Ocular Pharm Flashcards
(36 cards)
Artificial Tears/ocular lubricants
Class: artificial tear solution/optical lubricant
Indication: dry eye syndrome
Contraindication: contact lens wearers (remove before using)
MOA: protect and lubricate mucus membrane and relieve dryness/irritation
Pharmacokinetics:
ROA: drops
Common Adverse Effects: blurred vision, crusting of eyelids, mild stinging of eyes
Topical Immunosuppressant
Class: topical immunosuppressant (cycloflorine)
Indication: dry eye syndrome
Contraindication: contact lens wearers (remove 15 minutes before using)
MOA:
Pharmacokinetics:
ROA: drops
Common Adverse Effects: eye pain, burning sensation, foreign body sensation of eye, HA
Sulfacetamide sodium
Class:
Indication: corneal/conjunctival/eyelid infections, post-operative prophylaxis
Contraindication: CrCl <15, warfarin interaction, SULFA ALLERGY
MOA: inhibits folic acid synthesis
Pharmacokinetics:
ROA: drops/ointment
Common Adverse Effects: photosensitivity, GI, thrombocytopenia, leukopenia, hyperkalemia, SJS, rash
Erythromycin ointment
Ilotycin, romycin Class: erythromicin ointment Indication: corneal/conjunctival/eyelid infection, post-operative prophylaxis Contraindication: n/a MOA: inhibits RNA protein synthesis Pharmacokinetics: macrolide, bacteriostatic, 50s ribosomal subunit, CYP34A inducer ROA: drops/ointment Common Adverse Effects: GI, NV
Ciprofloxacin
Class: fluoroquinolone
Indication: corneal/conjunctival/eyelid infections, post-operative prophylaxis
Contraindication: warfarin, kidney disease or dysfunction
MOA: inhibits DNA gyrase, nucleic acid synthesis
Pharmacokinetics:
ROA: drops or ointment
Common Adverse Effects: GI, NV, seizures, prolong QT interval, photosensitivity, BLACK BOX for tendonitis, tendon rupture, neuropathies
Gentamicin
Class: aminoglycoside
Indication: corneal/conjunctival/eyelid infections, post-operative prophylaxis
Contraindication: n/a
MOA: inhibits bacterial protein synthesis by binding 30s
Pharmacokinetics: drops or ointment
ROA: drops or ointment
Common Adverse Effects: burning sensation of eyes, irritation, may prolong corneal healing
Anti-cholinergic Mydriatic
Class: Anticholinergics
Indication: Pupil Dilation, Treatment of uveitis, cyloplegic refraction in kids
Contraindication: Glaucoma or suspicion of acute-angle (check IOP first)
MOA: Paralysis of Iris sphincter by inhibition of parasympathetic innervation; cycloplegia by paralyzing ciliary muscle (loss accommodation = blurred near vision)
Pharmacokinetics:
ROA: eye drops
Common Adverse Effects: Topical SE are rare. Neuro problems (ataxia, confusion, psychosis), anti-cholinergic effects (tachy, dry mouth, urinary retention, constipation), very rarely precipitates angle-closure glaucoma
Phenylephrine
Class: Sympathomimetic Mydriatic
Indication: Pupil dilation
Contraindication: Infants (cardiac complications)
MOA: Stimulates iris dilator muscle (alpha-1 adrenergic), Iris dilation only (no cycloplegia)
Pharmacokinetics:
ROA: Drops (3-5 hours)
Common Adverse Effects: HTN
Topical NSAIDS
Class: anti-inflammatory
Indication: Pain, inflammation, macular edema, pre/post-operative
Contraindication:
MOA: COX inhibition
Pharmacokinetics:
ROA: drops
Common Adverse Effects: epithelial toxicity, GI bleeding/ulceration, thrombocytopenia, interacts w/ aspirin, nephrotoxic
Topical Corticosteroids
Class:anti-inflammatory
Indication: corneal injury, mild/moderate inflammation of lid/conjunctiva, cornea/sclera
Contraindication: Corneal abrasion, herpes, immunocompromised pt, do not prescribe w/ abx
MOA: reduces inflammation
Pharmacokinetics:
ROA: eye drops, milky suspension so shake before using
Common Adverse Effects: IOP, cataracts, scleral melting, exacerbation of viral and/or bacterial infection,
Beta-blockers for topical glaucoma
Timolol (nonselective beta-1 and beta-2)*
Betaxolol (mainly blocks beta-1)
MOA: Reduce aqueous production and IOP
Potential Systemic Effects: cardiac (arrhythmia, bradycardia, hypotension), respiratory (asthma, bronchospasm), Neuro/psych (HA, depression, confusion, dizziness), Block diabetic hypoglycemic response, nausea, impotence
Carbonic anhydrase inhibitors for glaucoma
Dorzolamide, Brinzolamide (common)
MOA: Reduce aqueous production
Potential Systemic Effects: Ocular burning, bitter taste, Sulfa allergy (ask about allergy hx)
Alpha-2 agonists for glaucoma
Brimonidine common
MOA: Reduce aqueous production
Potential Systemic Effects: AVOID IN KIDS <2yo, HA, syncope, fatigue, muscle pain, dry nose and mouth, taste alteration, GI sx
Cholinergics for glaucoma
Pilocarpine common
MOA: Increase aqueous outflow and induce miosis (stretch trabecular meshwork)
Potential Systemic Effects: neurologic problems, HA, confusion, depression, tremor, Parasymp effects diarrhea, bradycardia, HoTN, bronchospasm, ass w/ higher rate retinal detachment
Topical ophthalmic med application
- Pt tilt head back and look up
- Pull lower lid down/forward
- Apply drop/ointment to lower fornix
- Give pt a tissue
- Nasal punctual occlusion
gtts
drops
ung
ointment
Proparacaine
Anesthetic
Lasts about 20 min
Clinical use: Pain relief to ease exam, for IOP checks, surgical procedures
SE: tremor, restlessness
CHRONIC USE IS TOXIC TO CORNEA! (hide bottle from pt so they don’t take it)
Warn pt of initial sting
Tetracaine
Anesthetic
Lasts about 30 min
Clinical use: Pain relief to ease exam, for IOP checks, surgical procedures
SE: tremor, restlessness
CHRONIC USE IS TOXIC TO CORNEA! (hide bottle from pt so they don’t take it)
Warn pt of initial sting
Fluorescein Strip
Wet tip of strip w/ proparacaine
Apply to inner lower lid (do NOT touch cornea)
Use cobalt blue light. Dye appears green
Clinical uses: Corneal abrasion/ulcers/epithelial path, red painful eyes, IOP pressure check
Anticholinergic Mydriatics
Atropine (7-14 days)
Cyclopentolate (12 hours)
Tropicamide (4-6 hours)
Mydriatic for routine dilated exam
Phenylephrine (2.5%) OR
Tropicamide (0.5 or 1%)
Kids: Cyclopentolate (1%)
Considerations before dilating pupil
Consult an ophthalmologist?
Pupils: Rule out RAPD (relative afferent pupillary defect)
IOP: Avoid inducing acute angle-closure glaucoma
Pharm that stops aqueous humor production
Beta-blockers
Alpha-2 agonists
CAI’s
