Pharmacology I - Topical Agents
NYIT PA Program
What are the common classes of ophthalmic drugs?
Anti-inflammatories + Anti-infectives,
Mast Cell Wall Stabilizers,
What drug is the beta-blocker eye-drops used for glaucoma?
Timolol ophthalmic drops
-Suppresses aqueous production
- Good for both open and closed angle glaucoma
What are the side effects of timolol?
Beta blocker side effects, but less severe than systemic beta blockers
-Acute exacerbation of asthma,
What is the parasympathomimetic glaucoma agent?
-Increases aqueous outflow
-Good for closed angle glaucoma
What are the side effects of pilocarpine?
Constricted pupil (pinpoint),
What adrenergic is used for glaucoma?
What side effects are associated with ophthalmic epinephrine?
What carbonic anhydrase inhibitor diuretic is used for glaucoma?
-Supresses aqueous production
-Causes huge fluid shift out of anterior chamber
What side effects are associated with acetazolamide?
What may occur from prolonged used of topical antibiotics?
Overgrowth of non-susceptible organisms, including fungi
What Quinolones are used as an ophthalmic anti-infective?
-Used for virtually every kind of bacterial eye infections
What age restrictions are associated with Quinolones ophthalmic use?
Safety/effectiveness not established in children < 1 yoa, treat them very conservatively
What aminoglycoside is used as an ophthalmic anti-infective agent?
Ointment or drops
Gentamycin Ophthalmic clinical Pearls
Bacterial Resistance may occur
If purulent discharge develops, discontinue use
Most commonly given as an ointment
What sulfonamide is used as an ophthalmic anti-infective?
Not commonly used
Not good for Gonorrhea or P. aeruginosa
Remember sulfa allergies
What Macrolide is commonly used as an ophthalmic anti-infective?
Good for kids
Wimpy on bad bacteria
*Very few side effects*
What combination anti-infectives are often used for ophthalmic infections?
Polymyxin B (causes sensitization),
Antiviral Clinical Pearls
Pts. with suspected ophthalmic herpes should be seen emergently by an ophthalmologist
- NEVER give steroids if herpes
Always store under refrigeration
No drug toxicity hase been documented
What drug is commonly given for viral eye infections?
-Used for herpes of the eye
What drugs are used as an ocular antihistamine?
-For ocular pruritis, and allergic conjunctivitis
-Avoid contact lens for 10 minutes
-Preg Cat C
What is the ocular NSAID?
Only used for temporary relief of itching (< 1 week)
Do not use with soft contact lens
What mast cell wall stabilizer is used for allergic eye reactions?
Inhibits type I hypersensitivity reactions
What is the most common ophthalmic steroid?
Treatment should last days to weeks
Dosage gently tapered when given for more than five days
NEVER use if suspected herpes eye infection
What Sympathomemetic is used to dilate the eyes?
-Max action is between 10-60 minutes
Why are vasoconstrictors used ophthalmologicly?
Indicated for the temporary relief of redness and itching due to pollen or animal hair
contraindicated in narrow-angle glaucoma, concurrent MAOI use, and contact lens wearers
What is the most common vasoconstrictor used ophthalmologicly?
What adverse effects are associated with using ophthalmic vasoconstrictors?
May precipitate cardiac arrhythmias and even myocardial infarction
Significant B/P elevation is rare
Rebound miosis (pupilary contraction) has been reported in older patients 1 day after use
May percipitate acute narrow angle glaucoma
What is Indicated for patients with moderate-to-severe dry eye syndromes?
Artificial tears (lubricants)
What is used as an eye-irrigation solution?
A balanced salt solution
NOT used as a rinsing or soaking agent for contact lenses
What drug is used to numb the eye for ophthalmic procedures including removal of superficial foreign bodies?
-Blocks sodium ion conduction in nerves
-Never give this drug to patients to self-administer
-Causes epithelial shedding in the cornea
What is used to stain the eye to see changes of the integrity of the cornea?
What are the cutaneous drug classes?
Topical acne preperations
What are the different ways a topical drug can be prepared
Longest lasting => Shortest
What are the typical topical corticosteroid?
Most potent => Less potent
Topical corticosteroid clinical pearls.
Potency is the most important variable in selecting a topical corticosteroid
The potency is not determined by its strength but rather by vasoconstrictor assays
Topical corticosteroids have the same pharmacologic effects as systemic steroids***
What are the topical antibiotics?
Polymyxin B sulfate,
What is used for the localized treatment of impetigo caused by S. aureus?
What antibiotic is indicated for prophylaxis of infection and sepsis in 2nd degree and 3rd degree burns of the skin
-looks like white cake frosting
-Remember sulfa allergies**
-May permanently stain the skin
What is used for the treatment of tinea pedis, tinea cruris, tinea corporis, tinea versacolor caused by M. furfur, and candidiasis caused by C albicans?
What is used for the treatment of scabies and lice?
-Neutrotoxin that kills lice, mites, ticks, and fleas
**Contraindicated with hypersensitivities to CHRYSANTHEMUMS **
What are the categories of otic medications?
What is the common otic antibiotic?
What is the Antifungal/Astringent Combination?
Acetic acid, Propylene Glycol Diacetate
-Tympanic membrane must be intact
What are the Antibiotic/Steroid Otic Preparations?
Polymyxin B sulfate, neomycin, hydrocortisone solution and suspension
-Contraindicated with cutaneous viral infections, and perforated TM
What drug is used as an anesthetic for acute otalgia?
Antipyrine with benzocaine in glycerine
What is the common wax softener?
-Contraindicated with perforated tympanic membranes
-Very similar to hyrdogen peroxide (very cheap substitute)
What are the intra-oral drug classes?
Gingivitis and prophylaxis
What is the common Intra-oral Antifungal Preparation?
What drug is used for oral herpes?
-Pro-drug metabolized into famcyclovir
-Valacyclovir is much better
What is used for gingivitis?
Chlorhexidine oral rinse
What makes up magic mouthwash?
Equal parts Benadryl, Maalox and viscous Lidocaine
-Analgesia for intra- and peri-oral lesions, esp. gingival stomatitis
What are the vaginal medication drug classes?
What is the vaginal antifungal?
-"azoles" break down the cell walls of the fungus and cause it to dissolve
What is the vaginal antibiotic drug?
What is the vaginal antiprotozoal drug?
-DO NOT take with ALCOHOL