Pharm module 10: eyes, ears and skin

Myopia

nearsightedness

Hyperopia

farsightedness

Presbyopia

age-related, harder to see things up close

Glaucoma

• one of the leading causes of blindness in the US

• optic nerve damage due to increased intraocular pressure

• norm: 10-21mm Hg

Glaucoma s&s

• blurred vision

• halos around lights

• difficulty focusing and adjusting to low light

• loss of peripheral vision

• headache and ache around the eyes

Conjunctivitis

pink eye

Conjunctivitis s&s

• redness

• tearing

• itching

• edema

• burning

Blepharitis

chronic infection of glands and lash follicles on the eyelids

Blepharitis s&s

• burning

• redness

• itching of anterior eye

Keratitis

inflammation of the cornea

Keratitis s&s

• irritation

• increase tear production

• photophobia

Drug penetration greater if:

• achieves high concentration in blood

• fat soluble, inflammation present

• drug is poorly bound to serum proteins

Atropine MOA

• anticholinergic

• blocks acetylcholine in the CNS

• dilates (mydriasis)

• prevents accommodation of near vision

Atropine indication

• dilation in acute/inflammatory conditions of iris/uveal tract

• measures refractive errors

• tx of uveitis

Atropine contraindication

presence of glaucoma

Atropine AE

• stinging

• blurred vision

• light sensitive

Phenylephrine MOA

• adrenergic agonists

• contracts dilator muscles

• mydriasis

• vasoconstriction

• increased outflow of aqueous humor

Phenylephrine indication

• prior to eye exam

• wide angle glaucoma

• redness relief

Phenylephrine contraindication

• HTN

• V tach

• narrow angle glaucoma

Phenylephrine AE

• dysrhythmia

• HTN

• MI

• syncope

• subarachnoid bleed

Lidocaine MOA

• local anesthetic (ends in “-caine”)

• decrease neuron membrane permeability to sodium ions → blocks nerve impulses

Lidocaine indication

• surgery

Lidocaine contraindication

• hypersensitive

Lidocaine AE

• red eye (conjunctival hyperemia)

• double vision (diplopia)

• changes in vision

Bimatoprost MOA

• prostaglandin analog (ends in “-prost”)

• increase aqueous humor outflow → lowers IOP

Bimatoprost indication

• open angle glaucoma

• ocular HTN

• hypotrichosis: eyelash unable to grow

Bimatoprost contraindication

hypersensitivity

Bimaprost AE

iris and eyelid hyperpigmentation

Timolol maleate MOA

• beta adrenergic blockers (ends in “-lol”)

• reduce aqueous production + increase outflow → lowers IOP

Timolol maleate indications

• chronic open angle glaucoma

• aphakic glaucoma (no lens in eye)

• ocular HTN

Timolol maleate contraindication

• asthma, COPD

• HF, bradycardia

• AV block

• Left ventricular dysfunction

• cardiogenic shock

• why?: beta blockers slows everything down

Timolol maleate AE

burning and stinging

Timolol maleate memory trick

Timolol chills too much — lungs close, heart slows, and pumps fail

Brimonidine MOA

• alpha2 adrenergic agonist

• reduce aqueous production + increase outflow → lowers IOP

Brimonidine indication

• open angle glaucoma

• ocular HTN

• ocular redness

Brimonidine contraindication

• MAOI usage past 14 days

• caution in cardiovascular disease

Brimonidine AE

• cardio: HTN, hypotension, bradycardia, tachycardia

• CNS: headache, dizziness, somnolence, diminished attention/alertness, insomnia

• respiratory: bronchitis, cough, dyspnea, sinusitis, nasal dryness, apnea

• stinging and burning

Pilocarpine MOA

• cholinergic drug

• stimulates cholinergic receptors → miosis, loss of accommodation, and lowers IOP

Pilocarpine indication

• chronic glaucoma

• acute closed angle glaucoma

Pilocarpine contraindication

• inflammation of anterior chamber of eye

Pilocarpine AE

• ocular: burning, ciliary spasm, lens opacity, retinal detachment, myopia, diminished visual acuity

• CNS: headache

• Cardiopulmonary: htn, tachycardia, bronchial spasm, pulmonary edema

Acetazolamide MOA

• carbonic anhydrase inhibitors

• inhibits carbonic anhydrase in the eye → reduce aqueous humor production → lowers IOP

Acetazolamide indication

open angle glaucoma

Acetazolamide contraindication

• Addison disease

• electrolyte imbalance

• kidney liver disease

• growth retardation in kids

Acetazolamide AE

• stevens-johnson syndrome

• agranulocytosis, hemolytic anemia, aplastic anemia, leukopenia, pancytopenia

• metabolic acidosis

Mannitol MOA

• osmotic diuretic

• creates osmotic gradient between plasma and ocular fields → lowers IOP

Mannitol indication

• acute attacks of glaucoma

• before surgery

Mannitol contraindication

• dehydration

• abd pain

• appendicitis

• pulmonary edema

• cardiac decompensation

Mannitol AE

• hyperosmolar nonketotic coma

• confusion, headache, syncope

• dysrhythmias, N/V, severe dehydration

Ciprofloxacin MOA

• antibacterial (ends in “-oxacin”)

• inhibits DNA gyrase → breakage of double stranded DNA

Ciprofloxacin indication

• aerobic gram (-) organisms

• corneal ulcer

• bacterial conjunctivitis

Ciprofloxacin contraindication

partially metabolized by liver

Ciprofloxacin AE

• N/V, abd discomfort

• photosensitivity

• Black box: tendonitis, peripheral neuropathy, cardiac effects

Trifluridine MOA

• antiviral

• causes formation of defective viral proteins → interferes with viral replication

Trifluridine indication

• primary keratoconjunctivitis

• recurrent epithelial keratitis caused by herpes 1 and 2

Trifluridine contraindiction

hypersensitivity

Trifluridine AE

• burning and stinging

• increased IOP

• Palpebral edema

• stromal edma

Natamycin MOA

• antifungal ("ends in “-mycin”)

• increase cellular permeability to susceptible fungi → easy for body to kill

Natamycin indication

Blepharitis, conjunctivitis, and keratitis

Natamycin contraindication

hypersensitive

Natamycin AE

• chest pain

• opacity of the cornea, eye pain, edema, dyspnea, hyperemia, irritation, foreign body sensation of the eye, tearing, visual changes

• dyspnea

Cromolyn sodium MOA

• antiallergic ophthalmic drug

• reduces the release of leukotrienes → stops reaction to an allergen

Cromolyn sodium indication

• seasonal keratitis, conjunctivitis, keratoconjunctivitis

Cromolyn sodium contraindication

Pregnancy

Cromolyn sodium AE

• edema, dryness, irritation, itching, rash and tearing

• styes may develop

Emedastine difumarate MOA

• H1 receptor antagonist

• competes with histamine → reduce allergic response

Emedastine difumarate indication

seasonal allergic conjunctivitis

Emedastine difumarate contraindication

hypersensitivity

Emedastine difumarate AE

• fatigue

• pruritis

• blurring of vision

• asthma

• SOB

Dexamethasone

• corticosteroid

• suppresses migration of neutrophils → decrease inflammation

Diclofenac MOA

• anti-inflammatory

• decreases the formation of prostaglandin → stops inflammation

Diclofenac indication

• after cataract extraction

• corneal refractive surgery

Cyclosporine emulsion MOA

• immunosuppressant

• increases tear production

Cyclosporine emulsion indication

• keratoconjunctivitis sicca

Neomycin-polymyxin B-hydrocortisone class

anti-infective, antiseptic, glucocorticoid and acidifying agent

Neomycin

• aminoglycoside

• bind to 30S ribosome of susceptible bacteria → stops bacteria protein synthesis

Polymyxin B

• misc. anti-infective agent

• binds to lipid phosphates in bacterial cell membrane → changes permeability → cell death

Hydrocortisone

• steroid

• stabilizes leukocyte lysosome membrane → decreases inflammation

Neomycin-polymyxin B-hydrocortisone indication

acute otitis externa

Neomycin-polymyxin B-hydrocortisone contraindication

hypersensitive

Neomycin-polymyxin B-hydrocortisone AE

• burning

• stinging

Drug of choice for necrotizing otitis externa?

Ciprofloxacin

Ciprofloxacin black box warning

• tendonitis

• peripheral neuropathy

• cardiac effects

Amoxicillin MOA

• antibacterial

• inhibits cell wall synthesis → cell death

Amoxicillin indication

• acute otitis media

• gram (+) and (-)

• often given with aminoglycosides for serious infections

Amoxicillin contraindication

• potential cross allergy with cephalosporins

Amoxicillin AE

• GI: n/v, sore throat, abd pain, diarrhea

• superinfections if pt does not finish all meds

Adjuvant meds for pain & fever related to ear infections

• aspirin

• acetaminophen

• ibuprofen

Aspirin MOA

• inhibits prostaglandin synthesis → reduce pain and fever

• reye’s syndrome → do not give kids

Acetaminophen MOA

• acts on hypothalamus → increase vasodilation and sweating → fever reduction

• inhibits mostly COX-2

Ibuprofen MOA

• inhibits prostaglandin synthesis in CNS + PNS → reduce pain

• inhibits mostly COX-1 → GI issues

Topical corticosteroids MOA

• blocks production of IL-1 → decrease inflammation, fever and immune response

Topical corticosteroids indication

• inflammation in skin conditions

• reduce redness

• reduce psoriasis and seborrheic dermatitis

Topical corticosteroids contraindication

hypersensitive

Topical corticosteroids AE

• high potency → suppresses hypothalamic–pituitary–adrenal (HPA) axis → Cushing syndrome

What type of antibacterial is used to treat cellulitis and postoperative wound infections?

Cephalosporins

What antibacterial is used for severe acne and rosacea?

Tetracyclines

Cephalosporins general

• starts with “cef-”

• more active against gram (-) vs. penicillin

• most common used → 3rd gen → Ceftriaxone

Cephalosporin MOA

• binds to penicillin-binding proteins → inhibits cell wall synthesis → cell death

Cephalosporin indication

• surgical prophylaxis

• sepsis

• soft tissue infections → cellulitis

• postop wound infections