Page 932 - TNFlipTest

OP42 Ophthalmology
Common Medications
Toronto Notes 2019
Green Red White
Yellow Blue Purple Teal Orange Tan Grey Pink
Cholinergics Anti-cholinergics Anesthetics, antibiotics, artificial tears, steroids β-blockers
β-blocker combinations α-agonists
Prostaglandins
Carbonic anhydrase inhibitors Fluoroquinolones
NSAIDs Anti-inflammatories, steroids
Common Medications
TOPICAL OCULAR DIAGNOSTIC DRUGS
Fluorescein Dye
• watersolubleorange-yellowdye
• greenundercobaltbluelight(ophthalmoscopeorslit-lamp) • absorbedinareasofepithelialloss(ulcerorabrasion)
• alsostainsmucusandcontactlenses
Rose Bengal Stain
• stainsdevitalizedepithelialcellsandmucus
Anesthetics
• e.g.proparacaineHCl0.5%,tetracaine0.5%
• indications:removalofforeignbodyandsutures,tonometry,examinationofpainfulcornea
• toxictocornealepithelium(inhibitmitosisandmigration)andcanleadtocornealulcerationand
scarring with prolonged use, therefore NEVER prescribe
Mydriatics
• dilatepupils • twoclasses
■ cholinergic blocking (e.g. tropicamide – Mydriacyl®)
◆ dilation plus cycloplegia (loss of accommodation) by paralysis of iris sphincter and the ciliary body ◆ indications: refraction, ophthalmoscopy, therapy for iritis
■ adrenergic stimulating (e.g. phenylephrine HCl 2.5%)
◆ stimulate pupillary dilator muscles, no effect on accommodation ◆ usually used with tropicamide for additive effects
◆ side effects: HTN, tachycardia, arrhythmias
Table 13. Mydriatic Cycloplegic Drugs and Duration of Action
Drugs
Tropicamide (Mydriacyl®) 0.5%, 1% Cyclopentolate HCI 0.5%, 1% Homatropine HBr 1%, 2%
Atropine sulfate 0.5%, 1% Scopolamine HBr 0.25%, 5%
Duration of Action
4-5 h 3-6 h 3-7 d 1-2 wk 1-2 wk
GLAUCOMA MEDICATIONS
Table 14. Glaucoma Medications
Drug Category
α-Agonist
Non-selective
• epinephrine HCl 1% (Epifrin®)
• dipivalyl epinephrine 0.1% (Propine®) α2-selective
• brimonidine 0.2% (Alphagan®)
• apraclonidine 0.5% (Iopidine®)
β-Blocker Non-selective
• timolol (Timoptic®)
• levobunolol (Betagan®) β1-selective
• betaxolol (Betoptic®)
Carbonic Anhydrase Inhibitor
• dorzolamide (Trusopt®)
• brinzolamide (Azopt®)
• oral: acetazolamide (Diamox®), methazolamide (Neptazane®)
Parasympathomimetic (cholinergic stimulating) • pilocarpine (Pilopine®)
• carbachol (Isopto Carbachol®)
Prostaglandin Analogues
• latanoprost (Xalatan®) • travaprost (Travatan®) • bimatoprost (Lumigan®)
Dose
1 gtt OS/OD bid/tid
1 gtt OS/OD qd/bid
1 gtt OS/OD tid Diamox®: 500 mg PO bid
1-2 gtts OS/OD tid/qid
1 gtt OS/OD qhs
Effect
Comment/Side Effects
1. Non-selective: mydriasis, macular edema, tachycardia 2. Selective: contact allergy, hypotension in children
Bronchospasm (caution in asthma/COPD)
Increased CHF
Bradycardia, hypotension, depression, heart block, impotence
Must ask about sulfa allergy
Generally local side effects with topical preparations Oral: diuresis, fatigue, paresthesias, GI upset
Miosis
Reduced night vision
Increased GI motility, brow ache, headache Reduced heart rate
Iris colour change Periorbital skin pigmentation Lash growth
Conjunctival hyperemia
1. Non-selective: reduced aqueous production + increased TM outflow
2. Selective: reduced aqueous production + increased uveoscleral outflow
Reduced aqueous production
Reduced aqueous production
Increased TM outflow
Increased uveoscleral outflow
(uveoscleral responsible for 20% of drainage)
Cosopt® = timolol + dorzolamide; Xalacom® = timolol + lantanoprost; Combigan® = timolol + brimonidine; DuoTrav® = tinolol + travaprost; gtt = drop, gtts = drops