Ocular Drugs

Question 1

residence time

Answer 1

the amount of time a drug spends on the eye– goal is to increase residence time

Question 2

issues with ocular topicals

Answer 2

corneal barrier (cant perm)
iris pigment
can be distributed by nasal mucosa –> systemic effects

Question 3

issues with ocular ointments

Answer 3

hard to measure/dose
causes blurry vision for 15 min
diffic to apply
don’t refrigerate

Question 4

ocular lubircants

Answer 4

aka artificial tears
for dry eyes (oft caused by meds or contacts)
purpose: protect, heal wounds, lubricate
hypo or isotonic
some = vasoconstrict

Question 5

cyclosporine

Answer 5

class: immunomodulator/anti-inflamm
MOA: inhib T-cells
indications: dry eye, transplants, RA, psoriasis
CI: allergy. class C preg
ADR: ocular burning, hyperemia, discharge, epiphora, pn, FBO, pruritus, sting

Question 6

sulfacetamide

Answer 6

class: AB
MOA: bacteriostatic. inhib prot synthesis
indication: broad spectrum. conjunctivitis
CI: allergy. silver rx interxn
ADE: corneal ulcer, irritation, stinging, burning

Question 7

Fluoroquinolones (names)

Answer 7

Besifloxacin
Ciprofloxacin
Gatifloxacin
Levofloxacin
Moxifloxacin
Ofloxacin

Question 8

Fluoroquinolones

Answer 8

Class: AB
MOA: bactericidal. inhib DNA gyrase
indication: broad spectrum. conjunctivitis, corneal ulcer
CI: allergy
ADR: burning, FBO, photophobia, blurry, tear, dry

Question 9

Macrolides (names)

Answer 9

Erythromycin

Azithromycin

Question 10

Macrolides

Answer 10

Class: AB
MOA: bacteriostatic. inhib prot synthesis
indication: broad spectrum. acute bact infection, neonatal gonorrhea/chlamydia
CI: allergy
ADR: irritation, redness

Question 11

Aminoglycosides (names)

Answer 11

Gentamicin
Tobramycin
Tobramycin/dexamethasone
Tobramycin/fluorometholone acetate

Question 12

Aminoglycosides

Answer 12

Class: AB (+steroid)
MOA: bactericidal. binds ribosomal RNA
indications: broad spectrum. topical tx of bact infection (tobradex for inflamm conditions)
CI: allergy. tobradex = fungal or viral infect or mycobact infect
ADR: corneal ulcer, burning, conjunctivitis, hyperemia (rare: thrombocytopenic purpura, hallucinat)

Question 13

Polymyxins (names)

Answer 13

Trimethoprin/polymyxin

Bacitracin/polymyxin

Question 14

Polymyxins

Answer 14

Class: AB 
MOA: bactericidal. increase mem perm
indication: broad spectrum. bact conjunctivitis, blepharitis, superficial infect
CI: allergy
ADR: irritation

Question 15

Natamycin

Answer 15

Class: Antifungal (only ocular)
MOA: fungicidal. binds mem and change perm
indication: fungal infect
CI: not fungal
ADR: poor GI absorption

Question 16

Ocular Antihistamines (names)

Answer 16

Emedastine difumarate
Epinastine HCl
Alcaftadine
Azelastine
Ketotifen fumarate

Question 17

Antihistamines

Answer 17

Class: antihistamines
MOA: H1 receptor antag
indication: allergic conjunctivitis
CI: allergy
ADR: irritation, burning/stinging, redness, pruritis

Question 18

ocular NSAID (names)

Answer 18

Diclofenac sodium
Ketorolac tromethamine
Flurbiprofen sodium
Bromfenac
Bromfenac sodium
Nepafenac

Question 19

ocular NSAIDs

Answer 19

class: anti-inflammatory
MOA:
indication: pn/inflamm after surgery, pn w/ corneal abrasion, blepharitis, allergic conjunctivitis
CI: infection, allergy (Bromfenac = sulfite allergy)
ADR: slower healing, keratitis, corneal melt, stinging/burning, lacrimation

Question 20

ocular autonomics

Answer 20

normal: normal pupils
anisocoria: 1 pupil blown
miosis: pinpoint
mydriasis: dilated

Question 21

Cycloplegics (part)

Answer 21

Class: Anticholinergic
MOA: weakens ciliary musc ( –> dilate pupil)
indication: diagnostic, corneal ulcer, uveitis/iritis)

Question 22

Glaucoma Meds (classes/names)

Answer 22

Prostaglandin analogs
Beta-blockers
Alpha agonists
Carbonic anhydrase inhibitors

Question 23

PG analogs (names)

Answer 23

Latanoprost
Travoprost
Tafluprost
Unoprost
Bimatoprost

Question 24

PG analogs

Answer 24

Class: ____ (prodrug)
MOA: increase uveoscleral and/or trabecular outflow
indication: glaucoma/increased IOP
CI: allergy
ADR: macular edema, conjunctival injection, hyperpigmentation (esp latanoprost), eyelash growth, uveitis

Question 25

Beta-blockers (names)

Answer 25

``` nonselective: Timolol Levobunolol Carteolol Metipranolol selective(B1): Betaxolol ```

Question 26

Beta-blockers

Answer 26

``` Class: Beta-blocker MOA: beta-adrenergic antag (block B receptor) indication: glaucoma, increased IOP CI: heart prob, asthma, lung prob ADR: inhib SNS ```

Question 27

Alpha agonists (names)

Answer 27

Apraclonidine (1st gen) Brimonidine (2nd gen) Brimonidine+timolol (2nd gen)

Question 28

Alpha agonist

Answer 28

Class: alpha agonist MOA: improve aqueous humor outflow indication: glaucoma, increased IOP CI: pt taking MAOIs,

Question 29

Carbonic anhydrase inhibitors (names)

Answer 29

Acetazolamide (oral) Dorzolamide (topical) Dorzolamide + timolol (topical) Brinzolamide (topical)

Question 30

Carbonic Anhydrase Inhibitors

Answer 30

``` Class: diuretic MAO: inhib CA-II. decrease aqueous humor/Na and fluid transport indication: glaucoma, increased IOP CI: ADR: ```

Question 31

Macular Degeneration (AMD) Rx (names)

Answer 31

VEG-F inhibitors: Pegaptanib Bevacizumab Aflibercept

Question 32

Pegaptanib

Answer 32

``` Class: veg-f inhib MOA: indication: wet AMD IOP CI: ADR: endophthalmitis, increased IOP, blepharitis, conjunctivitis, photopsia, bronchitis, diarrhea, HA ```

Question 33

Bevacizumab

Answer 33

Class: Veg-f inhib MOA: indication: colon CA, glioblastoma, renal CA, off label AMD CI: ADR: infection, death, blood clot, GI probs

Question 34

Aflibercept

Answer 34

Class: veg-f inhib MOA: indication: wet AMD, macular edema after CRVO CI: preg class C ADR: conjunctival hemorrhage, eye pn, cataract, floaters, increased IOP