Flashcards in Ophthalmology Pharm Week 2 Deck (42):
Indications for NSAIDs?
Used for analgesia, antipyretics and anti-inflammatory effects.
Five NSAIDs used for post op pain after surgery?
What NSAID is used for photophobia?
What NSAIDs are used for prevention of intraoperative myosis?
(Ocufen and Profenal)
What NSAID is used for relief of ocular inflammation due to seasonal allergic conjunctivitis?
Ketorlac tromethamine O.5% soln (Acular)
Downsides to NSAIDs?
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
Should we as PAs every prescribe corticosteroids?
never, only ophthomalogist
Mechanism of action for corticosteriods for the eye?
reduce inflammation and decrease edema
Indications for corticosteroids?
Treatment of steroid responsive inflammatory conditions. Some examples are:
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)
Side effects of corticosteriod treatment?
3. inhibition of corneal epitheliem/stromal healing
Repeated use or long term use hazards of corticosteroids?
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
Contraindications for corticosteriod treatment?
1. Viral disease of the cornea or conjunctiva (herpes simplex keratitis)
2. Mycobacterial or fungal infections of the eye
Agents for glaucoma?
(whats 1st line?)
(whats 2nd line?)
(1st line) Prostaglandin Analogs
(2nd line) Beta Blockers
Alpha adrenergic agonists *
Cholinergic agonists *
Carbonic Anhydrous Inhibitors *
Mechanism of action for prostaglandin analogs?
Increase uveoscleral outflow of the aqueous.
(giving it another way to drain other than through the trabecular meshwork)
Medications that are prostaglandin analogs?
Latanoprost (Xalatan) $95-$131
Bimatoprost (Lumigan) $251
Tafluprost (Zioptan) $125
Side effects of prostaglandin analongs?
Decreased visual acuity
Foreign body sensation
Could change the color of the iris
What should we not mix with prostaglandin analogs due to drug interactions?
Mechanism of action of beta bockers?
2 ways it could help
May decrease aqueous humor formation or increase outflow
Types of beta blockers?
Timolol maleate (Timoptic)
Levobunolol (Betagan, AKBeta)
MOA of Betaxolol (Betoptic)?
Selectively blocks beta1-adrenergic receptors with little or no effect on beta2-receptors.
(affects heart not lungs)
MOA of Timolol maleate (Timoptic)?
Nonselective beta-adrenergic blocking agent
MOA of Levobunolol (Betagan, AKBeta)?
Nonselective beta-adrenergic blocking agent
If you have an asthmatic patient what will you decide to treat with (which drug?)
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
What are adverse affects of beta blockers due to?
systemic absorption of the drug
What are these systemic adverse affects caused by beta blockers?
1. Decreased cardiac output
2. Bronchial constriction/Bronchospasm
4. Heart block
What should be monitored in patients recieving topical beta blocker therapy?
pulse rate and blood pressure
Contraindications for beta blockes?
2. Severe chronic obstructive pulmonary disease
3. Sinus bradycardia
4. Second- and third-degree AV block
5. Overt cardiac failure
MOA for alpha adrenergic agonists?
Reduce intraocular pressure (IOP) by increasing outflow and reducing production of aqueous humor
types of alpha adrenergic drugs?
MOA for brimonidine (alphagan)?
MOA for apraclonidine (iopidine)?
Potent alpha-adrenergic agent selective for alpha2-receptors with minimal cross-reactivity to alpha1-receptors.
Side effects of alpha adrenergic agonists?
1. Dry mouth,
2. allergic conjunctivitis,
4. ocular pruritus
Alpha Adrenergic Agonists are effective but not used much. Why?
Too many side effects that are caused by its many drug interactions
MOA of cholinergic agonists?
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.
Drug for cholinergic agonists?
-not used often
Side effects of cholinergic agonists?
1. brow ache
2. induced myopia
3. decreased vision in low light
MOA for carbonic anhydrase inhibitors?
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
Types of Carbonic anhydrase inhibitors?
Dorzolamide HCl (Trusopt) 2%
Brinzolamide (Azopt) 1%
Side effects of carbonic anhydrase inhibitors?
Rare, but include
1. superficial punctate keratitis
3. depression, and
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