Pediatric Ocular Pharmacology Flashcards by Sarah W

What are the topical antivirals used in children?

Trifluroidine 1% (Viroptic); Gancyclovir (Zirgan)

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What ages can trifluoridine be used for?

6 and up

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What are the oral antiviral agents that can be prescribed for children?

acyclovir, valacyclovir

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At what age can oral antivirals be prescribed?

2 years old

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What is the dosage frequency for trifluridine 1% (Viroptic)

Q2H, up to 9x/ day

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What is the dosage frequency for Gancyclovir (Zirgan)

5x/ day until heals then TID x7 days

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What is the dosage for oral acyclovir?

10-20mg/ kg 4x per day

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What is the dosage for oral valacyclovir?

20mg/ kg 3x/ day for 5 days

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What is a common cause of Viral Conjunctivitis?

Upper respiratory infections

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What are non-prescription treatments for viral conjunctivitis?

cool compresses, artificial tears, hygiene

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When do we consider antibiotics in viral conjunctivitis?

secondary infection

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What steroids are prescribed for children?

loteprednol etabonate 0.2% (Alrex); 0.5% lotemax; fluoromethalone 0.1% (FML); 0.25% (FML forte); Prednisolone acetate 1% (pred forte); difluprednate 0.05% (Durezol)

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What is the only steroid agent that is established and recommended for children?

Fluoromethalone

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What formulations are available for fluoromethalone?

ung or soln

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what ages is fluoromethalone prescribed?

2 years old and up

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What are the steroid and antibiotic combination drops that are available for children?

TobraDex (Dexamethasone 0.1% + Tobramycin 0.3%);
Zylet (Loteprednol 0.5% + Tobramycin 0.3%);
Maxitrol (Dexamathasone 0.1% + Neomycin 0.35% + Polymixin B);
Blephamide (Sulfacetamide 10% + Prednisolone 0.2%);
pred G (Gentamicin + prednisolone)

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What is the dosage frequency for all steroid/ Ab combo drops except for pred G?

1 gtt q4-6 hours

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What is the dosage for Pred G

1 gtt 2-4x/ day

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15-67% of uveitis cases in children are secondary to what systemic condition?

JIA-U

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Which type of uveitis is usually idiopathic in children?

intermediate uveitis

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JIA-U commonly presents as chronic _____________ uveitis, which is often clinically ____________

anterior; silent

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Enthesitis-related arthritis (ERA) category of JIA presents as what type of uveitis?

Acute anterior uveitis- symptomatic, unilateral and episodic

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When is the highest risk of uveitis with JIA?

within 4 years of onset

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What are risk factors of JIA-U

gender, JIA category, age of onset, ANA and HLA-B27 positivity

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How does JIA cause uveitis?

T and B lymphocytes generate an immune response against native intraocular antigens

JIA patients that are ANA positive have a (higher/ lower) risk of chronic anterior uveitis

higher

Which subtype of JIA has the highest risk of uveitis?

Oligoarthritis or polyarthritis, ANA +, age of onset at 6 or under; 4 years or less duration of disease

What is the frequency of screening for a high risk JIA patient?

q3 months

What is the treatment for children with uveitis secondary to JIA?

pred forte qid (or more); cyclopentolate QD (prevent synechiae, pain relief); systemic steroids, NSAIDs, Methotrexate, TNFI (Biologics)

If a child with uveitis secondary to JIA is a steroid responder (IOP > 30 mmHg), what hypotensive should be used?

Timoptic 0.25%

What is the only approved NSAID for children?

Acular (Ketorolac tromethamine 0.5%) for children older than 2 years old

What are indications for systemic steroids in children?

Asthma, allergies, inflammation

Systemic side effects of steroids (systemic)

weight gain, stomach ulcers, sleep difficulties, increased blood pressure, increased blood sugar, decreased wound healing

What are steroid Allergy medications for children?

Flonase, veramyst, Nasonex, Rhinocort, omnaris

Which two systemic steroids used for allergies are used in children 6 years old or older?

Rhinocort (Budesonide) and Omnaris (Ciclesonide)

Which two systemic steroids used for allergies are used in children 2 years and older?

veramyst (Fluticasone) and Nasonex (Nometasone)

At what age is Flonase (fluticasone) used?

4 years old and up

What are ocular allergy medications used for acute allergies in children?

* Ketotifen 0.025% (zaditor, alway); * Olopatadine 0.1% or 0.2% (Patanol/ Pataday); * Alcaftadine 0.25% (lastacraft, pazeo) *others non-bold on slide

What are agents for chronic ocular allergies?

* Pemirolast Potassium 0.1%, * Nedocromil Sodium 2%, * Lodoxamine Trimethamine 0.1%, * Cromolyn Sodium 4%

What are off label therapeutic agents used for chronic ocular allergies?

pred forte, durezol, lotemax/ alrex

What is the indication and MOA for Verkazia 0.1% (cyclosporine ophthalmic solution)

VKC in children 4 and up; calcineurin inhibitor immunosuppressant

True or False: Pediatric glaucoma generally does not require surgical intervention?

False

What is the long-term prognosis for pediatric glaucoma?

poor

What are commonly prescribed therapeutic agents for pediatric glaucoma?

brimonidine 0.2%, dorzolamide, timolol 0.25%, 0.5%; cosopt, prostaglandin analogs

What is the most common cause of pediatric hyphema?

blunt trauma

What is commonly seen with a hyphema?

tears in anterior ciliary body and iris vessels; iridodialysis, cyclodialysis

How many RBC's are found in the anterior chamber in a microscopic hyphema?

1-4+

How is a macroscopic hyphema graded?

by percentage of space they occupy; measure height in mm in anterior chamber

What are possible complications of hyphema?

corneal blood staining (~5%), secondary hemorrhages; Elevated IOPs, Optic atrophy, glaucoma, amblyopia

What two medications are used for Hyphema management?

Atropine (BID) and Pred Forte (Q1H or Q2H initially)

What medications are NOT used for hyphema?

aspirin and ibuprofen

How often should you see a patient with a hyphema?

daily

What is important to monitor when a pediatric patient has a hyphema?

IOP

What is a non-medication management technique for hyphema?

bed rest with head elevated 30 degrees

What is a masquerader of hyphema?

xanthogranuloma

What are the FDA subcategories of Pediatrics?

neonates: birth to 1 month; infants: 1 month to 2 years; Children: 2 to 12 years; Adolescent: 12-16 years

When do cytochrome P450 levels reach adult levels? What about other enzyme systems?

1-2 years old; 10 years old

How is GI absorption different in children?

increased bioavailability of acid labile drugs, decrease bioavailability weakly acidic drugs, gastric emptying time

How does the blood brain barrier differ between children and adults?

Children: less effective

What anesthetics are used for children?

0.5% proparacaine, 0.4% benoxinate

What are the precautions when using Phenylephrine HCl?

cardiovascular disease, premature infants and children in the first 6 months of life

What strength of Phenylephrine HCl is used in children?

2.5% max dose 2 gtts spaced 5 minutes apart

What is in the combo mydriatic spray?

0.5% tropic + 2.5% phenyl + 0.5% Cyclo

What concentration of atropine is used in light irides? dark irides?

0.5% atropine in light irides, 1.0% in dark irides

What is the duration of action for atropine?

2-3 weeks

What is the onset of action for atropine drops?

3-6 hours

What populations may be hypersensitive to cholinergic antagonists?

Down syndrome, spastic paralysis, brain damage and very light pigmentation

What is the antidote for atropine toxicity

physostigmine salicylate

What concentration of cyclopentolate is used in children under 1 year old?

0.5%

what concentration of cyclopentolate is used in children over 1 year old?

1.0%

What cycloplegic agent is used in premature or LBW babies?

cyclomydril

what is the maximum cycloplegia action for cyclopentolate?

40 minutes

Because of the risk of side effect, what % of cyclopentolate is NOT used in children?

What are the benefits of tropicamide 1%?

less potent, very safe, less adverse effects

What are 3 common uses of antibiotics in children?

bacterial conjunctivitis, K ulcer, K abrasion

Fluroquinolones inhibit bacterial DNA gyrase and are approved in children (older/younger) than 1 year old?

older | Moxeza: >/= 4 months

What aminoglycosides are used in children?

Tobrex (infants 2 months and older); Neomycin (NE); Gentamicin (6 yo and older)

Which macrolides are indicated for use in children?

erythromycin (infants and newborns), azithromycin 1% (1 yo and up)

What are 3 antibiotics commonly used in children?

penicillins, cephalosporins, macrolides

What is the most common cause of orbital cellulitis?

paranasal sinuses

What are causes of preseptal cellulitis?

breaches in skin barrier: trauma, insect bites; adjacent infections: hordeolum, dacryocystitis

What are the two bacteria that cause preseptal or orbital cellulitis?

staphylococcus aureus and streptococcus bacteria

When is the maxillary sinus fully developed?

6 years of age

what are the most commonly prescribed antibiotics for preseptal cellulitis in kids?

augmentin (250-500 mg po TID or 875 mg po BID); Keflex (250-500 mg po TID)

When is hospitalization and IV indicated in preseptal cellulitis?

severe cases or children under 5 years old

Pediatric Ocular Pharmacology Flashcards

(85 cards)