Yali's quizlet: Drugs Affecting the Eyes, Ears and Skin

Atropine MOA

• Blocks the effect of

acetycholine in the

central nervous

system

• Produces mydriasis

(dilation) and

prevents

accommodation of

near vision

Atropine indication/use

• Dilation in acute

conditions of the

iris and uveal tract

• For eye exams

(measurement of

refractive errors)

• Treatment of

uveitis

Atropine contraindications

• Presence of

glaucoma

Atropine AE

• May cause stinging

• Careful of

potential systemic

effects

phenylephrine MOA

• Contraction of

dilator muscles of

pupil

• Produces mydriasis

(dilation),

vasoconstriction and

increased outflow of

aqueous humor

phenylephrine indication/use

• For eye exams

(measurement of

refractive errors)

• Treatment of wide-

angle glaucoma

• Relief of redness

with eye irritation

phenylephrine contraindications

• Hypersensitivity

reactions

• Hypertension

• Ventricular

tachycardia

• Narrow-angle

glaucoma

phenylephrine AE

• Careful of potential

systemic effects

• Dysrhythmia,

hypertension,

myocardial

infarction,

syncope,

subarachnoid

bleed

Lidocaine MOA

• Decreases neuron

membrane

permeability to

sodium

• Blocks the

initiation and

conduction of

nerve impulses

Lidocaine indication/use

• Local anesthesia

during ophthalmic

procedures

• Surgery,

tonometry, etc.

• Treatment of

uveitis

Lidocaine contraindications

• hypersensitivity

Lidocaine AE

• May cause burning

• Conjunctival

hyperemia, corneal

epithelial changes,

diplopia and

changes in vision

bimatoprost MOA

• Decreases

intraocular

pressure by

Increasing outflow

of aqueous humor

bimatoprost indication/use

• Open angle

glaucoma

• Ocular

hypertension

• Hypotrichosis of

eyelashes (unable

to grow)

bimatoprost contraindications

• Hypersensitivity

bimatoprost AE

• Iris and eyelid

hyperpigmentation

timolol maleate MOA

• Reduces aqueous

humor production

• Increase outflow

timolol maleate indication/use

• Chronic open angle

glaucoma

• Aphakic glaucoma

• Ocular

hypertension

timolol maleate contraindications

• Known

hypersensitivity

• Asthma, COPD

• Heart failure,

bradycardia, AV

block, left

ventricular

dysfunction,

cardiogenic shock

timolol maleate AE

• May cause stinging

• Careful of

potential systemic

effects

brimonidine MOA

• Reduces aqueous humor

production

• Increases uveoscleral

outflow

brimonidine indication/use

• Open angle glaucoma

• Ocular hypertension

brimonidine contraindications

• Known hypersensitivity

• Use within 14 days of

MAO inhibitor

• Caution in patients with

advanced cardiovascular

disease

brimonidine AE

• Hyper or hypotension,

bradycardia

• Headache, dizziness,

somnolence, diminished

attention and alertness,

insomnia

• Bronchitis, cough,

dyspnea, nasal dryness,

apnea

• Stinging and burning of

eye, dryness, irritation,

eye pain

pilocarpine MOA

• Stimulates cholinergic

receptors in the eye

• Causes miosis, loss of

accommodation,

lowering of intraocular

pressure

pilocarpine indication/use

• Chronic glaucoma

• Angle-closure

glaucoma

pilocarpine contradindications

• Known hypersensitivity

• Acute inflammation of the anterior chamber

pilocarpine AE

• Stinging and burning of eye, lacrimation, ciliary spasm, lens opacity, retinal detachment,

myopia, diminished

visual acuity

• Headache

• Hypertension,

tachycardia, bronchial

spasm, pulmonary

edema

acetazolamide MOA

• Inhibits carbonic

anhydrase in the

eye

• Reduce aqueous

humor production

acetazolamide indication/use

• Open angle

glaucoma

acetazolamide contraindications

• Known

hypersensitivity

• Caution in

• children- growth

retardation

• Older adults

with kidney or

liver dysfunction

acetazolamide AE

• Stevens-Johnson

syndrome

• Agranulocytosis,

hemolytic anemia,

aplastic anemia,

leukopenia,

pancytopenia

• Metabolic acidosis

mannitol MOA

• Creates osmotic

gradient between

plasma and ocular

fields

mannitol indication/use

• Acute attacks of

glaucoma

• Reduce IOP prior

to surgery

mannitol contraindications

• Severe

dehydration,

abdominal pain,

pulmonary edema,

cardiac

decompensation

mannitol AE

• Hyperosmolar

nonketotic coma

• Confusion,

headache

• Dysrhythmias

• Nausea, vomiting,

dehydration

Ciprofloxacin MOA

• Bactericidal agents

(cell death)

• Interferes with

enzymes required

for synthesis of

bacterial DNA

Ciprofloxacin indication/use

• Aerobic Gram(-)

organisms

• Respiratory, GI and

GU infections;

bones, joints and

skin infections

Ciprofloxacin contraindications

• Partially

metabolized by

liver

Ciprofloxacin AE

• Nausea, vomiting,

abdominal

discomfort

• Photosensitivity

• BLACK BOX-

Tendonitis,

peripheral

neuropathy, cardiac

effects,

hypersensitivity

reactions

trifluridine MAO

• Interferes with viral

replication

trifluridine indication/use

• Primary

keratoconjunctivitis

• Recurrent epithelial

keratitis caused by

HSV 1 and 2

trifluridine contraindications

• Known

hypersensitivity

trifluridine AE

• Increased IOP

• Palpebral edema

• Stromal edema

natamycin MOA

• Increases cellular

permeability to

susceptible fungi

natamycin indication/use

• Blepharitis,

conjunctivitis,

keratitis

natamycin contraindications

• Known

hypersensitivity

natamycin AE

• Hypersensitivity

and allergic

reactions

• Chest pain

• Opacity of the

cornea, eye pain,

edema, hyperemia,

foreign body

sensation, tearing,

visual changes

• dyspnea

cromolyn sodium MOA

• Reduces the release

of leukotrienes

cromolyn sodium indication/use

• Vernal keratitis,

conjunctivitis,

keratoconjunctivitis

cromolyn sodium contraindications

• Known

hypersensitivity

• Pregnancy

cromolyn sodium AE

• Eye effects- edema,

dryness, irritation,

itching, rash and

tearing

• May develop styes

emedastine difumarate MOA

emedastine difumarate MOA

emedastine difumarate indication/use

• Seasonal allergic

conjunctivitis

emedastine difumarate contraindications

• Known

hypersensitivity

emedastine difumarate AE

• Eye effects-

burning, stinging,

blurring of vision

• Fatigue, asthma,

shortness of

breath

• May develop styes

neomycin-polymyxin B-hydrocortisone MOA

• Each component has its own MOA

• Neomycin-

aminoglycoside, inhibits

bacterial protein

synthesis

• Polymyxin B- changes

bacterial cell membrane

permeability

• Hydrocortisone- steroid,

decreases inflammation

neomycin-polymyxin B-hydrocortisone indication/use

• Acute otitis externa

caused by P. aeruginosa,

Proteus and S. aureus

neomycin-polymyxin B-hydrocortisone contraindications

• Known hypersensitivity

neomycin-polymyxin B-hydrocortisone AE

• Burning, stinging

Amoxicillin MOA

• Inhibits bacterial

wall synthesis

• Binds to proteins

Amoxicillin indication/use

• Both gram + and

gram - bacterial

infections

• Skin, soft tissue,

respiratory, GI and

GU infections

• Often given with

aminoglycosides for

serious infections

Amoxicillin AE

• hypersensitivity to

drugs

• GI effects

• development of

superinfections.

Amoxicillin contraindications

• Potential cross-

allergy with

cephalosporins

Topical Corticosteroids MOA

• block production

of IL-1

• Decrease

accumulation of

lymphocytes and

macrophages

• Suppress release

of cytokines,

histamine,

prostaglandin

Topical Corticosteroids indication/use

• Treat

inflammation with

dermatologic

disorders

• Reduce erythema

• Reduce psoriasis

and seborrheic

dermatitis

• Reduce pruritis

Topical Corticosteroids contraindications

• Hypersensitivity a

Topical Corticosteroids AE

• Hypersensitivity

at site of

administration

• High potency can

produce Cushing

syndrome

Cephalosporins MOA

• Inhibits bacterial

wall synthesis

• Binds to one or

more penicillin-

binding proteins

• Wide distribution

• Therapeutic

concentrations

achieved in most

body fluids

Cephalosporins indication/use

• Surgical prophylaxis

• Skin, soft tissue,

respiratory, bones

and joints, urinary

tract, brain and

spinal cord,

septicemia (Sepsis)

Cephalosporins contraindications

• Max concentrations

in liver and kidneys

• Crosses placenta

• Contraindicated in

previous

anaphylactic

reaction to PCN

• Cross-sensitivity

• Contraindicated in

Cephalosporin

allergy

Cephalosporins AE

• Abdominal pain, diarrhea, gastritis, nausea, and vomiting

• Hypersensitivity reactions and superinfections

tetracycline MOA

• Tetracyclines

• Penetrate microbial cells,

inhibiting protein synthesis

• Oral route is effective and preferred.

tetracycline indication/use

• Broad spectrum Gram- and

gram+

• Drug of choice in specific infections

• Cholera, Rocky Mountain spotted fever, syphilis,

typhus, H. pylori, etc.

• Useful in animal bites,

Lyme's disease

• Chlamydia infections,

adjunct in STD treatment,

prophylaxis/treatment of anthrax

• Long-term acne treatment,

substitute for PCN in

hypersensitivity.

tetracycline contraindications

• Contraindicated during

pregnancy or in children less

than 8 yo

• may harm the unborn baby

or cause permanent tooth

discoloration later in the

baby's life

tetracycline AE

• Hypersensitivity reactions

• Tooth discoloration

Nystatin MOA

•Binds with ergosterol

•Changes permeability of

cell membrane

•Promotes leakage of the

cellular contents

Nystatin indication/use

•Topical infection- Nystatin

•Systemic infection-

Amphotericin B

•candidiasis, endocarditis,

histoplasmosis, septicemia

Nystatin contraindications

•Measure/follow vital signs

•Typically, central line

administration

•Labs

•BUN, creatinine

•AST, ALT, Bilirubin

•Patient teaching-

•Takes several weeks to

see effect

•good hygiene to prevent

reinfection or spread

Nystatin AE

•BLACK BOX- amphotericin

only for potentially fatal

infections

•Fever, chills, malaise,

muscle and joint pain,

N/V, anorexia, H/A

•Hypotension, Tachycardia

•Extravasation, flushing,

skin rash

•Thrombocytopenia,

agranulocytosis

•Tinnitus, diplopia

•Renal/hepatotoxicity

Acyclovir MOA

• Inhibits DNA

polymerase,

interrupting viral DNA

replication

• Reduces viral

shedding

• Prevent formation of

new lesions

Acyclovir indication/use

• Recurrent HSV and

VZV infections in

immunocompromised

patients

• Genital herpes

Acyclovir contraindication

• Known hypersensitive

• Heart failure

• Kidney disease

• lactation

Acyclovir AE

• Malaise, headache,

nausea, vomiting

• Renal toxicity

diphenhydramine MOA

• Structurally related to

Histamine- occupy

receptor sites

• Prevent/reduce most

physiologic effects that

histamine produces at

receptor sites

• Inhibit effects of

histamine including:

vascular permeability,

edema formation,

bronchoconstriction

and pruritis

diphenhydramine indication/use

• Diphenhydramine

(Benadryl) is prototype;

hydroxyzine pamoate

(Vistaril, Atarax);

promethazine

(Phenergan).

• Hypersensitivity

reactions (Allergic

rhinitis, conjunctivitis,

dermatitis)

• Motion sickness

• Insomnia

• Parkinsonism

diphenhydramine contraindications

• Pregnancy or lactation

• Used with caution in

renal and hepatic

impairment pts,

arrhythmias or

prolonged QT intervals.

• In MANY OTC products

so watch for concurrent

use/overdose.

• Young children may have

paradoxical effect

• May cause confusion,

dizziness or syncope in

older adults

• Difficulty voiding with

BPH

diphenhydramine AE

• High incidence of

drowsiness and

anticholinergic effects

cetirizine MOA

• Bind preferentially to

peripheral rather than

central H1 receptors

• Histamine receptor

sites in GI tract, blood

vessels and respiratory

tract

• Do not readily enter

the brain from the

blood

• Onset of action is

within 1 hour; peak

serum levels achieved

in 2 to 3 hours

cetirizine indication/use

• Supplanting the first-

generation H1 receptor

antagonists in the

symptomatic

treatment of allergic

rhinitis and in the relief

of pruritus in urticaria

• Have a mild beneficial

effect in chronic

asthma

cetirizine contraindications

• Known sensitivity

• Older adults causes

sedation and renal

function

• Less likely to impair

mentation in older

adults

cetirizine AE

• Drowsiness

• Headache

• Dizziness

• Nausea

• Vomiting

• Fatigue

isotretinoin MOA

• Suppresses sebum

production by

normalizing

keratinization and

decreasing size of

sebaceous glands

• Inhibits comedone

formation, inhibits

inflammation

• decrease severity and

number of lesions

isotretinoin indication/use

• Moderate to severe

acne

• Severe recalcitrant

nodular acne

isotretinoin contraindications

• Known sensitivity

• Pregnancy-

teratogenicity

• Two negative

pregnancy tests,

strict contraceptive

measures

• iPLEDGE program

isotretinoin AE

• Most common-

Erythema, Peeling,

dryness, Burning

• BLACK BOX-

Spontaneous

abortion, life-

threatening

congenital anomalies

• Depression,

psychosis, changes in

mood

• GI effects