-
phenylephrine hydrochloride (Mydfrin/AK-Dilate)
- -mydriasis WITHOUT cycloplegia, conjunctival blanching
- -direct-acting adrenoceptor agonist
- 2.5%, 10% (do NOT use in geriatrics, children, ppl with CVD), often used in combo
- -great potential for ADRs so not most commonly used mydriatic
-
Most common ADR for mydriatic drops?
- -transient stinging
- -blurry vision
- -local irritation/discomfort
- -photophobia
-
tropicamide (Diophenyl-T, Paremyd)
- cholinergic antagonist (acts on sphincter)
- -safest mydriatic
- -use in combo with phenylephrine for diabetics
- -use with cyclopentolate for darkly pigmented eyes
- -ADR: stinging, slight increase in IOP
-
dapiprazole (Rev-Eyes)
- -miotic, competitive alpha-adrenoceptor antagonist
- -most effective for phenylephrine-dilated eyes
- -partial effective for tropicamide/combo dilated eyes
- -do NOT use in cases of uveitis
- -ADR: conjunctival injection, mild ptosis, burning, lid edema, blurred vision
-
atropine
- strongest mydriatic and cycloplegic agent
- 2 weeks
- for uveitis, amyblopia, refraction
- -ADR: fatal if ingested
-
cyclopentolate
- mydriatic (1dy) and cycloplege (24h)
- -for refraction and uveitis
- -third strongest agent
-
homatropine
- mydriatic (1-2d) and cycloplege (1-2)
- -for uveitis
- -second strongest agent
-
dicloxacillin
- Penicillinase-resistant antibiotic for internal bleph or chlamydia affecting the eye
- Adult: 125-500 mpg po qid
- Child: 12.5-25 mg/kg/day po divided by qid
-
Amoxicillin (Clavulin, Augmentin)
- Penicillin antibiotic for acute dacryocystitis
- -extended spectrum of activity
- *targets plasmid-mediated B-lactamases
- Adult: 500mg PO q8h x10days
- Child: 20-40 mg/kg/day divided PO tid
-
Treatment for corneal edema (acute) and recurrent corneal erosion (prophylaxis)?
- Muro 128 -hypertonic (pulls water from epithelium)
- -2% and 5% NaCl solution, stings -> reflex tearing is hypotonic which defeats purpose, use only for Fuch's dystrophy
- -5% ointment, use 6wks-3mths at night, no stinging
-
Refresh
- artificial tears with carboxymethylcellulose (CMC) viscosity enhancing agent
- -therapeutic action: heals ocular surface
- -mucoadhesion
-
Blink
- artificial tears with hyaluronic acid (sodium hyaluronate) viscosity enhancing agent
- -therapeutic action: heals ocular surface
- -shear-thinning (reduces irritation from blinking)
-
Biorefresh
- artificial tears with hydroxypropyl methylcellulose (HPMC) viscosity enhancing agent
- -therapeutic action: heals ocular surface
-
Three main components in ointments?
- white petrolatum
- mineral oil (helps melt petrolatum at body temp)
- lanolin (absorbs water -> improves solubility)
-
1 mL is approximately how many drops?
20 drops
-
Px with dry eye may experience increased drug absorption because...
- -drug less diluted
- -increased contact time
- -epithelial damage increases corneal penetration
-
cephalexin (Keflex)
- 1st generation cephalosporin
- -effective against G+
- -contraindic. with hypersensitivity
- -Adults: 250-500mg po
- kids: 25-50mg/kg/day po in 4 divided doses
-
cephalosporins
ADRs and contraindic?
- -ADRs: known hypersens, cross allergies with penicillins
- -Contraindic: hemophilia (secondary vit K deficiency), Cefaclor contraindic. in Px with drug-related joint and skin rxns
-
Antibiotic that attacks G+ cell memb?
gramicidin (Polysporin, Polycidin) -OTC
-
Antibiotic that attacks G- cell memb?
- Polytrim (1% trimethoprim + polymyxin B)
- good for pseudomonas
-
Px presents with lid itching, lid swelling, conjunctival erythema, epithelialbreakdown (SPK) which is a common ADR seen in...?
- ophthalmic aminoglycosides after 1-2 wks of usage
- ie. gentamicin, tobramycin, neomycin (allergic rns of lids and periocular skin as well)
-
Which antibiotics have ADR of ototoxicity (auditory and vestibular), nephrotoxicity when administered systemically?
aminoglycosides
-
Which antibiotics have ADR of corneal and conjunctival toxicity when administered topically?
- aminoglycosides
- ie. gentamicin, tobramycin
-
Which antibiotic has ADR of pseudotumor cerebri with papilledema?
gentamicin (an aminoglycoside)
-
erythromycin
- -2nd line drug to treat infectious internal hordeola
- -first line in infants/children with chlamydia
- -Adult (for infection): 500mg qid x 7 days
-
azithromycin (Zithromax)
- -Category B (innocuous drug esp for pregnant women)
- -drug of choice for chlamydial infections
- -Adults: 250mg qd x 5 days
- -Child: one dose 1g
-
Voltaren (diclofenac)
- 0.1% diclofenac
- topical ophthalmic NSAID qid for post cat surgery
-
Acular LS
- ketorolac tromethamine 0.4%
- topical ophthalmic NSAID qid for post corneal surgery
- -reduced ocular pain and burning/stinging
-
Which topical ophthalmic NSAID would you use for less stinging?
- Acular LS (ketorolax tromethamine 0.4%)
- qid
- used post op
-
Nevanac (nepafenac ophthalmic solution 0.1%)
- superior pharmacokinetics (permeability, distribution and activation), good for convenience (only tid), good for posterior seg (ie. CME after cat surgery)
- BAK 0.005%
-
Extensive use of topical steroid should be avoided if...
- -DM
- -infectious disease (could be masked or made worse)
- -chronic renal failure
- -coronary heart failure
- -HTN
-
Ocular ADRs of topical steroids
- Uveitis
- Mydriasis
- Ptosis
- TRansient ocular discomfort
- -Systemic ADRs are rare (hyperglycemia, lipid deposits, decrease wbc, CNS mood changes, reduced allergic response)
-
Steroid dosing?
- mild/moderate inflammation-q4h/q6h
- Severe inflammation-q1h or q1/2h Pulse dosing
- Severe inflammation with dry eye -qid
- mild uveitis -q1h
-
Why taper steroids?
- steroids reduce wbc in blood -> wbc proliferate when therapy is stopped -> lots of residual antigens produced in ocular tissues -> massive inflammatory reaction
- EXCEPTION LOTEPREDNOL!
-
Glucocorticoid potency?
- 1. acetate
- 2. alcohol
- 3. sodium phosphate
-
Pred Forte
Inflamase Forte
- PF: prednisolone acetate 1%
- IF: sodium phosphate 1%
- -greatest anti-inflammatory efficacy
- -increase IOP
-
Flarex
FML
FML Forte
- F: fluorometholone acetate 0.1%
- FML: fluorometholone alcohol 0.1%
- FML F: fluorometholone alcohol 0.25%
- -doesn't raise IOP as much
- -better for long-term and more anterior (less deep) inflammations
-
Maxidex
Decadron
- M: dexamethasone alcohol 0.1%
- D: dexamethasone sodium phosphate 0.1%
- -greatest potential for IOP increase
-
Vexol
- rimexolone 1.0%
- -not a true soft steroid
- -reduced propensity to increase IOP
-
Alrex
Lotemax
- A: 0.2% loteprednol susp
- -Tx of ocular allergies
- L: 0.5% loteprednol susp
- -loteprednol is a soft steroid
- -don't need to taper loteprednol
- -Lotemax indicated for inflammation/acute anterior uveitis, GPC (qid for 6 wks), seasonal allergic conj.
-
Three fluoroquinolines indicated for corneal ulcer?
- Ciloxan (2nd gen) ciprofloxacin
- Ocufox (2nd gen) ofloxacin
- Iquix (3rd gen) levofloxacin
-
Common 4th generation fluoroquinoline antibiotics?
- Zymar/Zymaxid (gatifloxacin)
- Vigamox (moxifloxacin) NOT preserved
- Besivance (besifloxacin) susp
-
Zymar
- gatifloxacin
- 4th gen fluoroquinoline
- approved for conj only
- sign: 1gt q2h while awake (up to 8gtt) for days 1-2, then 1gt qid for days 4-7
-
Vigamox
- moxifloxacin (4th gen fluoroquinoline antibiotic)
- self-preserved agent
- 1gt tid for 7 days
- best for S. aureus
-
Besivance
- besifloxacin (4th gen fluoroquinoline antibiotic)
- approved for Tx of conj
- Sig: 1 gt tid x 7 days
- Durasite increase contact time
- Resistance less likely (affects both topoisomerase II and IV like all 4th gen fluroquinolines)
-
Best drug for MRSA?
- Cipro (ciprofloxacin) or Duricef (cefadroxil)
- -affect DNA synthesis
-
Best drug for Staph aureus
moxifloxacin (Vigamox)
-
Best drug for coagulase negative staph
moxifloxacin (Vigamox) and gatifloxacin (Zymar)
-
Best drug for pseudomonas?
ciprofloxacin (Ciloxan)
-
Azasite
- broad spectrum azithromycin (macrolide) antibiotic
- G+, G-, atypical
- well absorbed in eyelids can be used for posterior bleph.
- -Sig: 1gt bid x 2d followed by 1gt qd x 5d
-
Fucithalmic
- fusidic
- acid 1%
- -broad spectrum bactericidal antibiotic
- -resistance in vitro -> use with completmentary antibiotic
- -for conj. S. aureus
- -bid
-
Tx of chlamydial conj?
- Orals for 3-6 wks:
- 1. tetracycline or erythromycin 250-500 mg qid
- 2. doxycycline bid
- 3. clarithromycin bid
- 4. azithromycin 1g po ONCE only
- Topical for 2-3 wks:
- 1. erythromycin tid (or tetra or sulfa)
-
Tx of acne rosacea?
- 1. tetracycline qid
- 2. doxycycline qd to bid
- 3. erythromycin or azithromycin
-
Tx of preceptal cellulitis?
- USE A CEPHALOSPORIN
- 1. Augmentin or Clavulin (amoxicillin/clavulanate) 500mg tid
- 2. cefaclor (Ceclor) or cephalxin (Keflex)** 500mg bid
- 3. trimethoprim
- 4. erthromycin
-
Zovirax
- acyclovir for active epithelial HSV
- 400mg 5x/d x 10d
-
Valtrex
- valacyclovir for active epithelial HSV
- 500mg tid x 7d
-
Famvir
- famciclovir for active epithelial HSV
- 250mg tid x 7d
-
Tx of viral conjunctivitis?
- 1. loteprednol steroid, Pred Forte, Flarex, Vexol bid-qid
- 2. topical antibiotic-steroid combo (Tobradex, Maxitrol) qid
-
Tx of herpes zoster ophthalmicus?
- Within 72 h for 7-10 days
- 1. acyclovir 800mg (twice the amt of simplex Tx) 5x/d
- 2. valacyclovir 1000mg tid
- 3. famcyclovir 500mg tid
-
contraindications of oral antivirals such as Zovirax, Valtrex, Famvir, Zirgan, Viroptic etc.
- -renal clearance (caution in elderly, dehydration, and renal impairment)
- -CNS ADRs
- -leukopenia in immunocompromised Px
-
Natacyn
- natamycin 5%
- first choice for filamentary fungal keratitis
- q1h
- steroids are contraindicated for fungal keratitis
-
Brolene
- propamidine isethionate 0.2%
- used to treat Acanthamoeba keratitis
alternative is chlorhexidine 0.2%
-
pyrimethamine bid or sulfadiazine qid are used to treat...
anti-infectives for Toxoplasma gondii
- If sulfa allergy develops, use clindamycin 300mg po tid
- If viritis gets worse, use prednisone 20-80mg for 4 wks with taper after beginning the antibiotics for ~2days
-
Genteal, Refresh MD
- -artificial tears
- -carboxymethylcellulose
- -non-medical Tx of allergies, dry eye
-
BION tears
- -artificial tears
- -hydroxypropylmethyl, dextran, bicarbonate buffer
- -non-medical Tx of allergies
-
vasoconstrictors for allergies (adrenoreceptor agonists)
- -phenylephrine
- -naphazoline (the best)
- -oxymetazoline
- -tetrahydrozoline
- -ADRs: stinging, blurring, IOP fluctuations (except oxymetazoline)
- -Caution: CVD, hyperthyroidism, DM
- -Contraind: narrow-angle glaucoma, narrow angles
-
Livostin (levocabastine hydrochloride)
- -Rx topical antihistamine
- -0.05% suspension, potent
- -for acute care of intense symptoms
- -bid normally, or qid for a week then 1-3x per day as needed
- -discard open bottle after 1 mth
- -for 12+ yo Pxs
-
Pure mast cell stabilizer for allergies
- 1. Opticrom/Crolom (cromolyn sodium) 2%/4% 1 gt qid OTC
- 2. Alomide (lodoxamide HCl) 0.1% soln 1 gt tid or qid Rx
- 3. Alocril (nedocromil sodium) 2% bid-qid
- -prophylatic for future allergice reactions
- -lasts for months after proper dosing
-
Dual activity (antihistamine and MC stabilizer) for allergies
- 1. Pataday (olopatadine) 0.2% qd 3+yo Px
- 2. Alaway/Refresh Allergy/Zaditor (ketotifen fumerate) 0.025% bid stings more but cheaper
- -temporary prevention of itching in allergic conjunctivitis
-
Microbial keratitis (ie. from extended CL wear or poor hygiene, H. Influenza, trauma, corneal disease ie. bullous keratopathy, exposure, dry eye)
- cease CL wear
- -no patching
- -refer to corneal specialist in severe cases
- -oral painkillers
- -cycloplegic agent (comfort)
- -fluoroquinolones for pseudomonas
-
Pseudomonas corneal infection
- Low risk vision loss (small peripheral infiltrate, min AC rxn)
- -Fluoroquinolone (moxifloxacin) q 2-4h + tobramycin ung (for CL Px)
- Borderline risk (med peripheral infiltrate, epith defect, AC rxn, discharge)
- -Fluoroquinolone q1h around the clock
- Vision threatening
- -loading dose 1gt q5min for 5 doses, then 1gt q15mins for 3 doses, hen 1gt q30-60mins around the clock. May need hospital.
-
Penicillin
- -effective against G+ bacteria, for eye infections
- -inhibit cell wall synth
- -ADR: hypersens, GI
- -stronger, more resistant to penicillinase: dicloxacillin, amoxicillin
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