PHRD5985 Pharmacotherapy Lecture 18 - Glaucoma & Otics

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  1. main tx of ACAG
  2. purpose of NLO
    • increase efficacy of drops
    • dec freq of dosage
    • reduce systemic SE's
  3. goal reduction of IOP
    reduce by 15-30%
  4. 1 first-line tx options of glaucoma
    • beta-blockers
    • prostaglandin analogs
  5. MOA of beta-blocking agents in glaucoma
    decrease aqueous humor production
  6. dosing freq of beta-blockers for glaucoma
  7. examples of beta blockers
    • timolol
    • betaxolol (better for pts w/ COPD)
  8. MOA of prostaglandin analogs for tx of glaucoma
    inc uveoscleral outflow
  9. dosing freq of prostaglandin analogs
    once daily in evening (preferably)
  10. notable SE's of prostaglandin analogs
    inc pigmentation of iris, eyelid, growth of eyelashes
  11. only PG analog approved as 1st line
  12. single-use, preservative free PG analog
    tafluprost (Zioptan)
  13. MOA of carbonic anhydrase inhibitors
    dec aqueous humor production by blocking active secretion of sodium/bicarb ions from ciliary body to aq humor
  14. examples of carbonic anhydrase inhibitors
    • dorzolamide
    • brinzolamide
  15. dosing freq of carbonic anhydrase inhibitors

    BID if NLO
  16. notable SE of carbonic anhydrase inhibitors
    • **corneal abrasion
    • allergic conjunctivitis
  17. pop to use caution in for tx w/ carbonic anhydrase inhibitors
    sulfa allergic
  18. MOA of alpha-2 adrenergic agonists
    dec aqueous humor production
  19. notable SE's of a2 adrenergic agonists
    • allergic conjunctivitis
    • mild mydriasis (dilation)
  20. dosing freq of a2 adrenergic agonists

    BID if NLO
  21. pop to use caution in tx w/ a2 adrenergic agonist
    clonidine allergic
  22. MOA of parasympathomimetics/miotics
    cholinergic agents that inc aqueus humor trabecular outflow
  23. freq of dosing of pilocarpine insert
    insert in conjunctival sac qweek at bedtime
  24. freq of dosing of pilocarpine gel
  25. goal for high baseline IOP
  26. goal for normal baseline IOP
  27. when to follow up w/ IOP
    4 weeks after tx, then q3-6mos when stable
  28. drugs that induce/exacerbate POAG IOP
    • CCSs
    • anticholinergics
  29. drugs that induce/exacerbate ACAG IOP
    • anticholinergics
    • heterocyclic antidepressants
    • topical sympathomimetics
    • ipratropium
  30. acute otitis externa (AOE)
    swimmer's ear
  31. req's for dx of AOE
    • 1) rapid onset (48hr)
    • 2) otalgia, itching
    • 3) EAC edema
  32. AOE tx for otalgia
    • systemic pain relief
    • otic CCS
  33. rec'd tx length w/ otic antimicrobials for AOE
    7-10d (10-14d if severe)
  34. dosing freq of ofloxacin (otic antimicrobial)
    once daily x 10d
  35. dosing freq of otic ciprofloxacin/hydrocortisone (Cipro HC)
    BID x 7d
  36. which drug class is ototoxic (CI if perf or tymp tubes)
    aminoglycosides (eg: neomycin)
  37. dosing of neomycin combo otic drops
    TID-QID (max 10 days)
  38. otic acetic acid CI
    perforated tympanic membrane or tymp tubes
  39. when acetic acid prods are used
    fungal infection or tried all other antimicrobials
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PHRD5985 Pharmacotherapy Lecture 18 - Glaucoma & Otics
glaucoma & otics
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