Ocular Pharm 261

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Author:
Alicat38
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203919
Filename:
Ocular Pharm 261
Updated:
2013-06-13 19:54:04
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Optom 261
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Midterm Material
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  1. 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
  2. Most common ADR for mydriatic drops?
    • -transient stinging
    • -blurry vision
    • -local irritation/discomfort
    • -photophobia
  3. 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
  4. 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
  5. atropine
    • strongest mydriatic and cycloplegic agent
    • 2 weeks
    • for uveitis, amyblopia, refraction
    • -ADR: fatal if ingested
  6. cyclopentolate
    • mydriatic (1dy) and cycloplege (24h)
    • -for refraction and uveitis
    • -third strongest agent
  7. homatropine
    • mydriatic (1-2d) and cycloplege (1-2)
    • -for uveitis
    • -second strongest agent
  8. 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
  9. 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
  10. 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
  11. Refresh
    • artificial tears with carboxymethylcellulose (CMC) viscosity enhancing agent
    • -therapeutic action: heals ocular surface
    • -mucoadhesion
  12. Blink
    • artificial tears with hyaluronic acid (sodium hyaluronate) viscosity enhancing agent
    • -therapeutic action: heals ocular surface
    • -shear-thinning (reduces irritation from blinking)
  13. Biorefresh
    • artificial tears with hydroxypropyl methylcellulose (HPMC) viscosity enhancing agent
    • -therapeutic action: heals ocular surface
  14. Three main components in ointments?
    • white petrolatum
    • mineral oil (helps melt petrolatum at body temp)
    • lanolin (absorbs water -> improves solubility)
  15. 1 mL is approximately how many drops?
    20 drops
  16. Px with dry eye may experience increased drug absorption because...
    • -drug less diluted
    • -increased contact time
    • -epithelial damage increases corneal penetration
  17. 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
  18. 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
  19. Antibiotic that attacks G+ cell memb?
    gramicidin (Polysporin, Polycidin) -OTC
  20. Antibiotic that attacks G- cell memb?
    • Polytrim (1% trimethoprim + polymyxin B)
    • good for pseudomonas
  21. 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)
  22. Which antibiotics have ADR of ototoxicity (auditory and vestibular), nephrotoxicity when administered systemically?
    aminoglycosides
  23. Which antibiotics have ADR of corneal and conjunctival toxicity when administered topically?
    • aminoglycosides
    • ie. gentamicin, tobramycin
  24. Which antibiotic has ADR of pseudotumor cerebri with papilledema?
    gentamicin (an aminoglycoside)
  25. erythromycin
    • -2nd line drug to treat infectious internal hordeola
    • -first line in infants/children with chlamydia
    • -Adult (for infection): 500mg qid x 7 days
  26. 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
  27. Voltaren (diclofenac)
    • 0.1% diclofenac
    • topical ophthalmic NSAID qid for post cat surgery
  28. Acular LS
    • ketorolac tromethamine 0.4%
    • topical ophthalmic NSAID qid for post corneal surgery
    • -reduced ocular pain and burning/stinging
  29. Which topical ophthalmic NSAID would you use for less stinging?
    • Acular LS (ketorolax tromethamine 0.4%)
    • qid
    • used post op
  30. 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%
  31. 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
  32. 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)
  33. Steroid dosing?
    • mild/moderate inflammation-q4h/q6h
    • Severe inflammation-q1h or q1/2h Pulse dosing
    • Severe inflammation with dry eye -qid
    • mild uveitis -q1h
  34. 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!
  35. Glucocorticoid potency?
    • 1. acetate
    • 2. alcohol
    • 3. sodium phosphate
  36. Pred Forte
    Inflamase Forte
    • PF: prednisolone acetate 1%
    • IF: sodium phosphate 1%

    • -greatest anti-inflammatory efficacy
    • -increase IOP
  37. 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
  38. Maxidex
    Decadron
    • M: dexamethasone alcohol 0.1%
    • D: dexamethasone sodium phosphate 0.1%
    • -greatest potential for IOP increase
  39. Vexol
    • rimexolone 1.0%
    • -not a true soft steroid
    • -reduced propensity to increase IOP
  40. 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.
  41. Three fluoroquinolines indicated for corneal ulcer?
    • Ciloxan (2nd gen) ciprofloxacin
    • Ocufox (2nd gen) ofloxacin
    • Iquix (3rd gen) levofloxacin
  42. Common 4th generation fluoroquinoline antibiotics?
    • Zymar/Zymaxid (gatifloxacin)
    • Vigamox (moxifloxacin) NOT preserved
    • Besivance (besifloxacin) susp
  43. 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
  44. Vigamox
    • moxifloxacin (4th gen fluoroquinoline antibiotic)
    • self-preserved agent
    • 1gt tid for 7 days
    • best for S. aureus
  45. 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)
  46. Best drug for MRSA?
    • Cipro (ciprofloxacin) or Duricef (cefadroxil)
    • -affect DNA synthesis
  47. Best drug for Staph aureus
    moxifloxacin (Vigamox)
  48. Best drug for coagulase negative staph
    moxifloxacin (Vigamox) and gatifloxacin (Zymar)
  49. Best drug for pseudomonas?
    ciprofloxacin (Ciloxan)
  50. 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
  51. Fucithalmic
    • fusidic
    • acid 1%
    • -broad spectrum bactericidal antibiotic
    • -resistance in vitro -> use with completmentary antibiotic
    • -for conj. S. aureus
    • -bid
  52. 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)
  53. Tx of acne rosacea?
    • 1. tetracycline qid
    • 2. doxycycline qd to bid
    • 3. erythromycin or azithromycin
  54. 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
  55. Zovirax
    • acyclovir for active epithelial HSV
    • 400mg 5x/d x 10d
  56. Valtrex
    • valacyclovir for active epithelial HSV
    • 500mg tid x 7d
  57. Famvir
    • famciclovir for active epithelial HSV
    • 250mg tid x 7d
  58. Tx of viral conjunctivitis?
    • 1. loteprednol steroid, Pred Forte, Flarex, Vexol bid-qid
    • 2. topical antibiotic-steroid combo (Tobradex, Maxitrol) qid
  59. 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
  60. 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
  61. Natacyn
    • natamycin 5%
    • first choice for filamentary fungal keratitis
    • q1h
    • steroids are contraindicated for fungal keratitis
  62. Brolene
    • propamidine isethionate 0.2%
    • used to treat Acanthamoeba keratitis

    alternative is chlorhexidine 0.2%
  63. 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
  64. Genteal, Refresh MD
    • -artificial tears
    • -carboxymethylcellulose
    • -non-medical Tx of allergies, dry eye
  65. BION tears
    • -artificial tears
    • -hydroxypropylmethyl, dextran, bicarbonate buffer
    • -non-medical Tx of allergies
  66. 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
  67. 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
  68. 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
  69. 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
  70. 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
  71. 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.
  72. 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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