Basic Oc Pharm

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Hydrocortisone

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LEAST EFFICACIOUS; combo only; suspension or ointment Topical Steroid Anti-Inflammatory

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Prednisilone (Pred Forte, Pred Mild)

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Topical Steroid Anti-Inflammatory synthetic cortisol analog; Acetate better for suppressing corneal inflammation ; 1% acetate form generally considered the most effective anti-inflammatory topical ocular steroid for anterior segment inflammation (drug of first choice); Phosphate form better for external disease

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Dexamethasone (Maxidex)

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Topical Steroid Anti-Inflammatory SECOND CHOICE for severe anterior segment inflammation; Less effective than prednisolone and more prone to raise IOP

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Fluorometholone (FML)

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Topical Steroid Anti-Inflammatory Progesterone analog; Good for external ocular inflammation with relatively low potential to elevate IOP; Less anti-inflammatory efficacy than prednisolone and dexamethasone

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Medrysone

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Topical Steroid Anti-Inflammatory LEAST LIKELY TO RAISE IOP; Syntetic progesterone deriv; Least efficacious of group

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Loteprednol (Alrex/Lotemax)

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Topical Steroid Anti-Inflammatory new steroid less likely to raise IOP; metabolized to inactive form immediately upon cornea penetration

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Rimexolone (Vexol)

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Topical Steroid Anti-Inflammatory new steroid; equal to Fluorometholone in ocular hypertensive effects

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Triamcinolone (Aristocort A)

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Topical Steroid Anti-Inflammatory dermatologic cream; lid skin inflammation; do not use directly on eye

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Surodex Implant

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dTopical Steroid Anti-Inflammatory examethasone

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Retisert Implant

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Topical Steroid Anti-Inflammatory Fluocinolone

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Procaine

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Esters of para-aminobenzoic acid Ocular Anesthetics

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Chloroprocaine

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Esters of para-aminobenzoic acid Ocular Anesthetics

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Tetracaine

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Esters of para-aminobenzoic acid Ocular Anesthetics

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Benoxinate

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Esters of para-aminobenzoic acid Ocular Anesthetics

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Lidocaine

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Amides of Benzoic Acid and Ocular Anesthetics

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Mepivacaine

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Amides of Benzoic Acid and Ocular Anesthetics

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Bupivicane

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Amides of Benzoic Acid and Ocular Anesthetics

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Etidocaine

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Amides of Benzoic Acid and Ocular Anesthetics

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Sodium Chloride

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Topical Ocular Hyperosmotics

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Glycerin (glycerol)

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Topical Ocular Hyperosmotics

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Glucose

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Topical Ocular Hyperosmotics

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MC, HEC, HPC, HPMC, CMC

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Substituted cellulose ethers Ocular Lubricants

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Polyvinyl alcohol

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Polyvinyl polymer Ocular lubricant

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Polyvinylpryolidone (Povidone)

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Other polymeric system ocular lubircant

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Retinol

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vitamin A derivative ocular lub.

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Sodium Hyalluronate

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Viscoelastic agent Oc. Lub

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Chondroitin Sulface

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Viscoelastic agent Oc. Lub

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Acetylsteine

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Mucolyticagent Oc lub.

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Lacrisert

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Artifical Tear Insert Oc. Lub

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Tear Gard

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Lipid Oc. Lub

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Diclofenac Sodium (Voltaren)

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NSAIDs Anti-inflammatory acetic acid deriv reduce pain and inflammation; post-op cataract surgery; off label use: keratitis, uveitis, CME

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Keterolac (Acular)

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NSAIDs Anti-inflammatory propionic acid deriv; itching drom allergy, post-op cataract surgery; off label use: keratitis, uveitis, CME

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Flurbiprofen (Ocufen)

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NSAIDs Anti-inflammatory phenylalkanoic acid; blocks intraoperative miosis; off label use: non-surgical inflammation,CME

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Suprofen (Profenal)

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NSAIDs Anti-inflammatory Intraoperative miosis; off label use similar to others

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Nepafenac (Nevanac)

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NSAIDs Anti-inflammatory –First FDA approved topical ocular non steroidal anti-inflammatory prodrug; rapidly penetrates cornes; Converted into the active compound Amfenac by ocular tissue hydrolases

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Proxicam (Feldene)

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NSAIDs Anti-inflammatory topical NSAID for cataract surgery in clinical trials

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Levocabastine (Livostin)

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Antihistamines single drug ocular

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Emadastine difumrate (Emadine)

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Antihistamines single drug ocular

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Diphenhydramine (Benadryl)

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Antihistamines single drug ocular

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Antihistamines Chlorpheniramine (Chlor-trimeton)

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Antihistamines single drug ocular

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Claritin, Clarinex, Allegra, Zyrtec

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Antihistamines single drug ocular

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Phenylephrine

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Antihistamines single drug ocular

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Naphazoline, Oxymetazoline

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Antihistamines single drug ocular

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Tetrahydrozoline

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Antihistamines single drug ocular

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Cromolyn Sodium (Opticrom, Crolom)

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Antihistamines single drug ocular

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Nedocromil Sodium (Alocril)

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Antihistamines single drug ocular

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Lodoxamide (Alomide)

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Antihistamines single drug ocular

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Pemirolast potassium (Alamast)

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Antihistamines single drug ocular

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Olopatadine (Patanol)

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Antihistamines single drug ocular

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Ketotifen Fumarate (Zaditor)

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Antihistamines single drug ocular

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Azelastine HCl (Optivar)

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Antihistamines single drug ocular

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Epinastine HCl (Elastat)

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Antihistamines single drug ocular

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Restasis

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Antihistamines single drug ocular

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Latanoprost (Xalatan)

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Prostaglandin Analogs first one FDA approved; reduces IOP 31-35%; additive effect with alpha agonist, beta blocker, CAIs; darkens iris and skin around eye;

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Travoprost (Travatan)

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Prostaglandin Analogs FDA second line drug;

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Bimatoprost (Lumigan)

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Prostaglandin Analogs Increases aqueous outflow through both trabecular meshwork and uveoscleral routes

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Unoprostone isopropyl (Rescula)

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Prostaglandin Analogs •May be efficacious in patients who have not responded to Xalatan

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Acetazolamide (Diamox)

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Carbonic Anhydrase Inhibitor ORAL, IV; USES: Break attack of AACG (oral route); CSOAG when control not obtained with topical drugs; Macular edema associated with cataract surgery, retinitis pigmentosa and pars planitis. SIDE EFECT: Myopic shift

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Methazolamide (Neptazane)

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Carbonic Anhydrase Inhibitor ORAL; lower dose than Diamox, less protein binding, high ocular penetration, safer for COPD

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Dichlorphenamide (Daranide)

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Carbonic Anhydrase Inhibitor ORAL; poor tolerance, limited use; potassium loss and anorexia

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Ethoxzolamide (Cardrase)

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Carbonic Anhydrase Inhibitor ORAL; similar use as Diamox but electrolyte imbalance = short term use

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Dorzolamide (Trusopt)

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Carbonic Anhydrase Inhibitor TOPICAL; Inhibits CA isoenzyme II, slowing production of bicarbonate ions in ciliary body; Tx of ocular hypertension and CSOAG; Available as single drug (Trusopt) or in combination with timoptic (Cosopt); IOP lowered 3-5mm

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Brinzolamide (Azopt)

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Carbonic Anhydrase Inhibitor TOPICAL; suspension, shake before use; lowers IOP 4-5mm;

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Mannitol

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Hyperosmotics Glaucoma IV agent of choice; does not cause tissue necrosis

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Glycerin

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Hyperosmotics Glaucoma ORAL; USE FOR CORNEAL EDEMA (topical); most common agent for tx of AACG; ORAL = 50% sol'n over ice;

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Isosorbide

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Hyperosmotics Glaucoma similar to mannitol but oral; not metabolized (safer for DM);

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Sodium ascorbate

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Hyperosmotics Glaucoma infrequent used oral or IV, oral route may not lower IOP;

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Ethyl alcohol

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Hyperosmotics Glaucoma seldom used due to CNS effects

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Urea

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Hyperosmotics Glaucoma rarely used, IV or oral,

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Hydroxyamphetamine INDIRECT ACTING

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Causes release of norepinephrine & inhibits MAO & inhibits UPTAKE #1; Routine pupil dilation; As a single drug was useful for differential between pre & post ganglion Horner’s

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Cocaine

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Alkaloid of coca leaf & ester of benzoic acid; anesthetic; Potentiates adrenergic activity by blocking reuptake of norepinephrine; Differential diagnosis of preganglionic from postganglionic (SYMPATHETIC) Horner’s Syndrome

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Pilocarpine (no longer used)

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Cholinergic Agonist Direct acting DX ADIES TONIC PUPIL; Effects cardiovascular system, exocrine glands and smooth muscle; Causes (BEST) miosis, spasm of accommodation, increased aqueous outflow (reduced IOP), thickening of the lens and narrowing of anterior chamber

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Carbachol (rare use)

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Cholinergic Agonist direct acting used in people allergic ti Pilo; contraindicated in corneal abrasions, allergy, bronchila asthma, etc

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Physostigmine (Eserine) (rare use)

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Indirect acting reversible Cholinergic Agonist inhibits AChE; Muscarinic and nicotinic stimulation with a few hour duration; Maximal miosis in 30 min. lasting 3 - 4 hours; Reduces IOP, longitudinal muscle stimulation; CSOAG & some secondary Gs; lid phthirus pubis

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Demacarium (rare use)

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Indirect acting reversible Cholinergic Agonist Indirect acting reversible Two molecules of neostigmine linked by a series of 10 methylene groups; IOP decreases within a few hours, lowest in 24 hours and lasts up to several days; Transient paradoxical IOP elevation

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Diisopropylfluorophosphate (DFP)

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Indirect acting irreversible Cholinergic Agonist inactivates AChE & BuChE with preference for BuChE; Highly lipid soluble; Dx & Tx accommodative esotropia; Tx of phthiriasis palpebrarum; may cause respiratory death; pinpoint myosis

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Echothiophate (Phospholine Iodide)

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Indirect acting irreversible Cholinergic Agonistinactivates AChE & BuChE with preference for AChE; low lipid soluble, safer for CNS; Dx & Tx of accommodative esotropia; SIDE EFFECT: Ant. & post. subcapsular & nuclear cataract; Retinal detachment, iris cyst

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Atropine

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Cholinergic Antagonist Parasympatholytics DEADLY; 1%, mydriasis in 30-40 min. with 7-10 day recovery, cycloplegia in 60-180 min.with 7-12 day recovery; CLIN USE: cyclo refraction, iridocyclitis, amblyopia (alt to patching)

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Homatropine

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Cholinergic Antagonist Parasympatholytics 1/10 as effective as atropine with shorter duration of action; Tx of iridocyclitis;

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Scopolamine

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Cholinergic Antagonist Parasympatholytics Effects similar to atropine but shorter duration; Treatment of anterior uveitis; Used in patients allergic to atropine; No deaths reported from topical use

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Cyclopentolate

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Cholinergic Antagonist Parasympatholytics Routine cycloplegic refractions for all ages; Tx of iridocyclitis in patients sensitive to other drugs, but more frequent instillation; CNS toxicity primarily in children

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Tropicamide

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Cholinergic Antagonist Parasympatholytics aGreater ocular penetration than other drugs in class; Faster onset time & shorter duration; Drug of choice for routine ophthalmoscopy ; IOP can rise in eyes with CSOAG

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Naphazoline (Vasocon)

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Imidiazole Derivative More alpha then beta stimulation; CNS depression; Prolonged use: epithelial Xerosis; No rebound conjunctival congestion; Mydriasis & IOP elevation can occur; Excessive ocular use: HBP & arrhythmias

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Tetrahydrozoline (Visine, Murine)

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Imidiazole Derivative More alpha then beta stimulation; CNS depression; Prolonged use: epithelial Xerosis; No rebound conjunctival congestion; Mydriasis & IOP elevation can occur; Excessive ocular use: HBP & arrhythmias

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Oxymetazoline (Visine LR/Ocuclear (CAN))

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Imidiazole Derivative More alpha then beta stimulation; CNS depression; Prolonged use: epithelial Xerosis; No rebound conjunctival congestion; Mydriasis & IOP elevation can occur; Excessive ocular use: HBP & arrhythmias