Eye, Ear, and Skin Drug Therapy PDF

Chapter 59\ \ Drug Therapy for Disorders of the Eye Drugs for Glaucoma \#1 Prostaglandin analogs - Most widely prescribed glaucoma drugs - Prototype: bimatoprost (Latisse, Lumigan) - For open-angle glaucoma, ocular hypertension - Action -- ocular hypotension - Use -- open-angl...

Chapter 59\ \ Drug Therapy for Disorders of the Eye Drugs for Glaucoma \#1 Prostaglandin analogs - Most widely prescribed glaucoma drugs - Prototype: bimatoprost (Latisse, Lumigan) - For open-angle glaucoma, ocular hypertension - Action -- ocular hypotension - Use -- open-angle glaucoma and ocular hypertension - Adverse effects -- hyperpigmentation Beta-adrenergic blockers - Prototype: timolol maleate - For chronic open-angle glaucoma, aphakic glaucoma, secondary glaucoma, and ocular hypertension - Action -- blocks beta1 & beta2 to reduce intraocular pressure - Use -- chronic open-angle glaucoma and ocular hypertension - Adverse effect -- pain, systemic beta-adrenergic effects Alpha2-adrenergic agonists - Prototype: brimonidine - For open-angle glaucoma, ocular hypertension - Action -- reduces aqueous humor production - Use -- lowers intraocular pressure - Adverse effects -- CV effect -- hypo or hypertension, brady or tachycardia - Contraindications -- 14day washout for MAOI Cholinergic drugs - Prototype: pilocarpine - For chronic simple glaucoma; chronic and acute angle-closure glaucoma - Action -- stimulates cholinergic receptors in the eye, loss of accommodation and lowers intraocular pressure - Use -- chronic simple glaucoma - Adverse effects -- burning, conjunctival vascular congestion; CNS - headache; cardiopulmonary -- hypertension, tachycardia, bronchial spasm; GI -- nausea and vomiting, diarrhea, and increased salivation Carbonic anhydrase inhibitors - Prototype: acetazolamide (oral); brinzolamide, dorzolamide - For open-angle and secondary glaucoma - Action -- inhibits carbonic anhydrase in the eye reducing the rate of aqueous humor formation and lowering intraocular pressure - Use -- open-angle glaucoma - Adverse effects -- Stevens-Johnson syndrome, agranulocytosis, anemia, metabolic acidosis Osmotic drugs - Prototype: mannitol - Temporarily reduces IOP in acute attacks of glaucoma; also used for reduction of IOP prior to surgery Antibacterial drugs - For corneal ulcer and bacterial conjunctivitis - Prototype fluoroquinolone: ciprofloxacin - Most commonly prescribed Antiviral drugs - For primary keratoconjunctivitis; recurrent epithelial keratitis - Prototype: trifluridine - Most commonly administered Antifungal drugs - For fungal blepharitis, conjunctivitis, and keratitis - Prototype: natamycin Antiallergic drugs - For vernal keratitis, vernal conjunctivitis, and vernal keratoconjunctivitis - Prototype: cromolyn sodium - Decreases or stops the body\'s reaction to an allergen H1-receptor antagonists -- ocular pruritus - Prototype: emedastine difumarate - Adverse effects -- 11% report headache Corticosteroids - Prototype: dexamethasone - Decreases inflammation Anti-inflammatory drugs - Reduces inflammation after cataract extraction; used with corneal refractive surgery - Prototype: diclofenac Immunosuppressants - Increases tear production - Prototype: cyclosporine emulsion General Guidelines for Ophthalmic Drug Therapy - Topical administration is the most common route. - Correct administration essential for optimal therapeutic effects - Systemic absorption can be decreased by occluding the lacrimal duct. - Multiple drop types need 5- to 10-minute intervals between administrations. - Absorption decreased with eye inflammation Systemic absorption of ophthalmic drugs can be decreased by occlusion of the lacrimal duct for 3 to 5 minutes after instillation. Drug Therapy for Disorders of the Ear - Otitis Externa - Disorder of the external ear that produces inflammation, also known as swimmer's ear, caused by moisture in the ear canal, allergic reactions such as psoriasis, or trauma of the ear canal related to itching or scratching - Use of topical agents is most common, effective way to deliver high concentrations of medication to infected tissue. - Systemic medications are used if deep tissue infection develops outside the external canal or if the patient is immunocompromised. - When infection extends to the pinna, oral anti-infective agents are used. - Otitis Media - More common in children than in adults, pathogens enter the middle ear as a result of an alteration in the eustachian tube, can be caused by upper respiratory congestion, inflammation, or an allergic reaction, bacteria may enter the middle ear from contaminated secretions of the nasopharynx or perforation of the tympanic membrane. - Oral amoxicillin is the drug of choice. - Those allergic to penicillins may take cephalosporins. - Anti-infective, antiseptic, glucocorticoid, and acidifying agents. - Prototype: neomycin--polymyxin B--hydrocortisone - combination drug; antibiotics and steroid - For acute external otitis media (topical agent, -otic drops) - Action -- each drug in the combo has its own mechanism of action to inhibit bacterial growth or limit the inflamatory process - Use -- Acute otitis externa - Adverse effects - sensitivity - Fluoroquinolone - Prototype: ciprofloxacin - drug of choice for necrotizing otitis externa (IV then oral) - Action -- inhibits bacterial growth - Use -- treatment of necrotizing otitis externa - Adverse effects -- as per antibiotic lecture - Antibacterial agent - Prototype: amoxicillin (a penicillin) - Action - Inhibits cell wall synthesis of sensitive organisms, resulting in cell death - Use - For acute otitis media - Adverse effects include hypersensitivity to drugs, GI effects, and development of superinfections. - Patient Guidelines - Take the entire course of anti-infective agents. - Take adjuvant medications to reduce pain and fever. - Do not insert items in the ear. - Use earplugs when swimming. - Dry ear carefully following bathing or swimming. Drug Therapy for Disorders of the Skin - Guidelines for Dermatologic Drug Therapy - Drug selection dependent on condition or factors, including acuity, severity, location, extent; Drug dose dependent on drug strength, area, and method of application; Agent choice dependent on reason for use, patient response - Types of Dermatologic Drugs - Antimicrobials -- topical presentation - Antibacterials - Bacitracin, benzoyl peroxide, clindamycin, erythromycin, metronidazole, mupirocin, silver sulfadiazine - Antifungals -- butenafine, ciclopirox, clotrimazole, ketoconazole, nystatin - Antivirals - acyclovir - Use -- to treat bacterial, fungal and viral infections of the skin - Application can be oral, topical, or parenteral - Antiseptics -- - Action - kill or inhibit growth of bacteria, viruses or fungi - Uses -- primarily used to PREVENT infection - Corticosteroids - Uses -- topical for dermatitis to decrease inflammation - Emollients and moisturizers - Uses - lubricants - Enzymes - Trypsin - Uses -- debride wounds - Immunosuppressants - Pimecrolimus, tacrolimus -- both topical - Uses -- treat inflammatory skin conditions (psoriasis) - Keratolytics - Uses -- keratin-containing skin conditions - Retinoids (Isotretinoin) - Action -- suppression of sebum production - Uses -- primarily acne - Adverse effects -- Strictly regulated by FDA because of severe reproductive, and psychiatric effects, commonly causes dryness, arthralgia, hyperlipidemia - Contraindications -- Black Box warning -- pregnancy category X - Sunscreens