646 Ocular Pharm Final

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Topical NSAID Drugs (5)

Back 1

Diclofenac Na+ (Voltaren)

Flurbiprofen Na+ (Ocufen)

Ketorolac Tromethamine (Acular/Acuvail)

Nepafenac (Nevanac)

Bromfenac (Bromday)

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Topical NSAID S/E

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S/E: burning/stinging, hyperemia, atonic mydriasis, *CORNEAL MELTING (esp with previous generic)

Contra: Dry Eye, RA, Corneal Denervation, Cornea Problem

1 wk normally

1 month CME,

Front 3

Flurbiprofen (Ocufen)

Back 3

topical NSAID

Thirmesol preservative

Front 4

Diclofenac Na+ (Voltaren)

Back 4

Topical NSIAD

phenylaceic acid derivative

Front 5

Ketorolac tromethamine (Acular)

Back 5

Topical NSAID

Tx: Post op, Allergies

Acuvail - preservative free variant

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Nepafenac (Nevanac)`

Back 6

Topical NSAID - only suspension

Amide prodrug of Amfenac

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Topical NSAID - suspention

Back 7

Nevanac (Nepafenac) - suspention --> better penetration

amide prodrug, very effective

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Topical NSAID one/day

Back 8

Bromday (Bromfenac)

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Preservative Free NSAID

Back 9

Acuvail - Ketorolac Tromethamine 0.45%

Front 10

Ketorolac Tromethamine flavors

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Acular LS 0.4% - off lavel CME, GPC, Pterygia

Acuvail 0.45% - preservative free, BID

Acular 0.5% - stings

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Topical NSAID w/Thimerosol

Back 11

Fluriprofen (Ocufen) - least effective

inhibits intra operative miosis during cataract surgery

Front 12

Hyperosmotic Drugs

Back 12

NaCl (Muro-128, Absorbanac)

Glycerin

Glucose

Isoboride

Front 13

NaCl Muro-128, Absorbanac

Back 13

Hyperosmotic

most common Rx - 5%

solution, ung

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Hyperosmotic used in acute angle closure

Back 14

Glycerin

Front 15

hyperosmotic Glycerin

Use?
S/E
Contra

Back 15

oral, diagnostic purposes, Acute Angle closure

S/E: diuretic, HA, Nausea

Conta: DM, heart dz, kidney dz

Front 16

vanilla mint Hyperosmotic

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Isosorvide (Ismotic)

Preg B

OK for DM

Front 17

Peripheral Irodotomy

Back 17

Surgery for acute angle closure

Front 18

Argon Laser Trabeculoplasty (ALT)

Back 18

open TM
lasts 3-5 yrs

Front 19

Selective laser Trabeculoplasty (SLT)

Back 19

open TM photocoagulation melanin containing cells

done after Laser Traeculoplasty

Front 20

Trabeculectomy

Back 20

fistula btw Anterior Chamber & Subconj space

drainage pathway

Front 21

Glaucoma Drug Classes increase Outflow

Back 21

Prostaglandins

Sympathomimetics

Cholinergic Agonists

Front 22

Glaucoma Drugs that Decrease Production

Back 22

Beta Blockers

Carbonic Anhydrase Inhibitors

Front 23

Prostaglandins basics

Mech

S/E

Contra

Back 23

Teal Cap- QD @ night
Increase Uveosclearal Outflow- MMP; max effect 2wks Reduces IOP up to 35%,

S/E: pigmentation, conh hyperemia, hypertrichosis

Contra: Uveitis, HSV, CME, post opt

Front 24

Prostaglandins - Drugs (4)

Back 24

Latanoprost
Travoprost
Bimatoprost
Tafluprost

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Prostaglandins conj hyperemia most to least

Back 25

Bimatoprost > Travoprost > Latanoprost

Front 26

Latanoprost

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prostaglandin - teal cap

drops IOP 27-30%, increasing UVeoclrealal outflow

BAK

long term

Front 27

Travoprost

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Prostaglandin - Teal cap

preservative: SofZia

33% drop in IOP, increases outflow

Front 28

Brimatoprot (Lumigan, Latisse)

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Prostaglandin - Teal Cap
increases outflow Uveoscleral & Traecular!

No affinity for FP receptor/ not prodrug
BAK

Drops IOP > Travoprost > Lantanoprost (equally in AA/Blacks)

Front 29

Latisse

Back 29

Prostaglandin - teal cap

S/E: macular edema, punctate epi keratitis, conj hyperemia

Front 30

Preservative Free Prostaglandin

Back 30

Tafluprost

must be refrigerated

Front 31

Beta Blockers Basic

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yellow, Selective - light blue
IPO drop 20 -25%; decrease Production
B2 eye/lung; B1 Heart
QD in AM; Fast Acting --> Acute Angle Closure
Preg C

S/E: Flight/Fight, Vradycardia, Raynaud's, Bronchospasm, depression, Impotence, HA, insomnia, nausea

Contra: Asthma, cholesterol, CHF, Kids

Front 32

Beta Blocker Drugs

Back 32

Timolol
Levobunolol
Metipranolol
Carteolol
Betaxolol

Front 33

Selective Beta Blocker

Back 33

Betaxolol - Cap Light Blue

Front 34

Beta Blocker for BAK allergy

Back 34

Timoptic XE
Timoptic PF

Front 35

most comfort Beta Blocker

Back 35

Carteolol

Front 36

Betablocker ok for high cholesterol

Back 36

Careolol

intrinsic sypathomimetic activity

Front 37

weakest beta blocker (least drop in IOP)

Back 37

Betaxolol - selective

Front 38

Beta Blocker Suspention

Back 38

Betaxolol

Front 39

Alpha2 Adrenergic Agonists Basics

Back 39

Purple Cap
decrease production & increase Outflow

Apraclonidine
Brimonidine

Front 40

Apraclonidine

Back 40

Alpha 2 Agonists; purple cap
short term, Acute Angle Closure - tachyphylaxis

S/E: conh bleach, lid retraction, mydriasis (dilation), Head cold, Fatigue, bitter

Contra: MAOIs, CVD, allergic clonidine

Front 41

Brimonidin

Back 41

Alpha 2 Agonist - Purple Cap

30X stronger than Apraclonidine

Neuroprotective; Preg B
Better S/E than Beta-Blockers, Good for Elderly

S/E: blepharitis, conj follicles, Miosis (Constrict Pupil), Fatigue-Children

Contra: MAOIs, CVD, allergic clonidine

Front 42

Carbonic Anhydrase Inhibitors - CAI

Mech

Back 42

reversible non-comp binding w/Carbonic Anhydrase

Hydrogen --> Bicarbonate

Front 43

CAI basics

Back 43

drops AH production 45-55%

Orals - Drop IOP ~ 50%
Topicals - Drop IOP ~ 20%

works at night (Beta Blockers Don't)

Bitter Taste, hard on Liver & Kidney

Front 44

CAI Drugs

Back 44

Orals
- Acetazolamide
- Methazolamide

Topicals - Orange Cap
- Dorzolamide
- Brinzolamide

Front 45

Acetazolamide

Back 45

most used oral CAI Tx - Glaucoma; Decreases production
Tx: macular edema

Short Term Use - Acute Angle/ b/f surgery

S/E: bitter, numbness, metallic taste, decreased libido, depression, fatigue, Acidosis, Respiratory issues - BAD S/E

Contra: allergic sulfa; Liver or Kidney Dz

Front 46

Methazolamide

Back 46

Oral CAI - Glaucoma, decreases production
stacked w/topical therapy (NOT topical CAI)

Longer 1/2 life & fewer S/E than Acetazolamide

S/E --> Asains- Steven Johnson Syndrome; bitter
Contra: allergic sulfa; Liver or Kidney Dz

Front 47

Topical CAI

Back 47

Orange Cap - Drops IOP ~ 20%, decreases production
Don't use w/oral CAI
Dorzolamide
Brinzolamide

Front 48

Dorzolamide (Trusopt)

Back 48

Topical CAI - Orange Cap - decreases production

Not as pt friendly as Beta Blockers, Prostaglandins

S/E: sting/burns, bitter taste

Contra: Kidney Liver Dz, allergic Sulfa

Front 49

Brinzolamide (Azopt)

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Topical CAI - Orange Cap; Decreases AH Production
Drops IOP ~ 20%

Suspension

S/E: blur, sting, bitter

Contra: sulfa allergy, Kidney Liver Dz

Front 50

Combination Drugs

Back 50

Combigan: Brimonidine Dark Blue Cap (A2 agonist) & Timolol (B-blocker) drops IOP ~ 27%

Cosopt: Dorzolamide Square Bottle (CAI) & Timolol (B-blocker) drops IOP ~27%

Simbrinza - brinzolamide (CAI) and brimonidine (A2 Agonist) Drops IOP 21-35%

Front 51

which combo drugs are taken BID

Back 51

Combigan

Cosopt

Front 52

Which combo drugs are taken TID

Back 52

Simbrinza

Front 53

Drugs that decrease production & increase outflow

Back 53

Combigan

Cosopt

Simbrinza

Aparaclonidine

Brimonidine

Front 54

Mitotics - Cholinergic Agonist basics

Back 54

constricts pupil

Increases outflow
don't use much for glaucoma

Front 55

Cholinergic Agonist Drugs

Back 55

- Pilocarpine
- Physostigmine
- Edrophonium
- Pyridostigmine
- Neostigmine

Front 56

direct Cholinergic Agonist

Back 56

Pilocarpine - directly activates muscarinic recpetors
drops IOP ~ 15%
Green Cap
S/E Acc spasm, Miosis (constriction) pupillary block, retinal detachment, HA
SLUD: Salivation, lacrimation, urination, defecation

Contra: cataracts, under 40, retinal detachment, IOP > 40

Front 57

Indirect Cholinergic Agonists

Back 57

AChE inhibitors - Green Cap
Physostigmine
Edrophonium
Pyridostigmine
Neostigmine

Front 58

Antidote to Atropine toxicity

Back 58

Physostigmine -Green Cap

Front 59

Atropine is the antidote to ?

Back 59

Neostigmine Toxicity

Front 60

What is used w/Tensilon Test to Dx Myasthenia Gravis

Tx Myasthenia Gravis

Back 60

Edrophonium, Neostigmine - Indirect Cholinergic Agonist

Tx: Pyridostigmine, Neostigmine

Front 61

Tx Dry AMD

Back 61

AREDS 2 Formula: Vit C, Vit E, Zn, Cu, Omega-3, Leatein, Zeaxanthin

Front 62

Wet AMD drugs

Back 62

Verteporfin (Visudyne)

Ranibizumab (Lucentis)

Bevacizumab (Avastin)

Pegaptanib (Macugen)

Alifercept (Eylea)

Front 63

wet AMD drug generic

Back 63

evacizumab (Avastin)

Front 64

Wet AMD drug decoy receptors that bind VEGF-A & PIGF

Back 64

Alifbercept (Eylea)

newest

monthly x3, then every 2 mo

Front 65

Adies Tonic Pupil Dx drug

Back 65

hypersensitivity of muscarinic receptors

Pilocarpine 0.125% -should be too little concentration in normal, positive result if it dilates; Miosis

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very expensive Wet AMD drug

Back 66

Ranibizumab (Lucentis)

Front 67

wet AMD drug that uses lasers

Back 67

Verteporfin (Visudyne)

Front 68

Acute Angle Closure Tx (5)

Back 68

- Timolol

- Pred 1%

- Apraclonidine

- Acetazolamide

- Isosorbide (DM), Glycerol

- Pilocarpine 1 or 2%

Front 69

cycloplegics -
A Stupid Ho Can't Type

Back 69

Atropine
Homatropine
Scopolamine
Cyclopentolate
Tropicamide

Front 70

Mydriatics

Back 70

Dilates, less on Acc

Phenylephrine
Hydroxyamphetamine

Front 71

Paremyd

Back 71

hydroxyamphetamine + Tropicamide