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Flashcards in Ocular Drugs Deck (47):
1

Peri-ocular injections

less common, reach behind iris-lens diaphragm, bypasses conjunctiva and corneal epithelium which is good for drugs with low lipid solubility

2

Intraocular injection types

intracameral or intravitreal, intravitreal anti-VEGF- macular degeneration, intrav steroid- macular edema, intrav antibiotics- endophthalmitis, intraocular acetylcholine- cataract surgery

3

Ophthalmic medication

Cholinergic agonists, sympathomimetics, BBs, carbonic anhydrous inhibitors, prostaglandin analogues, intraocular decongestants, anticholinergic agents, NSAIDs, corticosteroids, antihistamines, antiinfectives

4

Glaucoma

intraocular pressure> 30 mmHg, open is chronic and closed is severe and acute, goal is to prevent vision loss, multiple agents give at least 10 mins apart

5

Cholinergic agonists

pilocarpine, carbachol

6

Cholinergic agonist MOA

cause miosis by contraction of the iris sphincter muscle which increases aqueous humor flow through the trabecular meshwork by longitudinal cilliary muscle contraction, accommodation

7

Cholinergic clinical uses

miosis, glaucoma, usually second or third line

8

Cholinergic ADRs

HA from accomadative spasm, retinal detachment (rare), systemic cholinergic effects are rare

9

Anticholinergic agents

atropine, cyclopentolate, phenylephrine (Cyclomydril), Tropicamide (Midriacyl)

10

Anticholinergic agents MOA

causes mydriasis by paralyzing the sphincter muscle and also causes cycloplegia by paralyzing the cilliary muscle

11

Anticholinergic clinical uses

eye exams where dilation is needed to facilitate exam of retina, fundoscopy, cycloplegic refraction, sublingual use of atropine drops for terminal secretions

12

Anticholinergic agents ADRs

blurred vision, nausea, vomiting, pallor, constipation, urinary retention

13

Sympathomimetics

epinephrine, brimonidine (Alphagan), TID drug

14

Sympathomimetics MOA

a2 agonist that reduces IOP by reducing the production of aqueous humor and improving drainage

15

Sympathomimetics Clinical use

open angle glaucoma, ocular HTN, can be used to prevent IOP post op

16

Sympathomimetcs ADRs

fatigue, conjunctival blanching, mydriasis, VERY well tolerated

17

Beta blockers

Timolol (Timoptic), Levobunolol (Betagan), Betaxolol (Betoptic)

18

Beta blockers MOA

reduce intraocular pressure by blocking B2 in ciliary epithelium, reduces production of aqueous humor, given BID except Timoptic

19

Beta blockers use

glaucoma

20

Beta blocker ADR

stinging, rarely systemic

21

Carbonic anhydrous inhibitors

Acetazolamide (diamox) (rare), Dorzolamide (Trusopt) (TID, Brinzolamide (Azopt) (TID)

22

Carbonic anhydrous inhibitors MOA

reduce IOP by buffering an acid residue which may be present in secretory cells as a result of production of aqueous humor

23

Carbonic anhydrous inhibitors Use

ocular HTN, glaucoma

24

Carbonic anhydrous inhibitors ADR

stinging, burning, bitter taste, Dorzolamide known for systemic absorption

25

Prostaglandin analogues

Bimatoprost (Lumigan), Latanoprost (Xalatan) generic available, Travoprost (Travatan)

26

Prostaglandin analogues MOA

reduce IOP by increasing aqueous humor drainage via a process not previously targeted

27

Prostaglandin analogues use

ocular HTN and glaucoma

28

Prostaglandin analogues ADRs

local irritation, iris pigmentation

29

Prostaglandin Pearls

first line, most efficacious, once daily dosing, combo available

30

Suspected pathogens of eye infections

str, pneumoniae, staph aureus, hemophilus sp, proteus sp, Klebsiella sp

31

Anti infective ophthalmic agents

Bacitracin, neomycin, sulfa (first line, cheap); erythromycin (all infants), tobramycin, Gentamicin (gram - bac), Cipro (gram -, cheap), levofloxacin (broad spectrum, $$), Moxifloxacin (recurrent infections, $$)

32

Anti infective ophthamic agents Pearls

similar to other infections, cultures not always obtained, response in few days, change to broad spectrum if no improvement

33

Intraocular decongestants

tetrahydrozoline (visine), oxymeazoline (Visine LR)

34

Intraocular decongestants MOA

sympathomimetic activity, promote constriction to result in clearing red eyes

35

Intraocular decongestant Pearls

red eyes, no ADR, risk of dependency (no more than 72 hrs)

36

Artificial tears

Many products available, balance salt solutions with viscosity inducing agents to prolong contact time, for dry eyes, may temporarily blur vision, very cheap

37

Intraocular NSAIDs

Diclofenac (Voltaren), Ketorolac (Acular), $$$

38

Intraocular NSAIDs MOA

inhibit COX I and II resulting in production of inflammatory mediaters

39

Intraocular NSAID uses

intraoperative miosis, inflammation post op, seasonal conjuctivitis, macular edema

40

Ocular antihistamines

Olopatadine (Patanol), Ketotifen (Zaditor), Azelastine (Optivar)

41

Ocular antihistamines MOA and use and ADR

histamine receptor blockers and mast cell stabilizers; for allergic conjuctivitis, mostly for prevention, burning, stinging

42

Ocular antihistamine Pearls

$$$, limit use to pt with ocular sx not controlled with systemic therapy or GLAUCOMA pts

43

Corticosteroids

Fluorometholone, prednisolone, dexamethoasone, hydrocortisone

44

Corticosteroids MOA

inhibition of arachadonic acid release from phospholipids by inhibiting prospholipase A2

45

Corticosteroids clinical use

postop, anterior uveitis, sever allergic conjuctivitis, vernal keratoconjunctivitis, prevention and suppression of corneal graft rejection, episcleritis, scleritis

46

Corticosteroids ADR

increased susceptibility to infections, glaucoma, cataract, mydriasis, scleral melting

47

Ocular complications associated with systemic drugs

ibuprofen, lovastatin, CCB, allopurinol (form cataract), amiodarone