Ophthalmic Meds- PNN

Closed vs open angle glaucoma

Open-angle glaucoma MC (90%)

Caused by the slow clogging of the drainage canals--> increased eye pressure

Closed-angle glaucoma (less common)

Caused by blocked drainage canals --> sudden rise in intraocular pressure

Develops very quickly & needs immediate medical attention

How to treat closed-angle glaucoma

IV acetazolamide

Timolol drops, apraclonidine, pilocarpine, prednisolone eye drops

If IOP remains elevated after 30 minutes, can give IV mannitol

Class of medications used for open-angle glaucoma (4)

-Prostaglandin analogues (first-line)

-beta-blockers

-intraocular alpha-2 agonist

-carbonic anhydrase inhibitors

Travoprast brand; when to discard

Travatan; discard 6 weeks after opening

Bimatoprost brand for glaucoma

Lumigan

Bimatoprost brand for eyelash growth. How to apply?

Latisse; apply to eyelid skin, not lash itself

Latanoprost brand and storage

Xalatan; refrigerate unopened; room temp for 6 weeks

Tafluprost brand and storage

Zioptan; refrigerate unopened; store at room temp for 28 days

Side effects of prostaglandin analogues

-darken the iris

-dark circles under the eyes

-eyelash growth and ingrown eye lashes

Beta blockers for glaucoma (4), include brand names

-betaxolol (Betoptic-S)

-carteolol (Ocupress)

-levobunolol (Betagan)

-timolol (Timoptic)

True or false: because beta-blockers for glaucoma are applied topically to the eye, they do not have systemic side effects

false; contraindicated in COPD, bradycardia, asthma, HF, hypotension, and heart block

Carbonic anhydrase inhibitors for glaucoma

-acetazolamide: PO/IV

-brinzolamide (Azopt)

-dorzolamide (Trusopt)

True or false: carbonic anhydrase inhibitors should not be used in patients with sulfa allergy

true

How are prostaglandin analogues vs beta-blockers vs carbonic anhydrase inhibitor eye drops dosed for glaucoma?

-prostaglandin: QHS

-beta-blockers: BID

-carbonic anhydrase: TID

Which beta-blocker is a suspension? Which carbonic anyhdrase inhibitor is a suspension?

betaxolol (Betoptic-S) and brinzolamide (Azopt)

Alpha-2 agonists for glaucoma

-brimonidine (Alphagan P and Mirvaso gel for face)

-aproclinidine (Iopidine)- can also be used for closed-angle

Dorzolamide and timolol brand

Cosopt

Brinzolamide and brimonidine brand

Simbrinza

Brimonidine and timolol brand

Combigan

About how long do mast cell stabilizers take to work?

5-14 days; so monotherapy is not for acute treatment

Mast cell stabilizers generic and brand (3)

cromolyn

nedocromil (Alocril

lodoxamide (Aloide)

What the pure antihistamine eye drops? Generic and brand

Emedastine (Emadine)

Elestat generic

Epinastine

Bepreve generic

Bepotastine

Alcaftadine generic

Lastacraft

Patanol vs pataday

-Patanol is 0.1% BID

-Pataday is 0.2% once daily

OTC antihistamine and mase cell stabilizer

Ketotifen 0.025% (Alway, Zaditor, Claritin Eye, Zyrtec Itchy Eye)

Naphcon-A, Opcon-A, and Visine -A are all OTC combos of which medications?

Pheniramine and naphazoline

Ketorolac 0.5% brand

Acular, Acuvail

What is the rec duration of ophthalmic ketorolac?

-Acular (for conjuctivits): 7 days

-Acuvail (for pain after surgery): 2 weeks

What is the least sedating oral antihistamine?

fexofenadine (Allegra)

What are the ophthalmic corticosteroids (6)? Which has the lowest side effects?

-Prednisolone (Pred Mild)

-Rimexolone (Vexol)-- lowest side effects

-Loteprenol (Lotemax, Alrex)-- lowest side effects

-Flurometholone (FML Forte)

-Difluprednate (Durezol)

-Prednisolone acetate (Pred Forte)

True or false: drops are preferred over ointment in children with bacterial conjunctivitis

false; ointment is preferred

Quinolones for bacterial conjunctivitis

-levofloxacin

-gatifloxacin

-moxifloxacin

-besifloxacin

-ciproloxacin

-oflaxacin

Zymaxid generic

gatifloxacin

Besivance brand

besifloxacin

Which ophthalmic fluoroquinolones comes as a suspension? Which as an ointment?

Besivance is a suspension, Ciloxin as an ointment

Moxifloxacin opthalamic brand

-Vigamox (>1 y/o) TID

-Moxeza (>4 months old) BID

AzaSite generic and storage

-azithromycin

-store in fridge; can be room temp for 14 days

cyclosporine ophthalmic brand

Restasis, Cequa, and Verkazia

Xiidra generic

lifitegrast for dry eyes

Azelastine/fluticasone brand and dosing for allergic rhinitis

Dymista; BID

What are the two nasal corticosteroids that can be used to allergic rhinits?

Fluticasone propionate (Flonase) and triamcinolone (Nasacort)

Immunotherapy for seasonal allergies can given via which routes?

SQ or SL

What are the sublingual allergen extract options (3)

-five-grass pollen (Oralair)

-timothy grass pollen (Grastel)

-Short ragweed pollen (Ragwitek)

Which glaucoma agents (class) increase aqueous outflow, helping to drain the fluid? (4)

-prostaglandin analogs

-alpha-2 adrenergic agonists

-cholinergic agonists

-rho kinase inhibitor (Rhopressa)

Which glaucoma agents (class) suppress aqueous inflow and decrease production of fluid? (3)

-beta-adrenergic blockers

-alpha-2 adrenergic agonists

-carbonic anhydrase inhibitors