Professional Documents
Culture Documents
Short –acting: phenylephrine and tropicamide and cell death; may be reversed by osmotic
Intermediate-acting: cyclogyl control of the cell
Long-acting: atropine Natamycin: accumulates in the cell
Indications: refraction, dx’c & tx’c dilation membrane; disrupts phospholipid film; not
ADR: HPN, glaucoma in NOA’s, psychosis, reversible
nightmares, flushing, palpitation, fever Azoles: fluconazole, itraconazole, miconazole,
ketoconazole
Miotics Interferes with synthesis of ergosterol in
Pilocarpine fungal membrane; direct action causing
Indications: treatment of angle closure glaucoma, membrane to be leaky
aids in ophthalmic laser procedures (iridotomies, Flucytosine: incorporated into fungal RNA, interferes
refractive laser) with protein synthesis
ADR: retinal detachment in high myopes
Antibiotics: ADR’s
Antibiotics Toxicities
Anti-bacterial, anti-virals, anti-fungals Punctate or filamentary keratitis
Indications: tx of infection (name 7 possible types of Hypersensitivities: contact blepharodermatitis
periocular or ocular infections) Ocular discomfort in anti-fungals
Preparation: drops or ointments Generally:
Routes of administration: topical, subconjunctival, ointments more toxic than drops
intravitreal (*oral) Anti-virals and anti-fungals more toxic than
Anti-bacterials: anti-bacterials
Erythromycin, erythromycin-colistin, fucidic Aminoglycosides most toxic among
acid, tobramycin, gentamycin, antibacterials
sulfacetamide, sulfacetamide-
chloramphenicol, polymyxin-neomycin- Topical steroids
gramicidin/bacitracin combinations, ANTI-INFLAMMATORY effect
quiniolones (ciprofloxacin, ofloxacin, INJURY (traumatic, infectious, autoimmune
levofloxacin, etc.) Infiltration by inflammatory cells
Edema
Anti-bacterials: New vessel formation
Mechanism of Action Corneal melting
Penicillins, cephalosporins, vancomycin, bacitracin:
inhibit bacterial cell wall synthesis; disruption of The role of PMN’s in tissue injury
bacterial cell wall Inflammatory Cell infiltration (PMN’s
Polymyxin, colistin: alters bacterial cell wall Release of hydrolytic enzymes
permeability, leakage of intracellular compounds
Denaturation of protein and necrosis of tissue
Chloramphenicol, tetracycline, erithromycin: o Corneal melting
reversible inhibition of protein systhesis
o Formation of scar tissue
Aminoglycosides: alteration of protein synthesis by
o Visual loss
binding to 30s bacterial ribosome unit leading to cell
o Final healing
death
o Termination of inflammation
Quinilones: interruption of bacterial nucleic acid
metabolism through inhibition of DNA supercoiling
Steroids: MOA
and systhesis
Steroids control PMN’s by:
Sulfonamides: blockage of specific metabolic steps
essential to the microorganism Producing involution of inflammatory cells
Suppressing migration of additional PMN’s
Anti-virals and MOA Inhibit release of hydrolytic enzumes from
trifluorothymidine: Inhibits thymidylate synthetase inflammatory cells
and thus DNA sysnthesis, incorporated into viral
DNA; more effective in treating steroid treated ulcers Steroids: Indications
idoxuridine: resembles thymidine; incorporated into External diseases of the eye: allergic conjunctivitis,
viral DNA; affects virus-infected cells and normal corneal graft rejection, sympathetic ophthalmia,
cells mucous membrane diseases, marginal corneal melts,
Acyclovir/ gancyclovir: cells infected with HSV disciform keratitis, padi keratitis, scleritis, phlycten,
specifies an enzyme, thymidine kinase which allergic contact dermatitis
mediates the phosphorylation of acyclovir into an Glaucoma: phacolytic glaucoma, glaucomato-
active form; phosphorylated acyclovir is incorporated iridoclyclitic crisis, acute angle closure glaucoma
into viral DNA chain and disrupts further viral Diseases of the orbit and optic nerve: thyroid-related
replication orbitopathy, orbital pseudotumor, optic neuritis,
retrobulbar neuritis
Trauma: acute chemical burns
Anti-virals REMEMBER: except for adrenal insufficiency,
Failure to heal of viral corneal ulcer: corticosteroids are neither curative nor specific
Resistant infection
Toxicity Steroids: Routes of administration:
Least toxic and most specific of anti-virals: acyclovir Topical:
and gancyclovir Mild steroids: flurometholone
Moderately strong:
Anti-fungals: MOA dexamethasone, prednisolone
Polyenes: bind to ergosterols in fungal cell acetate 0.5%
membrane Strong steroids: predisolone
acetate 1%
Subconjunctival/Subtenon’s- triamcinolone
Intravitreal- dexamethasone phosphate
Oral: prednisone 5 or 10 mg tabs
ADR: cataract and glaucoma
Topical NSAID’s
Examples: diclofenac, ketorolac
Indication: anit-inflammatory action in patients where
steroids are too strong or contraindicated (steroid-
responders); to maintain intra-operative mydriasis
ADR: punctate keratitis
Combination Steroid-Antibiotics
Examples:
prednisolone acetate-neomycin-polymyxin;
gentamycin-flurometholone
Dexamethasone-neomycin-polymyxin
Tobramycin-dexamethasone
For use in inflammatory conditions of the eye where
antibiotic prophylaxis is desired
Viral conjunctivitis
Post-op patients to control inflammation
Anti-glaucoma Meds
Indication: to control intraocular pressure in
glaucoma patients
MOA:
Beta blockers: (betaxolol, timolol,
levobunolol, metopranolol)- decreases
aqeuos humor formation
Pilocarpine
Mannitol, acetazolamide, dorzolamide:
increases outflow of aqueous humor
Prostaglandin analogs: latanoprost,
travoprost- increases uveoscleral outflow or
aqueous humor
Alphagan: aqueous suppressant also like PG
analog
Anti-allergic Meds
Antihistamines:
Mast cell stabilizers
Examples: olopatadine, cromolyn sodium, ketotifen
Artificial Tears
For dry eye problems
E.g.’s : tears naturale, refresh, lacryvisc, genteal,
vidisic gel, hialid, systane, etc.
With allergies or toxicities if with preservatives