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40 Cards in this Set
- Front
- Back
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Method for Topical Anti-infectives
Blepharitis Conjunctivitis Hordeolum Keratitis |
Blepharitis (inflammation of the eyelash follicles) use ointments
Conjunctivitis (purulent conjunctivitis)eye drops and warm compresses Hordeolum (stye) warm compresses creams Keratitis frequent around the clock drops |
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Herpes Zoster or Simplex Tx
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Topical Agents
Trifluridine, Vidarabine Systemic Acyclovir, Valacylcovir, Famciclovir |
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Cytomegaolovirs Tx
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IV, Intravitreal or Oral
Ganciclovir IV and/or Intravitreal Foscarnet (Both), Formivirsen (Intravitreal), Cidofovir (IV) |
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Cyclosporine Ophth. (Restasis)
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Lowers activity of T cells and their immune response.
Reduces inflammation in lacrimal gland, leading to increased tear production Not approved for patients < 17 years of age Does not reverse dry eye associated with ophthalmic anti-inflammatory drugs Contraindicated in ophthalmic infection, history of herpes keratitis |
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Ophthalmic CS Potency Differences
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Differ in potency:
Low potency: dexamethasone Intermediate: fluorometholone 0.1 and 0.25%), --loteprednol, prednisolone Na PO4 High: fluorometholone 0.5%, Prednisone acetate Adverse events: ↑intraocular pressure, cataracts, systemic side effects, infection |
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Ocular NSAIDS
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Multiple uses
Reduce intra-op miosis: diclofenac, flurbiprofen, ketorolac Postcataract: bromfenac, diclofenac, nepavanac, flurbiprofen, ketorolac Cystoid macular edema: diclofenac, ketorolac Ocular inflammation, seasonal allergy: bromfenac, diclofenac, ketorolac Adverse effects: ↑intraocular pressure, keratitis, edema, corneal deposits |
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Opthalmic Antihistamines
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H1 receptor blockers: levocabastine, pheniramine (combined with naphazoline in Naphcon A), olopatadine
Mast cell stabilizers: cromolyn, lodoxamide |
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Glaucoma
Open Angle |
Reduce aqueous formation:
Alpha 2 agonists Mixed alpha agonists Carbonic anhydrase inhibitors Increase outflow: Beta-blockers Cholinergics Prostaglandins |
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Glaucoma
Narrow Angle |
Iridoplasty
Acute and perioperative medications to reduce inflammation/ open angle: Cholinergics Carbonic anhydrase inhibitors Corticosteroids Hyperosmotics |
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Adrenergics for Glaucoma
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Mixed agonists: epinephrine, dipivefrin –
Adverse effects: dry eye, tachycardia, elevated BP Alpha 2 agonists: apraclonidine, brimonidine Adverse effects: dry eyes, sedation, fatigue, tachyphylaxis Adverse effects common to both groups: Corneal melanin deposits, hyperemia, headache |
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Glaucoma
Beta Blockers |
Timolol, betaxolol, levobunolol, carteolol
betaxolol is the only beta-1 selective agent Work by reducing aqueous humor production Contraindication: decompensated heart failure Adverse effects: bradycardia, hypotension, bronchospasm, hypoglycemic unawareness |
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Glaucoma
Cholinomimetics |
Direct acting: pilocarpine
Acts on (Muscarinic 3) on iris sphincter muscle Causes muscle to contract and engage in miosis. AChE inhibitors – rarely used Miosis pulls iris away from trabecular meshwork Adverse effects: myopia, night blindness |
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***Carbonic Anhydrase Inhibitors**
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Carbonic Anhydrase (type II) is found in ciliary epithelium, responsible for aqueous formation, so inhibitor decrease aqueous formation
***Reduces intraocular pressure*** Drugs: Acetazolamide (systemic), dorzolamide, brinzolamide suspension Adverse effects: Irritation, conjunctivitis in topical use |
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***PGF2a Analogs***
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Ophthalmic drops relax iris interior
Increase aqueous outflow via uveoscleral pathway. ***Used for open angle glaucoma*** Side effects: Permanent change in eye color Eyelash growth |
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Hyperosmotic
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Used for acute and perioperative ***reductions in intraocular pressure***
***Mannitol IV*** Glycerin and isosorbide orally Adverse effects: Headache, diuresis, dehydration Do not allow patients to drink! |
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Ophthalmic ggt
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Wash hands
Remove Cap Tilt head back, pull down lower lid Shake suspension gently W/O touching dropper, tip to eye & place ggt in Close eye ~2s (nasolacrimal occlusion) Replace cap *** No use ungt (wait 5 min) Wait 5 min b/w ggt Preservatives are TOXIC to severe dry eye/recent surgery Transient preservatives degrade rapidly ***Non-preserved are single use only*** Must use all preserved w/in 90d |
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Ophthalmic ungt
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Wash hands
Remove Cap Tilt head back, pull down lower lid Place thin ribbon in pouch w/o touching tip Close eye 30-60s Replace cap ***Ungt prolong contact time, but may blur vision for several min*** |
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Autonomic Eye Control
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A1 – AG: Contraction sm muscle (BV)
A1 – AG: Mydriasis (contraction) of iris radial sm muclse; ANTAG: Floppy Iris (risk w/ cataract surg) A1 – AG: dec secretion of lacrimal gland M3 – AG: accommodation of ciliary muscle; ANTAG – cycloplegia of ciliary muscle M3 – AG: miosis of iris sphincter; ANTAG: mydriasis of iris sphincter M3 – AG: inc secretion of lacrimal gland; ANTAG: dec secretion of lacrimal gland A2 – AG: dec aqueous humor B2 – ANTAG: dec aqueous humor |
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Imidazoline alpha agonists: naphazoline, oxymetazoline, tetrahydrozoline, xylometazoline
(Phenylephrine is prescription only) |
Get the red out.
Protonated at physiologic pH, used only topically SE: In patients with glaucoma, especially narrow angle glaucoma, mydriasis (pupillary dilation) my precipitate critical increases in intraocular pressure from occlusion of the canal of Schlemm |
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Ketotifen
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Ophthalmic Antihistamine
OTC brand names: Claritin eye, Zaaditor, Zyrtec, Itchy eye H1, ***inverse ag***, and mast cell stabilizer |
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Cromolyn
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Mast cell stabilization – promotes phosporylation of myosin (binds to actin to PX mobilization of granules)
Not absorbed systemically |
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Hypertonic Saline
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OTC for corneal edema
Painful when applied |
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Nutrient deficiencies & effects on the eye
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Vitamin A: xerosis, punctate keratopathy, night blindness
B1 (thiamine): optic neuritis B6 (pyridoxine): retinal atrophy C: cataracts E: retinal epithelium, ?macular degeneration K: hemorrhage Zinc: retinal epithelium, ?macular degeneration |
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Ophthalmis SE of Drugs
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Miosis
Cholinergics, opiates, sympatholytics, alpha2 agonists Mydriasis, photophobia Anticholinergics, meperidine,tricyclic antidepressants, sympathomimetics, cocaine Nystagmus CNS depressants, ketamine and PCP Optic neuropathy ***Amiodarone***, isoniazid, sulfonamides, OCs Corneal deposits ***Amiodarone***, antimalarials Color perception Digitalis, PDE-6 inhibitors, ethambutol Cataracts Steroids, allopurinol Floppy iris Alpha blockers Pigment deposits Antipsychotics, PG analogs, adrenergics |
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Swim-ear
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Isopropyl EtOH
TX of OE |
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Decongestants (OTC Systemics)
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Direct: ***phenylpropanolamine (Sudafed PE) – alpha ag***
Mixed: ***Pseudoephedrine (Sudafed)*** |
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Antihistamines (OTC Systemics)
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First Gen: Sedation + Antimuscarinic
Chlorpheniramine (Chlortrimeton) – less sedation & less antimuscurinic; ***Diphenhydramine (Benadryl)*** Second Gen: Less sedation Loratadine (Claritin); Cetirizine (Zytec) – amphoteric metabolite of hydroxyzine |
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OTC Antihistamies (for nausea/motion sickness/vertigo)
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Dimehydrinate (Dramamine)
Meclizine (Rx is Antivert; OTC II or Bonine) |
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Sleep Aid
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Doxylamine (Unisom)
Diphenhydramine (Benadryl) SE: hang over probs; may cause delirium w/ elderly; ***Chronically may promote nightmares*** |
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***Guaifenesin (Robitussin, Mucinex)***
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Throught to act as expectorant by irritating gastric mucosa and stimulating respiratory secretions
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Dextromethorphan
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Cough Suppressant
Opiate sigma receptor agonist, likely to modulate IP3 activity At excessive doses SE include: Nonselective serotonin reuptake inhibitor; NMDA antagonist |
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Codeine
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Cough Suppressant
C(V); in some states can be purchased without a prescription Metabolized to more active morphine by 2D6 |
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Urine Immunoassay Screen
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Amphetamines
Shows up for 2wks Interference: Sympathomimetics, selegiline BZ Shows up for 6wks Interference: variable, chlorpheniamine Cannabinoids Shows up for 6wks Interference: ibuprofen, naproxen Cocaine (benzyolecgoine) Shows up for 3wks Interference: ester & amide anesthetics, unlikely Opiods Shows up for 1wk Interference: Rifampin, FQs (semisynthetic & synthetic may not be detected) PCP Shows up for 10ds Interference: Ketamine, dextromethophan, diphenlhydramine, sertaline |
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Air-borne
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Mixture of: Vit C, E, A, Zn, Se, Mg, glutamine, lysine, lonicera, forsythia, schizonepeta, ginger, Chinese vitex, isatis, echinacea
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Andrographis (from India & China)
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Leaf and rhizome contain active constituents
Increase antibody activity, phagocytosis Anti-inflammatory AE:Allergic reaction, GI distress |
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Elderberry (Sambuccus niger)
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In vitro and in vivo, demonstrated activation of cytokine release
Anti-influenza (neuraminidase inhibition) |
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Slippery elm
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Mucilage is soothing to irritated mucous membranes; oleoresins may stimulate mucous secretions
Possibly effective in sore throat, cough |
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Zinc
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Found in hundreds of enzymes – vital role in DNA and RNA; light/rhodopsin interaction; vital for Vitamin A transport and use…
Likely safe if < 40mg/day; in excess, copper deficiency leading to anemia Possible use in Wilson’s disease (Zn acetate approved) May help reduce duration of common cold May help treat dysgeusia May promote wound healing in Zn deficient patients Intranasal likely unsafe --> anosmia |
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Hot Lemon Juice + Whiskey
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Dr. Bob’s TX & PX colds & sore throat
Lemon juice --> Vit C Astringent EtOH --> self sterilizing |
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Decongestants (Topical)
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***Phenylephrine (Neo-Synephrine®)***
Oxymetazoline (Afrin®) Xylometazoline (Otrivin) Naphazoline (Privine ®) ***Tetrahydrozoline (Murine Plus®)*** |
