Mastering Ophthalmic Solutions and Suspensions
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Questions and Answers

Which of the following is NOT a commonly employed ophthalmic dosage form?

  • Ointments
  • Solutions
  • Pills (correct)
  • Gels

    • Ophthalmic preparations are used to treat which of the following eye conditions?

  • Astigmatism
  • Cataracts
  • Dry eye (correct)
  • Myopia

    • Which of the following is the maximum volume of tear fluid that a non-blinking eye can accommodate?

  • 50 μL
  • 7 to 8 μL
  • 30 μL (correct)
  • 10 μL

    • Which of the following dosage forms for the eye has the longest duration of action?

    <p>Ointments</p> Signup and view all the answers

    What is the optimal volume for administering ophthalmic solutions or suspensions based on eye capacity?

    <p>5 to 10 μL</p> Signup and view all the answers

    Which of the following is NOT a pharmacological category of drugs for ophthalmic use?

    <p>Antivirals</p> Signup and view all the answers

    What is one of the special considerations in the preparation of ophthalmic products?

    <p>Sterility</p> Signup and view all the answers

    Which of the following viscosity enhancing agents is typically used at the highest concentration in ophthalmic solutions?

    <p>Methylcellulose</p> Signup and view all the answers

    Which factor can affect a drug's ocular bioavailability?

    <p>Protein binding</p> Signup and view all the answers

    Which parameter is checked by a compounding pharmacist during quality control of ophthalmic solutions?

    <p>Appearance and clarity</p> Signup and view all the answers

    Which of the following is NOT a requirement for ophthalmic solutions and suspensions?

    <p>Isotonicity</p> Signup and view all the answers

    What is the purpose of filtration in the preparation of ophthalmic solutions?

    <p>To achieve clarity</p> Signup and view all the answers

    Why are preservatives not included in unit-dose packages of ophthalmic products?

    <p>Preservatives can cause clouding of the cornea</p> Signup and view all the answers

    Which of the following is an example of a preservative used in ophthalmic solutions?

    <p>Benzalkonium chloride</p> Signup and view all the answers

    Which of the following is a recommended precaution when using ophthalmic drops and ointments?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is a correct step when administering ointments or eye gel for ophthalmic use?

    <p>Hold the tube close to the eyelid without touching it</p> Signup and view all the answers

    Which of the following is a side effect that may be encountered with the use of ophthalmic medication?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is a recommended practice for storing ophthalmic drops or ointments?

    <p>Keep the drops or ointment at room temperature</p> Signup and view all the answers

    Which of the following statements about tonicity is correct?

    <p>Isotonic solutions have an osmotic pressure equal to that of physiologic fluids.</p> Signup and view all the answers

    Which of the following is an important consideration for ophthalmic preparations?

    <p>Buffering and pH adjustment</p> Signup and view all the answers

    Why are antioxidants added to some ophthalmic solutions?

    <p>To decrease the rate of decomposition of the active ingredients</p> Signup and view all the answers

    What is the purpose of pH adjustment in ophthalmic solutions?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is an example of a non-erodible ocular insert?

    <p>Ocusert</p> Signup and view all the answers

    What is the purpose of the white annular border in Ocusert?

    <p>To improve visibility to the patient</p> Signup and view all the answers

    How long does Ocusert release pilocarpine continuously for?

    <p>7 days</p> Signup and view all the answers

    Which of the following drugs can induce marked dryness of the eye and interfere with the use of contact lenses?

    <p>Isotretinoin</p> Signup and view all the answers

    Which type of drugs can cause lens intolerance and damage to the eye by decreasing tear secretion?

    <p>Anticholinergic drugs</p> Signup and view all the answers

    Which of the following medications can cause dilation of the pupil in people who wear contact lenses?

    <p>Reserpine</p> Signup and view all the answers

    What is the advantage of hard contact lenses over soft contact lenses?

    <p>They are more durable</p> Signup and view all the answers

    What is a disadvantage of soft contact lenses?

    <p>They provide a high level of visual acuity</p> Signup and view all the answers

    Which type of contact lenses are made of rigid plastic resin polymethylmethacrylate (PMMA)?

    <p>Hard contact lenses</p> Signup and view all the answers

    Which type of contact lenses are suitable for extended wear?

    <p>Silicone hydrogel lenses</p> Signup and view all the answers

    What is the purpose of Lacrisert (hydroxypropyl cellulose ophthalmic insert)?

    <p>To relieve moderate to severe dry eye symptoms</p> Signup and view all the answers

    What is an advantage of RGP contact lenses?

    <p>They allow greater movement of oxygen</p> Signup and view all the answers

    What is the advantage of soluble ocular inserts?

    <p>They provide continuous release of medication</p> Signup and view all the answers

    What is a disadvantage of Ocusert?

    <p>Cutting sensation in the eye</p> Signup and view all the answers

    Which type of contact lens requires a routine care program that includes wetting to decrease their hydrophobic characteristics?

    <p>Hard lenses</p> Signup and view all the answers

    What is the purpose of enzymatic cleaners for contact lenses?

    <p>To break down and remove protein deposits</p> Signup and view all the answers

    Which type of solution is used for rinsing and storage of contact lenses?

    <p>Saline solution</p> Signup and view all the answers

    What do wetting solutions for hard lenses contain to facilitate hydration and spread of tears?

    <p>Surfactants</p> Signup and view all the answers

    Which of the following is a potential consequence of wearing contact lenses while sleeping?

    <p>Corneal scrape/scratch</p> Signup and view all the answers

    Which of the following is NOT a recommended practice for contact lens wearers?

    <p>Using saliva to moisten the lenses</p> Signup and view all the answers

    Which of the following conditions may make it difficult to use contact lenses?

    <p>Active thyroid gland or uncontrolled diabetes</p> Signup and view all the answers

    Which of the following is a clinical consideration when using contact lenses with ophthalmic medications?

    <p>Topical medications can affect the bioavailability of soft contact lenses</p> Signup and view all the answers

    True or false: Ophthalmic preparations are used to treat allergies, bacterial and viral infections, glaucoma, and other eye conditions.

    <p>True</p> Signup and view all the answers

    True or false: Ophthalmic products are designed to be instilled onto the internal surface of the eye.

    <p>False</p> Signup and view all the answers

    True or false: The normal volume of tear fluid in the cul-de-sac of the human eye is about 7 to 8 mL.

    <p>False</p> Signup and view all the answers

    True or false: It is important to wash your hands before and after applying ophthalmic drops or ointments.

    <p>True</p> Signup and view all the answers

    True or false: Chlorobutanol can be sterilized in an autoclave without decomposing?

    <p>False</p> Signup and view all the answers

    True or false: Most of the preservatives mentioned are effective against all strains of Pseudomonas aeruginosa?

    <p>False</p> Signup and view all the answers

    True or false: The dropper or tube should not touch the eye, eyelid, eyelashes, or any other surface to avoid contamination.

    <p>True</p> Signup and view all the answers

    True or false: Ophthalmic drops and ointments should be used exactly as indicated by the doctor or packaging, without using them for longer durations or in larger quantities.

    <p>True</p> Signup and view all the answers

    True or false: Thiomersal is bactericidal at neutral and alkaline pH levels?

    <p>False</p> Signup and view all the answers

    True or false: Expired ophthalmic products should not be used.

    <p>True</p> Signup and view all the answers

    True or false: Hypotonic solutions can induce red blood cell hemolysis?

    <p>True</p> Signup and view all the answers

    True or false: Viscosity enhancing agents are added to ophthalmic solutions to increase drug absorption and effect.

    <p>True</p> Signup and view all the answers

    True or false: Ophthalmic suspensions and ophthalmic ointments have the advantage of staying longer in contact with the surface of the eye, so their dosage is lower than with the solutions.

    <p>True</p> Signup and view all the answers

    True or false: Ophthalmic suspensions and ointments mix with lacrimal fluids more readily than low-viscosity solutions.

    <p>False</p> Signup and view all the answers

    True or false: Ophthalmic solutions are more commonly used than suspensions and ointments because they do not affect visibility.

    <p>True</p> Signup and view all the answers

    True or false: Protein bound drugs can penetrate the corneal epithelium due to the size of the protein-drug complex.

    <p>False</p> Signup and view all the answers

    True or false: The inserts provide for the release of the medication in a controlled manner and for prolonged periods of time.

    <p>True</p> Signup and view all the answers

    True or false: There are no differences in doses for children and adults when using ophthalmic products.

    <p>True</p> Signup and view all the answers

    True or false: Ophthalmic solutions must be free from foreign particles, which can be achieved by filtration.

    <p>True</p> Signup and view all the answers

    True or false: Most ophthalmic products can be sterilized by heat.

    <p>False</p> Signup and view all the answers

    True or false: Preservatives are included in unit-dose eye solutions to maintain product sterility during use.

    <p>False</p> Signup and view all the answers

    True or false: Antimicrobial preservatives must demonstrate stability, chemical and physical compatibility with other formulations, and packaging components.

    <p>True</p> Signup and view all the answers

    Ophthalmic inserts are defined as solid dosage forms inserted in the conjunctival sac.

    <p>True</p> Signup and view all the answers

    The Ocusert is an example of an erodible ocular insert.

    <p>False</p> Signup and view all the answers

    The Ocusert releases pilocarpine continuously for 7 days.

    <p>True</p> Signup and view all the answers

    True or false: Lacrisert (hydroxypropyl cellulose ophthalmic insert) is a soft contact lens.

    <p>False</p> Signup and view all the answers

    True or false: Hard contact lenses are made of rigid plastic resin polymethylmethacrylate (PMMA).

    <p>True</p> Signup and view all the answers

    True or false: Soft contact lenses are impermeable to oxygen and moisture.

    <p>False</p> Signup and view all the answers

    True or false: Soluble ocular inserts dissolve or erode at the end of their release.

    <p>True</p> Signup and view all the answers

    Soft lenses have a longer life span than hard or RGP lenses.

    <p>False</p> Signup and view all the answers

    The use of color additives in contact lenses is regulated by the USFDA.

    <p>True</p> Signup and view all the answers

    All soft lenses require a routine care program that includes cleaning, rinsing, and disinfection.

    <p>True</p> Signup and view all the answers

    Wetting solutions for hard lenses contain surfactants to facilitate lens hydration.

    <p>True</p> Signup and view all the answers

    True or false: Hard contact lenses allow oxygen to pass through them, providing oxygen to the cornea.

    <p>False</p> Signup and view all the answers

    True or false: Soft contact lenses are less likely than hard lenses to dislodge spontaneously.

    <p>True</p> Signup and view all the answers

    True or false: Rigid gas permeable (RGP) lenses are more comfortable than hard lenses.

    <p>True</p> Signup and view all the answers

    True or false: Soft contact lenses provide the same level of visual acuity as hard lenses.

    <p>False</p> Signup and view all the answers

    True or false: Isotretinoin can interfere with the use of contact lenses?

    <p>True</p> Signup and view all the answers

    True or false: Ophthalmic vasoconstrictors can cause dilation of the pupil in people who wear contact lenses?

    <p>True</p> Signup and view all the answers

    True or false: Medications that promote excessive tearing can interfere with lens wear?

    <p>True</p> Signup and view all the answers

    True or false: Contact lenses should not be worn while sleeping, unless the lens type allows it.

    <p>True</p> Signup and view all the answers

    True or false: Saliva can be used to moisten, clean, or help put contact lenses in the eyes.

    <p>False</p> Signup and view all the answers

    True or false: It is recommended to use specific solutions recommended for the type of contact lens being used.

    <p>True</p> Signup and view all the answers

    True or false: Infections, allergic reactions, inflammation, corneal scrape/scratch, and growth of abnormal blood vessels are potential problems with the use of contact lenses.

    <p>True</p> Signup and view all the answers

    Study Notes

    Ophthalmic Preparations

    • The eye is constantly exposed to the atmosphere, dust, pollutants, allergens, bacteria, and foreign bodies, making ophthalmic preparations necessary to treat various eye conditions.

    Definition and Purpose

    • Ophthalmic products are specialized dosage forms designed to be instilled onto the external surface of the eye (topical), administered inside (intraocular), or adjacent (periocular) to the eye, or used in conjunction with an ophthalmic device.

    Dosage Forms

    • Commonly employed ophthalmic dosage forms: solutions, gels, suspensions, ointments, ocular inserts, intravitreal injections, and implants.
    • Each dosage form has a specific purpose and duration of action:
      • Solutions: most often used, but relatively low duration of action.
      • Suspensions: slightly longer duration of action.
      • Ointments: even larger duration of action.
      • Gels: used for dry eye conditions, with a shorter duration of action.
      • Gel-forming solutions: increases ease of administration.

    Lacrimal System and Retention Time

    • The normal volume of tear fluid in the cul-de-sac of the human eye is about 7-8 μL.
    • A non-blinking eye can accommodate a maximum of about 30 μL of fluid, while a blinked eye can retain only about 10 μL.
    • The capacity of the eye to retain liquid and semisolid preparations is limited, therefore, topical applications are administered in small amounts.

    Pharmacological Categories of Drugs

    • Anesthetics
    • Antimicrobials (antibiotics, antifungals, antivirals)
    • Anti-inflammatory
    • Astringent
    • Beta-adrenergic blockers
    • Miotics
    • Vasoconstrictors

    How to Administer Drops and Ointments

    • Wash hands with soap and water before and after administration.
    • Use a clean dropper or tube, and do not touch the eye or eyelid with the dropper.
    • Tilt the head back, and pull the lower eyelid down to form a pocket.
    • Put the drops or ointment in the pocket, and then release the eyelid.
    • Blink slowly, and then gently close the eye.

    Recommendations and Precautions

    • Wash hands well before and after administration.
    • Use disposable medical gloves if administering to another person.
    • Make sure the dropper or tube is clean and does not touch the eye, eyelid, or other surface.
    • Do not use drops or ointments of another person.
    • Do not use contact lenses while using eye drops or ointments unless authorized by a doctor.

    Patient Counselling

    • Inform the patient about the correct number of drops to instill, frequency of application, duration of treatment, and proper storage of the medication.
    • Warn the patient about potential side effects, such as transient stinging or burning, foreign body sensation, itching, tearing, decreased vision, and margin crusting.

    Contact Lenses

    • Contact lenses are small lenses that are placed directly in the eye, resting on the cornea.
    • They offer aesthetic advantages and, in some cases, better vision than eyeglasses.
    • Types of contact lenses: hard, soft, and rigid gas permeable (RGP).

    Pharmaceutical Requirements

    • Clarity: ophthalmic solutions must be free from foreign particles.
    • Sterility: ophthalmic solutions and suspensions must be sterilized for safe use.
    • Isotonicity: the concentration of the solution should be equal to or near that of the tear.
    • pH and Buffering: the pH should be close to that of the tear drop.
    • Viscosity: the solution should have a suitable thickness.
    • Ocular Bioavailability: the solution should be able to release the active ingredient in the eye.

    Sterilization

    • Sterilization by filtration: the retention of all particulate matter, and the removal of microorganisms.
    • Examples of sterilizing filters: sterilization by filtration, and the use of a syringe affixed with a microbial filter.

    Preservation

    • Preservatives are included in multiple-dose eye solutions to maintain product sterility during use.
    • Ideal requirements of preservatives: stability, chemical and physical compatibility, and effectiveness.
    • Examples of preservatives: cationic wetting agents, organic mercurials, esters of p-hydroxybenzoic acid, and alcohol substitutes.### Microorganisms and the Cornea
    • Pseudomonas aeruginosa can invade an abraded or lacerated cornea, causing ulceration and even blindness
    • Combinations of benzalkonium chloride, polymyxin B sulfate, and EDTA can be effective against most Pseudomonas strains
    • EDTA makes P. aeruginosa more sensitive to benzalkonium chloride

    Preservation and Isotonicity

    • Thiomersal is an alternative preservative to benzalkonium chloride, suitable for soft contact lens wearers
    • Thiomersal is bacteriostatic and fungistatic at neutral and alkaline pHs, but bactericidal at acidic pH levels
    • Solutions with an osmotic pressure equal to that of body fluids (0.9% sodium chloride) are considered isotonic
    • Hypotonic solutions have a lower osmotic pressure, while hypertonic solutions have a higher osmotic pressure
    • Common tonicity adjusting agents include sodium chloride, boric acid, and dextrose

    pH Adjustment and Buffering

    • pH adjustment is important to provide comfort to the eye, enhance stability of the formulation, and enhance bioavailability
    • Most ophthalmic drugs are weakly acidic and have limited buffer capacity
    • Ophthalmic solutions are generally buffered at the pH of maximum stability of the drug(s) they contain

    Stabilizers, Antioxidants, and Viscosity

    • Stabilizers, such as antioxidants, are added to reduce the rate of decomposition of active ingredients
    • Examples of antioxidants include sodium sulfite, sodium bisulfite, and sodium metabisulfite
    • Viscosity enhancing agents, such as methylcellulose, hydroxyethylcellulose, and polyvinyl alcohol, help solutions remain in the eye for longer periods

    Ocular Bioavailability

    • Physiologic factors affecting ocular bioavailability include protein binding, drug metabolism, and lacrimal drainage
    • Tears contain enzymes capable of metabolic degradation of drug substances
    • Ophthalmic suspensions, gels, and ointments mix with lacrimal fluids less readily than low-viscosity solutions, resulting in longer residence time and enhanced bioavailability

    Quality Control and Ophthalmic Inserts

    • Compounding pharmacists should check the appearance and clarity, sterility, pH, and volume/weight of ophthalmic preparations
    • Ophthalmic inserts are sterile, solid dosage forms designed for insertion into the conjunctival sac
    • Examples of ophthalmic inserts include non-erodible inserts (e.g., Ocusert) and erodible inserts (e.g., Lacrisert)

    Contact Lenses

    • Types of contact lenses include daily wear, extended wear, and disposable wear
    • Contact lenses can be categorized as hard, soft, rigid gas permeable (RGP), and daily wear lenses
    • Advantages and disadvantages of each type of lens are discussed
    • Care of contact lenses involves cleaning, rinsing, disinfecting, and storing the lenses properly

    Care of Contact Lenses

    • Cleaning solutions, soaking solutions, wetting solutions, and combination solutions are used to care for contact lenses

    • Enzymatic cleaners break down protein deposits on soft lenses

    • Rinsing and storage solutions are used to rinse and store lenses

    • Wetting solutions are used for hard lenses to facilitate hydration and improve tear spreading

    • Combination solutions are available for convenience, but may have limited cleaning effectiveness### Medications Affecting Contact Lens Use

    • Certain medications administered via other routes can affect tears and interact with contact lenses, causing issues such as:

      • Orange stain (rifampin)
      • Turbidity of the lenses (ribavirin)
      • Ocular inflammation (salicylates)
      • Refractive changes (acetazolamide)

    Medications with Ocular Side Effects

    • Drugs with anticholinergic effects (e.g., antihistamines, tricyclic antidepressants) can:
      • Decrease tear secretion
      • Cause lens intolerance
      • Damage the eye

    Medications Interfering with Contact Lens Use

    • Isotretinoin (for severe acne) can induce marked dryness of the eye, interfering with contact lens use during therapy
    • Medications that promote excessive tearing (e.g., reserpine) or eye/eyelid edema (e.g., primidone, hydrochlorothiazide, chlorthalidone) may also interfere with lens wear

    Ophthalmic Vasoconstrictors

    • Can cause dilation of the pupil, especially in contact lens wearers
    • Effect lasts 1-4 hours, but is not clinically significant
    • FDA recommends informing patients of this side effect on the product label

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    Description

    Test your knowledge on the special considerations involved in preparing ophthalmic solutions and suspensions for pharmaceutical use. This quiz covers clarity, sterility, preservation, isotonicity, pH, buffering, antioxidation, viscosity, ocular bioavailability, packaging, and storage. Perfect for students at the School of Pharmacy, University of Puerto Rico.

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