Test 1 Flashcards
benzalkonium chloride (BAK)
preservative. surfactant. very stable. excellent antimicrobial. toxic effects on tear film and corneal epith. inc drug penetration. red TBUT in half. also a wetting agent.
thimerosal
preservative. organic mercury. inactivates respiratory enzymes. most effective in weakly acidic solutions. requires high continuous concentrations for biological effect. high rate of allergic and toxic rxns.
chlorohexidine
preservative. cationic diguanide. destroys semi-permeable layer of cytoplasmic membrane (bacteria). antimicrobial. not as effective as BAK or other preservatives.
chlorobutanol
preservative. detergent. cell lysis via disruption of microbial cell membrane lipid configuration. less effective antimicrobial than BAK. volatile-has odor. only effective in acidic pH. not effective alone, often combined w/ EDTA.
ethylenediaminetetraacetic acid (EDTA)
preservative. chelating agent that binds metal ions. effective by removing trace metal ions that organisms require (Ca2+, Mg). very slow acting-used in combo w/ other preservatives. contact dermatitis can occur
stabilized oxychloro-complex
oxidative preservative system. dissipates H2O, O2, Na and Cl free radicals. Cl free radicals inhibit microorganism protein synthesis-cell death (bacteriocidal?). neutralized by cells so no accummulation. effective antimicrobial but low toxicity. Purite (Refresh Tears and Alphgan-P (Allergan)).
sodium perborate
oxidative preservative system. catalyzed into H2O2, H2O, and O2. alters protein synthesis by oxidizing cell membranes and altering membrane-bound enzymes. neutralized by cells so no accumulation. effective antimicrobial but low toxicity. GenAqua (Genteal AT).
methyl/propyl/paraben
preservative. causes disorganization of microbial cells. used in AT, and non-medicated ointments. cause allergic rxns. unstable at high pH.
SofZia
preservative. most recent advancement. proprietary mixture of boric acid, propylene glycol, sorbitol, and zinc chloride. disrupts bacteria metabolic processes. rendered inactive when exposed to cations in tear film. less cytotoxicity to ocular surface than conventional preservatives. used in travaprost (Travatan Z).
polyvinyl alcohol (PVA)
viscocity agent. water-soluble viscosity enhancer. hydrophilic and hydrophobic sites. common conc: 1.4%. tx: corneal epithelial erosion, dry eye syndrome. inc drug residence time and ocular absorption. enhances oc contact time of drugs. wetting agent for CL. less viscous than MC. doesn’t disrupt cornea
hydroxypropyl methylcellulose (HPMC)
enhances viscosity. different MW and group substitutions. prolong tear film wetting time. inc fluorescein and dexamethasone penetration. 0.5% HPMC 2x ocular retention time of 1.4% PVA. less viscous than MC
carboxymethylcellulose/hydroxymethylcellulose (CMC)
enhances viscosity. carboxylic and hyroxylic groups provide anionic charge. promotes mucoadhesion. inc tear retention time. carboxym has greatest mucin adhesion than any other viscous agent. more bioadhesive than HPMC. more likely to create insoluble adhesives
polysorbate
viscosity and wetting agent. wetting agent: dec surface tension and inc spreading and penetration
methylcellulose (MC)
viscosity inc agent in AT. most freq used. forms viscous sol when added to water. stable compound at pH range tolerated by eye. unaffected by light or aging in sol. doesn’t support growth of microorganisms. conc 0.25-1%. conc >2% is viscous enough to be classified as an ung.
polyvinylpyrrolidone (povidone) (PVP(
viscosity agent. non-ionic surfactant. 3% and 5% sol. can form hydrophilic coatings in the form of absorbed layers; would mimic conj mucin
proplyene glycol
viscosity agent, tonicity agent
acetic, boric, and hydrochloric acids
buffers. adjusts pH of solution, varied solubility, weak acid or weak base
K and Na bicarbonate
buffer. adjusts pH of a solution, varied solubility, weak acid or base
K and Na borate
buffer. adjusts pH of a solution, varied solubility, weak acid or base
K and Na phosphate
buffer. adjusts pH of a solution, varied solubility, weak acid or base
K and Na citrate
buffer. adjusts pH of a solution, varied solubility, weak acid or base.
buffers, dextrans, dextrose, glycerin, propylene glycol, K and Na chloride
tonicity agents. effective osmolality. tonicity: sum of concentration of solutes that have the capacity to exert osmotic force across a membrane.
pilocarpine gel, vexol, betoptic S, azopt
polyacrylic acids. carbopol gels. inc viscosity with inc shear rate, blinking and ocular movement. good mucoadhesive and wetting properties.
betaxolol (Betoptic-S)
cation exchange resin (amberlite). dissolve and deliver hydrophilic and lipophilic compounds. red amount of free drug in solution. enhances ocular comfort.
procaine
local anesthetic. short acting. ester linkage. onset 7-8 min. novocaine. para
benzocaine
local anesthetic. ester linkage. no basic group
lidocaine
local anesthetic. med-long acting. amide linkage. onset 4-6 min. xylocaine
mepivacaine
local anesthetic. med-long acting. amide linkage. onset 3-5 min. carbocaine
bupivacaine
local anesthetic. med-long acting. amide linkage. onset 5-10 min. marcaine
etidocaine
local anesthetic. long acting. amide linkage. onset 3-5 min. duranest
proparacaine
local anesthetic. ester linkage. rapid onset. meta. w/ or w/o NaFl. little or no stinging/burning. doesn’t penetrate cornea/conj as well. localized allergic rxn rare. corneal thickness instability can occur for 5 min after instillation. preg cat: C. 0.5% sol. preservative: BAK. AK-Taine, Ophthaine
tetracaine
local anesthetic. long acting. ester linkage. rapid onset. para. 0.5% sol. moderate stinging/burning. corneal cell mb damae, loss of microvilli, and desquamation of superficial epith cells. localized allergic rxn rare. preg cat: C. preservative: chlorobutanol. AK-T-Taine
benoxinate
local anesthetic. ester linkage. rapid onset. para. only available in combo with dye. primarily used for app ton. more stinging/burning than proparacaine but less than tetracaine. less epith desquamation than proparacaine. localized allergic rxn rare. corneal thickness instability for 5 min after instillation. preg cat: C
lidocaine (topical)
local anesthetic. amide linkage. rapid onset. newest approved. 3.5% gel, unit dose, preservative free. 2 gtts prior to procedure. can be used in pts w/ ester sensitivity. preg cat: B. Akten
proparacaine + fluorescein sodium
fluoracaine, flucaine. preservative: thimerosal
benoxinate + fluorescein sodium
altafluor, fluress, flurox, flurate. preservative: chlorobutanol
benoxinate + fluorexon disodium
flurasafe. preservative: chlorobutanol
phenylephrine
mydriatic. 0.125%, 2.5%, 10%. adrenergic agonist.a1 receptors, little or no effect on B receptors. pupil dilation. blanches conj. widens palpebral fissure. IOP may dec in normals and COAG. preg cat: C. clear, colorless to slightly yellow. subject to oxidation, has antioxidant sodium bisulfite. max dilation 45-60 min. dilation recovery 4-6 hrs. little cycloplegic effect. compromised corneal epith enhances mydriatic effect. differentiate between scleritis and episcleritis. dx Horner’s syndrome. AK-Dilate, NeoSynephrine
phenylephrine 0.125%
decongestant
phenylephrine 2.5%
most commonly used in clinic. recommended for routine use. can have pigmented aqueous floaters. use for elderly and infants. AK-dialte: BAK, mydfrin: BAK, EDTA, neofrin: BAK, EDTA, neosynephrine: BAK
phenylephrine 10%
uses: breaking posterior synechiae, peripheral corneal vessel vasoconstriction during LASIK. can have pigmented aqueous floaters. significant risk of CV effects incl HTN and cardiac arrythmias. use in caution in pts w/ cardiac dz, hypo/hypertension, aneurysms, IDDM, and advanced arteriosclerosis. should not be used w/ atropine, should not have prolonged applicaiton. AK-dilate: BAK, neofrin: BAK, EDTA. neosynephrine: BAK, neosynephrine viscous: BAK, methylcellulose
phenylephrine ocular side effects
transient pain, lacrimation, keratitis, pigmented aqueous floaters, hyperemia, conjunctivitis, blurred vision, allergic dermatoconjunctivitis, rebound miosis. rebound conjunctival congestion after long term use. conjunctival hypoxia
phenylephrine systemic side effects
systemic hypertension, occipital HA, subarachnoid hemorrhage, ventricular arrhythmia, myocardial infarction, tachycardia, reflex bradycardia, blanching of skin
phenylephrine contraindications
MAOI’s and TCA’s can exacerbate adrenergic effects (esp CV effects), Grave’s disease (inc IOP), after cataract surgery (can cause CME)
hydroxyamphetamine
mydriatic agent. similar in structure to norepinephrine. indirect acting adrenergic agonist. primary action due to release of norepi. may directly act on a and B receptors (not clinically sig). 1% sol. little effect on acc. doesn’t inc IOP. onset within 15 min. max dilation within 60 min. d/a 6 hrs. preg cat: C. used to diff between central and pre/post gang sympathetic denervation in Horner’s syndrome.
Paremyd
1% hydroxyamphetamine + 0.25% tropicamide. effect independent of age, iris, or skin color. pupil size dec more rapidly than with phen or trop alone. 1 gtt mydriatic effect sig greater than w/ phen or trop alone.topical anesthetic doesn’t inc efficacy. 2 gtts 5 min apart-doesn’t induce additional mydriasis. preservative: BAK
hydroxyamphetamine ocular side effects
little if any ocular irritation. safe to use w/ shallow anterior angles. may be more readily counteracted by miotics. minimal inc in IOP in COAG, IOP dec also reported
hydroxyamphetamine systemic side effects
inc BP, tachyphylaxis, sinoauricular tachycardia w/ systemic admin, ventricular arrhythmia w/ systemic admin.
hydroxyamphetamine contraindications
similar to phenylephrine, may be safer for pts w/ IDDM, idopathic orthostatic hypotension, or chemical sympathectomy produced by therapy w/ systemic guanethidine, reserpine or methyldopa.
dapiprazole
mydriolytic. clinically used to reverse diagnostic mydriasis. blocks a receptors in iris dilator muscle. produces miosis and dec in IOP. 0.12% to 1.5% sig dec in pupil size. miotic effect dose dependent and lasts up to 6 hrs. dec IOP up to 6 hrs. inc AA. preg cat: B. miosis begins 10 min after instillation. tx of pigment dispersion glaucoma. Rev-Eyes: 0.5% sol: drug and diluent, mixed soln is clear, colorless, viscous, store at room temp for 21 days, 2gtts w/ and add 2 gtts 5 min later.
dapiprazole side effects
transient burning, conj hyperemia, SPK, corneal edema, chemosis, ptosis, lid erythema and edema, itching, dry eye, browache, BP and pulse rate not sig affected by topical use
dapiprazole contraindications
acute anterior uveitis (pupillary constriction is not desirable), pts w/ any hypersensitivity to any components of the preparation
atropine
non-selective muscarinic antagonist. stability depends on pH and temp. pKa 9.8. primarily ionized at phys pH-corneal penetration difficult. most potent mydriatic and cycloplegic available. absorbed systemically. part metab in liver, elim via urine. sulfate derivative. 0.5%, 1.0% sol, 1% ung. preg cat: C. recovery: m 7-10 days, c 7-12 days. preservative: BAK. tx: refraction, tx uveitis, tx myopia, tx amblyopia
atropine ocular side effects
allergic contact dermatitis, risk of angle closure glaucoma, inc IOP in pts w/ COAG.
atropine systemic side effects
low doses: bradycardia, high doses: tachycardia. tx for severe atropine toxicity is physostigmine, blocks: salivary gland, sweat gland, all cholinergic activity to GI, all urinary bladder musculature
systemic rxns to atropine in kids
diffuse cutaneous flush, depressed salivation/thirst, fever, urinary retention, tachycardia, somnolence, excitement/restlessness and hallucinations, speech disturbances, ataxia, convulsions
atropine contraindications
hypersensitiviey to belladonna alkaloids, COAG, angle-closure glaucoma, pts w/ tendency for inc IOP, do not exceed rec doses for infants, small children and elderly, children w/ Down’s Syndrome have hyperractive pupillary response w/ topical atropine (use cyclopentalate instead).
scopolamine
hyoscine. non-selective antimuscarinic. antimuscarinic potency on a weight basis is greater than atropine. available as transdermal patch for motion sickness. available as hydrobromide salt. 0.25% sol. preg cat: C. recovery: m 3-7 days, c 3-7 days. preservative: BAK. reserved primarily for pts w/ sensitivity to atropine. similar s/e and contraind to atropine, CNS toxicity more common. Isopto Hyoscine
homatropine
antimuscarinic. stable in solution. pKa 9.88. 0.32% unionized at phys pH. 1/10 as potent as atropine. comm avail as hydrobromide salt. 2.0% and 5.0% sol. preg cat: C. recovery: m 1-3 days, c 1-6 days. preservative: BAK. primary use is tx of anterior uveitis. s/e and contraind similar to atropine
cyclopentolate
antimuscarinic. stable water soluble ester. pKa 8.4, prim ionized form at phys pH. less effective mydriatic in darker irides. shorter onset and recov of cycloplegia in light vs dark eyes. formulated as hydrochloride salt. 0.5%, 1%, 2% sol. preg cat: C. recovery: m 1 day, c 0.25-1 day. preservative: BAK. drug of choice for cycloplegic refractions. faster onset and shorter duration. used to tx anterior uveitis. Cyclogel
cyclopentolate ocular side effects
transient stinging and lacrimation, conj hyperemia, allergic blepharoconjunctivitis (rare), inc IOP in COAG, precipitate angle closure
cyclopentolate systemic side effects
dose related, similar to atropine but more CNS effects. drowsiness, ataxia, disorientation, incoherent speech, restlessness, visual hallucinations. reversed by physostigmine
cyclopentolate contraindications
similar to atropine, smallest possible dose should be used, can reduce systemic absorption w/ nasolacrimal occlusion
tropicamide
non-selective antimuscarinic, moderate selectivity for M4 receptors. pKa 5.37. 2.3% ionized at phys pH. unionized molecules easily penetrate the corneal epith. faster onset and shorter d/a. 0.5% and 1.0% sol. recovery: m 6 hrs, c 6 hrs. preg cat: C. mydriatic effect less dependent on dose in light eyes. cycloplegic effect is dose related. preservative: BAK. drug of choice for procedures requiring mydriasis. pupillary dilation less dependent on iris pigmentation. greater m than c effect. used in combo w/ adrenergic agonists. Mydriacyl, Tropicacyl
tropicamide ocular side effects
transient stinging on instillation (esp 1%), inc IOP in COAG, precipitate angle closure in pts w/ narrow anterior chamber angles
tropicamide systemic side effects
enters systemic circulation rapidly but has low affinity for systemic muscarinic receptors, adverse systemic rxns rare, one of safest mydriatics in pts w/ systemic HTN, angina, or other CV dz, safe for retinal exams in neonates
tropicamide contraindications
pts w/ hypersensitivit to belladonna alkaloids may also exhibit cross-sensitivity to ocular topical formulation, pts w/ narrow ant chamber angles (risk for angle closure is small).
cyclomydril
combo of cyclopentolate and phenylephrine. preservative: BAK
murocoll-2
scopolamine and phenylephrine. preservative: BAK
fluorescein
yellow acid dye of xanthene series. hydrophilic. low toxicity. excellent fluorescent properties (influenced by conc, pH, presence of other substances, intensity and wavelength of absorbed light). generally formulated as a salt. freely soluble. weak acid. excitation peak: 490nm, emission peak: 530 nm. fluorescence inc w/ inc pH, nearly max at phys pH.
fluorescein clinical uses
assessment of ocular surface integrity. lacrimal system evaluation. applanation tonometry. contact lens fitting and management. intravenous preparation, angiography
fluoracaine
proparacaine + fluorescein sodium. preservative: thimerosal
fluress, flurox
benoxinate + fluroescein sodium. preservative: chlorobutanol
ful-glo, fluor-1-strip/AT
fluorescein strips. preservative: ful-glo (sterile) others, chlorobutanol
fluorescite, ak-fluor
fluorescein sodium, sterile, preparations for IV use
flurorescein adverse effects
hypersensitivity, extravasations at the injection site may cause local tissue necrosis, strong taste in mouth, nausea, vomitting, GI distress, dizziness or fainting, urine yellow at least 36 hrs, skin yellow for 6-12 hrs, in breast milk up to 76 hrs
fluorescein contraindications
hypersensitivity, avoid IV angiography during 1st trimester, not for nursing women, caution w/ asthmatics, don’t use with soft CL
fluorexon
2x weight of sodium fluorescein. less absorption by soft CL. hydrophilic. paler yellow-brown color compared to fluorescein. fluorescence much less. vulnerable to bacterial contamination. occasional conj injection. less stinging w/ benoxinate (compared to benox-fluor). non-toxic to ocular structures. not rec w/ high water content CL.
Flurasafe
benoxinate + fluorexon disodium. preservative: chlorobutanol
fluoresoft
fluorexon disodium. sterile
rose bengal
derivative of fluorescein. photoreactive compound. stained tissue is pink or magenta. stains dead epithelial cells and mucus. uses: ascertain suspected cornea/conj damage, aid for dx dry eye, corneal abrasions, FB, and corneal viral dz. strips and 1% sol. hurts on instillation. stains. stains edge of dendritic edges of corneal herpetic lesions (fluor stains center).
lissamine green
vital dye. stains degenerate cells, dead cells, and mucus. sterile strips. doesn’t hurt on instillation
indocyanine green
water soluble dye. peak absorption: 805 nm, peak emission: 835 nm. uses: fluorescent dye for retinal and choroidal angiography, identify choroidal neov in AMD. binds to plasma proteins and doesn’t leak through fenestrated capillaries. dry powder dissolved in diluent. safe as NaFl in IV. few toxic effects but can have severe allergic rxn. dec nausea and other adverse effects (ex. discolored urine, skin etc.).
methylene blue
vital stain. similar to rose bengal. aniline dye w/ peak absorption 660 nm. stains devitalized cells, mucus and corneal nerves. uses: stain lacrimal sac before dacryocystorhinostomy, outline glaucoma filtering blebs. 5% sol w/ BAK. irritating upon instillation (can inc penetration and dec discomfort w/ top anesth). contrain in pts allergic to dye.
polysaccharides
viscosity inc agent in AT. mucilages. viscous and adhesive properties. made of cellulose or vegetable gums. methylcellulose is a widely used cellulose mucilage. inc viscosity of tears. mod absorptive properties to oorneal epith. little effect on surface tension and osmotic pressure
substituted cellulose ethers
viscosity inc agent in AT. colloids dissolve in water to produce colorless sol of varying viscocity. has proper optical clarity, ref index similar to cornea, and nearly inert chemically. non-irritating and non-toxic. used to moisten CL. prolongs contact time of active drug. more viscous sol used for gonio
hydroxypropyl guar (HP-Guar)
viscosity agent. high MW. contained in Systane. gellabe lubricant used to mimic mucin layer of the tears. prolongs contact and retention time of polypropylene glycol. creates ocular shield that allows for epith repair.
gelatin, glycerin, polyethylene glycol, poloxamer 407, polysorbate 80, propylene glycol
viscosity increasing agents in AT
phosphate, phosphate-acetate, phosphate-citrate, phosphate-citrate-bicarbonate, borate, sodium hydroxide
common buffers in AT
vitamin A
nutrient in AT. essential for differentiation and maintenance of mucosal epith. inc mucous production in goblet cells. 3 forms: retinol, retinal, retinoic acid. lacrimal gland is primary provider of retinol. tretinoin is a normal metabolite and carboxylic form of retinol. viva-drops
vitamin B12
nutrient in AT. nec for normal cell growth. may protect eye from oxidative free radicals. inc healing rate of denuded epith. found in AT NutraTear
acetylcysteine
mucolytic agent. available as Mucomyst in 10% or 20% sol. unlabeled uses: tx of vernal conj GPC, filamentary keratitis assoc w/ aqueous deficient dry eye. commercial opth sol not available-must be compounded to 2% or 5% sol. dissolved mucous threads and dec tear viscosity
lacrisert (Merck)
AT insert. comfortable and well accepted by pts. disadv: discomfort, device comes out, blurred vision.
Refresh PM
non-medicated ointment. white petrolatum, mineral oil. no preservatives
pilocarpine
enhance tear production. parasympathomimetic agent w/ a muscarinic secretagogue. Salagan oral 5mg tablet. inc tear volume and flow (also inc saliva secretion). can cause GI stimulation/irritation, sweating, urinary freq, flushing and visual blurring. contraind in asthmatics, iritis, narrow angles.
bromhexine
tear stimulant. Bisolvan. may have stimulating effect on lacrimal gland and tear secretion. derivative ambroxol has equiv results. assoc w/ s/e of nausea, sweating, and rashes
diquafosol tetrasodium 2%
tear stimulant. potent and selective P2Y2 receptor agonist. inc mucin-like glycoprotein secretions in conj goblet cells. inc water flow through cells and tear production. may be in meibomian glands and could control lipid composition. so has effect on all 3 layers of the tear film. highly water soluble. not systemically absorbed. well tolerated. QID s unpreserved, sterile aqueous drop
Restasis
0.05% cyclosporin from Allergan. vehicle marked separately as Refresh Endura. pres free. single unit vials. emulsion. BID dosing, results after 3-6 mo. preg cat: C. most common s/e are mild burning and stingling. minimal systemic absorption. contraind in pts w/ active ocular infections or hypersensitivity. hasn’t been studied in pts w/ hx of herpes keratitis.
TheraTears Nutrition
fatty acids. capsule form supplement contains flaxseed oil. eicosapentaenoic acid and docosahexaenoic acid. promoted to tx OSD by dec inflamm and enhancing lipid and aq production
Systane Balance
propylene glycol. lubricant. for severe dry eye w/ assoc MGD. lipid based AT
FreshKote
focus laboratories. povidone 2%, polyvinyl alcohol. lipid based AT
Refresh Optive Advanced
lipid based AT. long lasting drye eye relief. allergan. works on all 3 layers of tear film
Lotemax
steroid to dec inflamm in dry eye
