Ophthalmology Pharm Week 2 Flashcards Preview

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Flashcards in Ophthalmology Pharm Week 2 Deck (42):
1

Indications for NSAIDs?
3

Used for analgesia, antipyretics and anti-inflammatory effects.

2

Five NSAIDs used for post op pain after surgery?

Diclofenac (Voltaren),
Suprofen (Profenal),
Brofenac (Xibrom),
Flurbiprofen (Ocufen),
Nepafenac (Nevanac)

3

What NSAID is used for photophobia?

Voltaren

4

What NSAIDs are used for prevention of intraoperative myosis?
2

(Ocufen and Profenal)

5

What NSAID is used for relief of ocular inflammation due to seasonal allergic conjunctivitis?

Ketorlac tromethamine O.5% soln (Acular)

6

Downsides to NSAIDs?
3

1. Have no effect on IOP
2. May cause burning and stinging
3. Don’t use for longer then 2 weeks or can cause corneal injury

7

Should we as PAs every prescribe corticosteroids?

never, only ophthomalogist

8

Mechanism of action for corticosteriods for the eye?
2

reduce inflammation and decrease edema

9

Indications for corticosteroids?
4

Treatment of steroid responsive inflammatory conditions. Some examples are:
Acute iritis
Stromal keratitis
Chemical burns
Episleritis/Scleritis

10

Types of corticosteriods for eye treatment? 6

And what is the most commonly used one?

1. Prednisolone acetate 1% soln (Pred Forte) most commonly used
2. Prednisolone sodium phosphate 1% or 0.125% soln (Inflamase Forte, Metreton)

3. Dexamethasone/Tobramycin oint/susp (Tobradex)
Steroid/antibiotic combo (STAY AWAY FROM THIS)
4. Dexamethsone 0.05%, 0.1% oint/soln
Topical dexamethasone preparations are also potent agents.

5. Fluorometholone 0.1% soln (Flarex)
6. Fluorometholone 0.25% susp. (FML-Forte)

11

Side effects of corticosteriod treatment?
3

1. Mydriasis,
2. ptosis,
3. inhibition of corneal epitheliem/stromal healing

12

Repeated use or long term use hazards of corticosteroids?
5

1. Cataracts
2. Corneal thinning and/or rupture
3. Glaucoma leading to optic neuritis
4. Immunosuppression: increased incidence of eye infections, mask acute (fungal) infections, prolong or exacerbate viral infections
5. Keratitis

13

Contraindications for corticosteriod treatment?
2

1. Viral disease of the cornea or conjunctiva (herpes simplex keratitis)
2. Mycobacterial or fungal infections of the eye

14

Agents for glaucoma?
(whats 1st line?)
(whats 2nd line?)
5

(1st line) Prostaglandin Analogs
(2nd line) Beta Blockers
Alpha adrenergic agonists *
Cholinergic agonists *
Carbonic Anhydrous Inhibitors *

15

Mechanism of action for prostaglandin analogs?

Increase uveoscleral outflow of the aqueous.
(giving it another way to drain other than through the trabecular meshwork)

16

Medications that are prostaglandin analogs?
3

Latanoprost (Xalatan) $95-$131
Bimatoprost (Lumigan) $251
Tafluprost (Zioptan) $125

17

Side effects of prostaglandin analongs?
5

Decreased visual acuity
Eye discomfort
Dry eye
Foreign body sensation
Could change the color of the iris

18

What should we not mix with prostaglandin analogs due to drug interactions?

NSAIDs

19

Mechanism of action of beta bockers?
2 ways it could help

May decrease aqueous humor formation or increase outflow

20

Types of beta blockers?
3

Betaxolol (Betoptic)

Timolol maleate (Timoptic)

Levobunolol (Betagan, AKBeta)

21

MOA of Betaxolol (Betoptic)?

Selectively blocks beta1-adrenergic receptors with little or no effect on beta2-receptors.
(affects heart not lungs)

22

MOA of Timolol maleate (Timoptic)?

Nonselective beta-adrenergic blocking agent

23

MOA of Levobunolol (Betagan, AKBeta)?

Nonselective beta-adrenergic blocking agent

24

If you have an asthmatic patient what will you decide to treat with (which drug?)

Betaxolol (Betoptic)
Because its selective for B1 which only affects the heart. Timolol maleate and Levobunolol are nonselective and affect both the heart and the lungs

Both will decrease HR

25

What are adverse affects of beta blockers due to?

systemic absorption of the drug

26

What are these systemic adverse affects caused by beta blockers?
5

1. Decreased cardiac output
2. Bronchial constriction/Bronchospasm
3. Bradycardia
4. Heart block
5. Hypotension

27

What should be monitored in patients recieving topical beta blocker therapy?
2

pulse rate and blood pressure

28

Contraindications for beta blockes?
5

1. Asthma
2. Severe chronic obstructive pulmonary disease
3. Sinus bradycardia
4. Second- and third-degree AV block
5. Overt cardiac failure

29

MOA for alpha adrenergic agonists?

Reduce intraocular pressure (IOP) by increasing outflow and reducing production of aqueous humor

30

types of alpha adrenergic drugs?
2

brimonidine (alphagan)
apraclonidine (iopidine)

31

MOA for brimonidine (alphagan)?

selective alpha2-receptor

32

MOA for apraclonidine (iopidine)?

Potent alpha-adrenergic agent selective for alpha2-receptors with minimal cross-reactivity to alpha1-receptors.

33

Side effects of alpha adrenergic agonists?
4

1. Dry mouth,
2. allergic conjunctivitis,
3. redness,
4. ocular pruritus

34

Alpha Adrenergic Agonists are effective but not used much. Why?

Too many side effects that are caused by its many drug interactions

35

MOA of cholinergic agonists?
2

1. Contract ciliary muscle, tightening the trabecular meshwork and allowing increased outflow of the aqueous.
2. Miosis results from action of these drugs on pupillary sphincter.

36

Drug for cholinergic agonists?

pilocarpine(pilocar, pilagan)
-not used often

37

Side effects of cholinergic agonists?
3

1. brow ache
2. induced myopia
3. decreased vision in low light

38

MOA for carbonic anhydrase inhibitors?
3

1. Reduce secretion of aqueous humor by inhibiting carbonic anhydrase in ciliary body
2. Duration of action is shorter than many other classes of drugs.
3. Used concomitantly with other topical ophthalmics

39

Types of Carbonic anhydrase inhibitors?
2

Dorzolamide HCl (Trusopt) 2%
Brinzolamide (Azopt) 1%

40

Side effects of carbonic anhydrase inhibitors?
4

Rare, but include
1. superficial punctate keratitis
2. nausea,
3. depression, and
4. fatigue

41

If you are giving more than one topical drug for glaucoma how much time should you wait before giving each drug?

10 min in between

42

What does a steamy cornea mean?

inflammation