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classification of eye medications
- anti-infective
- anti-inflammatory
- anti-glaucoma
- mydriatics
- local anesthetics
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opthalmic topical ointment and solution available for treatment of superficial infections of the eye caused by susceptible oragnisms
anti-infective
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opthalmic antibiotic preps/meds
- macrolides
- bacitracin
- sulfonamides
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anti-infective not considered first line therapy because of resistence and cost
fluoroquinolones
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why are aminoglycosides avoided as eye meds
because of toxicity to coreneal epithelium
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what should you consider if there is no improvement in 2-3 days of antiinfectives
- suspect microbial resistance
- inappropriate drug of choice
- incorrect dosage
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topical antiinfective therapy should not exceed ____ days
10
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how should eye medication be instilled
in the lower conjunctival sac to avoid contamnation of tip
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antiinfective PE
- possible hypersensitivity
- dont use eye makeup or contact lenses during treatment
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what should you instruct a Pt. to do when using more than one opthalmic med.?
- space 5 minutes apart
- administer most viscious med last
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anti infective side effects
- conjunctivits
- blurred vision
- burning
- stinging
- rash
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antiinfective CI
viral/fungal disease of ocular structure
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treatment to relieve inflammation of the eye or conjunctiva in allergic reactions, burns, postop, and irritation from foreign substances
anti-inflammatory
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types of anti-inflammatory agents
- Antihistamines
- Corticosteroids
- Opthalmic immunologic agent
- Nsaids
(ACON)
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relieves ocular pruritis (itching) associated w/ allergic conjunctivitis
antihistamine
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causes vasoconstriction of blood vessels & provides relief from minor eye irritation
decongestant
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antihistamine/decongestant meds
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treatment useful in acute stages of eye injury to prevent scarring (SHORT TERM)
corticosteroids
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who can prescribe corticosteroids
opthalmolgists
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how is systemic absorption of corticosteroids minimized
apply pressure on inner canthus
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corticosteroids SE
delayed healing of cornea wounds, cornea thinning, cornea ulceration
reduced resistance to bacteria, virus, fungus
increased intraocular pressure (depends on dose, frequency, treatment time)
- stinging, burning
- ocular pain
- cataracts
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corticosteroid CI
- acute bacterial, viral or fungal infections
- primary open-angle glaucoma
- pregnancy
- prolonged use
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corticosteroid meds
- prednisolone
- dexamethasone
- flurometholone
(pdf)
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treatment to produce tear production
opthalmic immunologic agents
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-
-when administered systemically, it’s an immunosuppressive agent for organ transplant rejection prophylaxis
-when administered topically, has minimal risk of systemic toxicity
restasis (topical cyclosporine)
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SE of OIA
- Ocular burning
- stinging
- blurred vision
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CI of OIA
applies to pts w/ active ocular infections; has not been studied in pts w/ chronic dry eye
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treatment for postop inflammation following cataract surgery
NSAIDS
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not first line agents for other eye conditions w/ inflammation, but are alternative to corticosteroids if any contraindications
NSAID
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NSAID caution
allergy to asprin
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abnormal condition in which increased intraocular pressure due to obstruction of outflow of aqueous humor
glaucoma
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2 types of glaucoma
- acute angle closure glaucoma
- chronic open angle glaucoma
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-sudden onset of pain, blurred vision, dilated pupil
-considered medical emergency
-if untreated, can cause blindness w/in few hours or days
Acute (angle-closure) glaucoma
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-more common
-bilateral
-develops slowly over periods of years w/ few symptoms except gradual loss of peripheral vision & blurred vision
-halos & central blindness are late manifestations
Chronic (open-angle) glaucoma
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Acute angle closure glaucoma treatment
- miotics (pilocarpine)
- osmotic agents/diuretics (mannitol)
- carbonic anhydrase inhibitors (diamox)
- surgery
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Chronic (open-angle) glaucoma Treatment:
- miotics
- carbonic anhydrase inhibitors
- local beta-adrenergic blockers (timolol drops)
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1st step in glaucoma therapy
ensure pt abstains from meds that will exacerbate glaucoma such as potent corticosteroids, antihistamines, anticholinergics.
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5 catgories of antiglaucoma drugs
Beta-adrenergic blockers: timolol (decrease rate of Aqueous Humor production)
Carbonic Anhydrase Inhibitors: diamox (decrease formation of AH)
Alpha agonists: alphagan-P (decrease production of AH & increase outflow)
Miotics: pilocarpine (Increase AH outflow)
Prostaglandin analogs: xalatan (Increase AH outflow)
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-gold standard against new glaucoma treatments
-used topically
Beta-adrenergic blockers: timolol
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Beta-adrenergic blockers: timolol SE
- aggrevation of preexisting cardiovascular & pulmonary disorders bradycardia
- hypotension
- dizziness
- bronchospasm
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a cardioselective beta-blocker used w/ caution in pts w/ bronchospastic pulmonary disease since it does not affect the pulmonary receptors
Betaxolol (Betoptic-S)
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reduce formation of hydrogen & bicarbonate ions
Carbonic Anhydrase Inhibitors
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-selective alpha-agonist that decreases formation & increases outflow of AH w/ minimal effects on cardiovascular or pulmonary hemodynamics
-alternative for those who have topical beta-blocker therapy contraindications
Alpha agonists: alphagan-P
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-cause pupil contractions
-reduces intraocular pressure by increasing AH outflow
-contracts ciliary muscles
-considered 3rd line therapy due to SE
-SHORT TERM treatment before surgery -has cholinergic action & SE
Miotics: pilocarpine
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-cause the greatest reduction in IOP
Prostaglandin analogs: xalatan & travatan
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used topically to dilate the pupil for examinations
mydriatics
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medication that acts as a cyclopegic
atropine
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paralyzes the muscle of accomodation
cyclopegic
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a sympathomimetic that produces mydriasis w/o cycloplegia
phenylephrine
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mydriatic PE
Aseptic technique must be used
Administration by closing tear duct after installation
Sensitivity to light
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applied topically for minor surgical procedures, removal of foreign bodies or painful injury
local anesthetic
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local anesthtic medication
tetracaine (tetra visc)
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local anesthetic PE
(pts given anesthetics): wear eye patch after use of tetracaine due to loss of blinking reflex
- (pts taking anesthetics):
- -crucial to continue glaucoma treatment for a lifetime & have regular eye exams to prevent future vision damage
- -aseptic technique
- -apply gentle pressure to inner canthus
- -use of eyecup to aid administration
- -close eye gently
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prolonged use due to danger of corneal erosions
local anesthtic CI
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SE: rare, expect w/ prolonged use – hypersensitivity
Anaphylaxis (pts allergic to –caine meds)
local anesthetic
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