pharm 2 - ENT and eyes

Goal for glaucoma treatment

decrease intraocular pressure

can do it 2 ways:

1. decrease aqueous production

2. increase aqueous outflow

Topical Beta Blockers MOA and indication

MOA:

-lowers intraocular pressure by decreasing aqueous production

Indication:

-1st line for glaucoma

drug names:

-Timolol

-Betaxolol

-Levobunolol

-Carteolol

Topical Beta Blockers ADEs

ocular stinging

heart block

bradycardia

bronchospasm

1 drop timolol = timolol 10mg PO!!!

Topical Prostaglandin Analogs MOA & Indication

MOA:

-lowers intraocular pressure by increasing aqueous humor outflow

Indications:

-1st line for glaucoma

drug names:

-Latanoprost

-Tavoprost

-Bimatoprost

-Tafluprost

Topical Prostaglandin Analogs ADEs

brown pigmentation of iris

may increase length and thickness of eyelashes (Latisse)

drug names:

-Latanoprost

-Tavoprost

-Bimatoprost

-Tafluprost

Topical Alpha Adrenergic Agonists MOA and Indication

MOA:

-lowers intraocular pressure by decreasing aqueous production

Indication:

-reduction of IOP in glaucoma or ocular hypertension

drug names:

-Apraclonidine

-Brimonidine

Topical Alpha Adrenergic Agonists ADEs and pt education

ADEs:

-dry mouth

-ocular hyperemia

-ocular stinging

Pt education:

-wait 15 min before inserting contacts

drug names:

-Apraclonidine

-Brimonidine (drowsiness, fatigue, hypotension)

Topical Cholinergics MOA and indication

MOA:

-lowers intraocular pressure by increasing aqueous outflow

Indication:

-second/last-line for glaucoma

drug names:

-Pilocarpine

-Echothiophate

Topical Cholinergics ADEs and contraindications:

ADEs:

-lens focused to near vision

-retinal detachment

-decreased visual acuity

Contraindications:

-caution in asthma or bradycardia

drug names:

-Pilocarpine

-Echothiophate

Topical Carbonic Anhydrase Inhibitors MOA and indication

MOA:

-lowers intraocular pressure by decreasing aqueous production

Indication:

-adjunct or alternative for glaucoma

drug names:

-Dorzolamide

-Brinzolamide

Topical Carbonic Anhydrase Inhibitors ADEs and pt education

ADEs:

-ocular stinging and bitter taste

-conjunctivitis

-photophobia

Pt education:

-wait 15 min before contacts

drug names:

-Dorzolamide

-Brinzolamide

Topical Rho Kinase Inhibitors MOA, indications, ADEs

MOA:

-lowers intraocular pressure by increasing aqueous outflow

Indication:

-glaucoma

-elevated IOP

ADE:

-subconjunctival hemorrhage

drug name:

-Netarsudil

Intravitreal VEGF inhibitors MOA and indication

MOA:

-inhibits formation of new blood vessels behind retina and may keep retina free of leakage

Indication:

-Macular degeneration

*given intravitreally*

drug names:

-Bevacizumab

-Ranibizumab

-Aflibercept

Intravitreal VEGF inhibitors ADEs

ADEs:

-eye infection

-increased IOP

-retinal detachment

-floaters

drug names:

-Bevacizumab

-Ranibizumab

-Aflibercept

Topical decongestants MOA and ADEs

MOA:

-weak adrenergic agonists that construct dilated blood vessels

ADEs:

-rare systemic, ocular stinging

drug names:

-Phenylephrine

-Naphazoline

-Oxymetazoline

-Tetrahydrozoline

Topical Steroids indication and ADEs

Indication:

-inflammatory disorders of eye

-uveitis

-iritis

-conjunctivitis

ADEs:

-cataracts

-reduced visual acuity

-glaucoma

-infection when long term

drug names:

-Prednisolone

-Difluprednate

-Dexamethasone

Topical NSAIs indication

post-op complication

ocular pain

drug names:

-Ketorolac

-Nepafenac

-Bromfenac

Topical Antihistamine indication

allergic conjunctivitis

drug names:

-Olopatedine

-Ketotifen

Artificial tears indication

dry eyes

aging

post-op

General eye drop education

COMPLIANCE

Check labels for benzalkonium (preservative) which can be absorbed by contact lenses - wait 15 min

-decrease absorption of medicine in eye

Close eye 3 min after administering

Cyclosporine MOA and indication

MOA:

-suppress immune response and promote resumption of tear production

Indication:

-dry eye

Eyedrops must be __________ and ear drop are often ___________

STERILE

ACIDIC

eye drops generally can be used in the ears but ear drops should NEVER be used in eyes

Carbamide Peroxide MOA and indication

MOA:

-releases hydrogen peroxide and softens impacted cerumen due to foaming action

Indication:

-ear wax removal

Carbamide Peroxide pt education

1. tilt head sideways

2. apply drops and keep in ear for several minutes

3. flush ear with warm water using bulb ear syringe

Mineral oil MOA and indication

MOA:

-loosens ear wax until it comes out on its own or with lavage

Indication:

-can be used every other day or on weekly basis for obstruction prevention

Evidence is AGAINST cotton swabs or other instruments in ear canal

-water trapped behind earwax can lead to infection

Topical Antibiotic ear drops MOA and indication

MOA:

-Ciprofloxacin/ofloxacin: inhibits DNA gyrase

-Dexamethasone: decreases inflammation

Indication:

-acute otitis externa (swimmers ear)

-otitis media (in pts with tubes)

drug names:

-Ciprofloxacin/dexamethasone

-Oflaxacin

Topical Antibiotic ear drops ADEs and ot education

ADEs:

-bacterial superinfection

-tendon inflammation

Pt education:

-warm solution for 1-2 min, lie down w affected ear up, remain in position for 5 min

-if infection >1wk, contact provider

drug names:

-Ciprofloxacin/dexamethasone

-Oflaxacin