Common Conditions of the eyes and ears Flashcards
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
The eyes are more sensitive than the ears. Eye drops can be used in the ears, but _
Never use an ear drop in the eye! The ear drops may not have the appropriate pH, may not be isotonic and may not be sterile.
These abbreviations can be mistaken (interchanged) for each other and can mean other things; know how to interpret them, but its safer to write them out. (Use right eye, instead of OD).
AD =
AS =
AU =
OD =
OS =
OU =
AD = right ear
AS = left ear
AU = each ear
OD = right eye
OS = left eye
OU = each eye
A is from the Latin for ear (auris)
O is for eye (oculus)
Eye and ear formulations:
1 drop = _________
suspensions: shake well
ointments: _____
Gels: _______________________
0.05 mL
apply to the conjunctival sac or over lid margins (for blepharitis). Ointments can make vision blurry. Do Not Use with contact lenses.
with cap on, invert and shake once to get the medicine into the tip before instilling into the eye.
Glaucoma:
is a disease of the eye that results in damage to the optic nerve and loss of the visual field (the vision straight ahead and the peripheral vision, measured by the visual filed test). the vision gets narrower as damage progresses.
With Glaucoma, in most cases, the ____________ is above the normal range.
(IOP) Intraocular pressure
normal range: 12-22 mmHg
-this increase in pressure of the eye is due to the fluid building up.
The goal of treatment with glaucoma is to _________
reduce the IOP
There are two main forms of glaucoma:
Which is the most common?
Open-angle glaucoma (most common)
-usually presents without symptoms and is treated with eye drops or surgery
Closed angle glaucoma also called Angle closure glaucoma.
-Is a sharp, sudden increase in IOP due to a blockage. This type of glaucoma usually presents with eye pain, headaches and decreased vision AND is a MEDICAL EMERGENCY that is treated surgically.
Key Drugs that can increase intraocular pressure (IOP):
-anticholinergics (antihistamines, oxybutynin, tolterodine, benztropine, scopolamine, trihexyphenidyl, tricyclic antidepressants)
- decongestants
-chronic steroids
-topiramate
Drug treatment:
Glaucoma treatments decrease IOP by targeting __________
the aqueous humor (fluid in the eye) in 2 main ways.
1) reduce aqueous humor production (make less fluid)
2) increase aqueous humor outflow (move fluid out)
Which drugs classes will reduce aqueous humor production (make less fluid)?
- Adrenergic alpha-2 agonists
- Beta blockers
- Carbonic anhydrase inhibitors
Which drugs classes increase aqueous humor outflow (move fluid out)?
- prostaglandin analogs
- cholinergics (Miotics)
- rho kinase inhibitors
- adrenergic alpha-2 agonists
____________ are used commonly as initial treatment. They are the most effective drugs at decreasing IOP ~30%; they are safe and used once daily.
prostaglandin analogs
a _______ is preferable if the pressure is high in one eye only because the darkening of the iris and eyelash thickening seen with prostaglandin analogs is not desirable in only one eye.
beta-blockers, reduce IOP ~22%
If monotherapy does not sufficiently decrease IOP, consider switching to a different medication or using combination therapy.
Counseling on proper administration technique and the importance of adherence is critical.
Which eye drops should be stored in the refrigerator before opening but once opened can be stored at room temperature?
latanoprost
latanoprostene bunod
tafluprost
Which prostaglandin analogs DO NOT contain the BAK preservative?
Travatan Z (travoprost) - uses alternative
Xelpros (latanoprost) - uses alternative
Zioptan (tafluprost) - preservative free
Which prostaglandin analog is NOT indicated for glaucoma?
Latisse
Which prostaglandin analog eye drop comes preservative free?
Zioptan (tafluprost)
Which eye drops come as a gel?
timolol
when do administer eye ointments?
usually at night so ointment stays in the eye
Lumigan
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
bimatoprost
class: Prostaglandin analog = -prost
Indications: Open angle glaucoma
MOA: increase aqueous humor outflow
Dosage forms:
Dosing: 1 drop into the eye at bedtime
Max dose: 1 drop into each eye daily at bedtime
Warnings:
*Ocular effects: *darkening of the iris, eyelid skin and eyelashes; *eyelash length and number can increase, contamination of multiple-dose ophthalmic solutions can cause bacterial keratitis
Side Effects:
*Blurred vision, stinging, increased pigmentation of the iris/eyelashes, eyelash growth/thickening, foreign body sensation
Pearls/Notes:
*Do Not exceed once daily dosing; can decrease efficacy
*Wait 5-10 minutes in between drops of 2 different medications
*Apply gels last. Wait 10 minutes after the last eye drop before use.
*Remove contact lenses prior to using eye drops. Wait 15 minutes to reinsert.
* Do not use with Latisse (bimatoprost). Can reduce the effectiveness of other prostaglandins.
* Products contain the preservative (BAK) benzalkonium chloride, remove contact lenses prior to use, then wait 15 minutes to reinsert.
Drug-Drug/Food interactions:
Xalatan
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
latanoprost
class: Prostaglandin analog = -prost
Indications: Open angle glaucoma
MOA: increase aqueous humor outflow
Dosage forms:
Dosing: 1 drop into the eye at bedtime
Max dose: 1 drop into each eye daily at bedtime
Warnings:
*Ocular effects: *darkening of the iris, eyelid skin and eyelashes; *eyelash length and number can increase, contamination of multiple-dose ophthalmic solutions can cause bacterial keratitis
Side Effects:
*Blurred vision, stinging, increased pigmentation of the iris/eyelashes, eyelash growth/thickening, foreign body sensation
Pearls/Notes:
* *Store in the refrigerator before opening; once opened, store at room temp**
*Do Not exceed once daily dosing; can decrease efficacy
*Wait 5-10 minutes in between drops of 2 different medications
*Apply gels last. Wait 10 minutes after the last eye drop before use.
*Remove contact lenses prior to using eye drops. Wait 15 minutes to reinsert.
* Do not use with Latisse (bimatoprost). Can reduce the effectiveness of other prostaglandins.
* Products contain the preservative (BAK) benzalkonium chloride, remove contact lenses prior to use, then wait 15 minutes to reinsert.
Drug-Drug/Food interactions:
Xelpros
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
latanoprost
class: Prostaglandin analog = -prost
Indications: Open angle glaucoma
MOA: increase aqueous humor outflow
Dosage forms:
Dosing: 1 drop into the eye at bedtime
Max dose: 1 drop into each eye daily at bedtime
Warnings:
*Ocular effects: *darkening of the iris, eyelid skin and eyelashes; *eyelash length and number can increase, contamination of multiple-dose ophthalmic solutions can cause bacterial keratitis
Side Effects:
*Blurred vision, stinging, increased pigmentation of the iris/eyelashes, eyelash growth/thickening, foreign body sensation
Pearls/Notes:
* *Store in the refrigerator before opening; once opened, store at room temp**
** Does NOT have BAK preservative**
*Do Not exceed once daily dosing; can decrease efficacy
*Wait 5-10 minutes in between drops of 2 different medications
*Apply gels last. Wait 10 minutes after the last eye drop before use.
*Remove contact lenses prior to using eye drops. Wait 15 minutes to reinsert.
* Do not use with Latisse (bimatoprost). Can reduce the effectiveness of other prostaglandins.
Drug-Drug/Food interactions:
Travatan Z
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
travoprost
class: Prostaglandin analog = -prost
Indications: Open angle glaucoma
MOA: increase aqueous humor outflow
Dosage forms:
Dosing: 1 drop into the eye at bedtime
Max dose: 1 drop into each eye daily at bedtime
Warnings:
*Ocular effects: *darkening of the iris, eyelid skin and eyelashes; *eyelash length and number can increase, contamination of multiple-dose ophthalmic solutions can cause bacterial keratitis
Side Effects:
*Blurred vision, stinging, increased pigmentation of the iris/eyelashes, eyelash growth/thickening, foreign body sensation
Pearls/Notes:
** Does NOT contain BAK preservative**
*Do Not exceed once daily dosing; can decrease efficacy
*Wait 5-10 minutes in between drops of 2 different medications
*Apply gels last. Wait 10 minutes after the last eye drop before use.
*Remove contact lenses prior to using eye drops. Wait 15 minutes to reinsert.
* Do not use with Latisse (bimatoprost). Can reduce the effectiveness of other prostaglandins.
Drug-Drug/Food interactions:
Vyzulta
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
latanoprostene bunod
class: Prostaglandin analog = -prost
Indications: Open angle glaucoma
MOA: increase aqueous humor outflow
Dosage forms:
Dosing: 1 drop into the eye at bedtime
Max dose: 1 drop into each eye daily at bedtime
Warnings:
*Ocular effects: *darkening of the iris, eyelid skin and eyelashes; *eyelash length and number can increase, contamination of multiple-dose ophthalmic solutions can cause bacterial keratitis
Side Effects:
*Blurred vision, stinging, increased pigmentation of the iris/eyelashes, eyelash growth/thickening, foreign body sensation
Pearls/Notes:
* *Store in the refrigerator before opening; once opened, store at room temp**
*Do Not exceed once daily dosing; can decrease efficacy
*Wait 5-10 minutes in between drops of 2 different medications
*Apply gels last. Wait 10 minutes after the last eye drop before use.
*Remove contact lenses prior to using eye drops. Wait 15 minutes to reinsert.
* Do not use with Latisse (bimatoprost). Can reduce the effectiveness of other prostaglandins.
* Products contain the preservative (BAK) benzalkonium chloride, remove contact lenses prior to use, then wait 15 minutes to reinsert.
Drug-Drug/Food interactions:
