reserve these for the specialists
What are opthalmic macrolide medications?
Erythomycin ointment and Azithromycin drops
What are indications for macrolides?
Lid infections, Conjunctivitis, Corneal abrasions, ulcer, Prevent infections after removing foreign bodies, Also used as prophylaxis of Gonococcal Ophthalmia Neonatroeum
What is the MOA of erythromycin ointment?
inhibit tRNA synthesis
What is the MOA of bacitracin ointment?
Inhibits bacterial cell wall synthesis
What are indications for bacitracin ointment?
Lid infections, Conjunctivitis, Corneal abrasion, ulcer, Prevent infections after removing foreign bodies
What is trimethoprim sulfate?
Polymyxin B Sulfate (Polytrim), Solution or ointment, Combination of two antibiotics. Ok for SULFA allergic patients.
WHat are indications for trimethoprim sulfate (polytrim)?
Lid infections, Conjunctivitis, Corneal abrasions, ulcer, Prevent infections after removing foreign bodies
What are the cheapest opthalmic antibiotics with the best coverage?
Erythromycin and polytrim
What are fluoroquinolones the drug of choice for?
corneal ulcers or for contact lens users to treat pseudomonas
Why should you avoid prescribing aminoglycosides?
due to toxicity to the corneal epithelium and can cause reactive keratoconjunctivitis after several days of use.
What are the main differences between antibiotic drops and ointments?
Drops are more comfortable, but must be administered more frequently. Ointments maintain antibacterial effect longer, but may cause blurriness
What are the opthalmic antivirals?
Idoxuridine (Dendrid), Trifuridine (Viroptic), Vidarabine (Vira-a)
Describe the use of idoxuridine (Dendrid)
Used for herpes simplex keratitis. Blocks reproduction of HSV. May cause irritation, pain photophobia. If no lessening of fluorescein staining in 14 days, start different therapy with Trifluridine (Viroptic)
Describe the use of trifuridine (Viroptic)
Used for keratoconjnctivitis, keratitis. May cause burning, stinging. Used if Vidarabine is ineffective
Describe the use of vidarabine (Vira-a)
Used for ketatoconjunctivitis, superficial karatitis. May cause temp visual haze, foreign body sensation and burning. Use if Viroptic is ineffective
What is the MOA of cycloplegics?
paralyze the ciliary muscles and cause dilatation of the pupil.
What are the indications for cycloplegics?
Dilation before eye examinations. Before and after eye surgery. Provide pain relief to patient with corneal abrasions and iritis/uveitis.
What are some cycloplegic medications?
Atropine (Isopto Atropine), Scopolamine (Isopto Hyoscine), Cyclopentolate (Cyclogyl), Mydriacyl (Tropicamide)
What are CI of cycloplegics?
Angle closure glaucoma and people with narrow angles
What are SE of cycloplegics?
Blurred vision, Burning or stinging, Eye irritation,
Increased sensitivity of eyes to light, Swelling of the eyelids
What are agents for glaucoma?
(1st line) Prostaglandin Analogs. (2nd line) Beta Blockers. Alpha adrenergic agonists. Cholinergic agonists. Carbonic Anhydrous Inhibitors *last three rarely used.
What is the MOA of prostaglandin analogs?
Increase uveoscleral outflow of the aqueous
What are some prostaglandin analogs?
Latanoprost (Xalatan), Bimatoprost (Lumigan),
Tafluprost (Zioptan) $125
What are SE of prostaglandin analogs?
Decreased visual acuity. Eye discomfort. Dry eye
Foreign body sensation
How do prostaglandin analogs interact with NSAIDs?
decreasing or increasing the ophthalmic effects
What is the MOA of opthalmic beta blockers?
May decrease aqueous humor formation or increase outflow
What are some opthalmic beta blockers?
Betaxolol (Betoptic)-selectively blocks beta 1 receptors, Timolol maleate (Timoptic), Levobunolol (Betagan, AKBeta) *last two are non-selective
What are adverse effects of beta blockers?
Decreased cardiac output. Bronchial constriction/Bronchospasm. Bradycardia. Heart block. Hypotension
What should be monitored with topical beta blocker use?
Pulse rate and blood pressure
What are CI of beta blocker use?
Asthma. Severe chronic obstructive pulmonary disease. Sinus bradycardia.Second- and third-degree AV block. Overt cardiac failure
What is the MOA of alpha adrenergic agonists?
Reduce intraocular pressure (IOP) by increasing outflow and reducing production of aqueous humor
What are some alpha adrenergic agonists?
Brimonidine (Alphagan P) and Apraclonidine (Iopidine) 0.5%, 1%. Both are selective alpha2-receptor
What are SE of alpha adrenergic agonists?
Dry mouth, allergic conjunctivitis, redness, ocular pruritis
Why are alpha adrenergic agonists not commonly used?
many side effects and many drug interactions.
What is the MOA of cholinergic agonists?
Contract ciliary muscle, tightening the trabecular meshwork and allowing increased outflow of the aqueous. Miosis results from action of these drugs on pupillary sphincter
What is a cholinergic agonist?
Pilocarpine (Pilocar, Pilagan)
What are SE of cholinergic agonists?
brow ache, induced myopia, decreased vision in low light
Why aren’t cholinergic agonists used anymore?
Out of favor due to side effects and questionable efficacy
What is the MOA of carbonic anhydrase inhibitors?
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
What are some carbonic anhydrase inhibitors?
Dorzolamide HCl (Trusopt) 2% and Brinzolamide (Azopt) 1%
What are SE of carbonic anhydrase inhibitors and why are they not used?
Rare, but include: superficial punctate keratitis
nausea, depression, and fatigue. Do not appear to be as effective as other therapies
What should you keep in mind if more than one topical opthalmic drug is being used for glaucoma?
administer drugs at least 10 min apart.
Why are there systemic effects of ocular drugs?
Eye is very vascular
What should you never use in ppl with history of narrow angle anterior chamber?
dilators
