Lecture 18: HEENT Drugs

Betaxolol (Betoptic)

MOA: Beta-blocker

• Decrease aqueous humor production by blocking β-receptors in the ciliary epithelium

Indication: Open-angle glaucoma (Adjunct therapy)

SE: Contraindicated in heart block and bradycardia

Brimonidine (Alphagan)

MOA: Alpha-2 agonist

• Decrease aqueous humor production

• Increase uveoscleral outflow

Indication: Open-angle glaucoma (Adjunct therapy)

SE:

• Caution in patients with cerebral or coronary insufficiency, Raynaud
  phenomenon

• Postural hypotension

Dorzolamide (Trusopt)

MOA: Carbonic anhydrase inhibitor

• Inhibits carbonic anhydrase in the ciliary processes of the eye —> decreased bicarbonate ion formation —> decreases sodium and fluid transport —> decreasing aqueous humor production and reduces IOP

Indication: Open-angle glaucoma (Adjunct therapy)

SE: Topical forms much less likely to cause systemic side effects but can cause local irritation and redness

Latanoprost (Xalatan)

MOA: Prostaglandin analogue

• ECM remodeling in the ciliary muscle → allows more aqueous humor to leave via the uveoscleral pathway → lower intraocular pressure

Indication: Open-angle glaucoma (first-line therapy)

SE: Brown discoloration of iris, lengthening and darkening of
eyelashes

Pilocarpine (Isopto Carpine)

MOA: Cholinergic Agonist - Lower IOP by increasing trabecular outflow of aqueous humor

• Stimulate muscarinic receptors → ciliary muscle contractions → open the trabecular meshwork → increase aqueous outflow through Schlemm’s canal → decrease IOP

Indication: Angle-closure glaucoma; open-angle glaucoma

SE:

• Ciliary spasm leading to headaches especially in younger patients

• Myopia

• Dim vision (small pupil)

Netarsudil (Rhopressa)

MOA: Rho kinase inhibitor

• Exact MOA is unknown

  • May reduce IOP by increasing the outflow of aqueous humor through the trabecular meshwork route

Indication: Open-angle glaucoma (Adjunct therapy)

SE: Red eye; ocular irritation

Acyclovir (Zovirax)

MOA: Stop HSV DNA replication (guanosine nucleoside analog)

Indication: ocular HSV

SE: Systemic (oral or IV) can cause nephrotoxicity

Erythromycin ophthalmic ointment (Ilotycin)

MOA: Macrolide antibiotic

Indication: bacterial conjunctivitis

Dose: apply 0.5in (1.25cm) of ointment inside the lower lid or 1-2 drops instilled 4x/day for 5-7 days

• It is reasonable to reduce the dose from 4x/day to 2x/day, if there is improvement in symptoms after a few days

What are the treatment options for external otitis media?

• Otic Antibiotic: aminoglycoside (ex. neomycin/polymyxin B) OR fluoroquinolone (ex. ciprofloxacin)

  • With or without a corticosteroid (ex. hydrocortisone) for infection

• For “malignant external otitis”: prolonged antipseudomonal antibiotic
  with duration of several months typically with IV ciprofloxacin, some patients may be switched to oral

What are the treatment options for acute otitis media?

Antibiotic: DOC amoxicillin OR erythromycin plus sulfonamide for 10 days

What are the treatment options for chronic otitis media?

• Regular removal of infected debris, use of earplugs to protect against water exposure, and topical antibiotic drops (ofloxacin 0.3% or ciprofloxacin/dexamethasone) for exacerbations

• Oral ciprofloxacin, active against Pseudomonas, 500mg twice a day for 1–6 weeks may help dry a chronically discharging ear

Treatment options for acute bacterial rhinosinusitis

Abx should be started in individuals who fail to improve within the 7 days period or those who are immunocompromised

• Initial empiric treatment with amoxicillin or amoxicillin/clavulanate rather than macrolides