NSAIDs
Examples
Indications
Diclofenac (Voltaren) Ketorlac tromethamine (Acular)
-used for analgesia, antipyretics, and anti-inflammatory effects
(do not affect IOP, not for long term use- can cause corneal injury)
Corticosteroids
Who uses them
MOA
Indications
- reserved for the ophthalmologist.
- reduce inflammation and decrease edema
Indications
-treatment of steroid responsive inflammatory conditions. Ex. acute iritis, stromal keratitis, chemical burns, episcleritis/scleritis
Corticosteroids
Examples
- Prenisolone acetate (Pred Forte)
- Prednisolone sodium phosphate (Inflamase Forte, Metreton)
- Dexamethasone/Tobramycin (Tobradex)»> This is a steroid/ antibiotic combo (overkill)
- Dexamethasone
- Fluorometholone (Flarex)
- Fluorometholone (FML-Forte)
Corticosteroids
SE
CI
SE
- Mydriasis, ptosis, inhibition of corneal epithelium or stromal healing
- Repeated use or long term use hazards: cataracts, corneal thinning and/or rupture, glaucoma leading to optic neuritis, immunosuppression (increased infections), keratitis
*reserve steroid for short term use
CI
- viral disease of the cornea or conjunctiva (herpes simplex Keratitis)
- mycobacterial or fungal infections of the eye
**leave for ophtho to prescribe
Agents for glaucoma
1st line
2nd line
Add ons
1st line- Prostaglandin analogs 2nd line-Beta blockers Add ons -alpha adrenergic agonists -cholinergic agonists -carbonic anhydrous inhibitors
Prostaglandin Analogs MOA Examples SE May interact with systemic what?
MOA
-increase uveoscleral outflow of the aquous
Ex.
Latanoprost (Xalatan)
Bimatoprost (Lumigan)
Tafluprost (Zioptan)
SE
- Decreased VA
- eye discomfort
- dry eye
- FB sensation
- can change color of iris?
–May interact with systemic NSAIDs by decreasing or increasing ophthalmic effects
Beta Blockers MOA Examples SE CI
MOA
-may decrease aqueous humor formation or increase outflow
Ex. Betaxolol (Betoptic)- selectively blocks beta1-adrenergic receptors with little or no effect on beta2-receptors Timolol maleate (Timoptic)-nonselective beta-adrenergic receptor Levobunolol (Betagan)- nonselective beta-adrenergic receptor
SE
-adverse effects are due to systemic absorption of the drug»> decreased cardiac output, bronchoconstriction/bronchospasm, bradycardia, heart block, hypotension
CI
- Asthma
- severe COPD
- sinus bradycardia
- second and third degree AV block
- Overt cardiac failure
Alpha Adrenergic Agonists
MOA
Examples
SE
MOA
-reduce IOP by increasing outflow and reducing production of aqueous humor
Ex.
Brimonidine (Alphagan P)- selective alpha2- receptor
Apraclonidine (Iopidine)- selective for alpha2-receptor with minimal cross-reactivity to alpha1-receptors
SE
-dry mouth, allergic conjunctivitis, redness, ocular pruritus
**Effective but not commonly used due to side effects. Many drug interactions
Cholinergic Agonists
MOA
Examples
SE
MOA
-Contract ciliary muscle, tightening trabecular meshwork and allowing increased outflow of the aqueous. Miosis results from action of these drugs on pupillary sphincter
Ex.
Pilocarpine (pilocar, Pilagan)- mimics muscarinic effects of acteylcholine at post ganglionic parasympathetic nerves. Diretly stimulates cholinergic receptors in the eye, decreasing resistance to aqueous humor outflow
SE
- Brow ache
- Induced myopia
- decreased vision in low light
Carbonic Anhydrase Inhibitors
MOA
Examples
SE
MOA
- reduce secretion of aqueous humor by inhibiting carbonic anhydrase in ciliary body.
- duration of action is shorter than many other classes of drugs
Ex.
Dorzolamide HCl (Trusopt)
Brinzolamide (Azopt)
SE
- Rare
- superficial puncatate keratitis
- nausea, depression, fatigue
*Do not appear ro be as effective as other therapies
How long should you wait between administering different topical ophthalmic drugs?
10 minutes!
What would you be careful of when prescribing a topical beta-blocker?
If the patient is already on a beta blocker, the blood pressure might go too low. Be aware!
Decrease systemic drug before adjusting the topical one.
