Pediatric Pharmacology 4 - Ocular Allergy Lecture Notes PDF

OCULAR ALLERGY 52  § History § Medical conditions § New pets/environment § Drug/food allergies § Symptomology ALLERGIC § Symptoms – usually bilateral § Itching...

OCULAR ALLERGY 52  § History § Medical conditions § New pets/environment § Drug/food allergies § Symptomology ALLERGIC § Symptoms – usually bilateral § Itching – but not always! CONJUNCTIVITIS § Redness § Tearing § Eye rubbing § Runny nose § Sneezing 53 § Signs § Papillae § Edema/chemosis § Injection § Caruncle à first place to see papillae in allergies § Allergic shiner 54  § Ketotifen 0.025% – Antihistamine/mast cell stabilizer; ≥3 years § Zaditor BID/ Alaway BID § Epinastine HCl 0.05% – Antihistamine/mast cell stabilizer; ≥2 years § Elestat BID § Azelastine HCl 0.05% – Antihistamine/mast cell stabilizer; ≥3 years § Optivar BID § Bepotastine Besolate 1.5% – Antihistamine/mast cell stabilizer; ≥2 years § Bepreve BID § Emastadine Difumarate 0.05% – Antihistamine; ≥3 years § Emadine QID § Alcaftadine 0.25% – Antihistamine/mast cell stabilizer; ≥2 years § Lastacaft Q D à a l s o a g o o d o p t i o n b c i t s o n c e a d a y a n d cheaper § Olopatadine 0.1%, 0.2%, 0.7% – Antihistamine/mast cell stabilizer; ≥3 years § Pataday Twice Daily Relief, Once Daily Relief, Extra Strength -impt to remember from this slide is we usually go straight to pataday 55 § Pemirolast Potassium 0.1% – Mast cell stabilizer; ≥3 years § Alamast QID § Nedocromil Sodium 2% – Mast cell stabilizer; ≥3 years § Alocril BID § Lodoxamide Trimethamine 0.1% – Mast cell stabilizer; ≥2 years § Alomide § Cromolyn Sodium 4% – mast cell stabilizer; ≥4 years § Opticrom QID / Crolom QID § OFF LABEL § Pred Forte § Durezol § Lotemax/Alrex 56  MTV’S ALLERGIC CONJUNCTIVITIS ALGORITHM O T C antihistamine – Rx antihistamine – Education and cool Alaway/Zaditor Optivar (azelastine), Rx combo –Pataday compresses family (olopatadine) Pediatrician/Allergist (ketotifen) Lastacaft (alcaftadine) UKS -kids should be showering at night to decrease the amount of allergens -cool compress can be used for light allergies 57 $20 $24 $26 58  § Unusually severe sight-threatening allergic eye disease § Male > female (3-4:1), onset usually before 10 years of age § Mediterranean decent (Italy>>>) § Symptoms § Severe itching and irritation, eye rubbing § Photophobia § FBS § Blurred vision § Blepharospasm -really bad allergic conjunctivitis -vernal implies that it only occurs in the spring but it can occur all year around 59  § Signs § Injection § Conjunctival hyperemia with edema § Edematous ptosis § Thick mucous (white) ropy discharge § Large superior tarsal papillae (“cobblestone”, Tarsal VKC) § Horner-Trantas dots (Limbal VKC), thickening and opacification of limbus § Shield ulcer -limbal is seen more frequently -GPC is only a CL condition 60 -cobblestone papillae 61  § Mild cases are self-limiting, resolve by puberty § Conventional allergic ocular treatment is often insufficient § Mild § Cool compresses § Topical antihistamine VKC TREATMENT § Moderate + MANAGEMENT § Mast cell stabilizer + antihistamine § Severe § Topical steroid: high pulse dose with quick tapering (FML/Lotemax/Alrex) § Oral steroid: sight-threatening cases § Verkazia: cyclosporine 0.1% emulsion § First FDA approved med for VKC! § QID § Penetrates the cornea very well -pt is on long term medication until puberty -regular pataday may not be effective but may want to use a strong combo drug or a steroid -oral steroids are implied when there is shield ulcers 62 63 64  GLAUCOMA MEDICATIONS 65  § 1/10,000 live births § Buphthalmos, blue/hazy cornea, megalocornea § Generally requires surgical intervention § Poor long-term prognosis § REFER to pediatric glaucoma specialist § Medical Treatment Options: § Beta blockers (FDA approved) § Prostaglandin analogs not effective § Alpha-adrenergics (Alphagan) NOT used, central nervous system depression -these kids usually have an IOP of 50-60mmHg 66  HYPHEMA MANAGEMENT 67 § Atropine BID § Taper to Q D once clot heals § Pred Forte for inflammation § q1h or q2h initially, depending on severity § Precautions: § No aspirin or ibuprofen!! § Monitor Q D until hyphema resolved § Monitor IOP § Bed rest, head elevated to 30° 68 COMMON SYSTEMIC MEDICATIONS IN CHILDREN 69 SYSTEMIC MEDS Systemic Steroids § Indications § Asthma, allergies, inflammation § Formulations § Inhaled § Intranasal § Oral § Topical § Side Effects § Weight gain, stomach ulcers, sleep difficulties, ↑blood pressure, ↑blood sugar, ↓wound healing § Cataracts, ↑IOP (glaucoma) 70 § Allergic Rhinitis – nasal spray § Flonase (Fluticasone) § ≥4 years § Veramyst (Fluticasone) § ≥2 years § Nasonex (Nometasone) § ≥2 years § Rhinocort (Budesonide) § ≥6 years § Omnaris (Ciclesonide) § ≥6 years 71 § Allergic Rhinitis – Oral § 1st Generation Antihistamines § Diphenhydramine (Benadryl) § 2nd Generation Antihistamines § Loratadine (Claritin): ≥2 years OTC § Cetirizine (Zyrtec): ≥6 mos § Fexofenadine (Allegra): ≥2 years, syrup or tablet § Desloratadine (Clarinex): ≥6 mos, available in Rx syrup § Montelukast (Singulair): ≥6 mos, granule packet; ≥4 years chewable tablet § Decongestants § Pseudoephedrine (Sudafed) § Phenylephrine HCl § Both ≥4 years 72 § ADHD § Depression + Anxiety + OCD: SSRIs § Ritalin/Concerta (methylphenidate) § Prozac (fluoxetine) § Adderall § Lexapro (escitalopram) (amphetamine/dextroamphetamine) § Zoloft (sertraline) § Strattera (atomoxetine) § Multivitamins/vitamins § Vyvanse (lisdexamfetamine) § Eczema § Seizure Disorders § Hydrocortisone § Keppra (levetiracetam) § Aquaphor, Cetaphil creams § Depakote (valproic acid) § Lamictal (lamotrigine) 73