optho pharm Flashcards
(25 cards)
What is the first line treatment for glaucoma?
prostaglandin analogs
beta-blockers are #2
-can also use: alpha-agonists, Carbonic anhydrase inhibitors, miotics, sympathomimetics,
prostaglandin analogs
Xalatan
- used to dec. intraocular pressure
- MOA: inc. uveoscleral outflow
- first line for glaucoma
- side effects: increased in melanin pigment in iris, hypertrichosis (long eyelashes), darkening of perioorbital skin
beta-blockers
timoptic=timolol, carteolol, betoptic
- used to decrease intraocular pressure
- blockade of beta-receptors in ciliary body decreases aqueous production
- side effects: bradycardia, bronchospasm/SOB, depression, dec. libido
- contraindications: asthama, severe COPD, bradycardia, heart block, CHF, myasthenia gravis
how can you decrease the amount of eye drop that enters the nasolacrimal system?
punctal occlusion
the nasolacrimal system is where drugs get systemic access, blocking this helps reduce systemic side effects and decreases “Tasting the drops”
how can you decrease the amount of eye drop that enters the nasolacrimal system?
punctal occlusion
the nasolacrimal system is where drugs get systemic access, blocking this helps reduce systemic side effects and decreases “Tasting the drops”
how long should you wait in between administering eye drops?
5 minutes
how long should you wait in between administering eye drops?
5 minutes
carbonic anhydrase inhibitors
- used to decrease intraocular pressure
- MOA: Inhibit carbonic anhydrase in pigmented and non-pigmented epithelium of ciliary body → decreased aqueous humor production
- side effects: kidney stones, paresthesias, unpleasant taste, acidosis
- contraindications: Sulfa allergy, Renal stones, Liver or kidney disease, Addison’s disease, Adrenal insufficiency, Thiazide diuretics, Steroids, Digitalis, Aspirin
carbonic anhydrase inhibitors
- used to decrease intraocular pressure
- MOA: Inhibit carbonic anhydrase in pigmented and non-pigmented epithelium of ciliary body → decreased aqueous humor production
- side effects: kidney stones, paresthesias, unpleasant taste, acidosis
- contraindications: Sulfa allergy, Renal stones, Liver or kidney disease, Addison’s disease, Adrenal insufficiency, Thiazide diuretics, Steroids, Digitalis, Aspirin
alpha adrenergic agonists
Used to decrease intraocular pressure
oMOA: Decrease aqueous production
oSide Effects: Allergic reaction (redness, itching), Allergic conjunctivitis
oContraindications: MAOIs, Children (can cause syncope)
oAgents: Alphagan P, Iopidine
alpha adrenergic agonists
Used to decrease intraocular pressure
oMOA: Decrease aqueous production
oSide Effects: Allergic reaction (redness, itching), Allergic conjunctivitis
oContraindications: MAOIs, Children (can cause syncope)
oAgents: Alphagan P, Iopidine
Miotics
- used to decrease intraocular pressure
- MOA: cause pupillary muscle constriction, which pulls open trabecular meshwork and increases trabecular outflow
- direct cholinergic: pilocarpine
- indirect cholinergic: AchEI
- Side effects: Intense miosis and accommodative spasm, iritis, iris cysts, lens induced myopia and anterior chamber shallowing, pupillary block, corneal haze
- Pilocarpine toxicity: salivation, lacrimation, sweating, N/V/D, bronchiolar spasm/pulmonary edema
- Worsens Parkinson’s disease
Miotics
- used to decrease intraocular pressure
- MOA: cause pupillary muscle constriction, which pulls open trabecular meshwork and increases trabecular outflow
- direct cholinergic: pilocarpine
- indirect cholinergic: AchEI
- Side effects: Intense miosis and accommodative spasm, iritis, iris cysts, lens induced myopia and anterior chamber shallowing, pupillary block, corneal haze
- Pilocarpine toxicity: salivation, lacrimation, sweating, N/V/D, bronchiolar spasm/pulmonary edema
- Worsens Parkinson’s disease
sympathomimetics
-used to decrease intraocular pressure
o Phenylephrine (alpha agonist)
o Mydriatic without cycloplegia
o Side effects: Acute hypertension, pulmonary edema, arrhythmia, death
o Never use 10% in infants
o Avoid in patients with sympathetic denervation (MAOIs, diabetics with neuropathy)
o Can cause angle closure in patients with narrow angle
sympathomimetics
-used to decrease intraocular pressure
o Phenylephrine (alpha agonist)
o Mydriatic without cycloplegia
o Side effects: Acute hypertension, pulmonary edema, arrhythmia, death
o Never use 10% in infants
o Avoid in patients with sympathetic denervation (MAOIs, diabetics with neuropathy)
o Can cause angle closure in patients with narrow angle
mydriatics
anticholinergics used to dilate eyes
eg. atropine (toxicity=: hot as a hare, red as a beet, dry as a bone, blind as a bat, mad as a hatter )
- MOA: Paralyze the parasympathetic iris sphincter and circular muscle of ciliary body
- side effects: Decreased GI motility, increased gastric secretions, dry mucous membranes, urinary retention (careful elderly men with BPH), tachycardia, confusion, restlessness
- can precipitate angle closure attack in patients with narrow angle
mydriatics
anticholinergics used to dilate eyes
eg. atropine (toxicity=: hot as a hare, red as a beet, dry as a bone, blind as a bat, mad as a hatter )
- MOA: Paralyze the parasympathetic iris sphincter and circular muscle of ciliary body
- side effects: Decreased GI motility, increased gastric secretions, dry mucous membranes, urinary retention (careful elderly men with BPH), tachycardia, confusion, restlessness
- can precipitate angle closure attack in patients with narrow angle
anti-VEGF drugs
Drugs: Ranibizumab, Bevacizumab (mAbs)
- used to inhibit vascular proliferation
- used to treat anything that causes neovascularization: Macular degeneration, Diabetic retinopathy, Retinal vein occlusions
- side effects: inc. ocular pressure, allergic rxn, possible risk thromboembolic event, cataract, infection, retinal detachment
anti-VEGF drugs
Drugs: Ranibizumab, Bevacizumab (mAbs)
- used to inhibit vascular proliferation
- used to treat anything that causes neovascularization: Macular degeneration, Diabetic retinopathy, Retinal vein occlusions
- side effects: inc. ocular pressure, allergic rxn, possible risk thromboembolic event, cataract, infection, retinal detachment
ocular complications of steroids
- Watch for steroid-induced glaucoma (accumulation of glycosaminoglycans in the trabecular meshwork)
- Cataract (PSC)
- Delayed wound healing, enhanced microbial/fungal proliferation, punctate keratopathy
ocular complications of steroids
- Watch for steroid-induced glaucoma (accumulation of glycosaminoglycans in the trabecular meshwork)
- Cataract (PSC)
- Delayed wound healing, enhanced microbial/fungal proliferation, punctate keratopathy
cautions with NSAIDS
- Worsens herpes
- Generic NSAID use associated with corneal melting
cautions with NSAIDS
- Worsens herpes
- Generic NSAID use associated with corneal melting
what antibiotic should you use in contact-lens wearers?
In contact lens wearers, use fluoroquinolone, because it covers Pseudomonas
