Ophthalmic Pharmacology

Beta-adrenergic Blockers
glaucoma, decreases aqueous production, Yellow

Beta-adrenergic Blockers, Side Effects
slow heart rate, decreased BP, exacerbation of asthma & emphysema, ocular discomfort, blurred vision, foreign-body sensation, photophobia, itching, tearing

timolol (Timoptic, Betimol)
Beta-blocker, OAG, 0.25% & 0.5% 1gtt BID

betaxolol (Betoptic)
Selective beta blocker (can be used in pts w respiratory ailments), OAG, 0.25% 1-2 gtts BID

levobunolol (Betagan)
Beta-blocker, OAG & ocular hypertension, 0.25% & 0.5% 1-2 gtts BID

metipranolol (Optipranolol)
Beta-blocker, OAG 0.3% 1gtt BID

carteolol (Ocupress)
Beta-blocker, OAG & intraocular hypertension, 1% 1gtt BID

Adrenergic-stimulating Agents or Sympthomimetics
glaucoma, improves aqueous outflow & uvealscleral output

Adrenergic-stimulating Agents, Side Effects
Increased HR & BP, tachycardia & arrhythmia, hypertension, hyperemia, stinging, blurry vision, headache, eye ache, brow pain, allergic lid reaction.

dipivefrin (Propine)
Adrenergic-stimulating Agent, OAG, causes fewer systemic side effects than epinephrine, 0.1% 1gtt every 12 hrs

epinephrine (Epifrin)
Adrenergic agonist, POAG, 0.5%, 1%, 2%, 1gtt QD-BID

Carbonic-Anhydrase Inhibitors (Oral & Topical)
Second line glaucoma, decrease formation and secretion of aqueous humor, SULFA DRUG, Orange

Carbonic-Anhydrase inhibitors, Side Effects
paresthesias, anorexia, gastrointestinal disturbances, headaches, altered taste & smell, bone marrow suppression, punctate keratitis, allergic reactions, blurred vision, tearing, dryness, and photophobia. SULFA DRUG.

acetazolamide (Diamox)
Carbonic-Anhydrase inhibitor, Oral, BID, not well tolerated

brinzolamide (Azopt)
Carbonic-Anhydrase inhibitor, glaucoma drop

methazolamide (Neptazane)
Carbonic-Anhydrase inhibitor, Oral, TID

dorxolamide (Trusopt)
Carbonic-Anhydrase inhibitor, Topical ointment

Alpha-adranergic Agonists
assists receptors which, upon absorption of epinephrine or norepinephrein, contol vasoconstriction, intestinal relaxation, pupil dilation, etc.
Purple

Alpha-Adrenergic Agonists Side Effects
Red eye

apraclonidine (Iopidine)
Alpha-adrenergic agonist

brimonidine (Alphagan)
Alpha-adrenergic agonist, glaucoma drop, 0.2% and 0.15%, 2nd Line

Prostaglandin Analogues
First Line, reduce pressure in eye by increase removal of aqueous humor. Treats Open-angle glaucoma.

Side Effects
Blurred vision, dry eyes, increase coloring of iris, growth of eyelashes, skin rash, inflammation of anterior chamber, upper respiratory tract infection.

Hyperosmotics
Oral, increase osmosis

glycerin (Osmoglyn)
Hyperosmotic, oral

ethyl alcohol
Hyperosmostic, oral

isosorbide
Hyperosmotic,oral

Hyperosmotics
Injection

mannitol (Osmitrol)
Hyperosmotic, injection

dorzolamid HCL & timolol maleate (Cosopt)
Combination agent, glaucoma drop

Topical Antibiotics treat
blepharitis, conjunctivitis, and corneal ulcers, Tan

Locally injected antibiotics treat
more severe bacterial corneal ulcers and endophthalmitis

Oral & Systemically injected antibiotics treat
severe endophthalmitis, orbital infections (incl. Orbital Cellulitis), acute dacryocistitis

Side Effects
!!!!!!!!!!!!!!!!

bacitracin

neomycin

tobramycin (Tobrex, AK-Tob)

gentamicin (Genoptic, GEntacidin)

sulfonamides (Bleph-10, Sulf-10)

fluoroquinolones (Ciloxan, Ocuflox, Quixin, Zymar, Vigamox, Iquix)

Antibiotic Combos

neomycin-polymycin B-bacitracin (Neosporin ointment)

neomycin-polymyxin B-gramicidin (Neosporin ophthalmic solution)

trimethoprim-polymyxin B (Polytrim)

polymyxin B-bacitracin (polysporin)

Antibiotic/Steroid combos

neomycin-dexamethasone (Neodecadron)

neomycin-polymyxen B-dexamethasone (Maxitrol)

tobramycin-dextramethasone (Tobradex)

gentamicin-prednisolone (Pred G)

sulfacetamide-prednisolone (Blephamide, Vasocidine)

neomycine-polymyxin B-hydrocortisone (Corisporin)

neomycin-polymyxen B-prednisolone (Polypred)

tobramycin-loteprednol etabonate (Zylet)

Antivirals
inhibits virus’ ability to reproduce, treats herpes infections

trifluorothymidine (Viroptic)

acyclovir (Zovirax)

valacyclovir hydrochloride (Valtrex)

famcyclovir (Famvir)

Antifungals
kill fungi, treat fungal blepharitis, keratitis, and conjunctivitis, and some internal infections, can be toxic to cornea

natamycin (Natacyn)

amphotericin B (Abelcet)

ketoconazole (Nizoral)

voriconazole (VFEND)

Antiallergic & Anti-Inflammatory Agents

corticosteroids
main drugs used to treat allergic reactions & inflammation

Cortisone
hormones derived from adrenal gland or made artifically

Topically
treats conditions involving eyelid or anterior segment

Side Effects
w/ long term use can cause glaucoma, infection, fungus, slow healing, cataract

predisolone acetate (Pred Forte)
0.12% and 1.0%

fluorometholone (FML)
0.1% and 0.25%

Systemic
treats disorders of posterior segment and acute/severe allergic reactions

Side Effects
can worsen hypertension, peptic ulcer, diabetes, and tuberculosis

prednisolone 5mg

dexamethasone (Decadron) 0.75%

Orally causes slow healing, swelling of face, promotes cataract and glaucoma, decreases resistence to infection, increases BP and blood sugar

olol = beta-blocker
in = adrenergic stimulating agent

Topical Advantages – Convenient – Economical – Safe (Sometimes systemic doesn’t cut it for the eye) Topical Limitations and Precautions – Compliance – Corneal/conjunctival toxicity – Nasal mucosal toxicity – Systemic side effects from nasolacrimal absorption WE WILL WRITE A …

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