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Ocular Pharmacology > Midterm 1 > Flashcards

Midterm 1 Flashcards

1
Q

Acyclovir (Zovirax)

A

Oral. Category B. Inhibits viral DNA replication via viral thymidine kinase. Used for acute tx of HSV keratitis and VZV. Few AE, may cause GI upset and HAs.
Dosing: For HSV: 400mg 5x/day for 7-14 days
For VZV: 800mg 5x/day for 7-14 days. CHEAP! good to use if pt doesn’t like drops

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2
Q

Valacyclovir (Valtrex)

A

Oral. Category B. An acyclovir pro-drug with greater GI absorption. For acute tx of VZV and HSV.
Dosing: 500 mg tid for HSV. 1g tid for VZV. OR 500mg qd for 5 years for recurrent HSV. Cheap, has 3-5x bioavailability of acyclovir.

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3
Q

Famciclovir (Famvir)

A

Oral. Category B. Inhibits viral DNA replication via viral thymidine kinase. Pro-drug of penciclovir. For acute tx of VZV and HSV.
Dosing: 250 mg tid for HSV, 500 mg tid for VZV OR 250 mg bid for 12 mos to suppress recurrent HSV. More expensive

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4
Q

Penciclovir (Denavir)

A

Topical. Category C. Inhibits viral DNA replication via viral thymidine kinase. For recurrent orolabial herpes (cold sores). Cream.

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5
Q

Trifluridine (Viroptic)

A

Topical. Category C. Inhibits viral AND HOST DNA synthesis via the enzyme thymidine synthetase. A thymidine analog gets incorporated into the DNA and prevents DNA replication. For recurrent HSV keratitis and stromal HSV. AE: SPK or SPEE, conj edema/hyperemia, delayed wound healing.
Dosing: 1 gt q2h x7 days; then q4-6h if pt is improving. Expensive

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6
Q

Ganciclovir (Zirgan)

A

Topical. Category C. Selectively targets virus infected cells only. Prodrug that is phosphorylated to active compound by HSV thymidine kinase. For recurrent HSV keratitis and stromal HSV. Also used off label for adenovirus and the tx of CMV retinitis.
Dosing: 1 gt 5x/day until ulcer heals then 1 gt tid x7 days. Equally effective as viroptic with less AE. Expensive, preferred topical tx.

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7
Q

Betadine (Providone Iodine)

A

Topical. Category C. Iodine based anti-septic that kills fungi, bacteria, and viruses. Used off label for adenovirus treatment also used as antiseptic in first aid kits and before cataract sx. Used in office. Stings eye, leaves a yellow stain

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8
Q

Zostavax

A

Vaccine for VZV, Boosts VZV-specific immunity via injection of live attenuated virus. For prevention of shingles.

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9
Q

Treatment for CMV Retinitis

A

Ganciclovir, Ziduvidine, Fosarnet, Cidovir. All taken orally or injected. Usually given by retninal specialist.

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10
Q

Natamycin (Natacyn)

A

Polyene. Topical suspension. Only topical drug FDA approved for use as an antifungal. Extremely broad spectrum. Increased cell membrane permeability, internal contents leak out leading to cell death. Fungicidal.

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11
Q

Amphotericin B

A

Antifungal. Polyene. Topical suspension. Increased cell membrane permeability, internal contents leak out leading to cell death. Fungicidal.

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12
Q

Flucytosine

A

Antifungal. Anti-metabolite. Impairs DNA synthesis. Turns into an antimetabolite in the cell. Considered fungistatic, stops growth of fungi but does not kill it.

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13
Q

Miconazole
Ketoconazole
Voriconazole
Itraconazole

A

Antifungal. Azoles. Block ergosterol synthesis needed for the cell membrane. Fungistatic first then fungicidal.

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14
Q 
Propamidine Isethionate (Brolene)
Hexamidine (Desmidine)
A

Anti-acanthamoeba. Diaminidines. Disruption of the cytoplasmic membrane causes increased permeability leading to a loss of the intracellular contents and death.

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15
Q

Polyhexamethylene Biguanide (PHMB)

A

Anti-acanthamoeba. Biguanide. The most common drug used. Disruption of the cytoplasmic membrane causes increased permeability leading to a loss of the intracellular contents and death.

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16
Q

Bacitracin

A

Antibiotic. Gram positive. Target the peptidoglycan bonds in the cell wall. Available in ointment. Mostly commonly rx’d for blepharitis.

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17
Q

Polysporin

A

Bacitracin and Polymixin B

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18
Q

Neosporin

A

Bacitracin and Polymixin B and Neomycin

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19
Q

Vancomycin

A

Antibiotic. Gram positive and MRSA. Targets the peptidoglycan bonds in the cell wall. Mainly given as an IV for MRSA and endoophthalmitis. Can be compounded for topical use and subconj injection. Used when other antibiotics are not effective, especially corneal ulcer. Dosing: 50mg/ml q30mins alternating with a gram negative drop for the first day. AE: ototoxicity, nephrotoxicity, red man syndrome.

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20
Q

Penicillin G and V

A

Natural penicillins. Gram positive, syphilis, gonorrhea. Inhibit the enzyme transpeptidase to prevent the formation of the peptidoglycan cell wall. Pen G available as IV, IM. PCN V available as oral. Rarely used because of resistance. Type 1 and 4 hypersensitivities common.

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21
Q

Ampicillin

Amoxicillin

A

Penicillins. Gram positive and negative. Inhibit the enzyme transpeptidase to prevent the formation of the peptidoglycan cell wall. Ampicillin available as oral. Amoxicillin available as oral and topical suspension. Indicated for deep infections, Dosing: 250 or 500mg tid x 5-14days. OR 500 or 875mg tid x5-14 days. Type 1 and 4 hypersensitivities common.

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22
Q

Augmentin

A

Amoxicillin and Clavulanic Acid.

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23
Q

Methicillin
Nafcillin
Cloxacillin
Dicloxacillin

A

Penicillinase resistant penicillins. Effective against staph. All have IV and oral formulations except methicillin which is just IV. Inhibit the enzyme transpeptidase to prevent the formation of the peptidoglycan cell wall. Rarely used by ODs. Type 1 or 4 hypersensitivities.

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24
Q

Cephalexin (Keflex)

Cephazolin

A

Cephalosporin. Gram positive. Cephalexin available in oral, cephazolin available as IV. Inhibit the enzyme transpeptidase to prevent the formation of the peptidoglycan cell wall.Cephalexin indicated for preseptal cellulitis, internal hordeolum. Dosing: 250-500 mg bid x 7-10 days. Contraindicated for PCN allergy

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25
Q

Cefuroxime
Cefaclor
Cefamandole

A

Cephalosporin. Gram positive and more gram neg coverage. Inhibit the enzyme transpeptidase to prevent the formation of the peptidoglycan cell wall. All formulated for oral. Cefamandole also formulated for IV and IM. Ok to give for PCN allergy.

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26
Q

Ceftriaxone

Ceftazimide

A

Cephalosporin. More gram neg. Formulated for oral, IM and IV. Inhibit the enzyme transpeptidase to prevent the formation of the peptidoglycan cell wall. Ceftriaxone indicated for Gonorrhea, meningitis, orbital cellulitis. Ok to give to PCN allergy

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27
Q

Sulfacetamide

Sulfadiazine

A

Antibiotic. Gram positive and gram negative coverage. Comes 10%, 15%, 30% solutions or 10% ung. Inhibit the enzyme to prevent production of folic acid. Sulfadiazine indicated for toxoplasmosis. Lots of AE. Contraindicated in pregnancy.

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28
Q

Bactrim (Septra)

A

Antibiotic. Gram positive and negative, effective against MRSA. Oral. Inhibits enzyme to prevent production of folic acid. Contraindicated in pregnancy.

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29
Q

Trimethoprim

A

Antibiotic. MRSA, not effective against pseudomonas. Inhibits enzyme to prevent production of folic acid. Oral. CI: pregnancy

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30
Q

Polytrim

A

Polymixin B and Trimethoprim

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31
Q

Ciprofloxaxin (Ciloxan)

A

Fluoroquinolone. Antibiotic. Gram neg, coverage against pseudomonas. Inhibit activity of DNA gyrase and topoisomerase 4, to prevent DNA replication. Drug of choice in pseudomonas. Available as ung, oral or solution. CI: pregnancy and under 18s.

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32
Q

Ocuflaxacin (Ocuflox)

A

Fluoroquinolone. Antibiotic. Gram neg coverage against pseudomonas. For bacterial corneal ulcer. Dosing: 1-2 gt q30 mins (day 1 and 2). (Days 3-7) 1-2 gt qhour, (Day 7-tx completion) instill 1-2 gt 4x/day. CI: pregnancy.

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33
Q

Levofloxacin (0.3% Quixin) (1.5% Iquix)

A

Fluoroquiolone. Antibiotic. More gram pos and pseudomonas. Inhibit activity of DNA gyrase and topoisomerase 4, to prevent DNA replication. Oral. Used if pt has pcn allergy. Dosing: 500mg qday x 7-10 days. CI: pregnancy

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34
Q

Gatifloxacin (0.3% Zymar) (0.5% Zymaxid)

A

Fluoroquinolone. Antibiotic. More gram pos and pseudomonas. Solution. Inhibit activity of DNA gyrase and topoisomerase 4, to prevent DNA replication. CI: pregnancy.

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35
Q

Moxifloxacin (Moxeza, Vigamox)

A

Fluoroquinolone. Antibiotic. More gram pos and pseudomonas. Oral and solution. Inhibit activity of DNA gyrase and topoisomerase 4, to prevent DNA replication. No preservative, use for sensitive eyes. CI: pregnancy

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36
Q

Besifloxacin (Besivance)

A

Fluoroquinolone. Antibiotic. More gram pos and pseudomonas. ONLY TOPICAL (resistance developed in oral). Inhibit activity of DNA gyrase and topoisomerase 4, to prevent DNA replication. Bacterial Conj. Dosing: 1 gt tid x 7days.

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37
Q

Polymoxin B

A

Antibiotic. Effective against pseudomonas. Increases permeability of the cell membrane. Only used in combos.

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38
Q

Gentamycin

A

Aminoglycoside. Antibiotic. Inhibits the 30s subunit. Oral and solution (has high systemic AEs so no oral) Can be fortified for corneal ulcer.

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39
Q

Tobramycin (Tobrex)

A

Aminoglycoside. Antibiotic. Inhibits the 30s subunit. Mainly gram neg, pseudomonas coverage. Available and solution and ung. Drug of choice for MRSA.

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40
Q

Neomycin

A

Aminoglycoside. Antibiotic. Inhibits the 30s subunit. Broad spectrum, no coverage against pseudomonas. Found in combos. Type 4 hypersensitivity with topical use.

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41
Q

Amikacin

A

Aminoglycoside. Antibiotic. Inhibits the 30s subunit. Injected into anterior/posterior chamber for endophthalmitis.

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42
Q

Tetracycline
Doxycycline
Minocycline

A

Antibiotic. Inhibit 30s subunit. All are oral. Indicated for acne rosacea, lyme disease, chlamydia, MGD, etc. Blepharitis and MRSA. CI: pregnancy, young children.

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43
Q

Chloramphenicol

A

Antibiotic. Inhibits the 50s subunit. Gram positive and negative. Irreversible side effects, so not used. Gray baby syndrome.

44
Q

Clarithromycin

A

Macrolide. Antibiotic. Inhibits 50s subunit. Oral, used for upper and lower respiratory infections. Dosing: 250mg 5-10 days.

45
Q

Erythromycin

A

Macrolide. Antibiotic. Inhibits 50s subunit. Oral is DOC for atypical pneumoniae and alternative to PCN and tetracycline. Dosing 250 mg qid 5-14 days. Ung is used for prophylaxis of opthalmic neonatorum, pediatric conj, and staph blepharitis.

46
Q

Azithromycin (Oral= Z-pak) (Sol: Azasite)

A

Macrolide. Antibiotic. Inhibits 50s subunit. Narrow spectrum: gram +, chlamydia, Lyme, Rickettsia, Gonorrhea, H. Flu. Oral is used for skin infection, internal hordeolum give as Z-pak. DOC for chlamydia: 1gm dose 1 time. Solution is given for bacterial conj, 1 gt bid x2days then q day 3-5 days. Do not give to child under 16

47
Q

Lincomycin

Clindamcin

A

Macrolide. Antibiotic. Inhibits 50s subunit. Narrow spectrum. Oral or injection. Used for severe infections and alternative to PCN

48
Q

MOA of all Oral steroids

A

Block the activity of the enzyme phospholipase A to prevent the formation of Arachidonic acid and it’s downstream effectors such as leukotrienes and prostaglandins

49
Q

General Effects of Oral steroids

A

Bind to glucocorticoid receptors in the human body and reduce the inflammatory response. Reduces capillary permeability and cellular exudation (reduction in redness and edema) Suppresses neovascularization, suppresses WBC migration and infiltration into the tissues. Inhibit fibrin deposition, pannus formation and scar formation

50
Q

Side effects of oral steroids

A

Oral is wore than topical. Immunosuppression: more prone to infection and delayed wound healing, increased blood glucose and BP (so caution in diabetic and HBP pts) Osteoporosis (stimulate osteoclasts and inhibit osteoblasts) Gastritis and kidney stones. Weight gain due to mineralocorticoid effects of fluid retention. Moon face and buffalo hump (redistribution of fat to the face, back of neck and abdomen) Increased IOP (topical more than oral) and Posterior subcapsular cataracts (oral more than topical). Contraindicated in Epithelial Herpetic infection.

51
Q

Tapering of steroids

A

It is necessary to prevent rebound inflammation. Steroids suppress inflammation not resolve it. Synthetic steroids slow the production of physiologic steroids. Tapering allow our body to start producing the normal level of natural steroids. Taper by 10mg if taking more than 40mg. Taper by 5 mg if taking 20mg. Taper by 2.5mg if taking 10 gm. Taper dose every 3-7 days. Steroids can be tapered more quickly or stopped abruptly if used for less than a week. If inflammation increases after tapering, start over and taper more slowly

52
Q

Hydrocortisone (5, 10, 20mg)

A

Oral steroid. Not really used because it has such weak activity (1.0) Indicated for anywhere that a topical or injection steroid cannot reach

53
Q

Prednisone (1, 2.5, 5, 10, 20, 50mg)

A

Oral steroid. Used most commonly by ODs. (4.0) Mild to moderate inflammation: 20-40mg initial dose. Severe inflammation: 40-80mg initial daily dose, increase if no improvement in 48 hours. Indicated for anywhere that a topical or injection steroid cannot reach.

54
Q

Methylprednisolone (4, 8, 16, 32 mg)

A

Oral steroid. Used most commonly by ODs (5.0) Medrol dosepak that comes in 4, 5, and 10 mg blister packs that are tapered over a 6 day course. Indicated for anywhere a topical or injection steroid cannot reach.

55
Q

Methylprednisolone Acetate (Depo-Medrol)

A

Injected steroid. Indicated for sympathetic ophthalmia, temporal arteritis, uveitis, and ocular inflammatory conditions unresponsive to topical corticosteroids.

56
Q

Triamcinolone (Kenalog)

A

Injected steroid. Formulations: Aqueous soluble: lower risk of embolization, atrophic changes, depigmentation. Viscous suspension: slowly absorbed. Long half-life- persists for 4-6 weeks. Dose: 0.1-1 cc. no FDA indications for ocular use. Used off-label by ODs. Indications: Anterior segment inflammation as an adjunct to topical and/or systemic steroids. If pt is non-compliant or severe inflammation exists.

57
Q

Retisert

A

Intravitreal steroid implant. Sustained delivary of fluocinolone acetonide for 2.5 years. Indicated for chronic non-infectious uveitis. Must be removed when done

58
Q

Iluvien

A

Intravitreal steroid implant. Sustained delivery of fluocinolone acetonide for 3 years. Indicated for diabetic macular edema. Must be removed.

59
Q

Ozurdex

A

Intravitreal steroid implant. Sustained delivery of dexamethasone for 6 mos. Indicated for diabetic macular edema and macular edema following BRVO and CRVO and chronic non-infectious posterior uveitis. Biodegradable.

60
Q

Dextenza

A

Punctal steroid implant. Sustained delivery of dexamethasone for 30 days. Inserted into the puncta. Indicated for allergic conjunctivitis.

61
Q

Dexamethasone Alcohol (0.1% Maxidex)

A

Suspension steroid Most commonly used in combinations.

62
Q

Dexamethasone Phosphate (0.1% Decadron)

A

Solution steroid. Most commonly used in combinations.

63
Q

Dexamethasone Phosphate (0.05% Decadron)

A

Ointment steroid. Most commonly used in combinations.

64
Q

Difluprednate (Durezol)

A

Emulsion steroid. No shaking required. BAK free. Good for severe cases of inflammatory conditions. Longer duration of action than Pred Forte., permits less dosing. One of the most efficacious drops.

65
Q

Fluorometholone Acetate (0.1% Flarex) (0.1% FML)

A

Suspension steroid for both. Ointment for FML as well. Next best option to Loteprednol for chronic usage because it has less tendency to increase IOP than other ketone steroids. Moderate efficacy, generic available.

66
Q

Loteprednol (0.2% Alrex)

A

Suspension steroid. Indicated for allergic conjunctivitis. Dosing: 1 drop qid for a week, then 1 drop bid for a month. Off label of mild inflammation. Has fewer AEs, less potential for cataracts and increased IOP. Best choice steroid for chronic, recurrent inflammatory conditions.

67
Q

Loteprednol (0.5% Lotemax)

A

Suspension, Ointment, and Gel steroid. Indicated for post-op inflammation, off-label use for inflammatory conditions. Has fewer AEs, less potential for cataracts and increased IOP. Best choice for chronic, recurrent inflammatory conditions.

68
Q

Prednisolone Acetate (1% Pred Forte)

A

Suspension steroid. Good for moderate-severe cases of inflammatory conditions. One of the most efficacious drops. Generic is NOT as effective.

69
Q

Prednisolone Acetate (1% Generic)

A

Suspension steroid. Has larger particles and must be really shaken. Goof for mild to moderate acute inflammatory conditions. Inexpensive compared to Pred Forte but NOT nearly as effective.

70
Q 
Prednisolone Acetate (0.12% Pred Mild)
Prednisolone Phosphate (1% Inflamase Forte)
A

Suspension and solution steroids respectively.

71
Q

Rimexolone (Vexol)

A

Suspension steroid

72
Q

Triamcinolone (0.1%)

A

Dermatologic cream steroid. Indicated for periocular dermatitis conditions. Generic available, found in injectable form as Kenalog.

73
Q

Steroid responders

A

1/3 pts. Steroid response= IOP increase more than or equal to 10mmHg secondary to aqueous production. Typically occurs 2-8 weeks after treatment. Occurs in normal and glaucomatous eyes. Get baseline IOP and monitor. May want to add Timolol in steroid responders to decrease aqueous production.

74
Q

Belphamide

A

Prednisolone Acetate (0.2%) and Sodium Sulfacetamide. Solution and ointment. Very low steroid concentration. Sulfanamides rarely used because of bacterial resistance. Contraindicated for Sulfa Allergies.

75
Q

Poly-Pred

A

Prednisolone Acetate 1% and Neomycin and Polymixin B. Suspension. Highly effective steroid. Only used for short periods of time.

76
Q

Pred-G

A

Prednisolone 1% and Gentamicin. Suspension and ointment. Highly effective steroid and gentamicin can cause SPK.

77
Q

Maxitrol

A

Dexamethasone 1% and Neomycin and Polymixin B. Suspension and ointment. Moderately effective steroid. Used for short periods only.

78
Q

TobraDex

A

Dexamethasone 0.1% and tobramycin. Suspension and ointment. Moderately effective steroid. Risk for increased IOP.

79
Q

TobraDex ST

A

Dexamethasone 0.05% and tobramycin. Suspension. Moderately effective steroid with less concentration. Has a Xanthum gum delivery system which reduces the settling of dexamethasone. It’s interaction with tears leads to 7x increased drop viscosity, increased retention time and less dosing.

80
Q

Zylet

A

Loteprednol and Tobramycin. Suspension. Highly effective steroid. Ester based with less potential to increase IOP and cause cataracts. Ideal choice for chronic conditions b/c or steroid component.

81
Q

Contraindication for Steroid-Antibiotic combos

A

All are contraindicated in Herpes epithelial Keratitis.

82
Q

Dosing for Steroid-Antibiotic combos

A

Ointments: 3-4 x days
Suspensions: q3-6 hours
Tapering is not recommended b/c of the antibiotic component. (leads to resistance)

83
Q

Indications for steroid-antibiotic combos

A

Inflammatory ocular conditions where bacterial infection or a risk of bacterial infection exists: Bacterial conjunctivitis, phylectenular keratoconjunctivitis. Pre- or Post- Op to surgery

84
Q

MOA of NSAIDs

A

prevent formation of prostaglandins (which are responsible for sensitizing pain receptors) in the arachidonic acid pathway by the inhibition of COX enzymes

85
Q

General Indications of NSAIDs

A

Allergies (however there are better options out there). Pain control (topical more than oral): abrasions, peri-operative, Betadine tx with epidemic keratoconjuctivitis. Inflammatory control (oral more than topical). CME in the retina.

86
Q

Main adverse effects of NSAIDs

A

Watch sub-epithelial infiltrate formation post corneal sx. Corneal melt syndrome. Older NSAIDs have burning, stinging, SPK and conjunctival hyperemia, Contraindicated in CL wearer b/c of the risk of the CL absorbing the preservatives.

87
Q

Diclofenac (0.1% Voltaren)

A

NSAID. Post-op inflammation after cataract extraction. Pain and photophobia in pts undergoing corneal refractive sx. Dosing: 1gt QID

88
Q

Ketorolac (0.5% Acular)
Ketorolac (0.4% Acular LS)
Ketorolac (0.45% Acuvail)

A

NSAIDs. Acular: ocular itching due to seasonal allergies, post op inflammation after cataract extraction Dosing: 1 gt qid
Acular LS: reduction of pain following refractive sx. LS means less stinging
Acuvail: post-op inflammation and pain after cataract extraction. Dosing: 1 gt bid. Preservative free.

89
Q

Bromfenac (0.07% Prolensa)

A

NSAID. Post-op inflammation and pain after cataract extraction. Dosing 1 gt qday. continued for 14 days. No shaking required, available in 1.6 and 3 mL bottle sizes.

90
Q

Nepafenac (0.1% Nevenac)

Nepafenac (0.3% Ilvero)

A

NSAID. Post-op inflammation and pain after cataract extraction. Nevanac dosing: 1 gt TID. Ilvero: 1 gt qday. Comfortable and well-tolerate, doesn’t sting as much, minimized potential for toxicity. Works well for CME b/c it is pro-drug that gets past the cornea well. Nepafenac is converted to Amfenac in the eye and allows for better penetration

91
Q

AREDS 1

A

ARMD supplement. Study showed a 25% reduction rate i progression to advanced ARMD. Indicated for supplementation to prevent progression in ARMD. Antioxidants: Vitamin C, E, Beta-carotene, Zinc, copper. Beta-carotene is assoc. with increased risk of lung cancer and zinc is assoc. with GI upset

92
Q

AREDS 2

A

ARMD supplement. Studies dow to tweak the formula of AREDS 1. Includes vitamins C and E. a reduced amount of zinc, copper, and lutein and zeaxanthin

93
Q

Macugen (pegaptanic)

A

Anti-VEGF. Inhibits VEGF-A165 only. Indicated for diabetic macular edema, wet ARMD, neovascularization, etc. AEs: endophthalmitis, retinal detachmennt, IOP spikes, thromboembolic events, cataracts, vitreous floaters, conj heme at injection site. MOA: humanized monoclonal antibodies which are inhibitors of VEGF. Bind to free floating VEGF molecules to prevent the attachment of VEGF to their receptors responsible for the neovascular growth signal. Have short half lives and need repeated injections to maintain effect.

94
Q

Avastin (bevacizumab)

A

Used off-label. Cheap. Has to be compounded at the pharmacy, so there are quality control concerns. Indicated for diabetic macular edema, wet ARMD, neovascularization, etc. AEs: endophthalmitis, retinal detachmennt, IOP spikes, thromboembolic events, cataracts, vitreous floaters, conj heme at injection site. MOA: humanized monoclonal antibodies which are inhibitors of VEGF. Bind to free floating VEGF molecules to prevent the attachment of VEGF to their receptors responsible for the neovascular growth signal. Have short half lives and need repeated injections to maintain effect.

95
Q

Lucentis (ranibizumab)

A

Anti-VEGF. Inhibits all isoforms of VEGF-A. Very expensive. Studies show that lucentis works the same as avastin. Indicated for diabetic macular edema, wet ARMD, neovascularization, etc. AEs: endophthalmitis, retinal detachmennt, IOP spikes, thromboembolic events, cataracts, vitreous floaters, conj heme at injection site. MOA: humanized monoclonal antibodies which are inhibitors of VEGF. Bind to free floating VEGF molecules to prevent the attachment of VEGF to their receptors responsible for the neovascular growth signal. Have short half lives and need repeated injections to maintain effect.

96
Q

Eyelea (aflibercept)

A

Anti-VEGF. Newest drug with a longer duration of action over the others. May good for pts that have been failed by the other drugs. It has a higher affinity for VEGF. Very expensive. Indicated for diabetic macular edema, wet ARMD, neovascularization, etc. AEs: endophthalmitis, retinal detachmennt, IOP spikes, thromboembolic events, cataracts, vitreous floaters, conj heme at injection site. MOA: humanized monoclonal antibodies which are inhibitors of VEGF. Bind to free floating VEGF molecules to prevent the attachment of VEGF to their receptors responsible for the neovascular growth signal. Have short half lives and need repeated injections to maintain effect.

97
Q

Jetrea (ocriplasmin)

A

Recombinant form of human plasmin. Not believed to be very effective. Indicated for treatment of vitreaomacular traction. AEs: recent cases of unknown vision loss. MOA: dissolves protein matrix of vitreoretinal interface, breaks down the bonds b/w the superficial retina and collagen fibrils, laminin and fibronectin

98
Q

Silver Nitrate

A

Chemocautery of conjunctival blood vessles. Used off label for superior limbic keratoconjunctivitis. Can be repeated numerous times safely. Needs to be compounded by pharmacist

99
Q

5-fluorouracil

Mitomycin-C (MMC)

A

Antimetabolites. Used in surgery to prevent scarring. MMC is 100x more potent than 5-FU so it is used more often.

100
Q

Gadolinium (Gd)

A

A paramagnetic metal ion that has a weak magnetism when a metal field is applied. Used for MRI contrast dye. Uncommon AEs: HA, nausea, vomiting. Eliminated via kidneys, so caution in renal failure pts.

101
Q

Fluorescein Angiography (FANG)

A

Injection is made into the veins and it diffuses out from all the capillaries except in the CNS and retina where ZO are present. Allows us to see if there is a leakage of the retinal blood vessels. AE: nausea/vomiting for 1-2 mins post-injection, otherwise very safe.

102
Q

Indocyanine Green Angiography (ICG)

A

Best for imaging the choroid due to the longer wavelengths of absorption/emittance of ICG and better penetration of the retinal tissues. Preferred in occult CNVM because it allows viewing of leakage through blood.

103
Q

Rho-Kinase inhibitors (ROCK)

A

Cytoskeletal reorganization in the TM increases spaces between the cells and allows for increased aqueous outflow by allowing the fluid to get out more quickly. Indicated for significant IOP lowering effects, improvement in ocular blood flow, inhibition of post-op scarring, promotion of retinal ganglion cell survival and axon regeneration. Lasts up to 12 hours. AE: hyperemia/redness.

104
Q

Trabodenoson

A

Increases TM outflow, removes accumulated proteins which can block the outflow of aqueous humor. Taken by mouth

105
Q

Marijuana (THC)

A

Cannaboid receptor agonism in the ciliary body and TM leads to decreased aqueous production. Lowering of IOP in glc but only for 3-4 hr.

106
Q

Riboflavin Cross-Linking

A

Acts as a photosensitizer for the induction of crosslinks between collagen fibrils as well as shielding the underlying tissues from UVA. Stiffens and flattens the cornea, used for keratoconus

107
Q

ReSure corneal sealant gel

A

Synthetic PEG hydrogel that seals corneal incision like glue. FDA approved for cataract surgert

Ocular Pharmacology (1 decks)

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