Pharmacology for Pharmacy Technicians, 4th Ed PDF

Pharmacology for Pharmacy Technicians, 4th Ed by Kathy Moscou PhD RPh MPH and Karen Snipe CPhT AS BA MEd 1  Chapter 15 Treatment of Diseases of the Eye 2  Lesson 15.1 Treatment o...

Pharmacology for Pharmacy Technicians, 4th Ed by Kathy Moscou PhD RPh MPH and Karen Snipe CPhT AS BA MEd 1  Chapter 15 Treatment of Diseases of the Eye 2  Lesson 15.1 Treatment of Diseases of the Eye 1. Learn the terminology associated with the eye and the treatment of glaucoma and ophthalmic infections. 2. List and categorize medications used in the treatment of and ophthalmic infections glaucoma. 3. Describe the mechanism of action for each class of drugs used in the treatment of glaucoma and ophthalmic infections. 4. Identify significant drug look-alike/sound-alike issues. 5. Identify warning labels and precautionary messages associated with medications used in the treatment of glaucoma and ophthalmic infections. 3  Key Terms Angle-closure glaucoma Open-angle glaucoma Aqueous humor Peripheral vision Blepharitis Photopsia Conjunctivitis (pink eye) Stye Cytomegalovirus retinitis Uveitis Dry eye disease Vitreous floaters Herpes simplex keratitis Herpes zoster ophthalmicus Intraocular pressure Iritis Condition Keratitis 4  Dry Eye Disease Eye does not produce tears properly or tears are not of the correct consistency and evaporate too quickly Common symptom is excessive tearing Inflammation of the surface of the eye may occur If left untreated, can lead to pain, ulcers, or scars on the cornea, and some loss of vision. 5  Bacterial Infections of the Eye Stye Blepharitis Conjunctivitis Iritis Keratitis Uveitis 6 Poll question Copyright © 2019 by Elsevier, Inc. All rights reserved. 7  Stye A small, painful lump located on the eyelid margin Caused by an acute, self-limiting infection of the oil glands of the eyelid Typically resolves on its own in a few days 8  Blepharitis (1 of 2) Anterior: Outside of eyelid Caused by Staphylococcus bacteria and scalp dandruff Posterior: Inside of eyelid Caused by dysfunction of oil glands in eyelid, seborrhea, psoriasis, and acne rosacea 9  Blepharitis (2 of 2) Symptoms: Eye pain or burning Excessive tearing Feeling of something in the eye Light sensitivity Blurred vision Dry eye Flaky scales on eyelids and lashes 10  Conjunctivitis Caused by allergies, bacteria, or a virus Itching, burning, and teary outflow Contagious when of bacterial origin 11  Iritis Associated with inflammation of the iris Most causes of iritis are unknown; known causes are herpes virus, autoimmune disease, eye trauma, infectious disease (histoplasmosis, toxoplasmosis, syphilis, tuberculosis), and juvenile rheumatoid arthritis. Symptoms of iritis include redness, blurred vision, inflammation, pain, and light sensitivity. Iritis Treatment includes the administration of corticosteroids and mydriatics 12  Keratitis Severe infection of cornea May be caused by bacteria or fungi Caused by trauma, immunodeficiency, and chronic eye surface disease 13 Bacterial Infections of the Eye: Treatment Classes of topical drugs used to treat infections of the eye: Aminoglycosides Sulfonamides Macrolides Quinolones Antiinfectives + corticosteroids 14  Uveitis Iritis Cyclitis Choroiditis Symptoms: Redness, blurred vision, pain, inflammation, and light sensitivity May develop suddenly or over time 15  Look-Alike/Sound-Alike Drugs for Bacterial Infections Bleph-10 and Blephamide Gentamicin and tobramycin Tobrex and TobraDex 16  Viral Infections of the Eye Cytomegalovirus retinitis: Opportunistic infection in patients who have HIV/AIDS Decreased vision, eye pain, floaters, photopsia May cause hemorrhage, cell death, blindness Herpetic eye disease: Herpes zoster ophthalmicus Herpes simplex keratitis Symptoms include eye pain, redness, cloudiness of cornea 17  Viral Infections of the Eye: Treatment Drugs used to treat viral infections of the eye: Cidofovir Foscarnet Ganciclovir Trifluridine Valganciclovir 18  Look-Alike/Sound-Alike Drugs for Viral Infections Viroptic, Vira-A, and Timoptic Natacyn and Naprosyn 19  Fungal Infections of the Eye Fusarium keratitis: Occurs in wearers of soft contact lenses Untreated can lead to blindness Treated with antifungals such as Natamycin 20  Parasitic Infections of the Eye Helminthic Infections Onchocerciasis Cysticercosis Toxocariasis 21  Fungal and Parasitic Infections of the Eye: Treatment Drugs used to treat fusarium keratitis: Natamycin Drugs used to treat toxoplasmosis: Sulfonamides Pyrimethamine 22 Helminthic Infections Onchocerciasis Cysticercosis Toxocariasis 23  Helminthic Infections: Treatment Drugs used to treat parasitic infections of the eye: Albendazole Ivermectin Praziquantel 24  Glaucoma Causes progressive damage to the structures in the eye Peripheral vision lost first Ability to see images from the sides, top, or bottom of the eye(s) lost Only central vision remains Diagnosis through tonometry 25  Pathophysiology (1 of 2) Open-angle glaucoma: Most common form of glaucoma Results from abnormal accumulation of aqueous humor Increased intraocular pressure (IOP) causes degeneration of the optic nerve 26  Pathophysiology (2 of 2) Angle-closure glaucoma: Angle is inflamed or trabecular meshwork angle is obstructed Aqueous humor drainage is impaired Sudden increase in eye pressure can cause blindness within a few days if untreated 27  Treatment Drugs that decrease the formation of aqueous humor Drugs that promote drainage of aqueous humor 28  Drugs That Decrease Aqueous Humor Formation (1 of 5) Beta-adrenergic antagonists (beta blockers) Alpha-adrenergic agonists Carbonic anhydrase inhibitors 29  Drugs That Decrease Aqueous Humor Formation (2 of 5) Beta-adrenergic antagonists: Inhibit action of epinephrine and norepinephrine on blood vessels in the ciliary body of the eye 30  Drugs That Decrease Aqueous Humor Formation (3 of 5) Alpha-adrenergic agonists: Prevent increased IOP Reduce blood flow in the ciliary body Reduce the formation of aqueous humor Produce effects similar to beta-adrenergic antagonists 31  Drugs That Decrease Aqueous Humor Formation (4 of 5) Carbonic anhydrase inhibitors: Decrease IOP by decreasing the rate of production of aqueous humors Carbonic anhydrase: Enzyme involved in the conversion of carbon dioxide and water to bicarbonate Aqueous humors: Production depends on transport of bicarbonate and sodium ions in ciliary structures 32  Drugs That Decrease Aqueous Humor Formation (5 of 5) Adrenergic agonists: Constrict blood vessels in the ciliary body Decrease the rate of aqueous humor formation 33 Poll Question Copyright © 2019 by Elsevier, Inc. All rights reserved. 34  Drugs That Increase Aqueous Humor Drainage (1 of 4) Cholinergic agonists Acetylcholinesterase inhibitors Prostaglandin analogs 35 Drugs That Increase Aqueous Humor Drainage (2 of 4) Cholinergic agonists: Bind to receptors and mimic the neurotransmitter acetylcholine Binding contracts ciliary muscles and pupil (miosis) Produce dilation of the trabecular meshwork and decreased IOP 36 Drugs That Increase Aqueous Humor Drainage (3 of 4) Cholinesterase inhibitors: Block the enzyme that deactivates acetylcholine Prolong the effects of acetylcholine 37 Drugs That Increase Aqueous Humor Drainage (4 of 4) Prostaglandin analogs: Mimic action of prostaglandin F2α Relax ciliary muscles to permit drainage of aqueous humors Dilate the trabecular meshwork to promote drainage 38  Look-Alike/Sound-Alike Drugs: Drugs That Increase Aqueous Humor Drainage Lopidine and Lodine Brimonidine and bromocriptine Acetazolamide and acetohexamide Isopto Carbachol and Isopto Carpine 39  Warning Labels Shake well (betaxolol suspension) Wash hands before use Avoid contamination of tip Remove contact lenses before use and wait 15 minutes before reinserting Store at room temperature Protect from light Do not discontinue without supervision 40 Questions? 41