pharm

Question 1

Fluorescein

Answer 1

Orange dye used to detect foreign bodies in the eye as well as abrasions, ulcers and infection, herpatic dendrites

. Any problems on the surface of the cornea will be stained by the dye and appear green under the blue light.

Question 2

Topical Anesthetics

Answer 2

Proparacaine (Alcaine), Oxybuprocaine AKA Benoxinate (Novesin, Novesine)
Very short acting

Tetracaine (Pontocaine, AK-T Caine PF)
Longer acting

Question 3

Topical Anesthetics SE

Answer 3

Stinging, irritation
Hypersensitivity reaction
Prolonged use may retard wound healing.
Must protect the eye from irritants until it wears off.

Question 4

Topical Anesthetics CI

Answer 4

any hypersensitivity to anesthetics, liver disease, taking anticholiesterases*, dry eye, perforating eye injury

Question 5

NSAIDS Indications

Answer 5

analgesia, antipyretics, anti-inflammatory.

Question 6

NSAIDS

Answer 6

Diclofenac (Voltaren), Suprofen (Profenal), Brofenac (Xibrom), Flurbiprofen (Ocufen), Nepafenac (Nevanac) are all used for post-op pain/inflammation after cataract surgery, some used for photophobia (Voltaren) and some used for prevention of intraoperative mioisis (Ocufen and Profenal)

Ketorlac tromethamine O.5% soln (Acular)
Relief of ocular inflammation due to seasonal allergic conjunctivitis.

Question 7

NSAIDS

Answer 7

Have no effect on IOP
May cause burning and stinging
1 drop to the affected eye QID
Don’t use for longer then 2 weeks or can cause corneal injury

Question 8

Corticosteroid Indications

Answer 8

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

Question 9

Corticosteroids

Answer 9

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

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

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

Question 10

Corticosteroids SE

Answer 10

Mydriasis, ptosis, inhibition of corneal epitheliem or stromal healing
Repeated use or long term use hazards:
Cataracts
Corneal thinning and/or rupture
Glaucoma leading to optic neuritis
Immunosuppression: increased incidence of eye infections, mask acute (fungal) infections, prolong or exacerbate viral infections
Keratitis

Question 11

Corticosteroids CI

Answer 11

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

Question 12

Decongestants MOA

Answer 12

Cause pupil dilation
Increase in outflow of aqueous humor
Vasoconstriction

Question 13

Decongestants Indications

Answer 13

Allergic conjunctivitis
Redness of the conjunctiva 
Increased tearing 
Itchiness 
Burning sensation 
Blurred vision due to the increase in tearing

Question 14

Decongestants

Answer 14

Naphazoline/Pheniramine maleate (Visine A, Naphcon-A, Opcon-A, etc.)
Naphazoline hydrochloride (Murine

Question 15

Decongestants SE

Answer 15

Burning, blurred vision, pupil dilation

Individuals should be informed that overuse of ophthalmic decongestants can lead to rebound congestion of the conjunctiva. Don’t use longer then 2 weeks.

Patients with narrow anterior chamber angles or narrow-angle glaucoma should not use these products.

Question 16

Antihistamines

Answer 16

Prescription
Olopatadine (Patanol, Pataday) 
Bepotastine (Bepreve)
Alcaftadine (Lastacraft)
OTC
Azelastine (Optivar)
Epinastine (Elestat)
Pemirolast (Alamast
Ketotifen *generic and most commonly found OTC

Question 17

Antihistamines SE

Answer 17

Most can be used in contact lens wearers *
Take contacts out and leave out for at least 10 minutes after medication
Side effects:
Eye irritation, stinging upon instillation of drops

Question 18

Mast cell stabilizer

Answer 18

Cromolyn Sodium (Opticrom)
Inhibits mast cell degranulation
Need to take QID and takes 1-2 weeks to work

Indications: Allergic conjunctivitis

Side effects:
Burning
Dry eyes

Question 19

Sulfonamides

Answer 19

MOA
Inhibits synthesis of folic acid

Indications:
Lid infections
Conjunctivitis
Corneal abrasion, ulcer
Prevent infections after removing foreign bodies

Question 20

Sulfonamides

Answer 20

Sulfacetamide (Bleph-10, Ocu-Sul, Sodium Sulamyd, Sulf-10)
Drops $30-$56, Ointment $66
Ok for kids at least 2 mo old
Oint ½” Q2-3 h & hs X 7-10 d, disp 3.5 g
Drops 1-2 gtts Q2-3 h & hs X 7-10 d, disp 5 ml
Side effects:
Local irritation, stinging, burning

Question 21

Fluoroquinolones

Answer 21

MOA:
Inhibits DNA synthesis
Indications:
Lid infections
Conjunctivitis (not for use as 1st line therapy)
Corneal abrasion, ulcer
Prevent infections after removing foreign bodies
Should be used for sure if a pseudomonas infection is suspected.

Question 22

Fluoroquinolones

Answer 22

Ciprofloxacin (Ciloxan)
Solution or ointment
Ofloxacin (Ocuflox)
solution
Levofloxacin (Quixin)
solution
Gatifloxacin (Zymar)
solution
Moxifloxacin (Vigamox)
Solution

Side effects:
Burning, stinging, foreign body sensation, photophobia

Question 23

Aminoglycosides

Answer 23

MOA:
Bind to ribosomes and inhibit tRNA synthesis

Indications:
Lid infections
Conjunctivitis
Corneal abrasion, ulcer
Prevent infections after removing foreign bodies

Question 24

Aminoglycosides

Answer 24

Gentamycin (Garamycin)
Soln, ointment
Tobramycin (Tobrex)
Soln, ointment
Neomycin
High incidence of allergy to neomycin in the general population.

Side effects:
Burning, itching, erythema
These can be toxic to the corneal epithelium and can cause a reactive keratoconjunctivits after several days of use. Best to reserve these for the specialists

Question 25

Macrolides

Answer 25

``` Erythomycin ointment ($10-$15) MOA: Inhibits tRNA synthesis Indications: Lid infections Conjunctivitis Corneal abrasions, ulcer Prevent infections after removing foreign bodies Also used as prophylaxis of Gonococcal Ophthalmia Neonatroeum ``` Azithromycin drops $116

Question 26

Bacitracin ointment

Answer 26

``` Indications: Lid infections Conjunctivitis Corneal abrasion, ulcer Prevent infections after removing foreign bodies ```

Question 27

Trimethoprim Sulfate - Polymyxin B Sulfate (Polytrim)

Answer 27

``` Indications: Lid infections Conjunctivitis Corneal abrasions, ulcer Prevent infections after removing foreign bodies ```

Question 28

Antivirals Idoxuridine (Dendrid)

Answer 28

``` Used for herpes simplex keratitis Blocks reproduction of HSV May cause irritation, pain photophobia Recurrence may be seen If no lessening of fluorescein staining in 14 days, start different therapy with Trifluridine (Viroptic) ```

Question 29

Antivirals

Answer 29

Trifuridine (Viroptic) Used for keratoconjnctivitis, keratitis May cause burning, stinging Used if Vidarabine is ineffective Vidarabine (Vira-a) Used for ketatoconjunctivitis, superficial karatitis May cause temp visual haze, foreign body sensation and burning Use if Viroptic is ineffective

Question 30

Cycloplegics

Answer 30

MOA: paralyze the ciliary muscles and cause dilatation of the pupil. Indications: Dilation before eye examinations. Before and after eye surgery. Provide pain relief to patient with corneal abrasions and iritis/uveitis

Question 31

Cycloplegics

Answer 31

Atropine (Isopto Atropine) Scopolamine (Isopto Hyoscine) Cyclopentolate (Cyclogyl) Mydriacyl (Tropicamide)

Question 32

Cycloplegics CI

Answer 32

Angle closure glaucoma People with narrow angles Caution: Children and elderly patients

Question 33

Cycloplegics SE

Answer 33

``` Blurred vision Burning or stinging Eye irritation Increased sensitivity of eyes to light Swelling of the eyelids ```

Question 34

Agents for Glaucoma

Answer 34

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

Question 35

Prostaglandin analogs

Answer 35

MOA: Increase uveoscleral outflow of the aqueous. Latanoprost (Xalatan) $95-$131 Bimatoprost (Lumigan) $251 Tafluprost (Zioptan) $125 ``` Side effects: Decreased visual acuity Eye discomfort Dry eye Foreign body sensation ```

Question 36

Beta Blockers MOA

Answer 36

May decrease aqueous humor formation or increase outflow

Question 37

Beta Blockers

Answer 37

Betaxolol (Betoptic) Selectively blocks beta1-adrenergic receptors with little or no effect on beta2-receptors. ``` Timolol maleate (Timoptic) Nonselective beta-adrenergic blocking agent Levobunolol (Betagan, AKBeta) Nonselective beta-adrenergic blocking agent ```

Question 38

Beta Blockers

Answer 38

``` Adverse effects of the beta-blockers are due to systemic absorption of the drug: Decreased cardiac output Bronchial constriction/Bronchospasm Bradycardia Heart block Hypotension ```

Question 39

Beta Blockers

Answer 39

``` Contraindications: Asthma Severe chronic obstructive pulmonary disease Sinus bradycardia Second- and third-degree AV block Overt cardiac failure ```

Question 40

Alpha Adrenergic Agonists

Answer 40

MOA: Reduce intraocular pressure (IOP) by increasing outflow and reducing production of aqueous humor Brimonidine (Alphagan P) Selective alpha2-receptor $32-$200 Apraclonidine (Iopidine) 0.5%, 1% Potent alpha-adrenergic agent selective for alpha2-receptors with minimal cross-reactivity to alpha1-receptors. Side effects: Dry mouth, allergic conjunctivitis, redness, ocular pruritis

Question 41

Cholinergic agonists

Answer 41

MOA: Contract ciliary muscle, tightening the trabecular meshwork and allowing increased outflow of the aqueous. Miosis results from action of these drugs on pupillary sphincter. Pilocarpine (Pilocar, Pilagan) Mimics muscarinic effects of acetylcholine at postganglionic parasympathetic nerves. Directly stimulates cholinergic receptors in the eye, decreasing resistance to aqueous humor outflow. Side effects: brow ache induced myopia decreased vision in low light

Question 42

Carbonic anhydrase inhibitors

Answer 42

MOA: Reduce secretion of aqueous humor by inhibiting carbonic anhydrase in ciliary body Duration of action is shorter than many other classes of drugs. Used concomitantly with other topical ophthalmics ``` Dorzolamide HCl (Trusopt) 2% Brinzolamide (Azopt) 1% ``` Side effects: Rare, but include superficial punctate keratitis nausea, depression, and fatigue