Eye Disorder Pharm

What topical anesthetic can be used to examine a corneal abrasion to give immediate relief but only last 20 minutes?

Proparacaine 0.5%

What are the preferred topical ointment for corneal abrasion.

Erythromycin 5mg/g (3.5 g tube) and Sulfacetamide 10%

how long should topical ointments be used for corneal abrasions

typically use 3-5 times daily for 3 -5 days; and decrease BID once foreign body sensation has resolved

if your patient wears contact lenses and they have a corneal abrasion what topical ointments are recommended?

Gentamicin, tobramycin, ciprofloxacin.

How often should patients with corneal abrasions follow up?

Daily

What medication should patients with corneal abrasions avoid due to it inhibiting repair?

a. Never use ophthalmic steroids

what pain control management can patients with corneal abrasions use?

NSAIDs (diclofenac).

Why is it not recommended to prescribe topical antibiotics when patients have viral conjunctivitis?

Can contribute to antibiotic resistance

What symptomatic relief can patients with viral conjunctivitis use

Warm or cool compress, OTC lubricating drops/gels, OTC antihistamines/decongestants but only for one week.

who is only able to prescribe topical steroids?

a. Ophthalmologists

your patient is taking decongestants for seasonal allergic conjunctivitis how long should they be taking decongestants for?

a. No more than 10 days duration

what over the counter medication can be used for allergic conjunctivitis that is a combo product?

Naphazoline

what topical NSAID is approved for ocular itching in seasonal allergic conjunctivitis?

a. Ketorolac (Acular)- 1 drop up to 4x daily

What is the first line topical treatment for bacterial conjunctivitis?

Erythromycin ointment, polymyxin B/trimethoprim, Polymyxin B with bacitracin ointment (polycin).

1. How long is polycin prescribed for and how many times are they allowed to place topical antibiotics in bacterial conjunctivitis?

4 X daily for 5-7 days

You have a patient present to clinic with bacterial keratitis you are wanting to start a treatment what is the recommended single therapy for this condition?

Single therapy with FQ is effective, but due to resistance use newer FQ drugs

what medications cause dry eyes?

Antihistamines, anticholinergics, TCA's, hormone therapy, beta adrenergic blockers.

what is a cause for dry eyes?

Contact Lens

1. what is the recommended treatment for dry eyes?

Ocular lubricants (artificial tears 3-4 times a day).

What is the only first corticosteroid FDA approved for short term dry eye treatment?

a. Loteprednol (Eysuvis)

how often is cyclosporine (Restasis) used for treatment of dry eye?

every 12 hrs

How long should you wait for after applying restasis in order to apply artificial tears?

15 minutes after application of Restasis to use artificial tears

What medications can precipitate angle closure glaucoma?

Anticholinergics, sympathomimetics

what are the secondary causes of primary open angle glaucoma?

Corticosteroids (topical, nasal, inhaled or systemic), ophthalmic anticholinergics, vasodilators, cimetidine

how should you treat primary open angle glaucoma when initiating monotherapy?

Initiate at a low dose (if medication route)

What is one treatment for primary open angle glaucoma that can decrease AH production?

Timolol (betimol, Timoptic, Timoptix XE)
Beta-adrenergic Blockers class

What are some side effects of Timolol (Beta-adrenergic Blockers) when treating primary open angle glaucoma?

Stinging, dry eyes, blurred vision, corneal abrasion

What is a prostaglandin analog that can help with treating primary open angle glaucoma by increasing AH outflow?

Latanoprost 0.005% (Xalatan, now generic)

What is an adverse effect of latanoprost?

Darkening of lashes, iris pigmentation turns brown

What is an alpha- 2 adrenergic agonist used to treat primary open angle glaucoma

Brimonidine (Alphagen P)

What is a topical carbonic anhydrase inhibitor that is used to treat glaucoma?

Dorzolamide (Trusopt)

What is a systemic carbonic anhydrase inhibitor medication that can be used to treat glaucoma if topical treatment fails, but has a lot of significant systemic effects?

Acetazolamide and Methazolamide

what cholinergic agent is used to treat glaucoma but is dosed 4 times daily and is rarely used?

Carbachol and Pilocarpine

What new glaucoma medication has a mechanism of action that may reduce IOP by increasing the outflow of aqueous humor through the trabecular meshwork route and patient instills 1 drop into affected eye daily?

Netarsudil (Rhopressa)

What new glaucoma medication has a mechanism of action that is latanoprostene bound. It is thought to lower intraocular pressure by increasing outflow of aqueous humor through both the trabecular meshwork and uveoscleral routes?

Latanoprostene bunod (Vyzulta)

when counseling your patients on using topical eye meds what is one thing that you should recommend avoiding when using a dropper

a. Avoid touching the dropper with finger or eye.

When counseling your patient and they tell you that they will be applying 2 or more topical agents. How many minutes should they separate the drops to allow optimal ocular contact?

Separate drops by 5 minutes

Your patient wears contact lenses, what coverage are you needing for corneal abrasions?

Pseudomonas coverage

what are some contraindications for using timolol for treatment in primary open angle glaucoma?

CHF, asthma, COPD, heart block