Ophthalmic Drugs PDF

Ophthalmic Drugs KR by Katie Robinson Overview of Eye Responsible for sense of sight. Nearly spherical, approx. 1 inch in diameter. Recessed into frontal skull Three layers to anterior cavity: Orbit. portion of eye. Drugs That Aff...

Ophthalmic Drugs KR by Katie Robinson Overview of Eye Responsible for sense of sight. Nearly spherical, approx. 1 inch in diameter. Recessed into frontal skull Three layers to anterior cavity: Orbit. portion of eye. Drugs That Affect the Eye Mydriatics Miotics Cycloplegics Cycloplegia Dilate the pupil. Constrict the pupil. Paralyze the ciliary body. Paralysis of accommodation. Example: apraclonidine Examples: Have mydriatic acetylcholine, properties. Examples: atropine, pilocarpine cyclopentolate Types of Ocular Drugs Antiglaucoma Drugs Antimicrobial Drugs Antiinflammatory Topical Anesthetics Drugs Reduce intraocular Treat bacterial, fungal, or Numb the eye for pressure. viral infections. Reduce inflammation procedures. and pain. Glaucoma Overview Aqueous Humor Flow Increased IOP Retinal Damage Inhibition of normal flow and Results in increased Pressure against retina drainage. intraocular pressure. destroys neurons. Types of Glaucoma Angle-closure Open-angle Glaucoma Glaucoma The angle is open, but Occurs when the angle the drainage system is between the iris and blocked. cornea is narrowed. Underlying Cause Can be primary, secondary, or congenital. Drugs Used to Reduce Intraocular Pressure Direct-acting Indirect-acting Adrenergics: Anti-adrenergics: cholinergics cholinergics sympathomimetics beta blockers Reduce IOP by Increase acetylcholine Stimulate alpha- Block beta-adrenergic constricting the pupil. levels, constricting the adrenergic receptors, receptors, reducing IOP. pupil. reducing IOP. Cholinergic Drugs 1 Mimic Acetylcholine 2 Also Called Mimic the Also called miotics, parasympathetic cholinergics. nervous system neurotransmitter acetylcholine. 3 Direct and Indirect 4 Pupillary Constriction Direct-acting and Cause pupillary indirect-acting drugs. constriction (miosis), which leads to reduced IOP. Cholinergic Drugs (Cont.) Direct-Acting Indirect-Acting Acetylcholine, Carbachol, Echothiophate (Phospholine Pilocarpine Iodide) Cholinergic Drugs: Indications Glaucoma Other Open-angle glaucoma. Ocular surgery. Angle-closure glaucoma. Convergent strabismus. Cholinergic Drugs: Adverse Effects Local Effects Systemic Effects Most limited to local effects. Systemic effects may occur with sufficient amounts entering the bloodstream. Indirect-Acting Agents Adverse Effects Most likely with indirect-acting agents. Hypotension, bradycardia, or tachycardia Headache, nausea, vomiting, diarrhea, abdominal cramps, asthma attacks Others Direct-Acting Miotics Acetylcholine Miochol-E Direct-acting cholinergic Used to produce miosis drug. during ophthalmic surgery. Pilocarpine Pilocarpine Ocular Insert Used as a miotic in the Applied once weekly by treatment of glaucoma. the patient. Sympathomimetics Mimic Pupil Dilation Neurotransmitters Stimulate dilator muscle Mimic epinephrine and contraction. norepinephrine. Aqueous Humor Glaucoma Treatment Outflow Used to treat glaucoma Enhance outflow through and ocular hypertension. canal of Schlemm. Sympathomimetics (Cont.) Apraclonidine Brimonidine Epinephryl (Epinal) Dipivefrin (Propine) (Iopidine) (Alphagan P) Prodrug of epinephrine. Hydrolyzed to epinephrine when applied topically. Penetrates tissues better. Sympathomimetics: Indications Chronic, open-angle glaucoma. Reduction of perioperative IOP. Reduction of ocular hypertension. Sympathomimetics: Adverse Effects Ocular Effects Systemic Effects Primarily limited to ocular effects. Rare systemic effects. Burning Hypertension Eye pain Tachycardia Lacrimation Extrasystoles Headache Faintness Apraclonidine (Iopidine) Pharmacology IOP Reduction Structurally and Reduces IOP by pharmacologically related stimulating alpha2 and to clonidine. beta2 receptors. Mechanism Clinical Use Prevents ocular Used to inhibit vasoconstriction, reducing perioperative IOP ocular blood pressure. increases. Apraclonidine (Iopidine) (Cont.) Similar Drug Adverse Effects Brimonidine (Alphagan P) used for glaucoma. Burning, eye pain, lacrimation. Beta-Adrenergic Blockers Reduce IOP No Effect Reduce aqueous humor Do not affect pupil size, formation. accommodation, or night vision. Increase aqueous humor outflow. Beta-Adrenergic Blockers: Indications Reduction of IOP Angle-Closure Glaucoma Additive Effects Chronic open-angle glaucoma. Treatment of some forms of angle- Systemic beta blockers with high closure glaucoma. doses of ophthalmic beta blockers Ocular hypertension. may result in additive effects. Beta-Adrenergic Blockers: Adverse Effects 1 Ocular Effects 2 Ocular Effects Transient burning and Blurred vision, pain, discomfort. photophobia. 3 Systemic Effects 4 Systemic Effects Headache, dizziness, Bronchospasm. cardiac irregularities. Timolol (Timoptic) Timolol Aqueous Humor Indications Beta-adrenergic blocker. Increases outflow and decreases Open-angle glaucoma and ocular formation. hypertension. Carbonic Anhydrase Inhibitors Brinzolamide Dorzolamide Brand name: Azopt Brand name: Trusopt Mechanism Result Inhibit carbonic anhydrase Reduces aqueous humor enzyme. formation. Carbonic Anhydrase Inhibitors: Indications Glaucoma Treatment Preoperative Use Open angle glaucoma. Reduce IOP before surgery. Angle closure glaucoma. Carbonic Anhydrase Inhibitors: Adverse Effects Oral Forms Sulfa Allergies Systemic effects possible. Cross-sensitivities may occur. Drowsiness, confusion Transient myopia, tinnitus Anorexia, vomiting, diarrhea Osmotic Diuretics Overview Ocular Hypotension Fluid Movement Create ocular Water forced from hypotension by aqueous and vitreous producing an osmotic humors into gradient. bloodstream. Reduced IOP Administration Reduced volume of Administered intraocular fluid and intravenously, orally, or thus reduced IOP. topically. Osmotic Diuretics (Cont.) Mannitol Isosorbide and Urea Indications Adverse Effects Used if glycerin is May also be used. Acute glaucoma Nausea, vomiting, unsuccessful. episodes, before and headache, fluid and after ocular surgery. electrolyte imbalance. Prostaglandin Agonists Newest Class Mechanism Newest class of drugs for glaucoma. Reduce IOP by increasing outflow of aqueous fluid. Prostaglandin Agonists (Cont.) Used for glaucoma treatment. Single daily dosing, effects last 20-24 hours. Eye color changes in some patients. Ocular Antimicrobial Drugs Administration Types Topical and systemic Antibacterial, antiviral, administration. and antifungal. Topical Application Combined Use May cause inflammation, Antibiotics with burning, and stinging. corticosteroids may hinder infection removal. Ocular Antibacterial Drugs Aminoglycosides Macrolides Antibacterial action. Antibacterial action. Gentamicin (Garamycin) Erythromycin tobramycin (Tobrex) azithromycin Ocular Antibacterial Drugs (Cont.) Polypeptides Quinolones Bacitracin and Polymyxin B. Ciprofloxacin, Gatifloxacin, Moxifloxacin, Levofloxacin, Ofloxacin. Sulfonamides Sulfacetamide Sulfisoxazole Brand name: Bleph-10 Brand name: Gantrisin Ocular Antifungal Drugs Natamycin (Natacyn) Conditions Treated Used topically to treat fungal infections. Blepharitis Conjunctivitis Keratitis Ocular Antiviral Drugs (Cont.) Trifluridine Application Adverse Effects Used for ocular infections caused Applied topically as drops. Secondary glaucoma, corneal by herpes simplex virus types 1 punctate defects, uveitis, and and 2. stromal edema. Ocular Antiinflammatory Drugs Arachidonic Acid Inflammatory Pathway Mediators Act on various parts of Reduce production of the pathway. inflammatory mediators. Pain and Erythema Prophylactic Use Reduce pain, erythema, Used after surgery to and inflammation. prevent inflammation. NSAIDs for Eye Ketorolac Flurbiprofen Brand name: Acular Brand name: Ocufen Bromfenac Diclofenac Brand name: Xibrom Brand name: Voltaren Corticosteroids Anti-Inflammatory Common Examples Reduce inflammation and irritation. Dexamethasone Fluocinonide Fluorometholone Loteprednol Medrysone Prednisolone Rimexolone Topical Ophthalmic Anesthetics Tetracaine Proparacaine Used to prevent eye pain. Used to prevent eye pain. Applications Short-Term Use Surgery Not for self-administration. Ophthalmic examinations Removal of foreign bodies or sutures Diagnostic testing and procedures Ophthalmic Diagnostic Drugs Ophthalmic Examinations Uveitis Treatment Used for various eye examinations. Pupillary dilation helps treat uveitis. Cycloplegic Mydriatics Cyclopentolate Other Cycloplegics Causes mydriasis and cycloplegia. Scopolamine Homatropine Used for diagnostic examinations. Tropicamide Not used for uveitis. Ophthalmic Dye Fluorescein Foreign Objects Diagnostic dye for Locates foreign objects corneal defects. in the eye. Contact Lens Fitting Defect Identification Used in fitting hard Highlights defects in contact lenses. green or yellow-orange. Ophthalmic Antiallergic Drugs Allergic Conjunctivitis Ophthalmic Antihistamines Treats symptoms of allergic conjunctivitis. Various antihistamines available for treatment. Ophthalmic Antiallergic Drugs (Cont.) Mast Cell Stabilizers Decongestants Cromolyn sodium (Crolom) Tetrahydrozoline Pemirolast (Alamast) Phenylephrine (Neo-Synephrine) Nedocromil (Alocril) Oxymetazoline (Visine LR) Lodoxamide (Alomide) Naphazoline (Clear Eyes) Ophthalmic Lubricants and Moisturizers Artificial Tears Over-the-counter products. Provide lubrication or moisture Available in drops or ointment Brand Names Murine, Nu-Tears, Moisture Drops, Tears Plus, Akwa Tears Lifitegrast (Xiidra) Newest agent for treatment of dry eyes. Twice daily administration Ophthalmic Lubricants and Moisturizers (Cont.) Restasis Treatment Ophthalmic form of cyclosporine. Used to treat keratoconjunctivitis sicca (dry eyes). Immunosuppressant drug. Can be used with artificial tears.