Pharmacology Unit 8 Part 1 Eye, Skin ----and Antiinfectives

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Leon
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Pharmacology Unit 8 Part 1 Eye, Skin ----and Antiinfectives
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2013-11-19 15:24:32
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Pharmacology Unit Part Eye Skin Antiinfectives
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Pharmacology Unit 8 Part 1 Eye, Skin ----and Antiinfectives
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  1. 1) What is glaucoma? What are the 2 types?
    • a) Congenital Glaucoma – surgery required
    • b) Primary Glaucoma
    • i) Narrow angle (acute congestive)-
    • (1) Cause: poor drainage because of position of iris
    • (a) drug treatment chiefly pupil constrictors
    • (b) eventually may be treated w/ surgery
    • ii) Wide angle (or chronic simple) –
    • (1) Cause: poor drainage most probably due to abnormal blood vessel permeability
    • (a) most common type of glaucoma
    • (b) requires permanent drug therapy
    • (c) pupil constriction often helps drainage
    • (d) use drugs to decrease aqueous humor formation
    • c) Secondary Glaucoma – develops 2ndary to other eye disease (i.e. inflammation) or cataract surgery
    • i) Treat w/ corticosteroid or Antiinfectives & glaucoma usually disappears
  2. 2) Drugs to treat glaucoma - What are they and how do they work?
    • a) Drugs to Constirct the Pupil: Miotics
    • i) Cholinergic Drugs
    • (1) (including anticholinesterase drugs)
    • (a) Pilocarpine, carbachol
    • (b) Ach-short duration, for surgery
    • (2) Therapeutic Uses:
    • (a) Wide angle primary glaucoma
    • (b) And especially narrow angle
    • (i) Contracts sphincters of iris
    • (ii) Vasodilation of vessels draining eye
    • (3) Side Effects
    • (a) Spasms of ciliary muscle (blurred far vision)
    • (b) Usually not bothered by other cholinergic side effects
    • (i) Can get headache, salivation, sweating, diarrhea, increased asthma attacks, decreased BP
    • (4) Caution: driving at night
    • b) Drugs to Reduce Fluid Formation
    • i) Carbonic Anhydrase Inhibitors
    • (1) (Used for acute attack or in combination for difficult cases)
    • (a) Inhibits one enzyme required for production of aqueous humor
    • (b) Taken orally
    • (2) Therapeutic Uses
    • (a) Glaucoma
    • (3) Side Effects
    • (a) Watch for cross-allergy in patients allergic to sulfa drugs
    • (b) Neurological effects possible including:
    • (i) Tingling in the extremities, lips, and anus
    • (ii) Long-term, flaccid paralysis and
    • (iii) Convulsion
    • (4) Caution
    • (a) Teratogenic in first trimester of pregnancy
    • ii) Adrenergic Drugs (see also under category C)
    • (1) Therapeutic Uses
    • (a) Wide angle primary glaucoma
    • (b) Glaucoma secondary to inflammation
    • (i) Given only after constrictor (cholinergic agent) to counteract pupil dilatory effect
    • (2) MOA
    • (a) *act chiefly to decrease formation of aqueous humor
    • (3) Side Effects
    • (a) Not serous
    • (4) Caution
    • (a) Narrow angle glaucoma
    • iii) Beta blockers
    • (1) like Timolol maleate (Timoptic®)
    • (a) betaxolol is B1 selective
    • (b) levobunolol & timolol are nonselective
    • (2) MOA
    • (a) Decrease fluid production (exact mechanism unknown)
    • (b) Doesn’t change size of pupil (not for Alpha1)(no interference night vision)
    • (c) One dose can be effective for 24 hours
    • (3) Therapeutics Uses
    • (a) Wide angle glaucoma
    • (4) Cautions – asthma, hearth disease (heart block, heart failure)
    • iv) Osmotic diuretics
    • (1) – may be given orally or parentally
    • (2) Acute attacks
    • (3) Preoperative use
  3. 3) Drugs to treat eye (ocular) inflammation and side effects?
    • a) Antiinfectives
    • i) –may be used topically or systemically
    • (1) Viral (Idoxuridine, Vidarabine) and fungal (Natamycin)
    • (2) Often find antibacterial agents in combination – i..e. Neosporin = bacitracin, polymyxin, and neomycin
    • ii) Therapeutic Uses-
    • (1) Eye infection or inflammation
    • iii) Cautions Systematically:
    • (1) May make patient sensitive to Antiinfectives that my be used again
    • (2) May develop resistant strains of organism
    • iv) Caution Topically:
    • (1) Local sensitivity may develop (eye inflammation)
    • (2) Normal flora interfered w/ so may encourage abnormal organisms
    • b) Steroids (For ocular inflammation/ NOT INFECTION)
    • i) Mechanism:
    • (1) Reduces scarring & impaired vision
    • (2) Reduced inflammation helps prevent proteins and blood cells form entering aqueous humor (would decrease intraocular pressure)
    • ii) Therapeutic Uses
    • (1) Allergic reactions of eye
    • (2) Severe injury
    • (3) Non-pus producing inflammation (i.e. chemical cause or irritant)
    • iii) Cautions
    • (1) Pus-producing inflammation
    • (a) Would reduce resistance to pathogenic organisms
    • (2) Prolonged therapy can cause systemic side effects, 2ndary glaucoma, and cataracts
    • c) Local Anesthetics
    • i) No-blink reflex
    • ii) Protect
  4. 4) What is an emollient, antiseptic, keratolytic? Indications for use?
    • a) Emollient
    • i) Fatty or oily substances that may be used to soften or soothe irritated skin & mucous membrane
    • b) Antiseptic
    • i) A substance used on living tissue
    • ii) Either inhibits or kills microorganisms capable of producing infection
    • (1) Ex: Benzoyl peroxide (for inflammatory acne) alcohols, iodine, phenols
    • c) Keratolytic
    • i) Keratin dissolvers, i.e. soften scale and loosen the outer horny layer of the skin
    • (1) Ex: salicylic acid found in wart removers, topical Vitamin A more specific to blackheads [noninflammatory acne]
    • d) Topical corticosteroids
    • i) Anti-inflammatory agents intended for topical use
    • ii) Not systemically absorbed to any great extent
    • iii) May cause dilation of capillaries, skin atrophy, and decreased skin pigmentation
    • iv) Do not use when infectious organisms are present
    • v) Allergies are possible
  5. 5) Acne- # main types of drugs we discussed. What types of acne does each type treat. Main side effects of any of these types of drugs.
    • a) Topical Drugs: for the treatment of mild to moderate acne
    • i) Tretinoin (Retinoic acid; Vitamin-A acid, Retin-A®, etc.) (Keratolytic)
    • (1) More for blackheads than whiteheads
    • (2) In the first few weeks, small blackheads may be converted to pustules so patients should prepare for temporary worsening which is usually followed by clearing
    • (3) Skin is more susceptible to sunburn and ultraviolet light; sunscreens should be used
    • (4) Possibility exists that Tretinoin might accelerate carcinogenic effect of ultraviolet radiation
    • ii) Benzoyl peroxide (Pan Oxyl®; Desquam-X®, etc) (bactericidal)
    • (1) More for whiteheads than blackheads
    • (a) Both Tretinoin & Benzoyl peroxide may be used concurrently in more severe cases
    • iii) Topical antibiotics are sometimes prescribes as well
    • (1) Clindamycin, erythromycin, and tetracycline are common examples
    • b) Systemic drug: for more severe acne
    • i) Tetracycline
    • (1) Often must be continued months or years
    • (2) Can get gastric upset & vaginitis, skin, fungal infections
    • (3) Decreases effectiveness of oral contraceptives
    • (4) Contraindicated in pregnancy (Category D)
    • ii) Erythromycins may be used instead of tetracycline
    • (1) Often must be continued months or years
    • (2) Can get gastric upset & vaginitis, skin, fungal infections
    • (3) Can be used w/ caution in pregnancy (Categories B&C)
    • iii) Oral Contraceptives – estrogen suppress sebum production
    • (1) Sometimes 3 months or more before effect seen
    • iv) Oral 13- Cisretinoic acid (Acutane®) – inhibits sebum production
    • (1) Teratogenic (now requires patient consent forms)
    • (2) Effective in osme patient w/ severe disease
    • (3) Many side effects commonly seen. Use w/ caution.
    • c) Not Proven Effective: Not to use:
    • i) Oral Zinc
    • (1) Not proven effective in double blind studies
    • (2) Can cause GI bleeding
    • (3) Beginning to reconsider test results
    • ii) Topical corticosteroids
    • (1) May actually make acne worse if inflammatory kind
    • (2) May be sued for eczema, psoriasis, or contact dermatomes like poison oak, but not acne
    • (3) For poison oak, oral administration is much more effective (ointments are not strong enough)

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