Pharm: Drugs for Ear and Eye Disorders

Agents used to treat Otitis Externa

topical otic anti-infectives

acid-alcohol solutions

otic analgesics

drugs that cause ototoxicity

aspirin/NSAIDS

Antibiotics: aminoglycosides, "mycins"

Antineoplastic: cisplatin, mechlorethamine

Loop diuretics

Anti-infectives without steroids

ofloxacin, neomycin, bacitracin, mupirocin, polymyxin/neomycin/bacitracin

Which topical anti-infective has a side effect of ototoxicity?

neomycin

if you miss a dose for the topical otic anti-infective, you should

use it as soon as possible

do not miss any doses

acid-alcohol solutions provide what 3 types of effects?

topical, antibacterial, and antifungal

antipyrine MOA

affects the prostaglandin system (anti-inflammatory effects)

benzocaine MOA

blocks nerve sodium channel and terminates signal proagation

otic analgesics contraindications

perforation of TM

best antibiotic choice for acute otitis media (AOM)?

amoxicillin

Cerumenolytics are used to treat

cerumen impaction

Cerumenolytics

Carbamide peroxide (Debrox)

triethanolamine polypeptide oleate (Cerumenex)

Cerumenolytics contraindications

perforated eardrum

ear discharge, pain, rash, or irritation around the ear

do not use carbamide peroxide for longer than

4 days

what ocular preparation is effective in infants and children?

erythromycin

When using both ointments and drops for eyes, which one should be used first?

drops first, then ointment

ophthalmic anesthetics

proparacaine

tetracaine

lidocaine

once ophthalmic anesthetics are applied, they starts working within _____ and last up to ______ mins

20-30 seconds, 15 mins

What topical eye agent can cause severe keratitis, opacification, and scarring of the cornea that could result in loss of vision?

proparacaine

What topical eye agent is highly toxic if it enters the systemic circulation?

proparacaine

Patient education for tetracaine

expect a brief burning or stinging sensation when first applied

Ophthalmic agents to treat conjunctivitis

anti-infectives

mast cell stabilizers

antihistamines

vasoconstrictors

Ophthalmic anti-infectives

sulfacetamide

erythromycin

tobramycin

ciprofloxacin

gentamicin

moxifloxacin

What eye agents are bacteriostatic?

sulfacetamide

bacitracin

erythromycin

what eye agents are bactericidal?

fluoroquinolones

polymyxin B

What eye agent is effective against E. coli, Klebsiella, and N. gonorrhea?

sulfacetamide

What eye agent has a wide spectrum of activity that makes it useful against both gram positive and gram negative bacteria?

bacitracin

What eye agent is useful against gram positive organisms such as strep and diptheria?

erythromycin

What eye agent is effective against pseudomonas?

fluoroquinolones

What agent is used in ophthalmic preparations because of its high affinity for phospholipids in the cell wall?

polymyxin B

tobramycin should not be used in conjunction with

systemic aminoglycosides

What ophthalmic agent can create a white crystalline deposit along the edges of the cornea?

floroquinolones

Ophthalmic mast cell stabilizers

nedocromil

cromolyn

lodoxamide

Ophthalmic mast cell stabilizers can also be found in combinations with ______ or _______. to further reduce inflammation

prednisolone or dexamethasone (corticosteroids)

Ophthalmic mast cell stabilizers clinical use

allergic conjunctivitis

Ophthalmic antihistamines

azelastine

epinastine

emedastine

ketotifen

levocabastine

olopatadine

Ophthalmic antihistamines MOA

noncompetitive H1-receptor antagonist and mast cell stabilizer properties

Ophthalmic antihistamines patient education

wait at least 15 mins after administration before re-inserting contact lenses

ophthalmic vasoconstrictors

naphazoline, oxymetazoline, tetrahydrozoline

ophthalmic vasoconstrictors adverse reactions

rebound redness (with freq administration)

ophthalmic vasoconstrictors contraindications

narrow angle glaucoma

Demulcents (ophthalmic lubricant) MOA

form a protective film on the ocular surface to allow epithelial repair

Hygroscopic agents (ophthalmic lubricant) MOA

draw water into corneal cells to protect against hyperosmotic stress

hypertonicity agents (ophthalmic lubricant) MOA

placed in ocular lubricants for the relief of corneal edema

polymers (ophthalmic lubricant) MOA

viscosity-increasing agents that bind to natural tears and to the mucosal surface of the eye to form a protective, lubricant film.

surfactants (ophthalmic lubricant) MOA

surface active agents that act as wetting agents to lower fluid surface tension and lubricate the eye

Ophthalmic lubricants clinical uses

dry eyes or wash away eye irritations

primary glaucoma treatment

rapid intervention with acetazolamide and pilocarpine, and osmotic agents (mannitol IV)

Direct-acting and indirect-acting miotics (glaucoma)

echothiophate powder, carbachol, pilocarpine

Direct-acting and indirect-acting miotics (glaucoma) MOA

constriction of pupil

opens canal of Schlemm, increases outflow of aqueous humor, decreases IOP

Pilocarpine can also be used to treat dryness of eyes caused by

Sjogrens syndrome

Direct-acting and indirect-acting miotics (glaucoma) adverse reactions

blurry vision

topical prostaglandin agonists (glaucoma)

latanoprost, bimatoprost, travoprost, unoprostone

topical prostaglandin agonists (glaucoma) MOA

increases outflow of aqueous humor

Latanoprost and bimatoprost are absorbed through the ______, then are hydrolyzed to become active

cornea

What 2 topical prostaglandin agonists are active once on the cornea?

travoprost and unoprostone

topical prostaglandin agonists (glaucoma) clinical use

open-angle glaucoma

topical prostaglandin agonists (glaucoma) adverse reactions

sensation of FB in the eye

eyelash changes

conjunctival hyperemia

systemic adverse reactions of topical prostaglandin agonists (glaucoma)

bronchospasm and hyperemia

topical prostaglandin agonists (glaucoma) are labeled pregnancy category C and should not be used during

lactation

Carbonic Anhydrase Inhibitors (glaucoma)

brinzolamide

dorzolamide

methazolamide

acetazolamide

clinical use of Carbonic Anhydrase Inhibitors (glaucoma)

open-angle glaucoma

Dorzolamide and brinzolamide (CA Inhibitors) adverse reactions

burning sensation, eye discomfort, blurred vision, eye redness, lacrimation, photophobia, xerophthalmia

Carbonic Anhydrase Inhibitors general adverse reaction

rash

Dorzolamide and brinzolamide (CA Inhibitors) have an adverse reaction of

bitter or altered sense of taste

Acetazolamide adverse reaction

crystalluria

carbonic anhydrase inhibitors contraindications

allergy or sensitivity to sulfonamides

Sympathomimetic agents (glaucoma)

dipivefrin

epinephrine

Sympathomimetic agents (glaucoma) MOA

decreases aqueous humor production

constricts blood vessels, thus increasing intraocular fluid outflow

Sympathomimetic agents can also be used to treat

ocular HTN

Sympathomimetic agents adverse reactions

stinging, eye irritation, increase in tears, and brow pain.

Therapy with dipivefrin should be stopped prior to a patient receiving

general anesthesia

Alpha-2 adrenergic agonists

Apraclonidine, brimonidine

Alpha-2 adrenergic agonists adverse reactions

lid retraction, mydriasis, local irritation, dry mouth, allergic conjunctivitis

drowsiness, FB sensation

Alpha-2 adrenergic agonists should not be used with ______ bc of potential hypertensive crisis

MAOIs

Alpha-2 adrenergic agonists contraindications

concurrent use of MAOIs

children under 2

what are the most commonly used agents to treat open-angle glaucoma?

beta blockers

beta blockers (glaucoma)

betaxolol

carteolol

levobunolol

timolol

beta blockers (for glaucoma) adverse effects

burning and stinging upon application, blurred vision, corneal staining, eye pruritus

bradycardia, hypotension

bronchospasm after long-term use

Ophthalmic osmotics

mannitol

Mannitol clinical uses

treatment of edema

reduction of oliguric renal failure

reduction of intracranial and intraocular pressure

Mannitol adverse reactions

blurred vision, rebound increased IOP, transient volume expansion, chest pain, tachycardia, nausea, vomiting, thirst, dehydration, hyper/hypokalemia, hyper/hyponatremia

What is the term that describes the paralysis of the accommodation reflex?

cycloplegia

agents used for pupillary dilation are _______ antagonists

muscarinic

agents used for pupillary dilation adverse reactions

blurry vision, photophobia

agents used for pupillary dilation contraindications

closed-angle glaucoma

infants under 3 months of age

Patient education for pupillary dilation agents

do not operate heavy machinery or drive until affects have worn off

mitotics work to _______ the pupil

constrict

agents used for pupillary dilation:

cyclopentolate, homatropine, tropicamide

which agent is used for pupillary dilation/cycloplegic refraction in children?

homatropine