Medicines in Optometry - drugs and abbreviations

Sig

Write on label

q

Every

q.o.d

Every other dy

q.h.s

every night at bedtime

q.d.

Every day

b.i.d.

Twice a day

t.i.d.

3 times a day

q.i.d.

4 times a day

gtt(s)

Drop(s)

ung

Ointment

sol

Solution

susp

Suspension

tab

Tablet

cap

Capsule

p.o.

By mouth

What are the glaucoma topicals?

1. Prostaglandin analogs

2. Carbonic anhydrase inhibitor

3. Beta blocker

4. Alpha agonist

5. Rho Kinase Inhibitor

Describe prostaglandin analogs

Most effective tx for GLC: 30% IOP decrease by increasing outflow

Give one gtt qhs (one drop at night)

What are the three major solutions for prostaglandin analogs

Xalatan (latanoprost 0.005%)

Lumigan (Bimatoprost 0.01%)

Travatan Z (travoprost 0.004%)

ALL EQUAL IN EFFICACY

Which of the three prostaglandin analogs are available as generics

Xalatan (latanoprost 0.005%)

Travatan Z (travoprost 0.004%)

What are the newer prostaglandin analogs?

lyuzeh: preservative free latanoprost 0.05%

Zioptan (Tafluprost 0.0015%sol) —> non preserved

Vyzulta (latanoprostene bunod 0.024% sol)

Describe the new prostaglandin Vyzulta

Latanoprostene bunod 0.024% sol

More effective than latanoprost 0.005%?

Nitric oxide donating (TM outflow)

More side effects?

How should a prescription be written?

Medicine/strength or concentration/form

Quantity

Sig: dosage/freq/route of admin/duration

Refills:

Other instructions:

Write an rx for one bottle of 0.01% lumigan for the eyes in solution to be taken one drop in both eyes every night before bedtime with one refill and to be used as directed

Lumigan 0.01% ophthal sol

One bottle

Sig: one gtt qhs, OU; use as directed

Refills: one

What are the side effects of prostaglandin analogs

Lash growth/new hairs on skin around eyes

Conjunctival hyperemia

Darkening of blue and green iridescent

Atrophy of orbital fat

What are the relative contraindications of prostaglandin analogs

Ocular inflammation

Macular edema

Herpetic corneal disease

Describe carbonic anhydrase inhibitors

Best adjunctive medication to PGA (prostaglandin analogs) for IOP: decreases aqueous production

BID as adjunctive therapy (twice a day) or TID as mono therapy (three times a day)

What are the two major topicals for carbonic anhydrase inhibitors

Azopt (brinzolamide 1% susp)—> better tx option

Trusopt (dorzolamide 2% sol) —> more irritating

Carbonic anhydrase inhibitors have a ___ half life. How can you tell?

Short

Can tell from fact that you have to take them more often

Side effects of carbonic anhydrase inhibitors

Metallic taste

What are the contraindications of CAI

Allergies—> can rx as long as the pt doesn't have a severe rxn to sulfa (CAI is not the same entity as the antibiotic)

Renal or hepatic impairment

Describe beta blockers

Former first line medication:

- cheaper that PGA

- decreases aqueous production

- little to no nocturnal IOP control

- Take BP and pulse before starting

What is the most common beta blocker for GLC tx

Timolol 0.25% and 0.5% sol; qd

Why are beta blockers more convenient than CAI

qd efficacy = bid

Meaning, studies show that taking a beta blocker one time per day is just as effective as 2 times a day

This is because beta blockers decrease aqueous production which doesn't occur at night

Side effects of beta blockers

Fatigue, depression, sexual dysfunction

Breathing difficulties

Congestive heart failure

Changes in BP

Contraindications of beta blockers

Asthma

Chronic obstructive pulmonary disease

Caution in diabetes —> mask hypoglycemia events

Bradycardia

Describe alpha agonists

Neuroprotective? —> now studies show that this is not the case?

Works on uveoscleral pathway for aqueous outflow and also works on aqueous inflow

Fast acting —> but short half life

What are the two major alpha agonists

Alphagan (brimonidine 0.2% or 0.15%)

Alphagan P (brimonidine 0.15% or 0.1% sol)

What is the difference between Alphagan and Alphagan P?

Alphagan P has purite: a preservative that is less allergenic than BAK in Alphagan

What are the side effects of alpha agonists

Tends to cause allergic reaction

Depression

What is a contraindication of an alpha agonist

MAOI —> monoamine oxidase inhibitors (antidepressant)

What is the Rho Kinase Inhibitor for GLC

Rhopressa (netarsudil 0.02% sol)

Describe Rhopressa

Not as effective as prostaglandins

One gtt QHS (every night at bedtime)

Better for NTG (normal tension glaucoma) —> better for people with already low pressures

Neuroprotective?

What are the four combination medications used for GLC

Cosopt

Combigan

Symbrinza

Rocklatan

What is Cosopt

Timolol 0.5% sol + dorzolamide 2% sol

Less effective than separate components in studies but in practice compliance is better

What Is Combigan

timolol 0.5% and brimonidine 0.2% sol

What is Symbrinza

Brinzolamide 1% susp + brimonidine 0.2% sol

What is Rocklatan

Netrasudil 0.02% + latanoprost 0.05% sol

Are combination meds as efficacious as separate components?

NO but compliance is better

What are the components of an allergy gtts

Decongestant: sympathomimetic: conjunctival vessel contraction,angle closure potential

Antihistamine: newer ones tend to be faster and long lasting

Mast cell stabilizer: prevent degranulation and release of histamine

Describe mast cell stabilizers (MCS)

Requires longer tx to be effective —> approx 4 weeks for seasonal allergies

Some symptomatic relief after 3 days —> not good choice by itself for acute allergic conjunctivitis

Examples of MCS

Crolom

alomide

alamast

alocril

Examples of decongestant/antihistamine combo

Opcon A, Naphcon A, Visine A

Note: A stands for antihistamine

Examples of antihistamine/MCS OTC (4)

Alaway, Zaditor (ketotifen 0.025% sol) bid

Pataday Twice Daily (olopatadine 0.1% sol) bid

Pataday Original (olopatadine 0.2% sol) qd

Pataday Extra Strength (olopatadine 0.7% sol) qd

What are alternatives allergy drops

Washing face: removes allergen from skin and lashes

Cold compresses: constrict BV

AT: dilutes and washes away allergen from fornices and tear prism

Weak steroid

What is the weak steroid that can be used as an allergy GTT alternative

Alrex (loteprednol0.2% susp) qid

Describe corticosteroids

Reduce inflammation (inflammation can cause more damage than condition)

Associated with tissue penetration and incidence of SE

What are the side effects of corticosteroids

IOP increase (minimum 2 week duration)

PSC (chronic use) —> posterior subcapsular cataract

Secondary infections

Contraindications of corticosteroids

NEVER during active herpetic infections: allows virus to bloom and geographic scarring of cornea

Use with caution when you do not understand what is happening

Herpes —> great masquerader

What is a very strong steroid

Durezol (Difluprednate 0.05% sol)

One gtt qid, then taper

What aer the strong steroids

Pred Forte

Lotemax

Maxidex

Describe Pred Forte

Strong steroid

Prednisolone acetate 1% susp

Avoid substitution with generic for uveitis

q1hr for "hot" eyes—> very inflamed

q4hr for mild inflammation

Describe Lotemax

Strong steroid

Loteprednol 0.5%susp

Softer steroid: less side effects

Describe Maxidex

Strong steroid —> older

Dexamethasone 0.1% sol

Name the mild steroids

Flarex, FML: fluorometholone 0.1% sol and susp, respectively; less corneal penetration

Pred Mild: prednisolone acetate 0.12% susp Avoid substitution

Alrex

Drugs for pain management

NSAID:

- ibuprofen: up to 200-800 mg po qid

- Acular LS: ketorolac 0.4% sol one gtt qid

Atropine: 1% ophthalmic sol; one gtt bid or tid

Why is atropine used in pain management

Midriatic to immobilize the iris to minimize pain

Describe Uveitis management (4)

Pred Forte 1 gtt q1h OD, OS or OU (specify)

- shake well, no substitutions, call if change

Atropine 1% sol 1 gtt bid OD, OS, or OU (specify)

- homatropine 5% sol 1 gtt bid OD, OS or OU (specify) also an option

F/U in 24-48 hrs

- check AC rxn, symptoms, IOP

Phenylepherine 10% sol in office to break posterior synechiae

What is the point in tapering steroids? When is this important in eye care

To reduce rebound inflammation

Important in uveitis

Less important in other conditions —> one inflammation has subsided, unless inciting agent/event re-occurs, no rebound (ex/ pinguecula)

What are the two taper schedules

Fast:

-qid x 4d, tid x 3d, bid x 2d, qd x 1d

Ow:

-qid x 1wk, tid x 1wk, bid x 1wk, qd x 1 wk

What are the important considerations for Taper

50% reduction in meds at certain times

- q1hr to q2hr

-q3hr to qid

- bid to qd

Harder to over treat, easier to under treat —> control inflammation, then taper

Use beta blocker for IOP, not PGA

What are the two combination antibiotic/steroid

Tobradex (ST) ophthal susp

Zylet ophthal susp

Describe Tobradex (ST) ophthal susp

Tobramycin 0.3% and dexamethasone 0.1% susp, ung

ST: improved suspension technology

What is Zylet ophthal susp

Tobramycin 0.3% and loteprednol 0.5% susp Avoid substitution

What are the preseptal oral antibiotics

Keflex

Augmentin

Zithromax

Describe Keflex

Oral preseptal antibiotic

Cephalexin (250 or 500 mg)

Preseptal: one 500 mg tablet po bid x 10d

Caution if allergic to PCN

Describe Augmentin

Oral preseptal antibiotic

Amoxicillin (250, 500, or 875 mg) + clavulanate (125 mg)

Preseptal: one 500 mg cap po bid x 10d

Caution if allergic to PCN or cephalosporin; take with food

Describe Zithromax

Azythromycin (250, 500, 600 mg)

Two 250 mg caps PO x 1d, one 250 mg cap x 4d

Aka Z-pack

Write a prescription for Keflex for 21 tabs to take twice a day by mouth for 10 days with no refills

Cephalexin 500 mg tabs

21 tabs

Sig: one tab bid po x 10 days

Refills: none

What are the oral antibiotics for blepharitis

Doxycycline

Tetracycline

Describe Doxycycline (and tetracycline)

20, 50, 75, 100, 150 mg pill sizes

For bleph: one 100 mg cap po bid x 7-10d

Chronic use: 20 mg cap po bid x 6 wks

What are the doxycycline/tetracycline contraindications

Not to be used with milk or antacids

Not to be used when younger than 8 —> maybe even younger than 12 —> affects bone and teeth formation

Caution with birth control pills (can affect efficacy)

What are the topical antibiotics

AzaSite

Zymaxid/Vigamox/Besivance

Polytrim

Tobrex

Erythromycin ung

Bacitracin ung

Describe Neomycin

Antibiotic with High allergic potential —> up to 25%

Describe Gentamicin

Antibiotic: 0.3 ophthalmic solution

More toxic and less effective in comparative on to tobramycin

Describe blephamide

Antibiotic

Ophthalmic susp or ung

Sufacetamide 10% + pred acetate 0.2%