Ocular Pharm

Direct topical administration

Drug needs to dissolve in tear film, lose a lot of the drug through the nasolacrimal duct

Solutions

Drugs dissolved in a solute

Advantage of solutions

Less effect on cision

Less incidence of contact dermatitis

Less toxic to ocular structure

Easy to apply

Disadvantage of using solutions

Short contact time

Dilution effects

Increased systemic absorption

Suspension

drugs suspended in a solute: solid particles

Large particle suspension

Relatively smaller surface area with lower availability

Smaller particles suspension

Higher availability but more rapid elution from ocular surface

Ointment

Drugs suspended in oil (80%)

Ointment advantages

Longer contact time

Not diluted

Protect cornea from drying

less expensive

Ointment disadvantage

Difficult to dose precisely

Increase ocular discharge

More difficult to administer and more contact dermatitis

May delay wound healing-relatively poor availability

How can infections of eye manifest

Conjunctivitis, keratitis, endophthalmitis

How do you get highest concentration to eye

Deliver drug directly to the eye

Triple Antibiotic ointments

Bacitracin/gramicidin, polymyxin B, Neomycin

Neomycin/polymyxin B dexamethasone

do not penetrate cornea

Triple antibiotic ointment indication

Broad spectrum combination for conjunctivitis, endophthalmitis, keratitis

Ocular surface inflammation and secondary bacterial infection

Aminoglycosides

Gentamicin, tobramycin and neomycin in combo

Aminoglycoside indications

Blepharitis, conjunctivitis, corneal ulcer,keratitis

Tobramycin-pseudomonas

Aminoglycoside adverse effect

Decrease wound healing for gentamicin

Oxytetracycline broad spectrum indication

Conjunctivitis, corneal ulcer, infectious fleine conjunctivits, and infectious keratoconjunctivitis in cattle

Oral doxycycline beneficial Chlamydofila felis

Increased corneal epithelial wound healing

Fluoroquinolones

Ciprofloxacin, gatifloxacinm levofloxacin,moxifloxacin, ofloxacin

Fluoroquinolone indication

Conjunctivitis, keratitis, aminoglycoside resistant pseudomonas

Ocular surface and intraocular infections

Chloramphenicol Broad spectrum indication

Conjunctivitis, keratitis, mycoplasma and chlamydofila, less effective against Pseudomonas and other gram - bacteria

PENETRATES INTACT CORNEA

Polyene antibiotics

Natamycin and Amphotericin B

Polyene antibiotics route of administration

Subconjunctival

Indications of Polyene antibiotics

Confirmed Ulcerative keratomycosis

Adverse effects of Polyene antibiotics

Local irritation

Azole Route of administration-Topical

voriconazole, miconazole, itraconazole

Azole Route of Administration-oral

Ketoconazole,fluconazole

Azole indications

Ulcerative and non-ulcerative keratomycosis

Azole Adverse effects

all azoles have minimal local irritation

Antiviral drugs on the eye are used for

Feline herpesvirus 1 infection

Route of administration antiviral drugs on eye-topical

Trif;uridine and idoxuridine (5-8 times/ day)

Vidarabine (5-8 times/ day)

Cidofovir (q12 hrs)

Antiviral drugs on eyes-oral

Famciclovir

Adverse effects of antiviral drugs on eyes

Ocular irritation might occur with topical administration

General treatment of corneal ulcers

Broad spectrum

Antifungal

Atropine to reduce pain and prevent adhesions in eye

Antiproteinases

Specific treatment of corneal ulcer

Antiproteinases

Autologous serum

Antitrypsin and macroglobulins

Chelation of MMP cofactors calcium and zinc for specific treatment corneal ulcers

Tetracyclines, N acetylcysteine, Disodium EDTA, systemic doxycycline and topic serum

Glaucoma General options I Beta adrenerfic antagonists

Timolol and betaxolol

Indications of timolol and betaxolol

Maintenance therapy Q12 hours topical

Adverse effect Timolol and Betaxolol

Systemic absorbed, bradycardia, systemic hypotension, exacerbation of asthma and compensated heart disease

Glaucoma general treatment options II carbonic anhydrase inhibitor

Dorzolamide and brinzolamide

Indications of dorzolamide and brinzolamide

Maintenance therapy Q8 hr topical

Emergency q15-30min

Adverse effects Dorzolamide and brinzolamide

Local ocular discomfort-brinzolamide better tolerated

Glaucoma general treatment options III prostaglandine analogues

Latanoprost, latanoprostene bunod, bimatoprost, travoprost

Effects of Prostaglandine analogue for glaucoma general treatment

Increasing uveoscleral non-conventional outflow

Latanoprostene bunod: uveoscleral and trabecular conventional outflow

Prodrugs converted by ocular esterases to active compounds

Glaucoma general treatment options II indication

Maintenance Q12-24 hours

Emergency Q 30 min

Which species do you not use Glaucome general treatment II on

Cats and horses

Adverse effects of Glaucoma general treatment options II

Conjuncyival hyperaemia, mark myosis in dogs, contradicted in secondary glaucoma anterior lens luxation, uveitis

Glaucoma general treatment options- IV osmotic diuretics

Mannitol IV;glycerol for oral

Mannitol indication

IV administration over 15-20 min

Management of acute primary glaucoma ONLY

Mannitol adverse effects

Not for anterior uveitis

Do not use in cardiovascular or renal disease

glaucoma general treatment options- V parasympathomimetic

Pilocaprine and demecarium bromide

Pilocaprine and demecarium bromide indications

Maintenance therapy : Q6-8 hours topical

Effective 30-40 % of dogs

increased tear production-neurogenic

Keratoconjunctivitis sicca

Glaucoma general treatment options-IV

Latanoprost, Dorzolamide w/out timolol, Dorzolamide +timolol+latanoprost

Glucocorticoids as antiinflammatory adverse

Do not use on a damaged cornea, contradicted in corneal ulceration

NSAID as antiinflammatory

topical or systemic

Diclofenac, flubiprofen, ketoroloc

Immunomodulators as anti-inflammatory drugs and indication

Cyclosporin A,tacrolimusm pimecrolimus

Equine recurrent uveitis, and keratoconjunctivitis sicca