MOA: work to both decrease production of fluid and increase drainage. This is the same class used to treat (Refresh: clonidine MOA: decrease the NE outflow in CNS, reduce sympathomimetic effects).
SE: burning or stinging, fatigue, headache, drowsiness, dry mouth and nose, relatively higher likelihood of allergic reaction.
May be less effective and require TID dosing.
Do not use with MAO inhibitors (MAOIs also target NE).
Alphagan-P has a pure preservative that breaks down into natural tear components and may be better tolerated in people who have allergic reaction to preservatives in other eye drops.
SE in eye drop form: stinging, burning, eye discomfort; in pill form: tingling hands and feet, fatigue, stomach upset, memory problems, frequent urination.
Caution: sulfa allergy, they are sulfa derivatives.
Methazolamide (Neptazane) and acetazolamide (Diamox, used in altitude sickness, idiopathic intracranial hypertension) are available as pills.
Brinzolamide: 1gtt TID
Dorzolamide 2%: 1gtt TID
Rho Kinase Inhibitors
Drug: Netarsudil (Rhopressa)
MOA: increase aqueous humor outflow
SE: may cause redness, corneal deposits, stinging, and small bleeds on the white of the eye.
New class of drug, costly.
Store in the refrigerator before open, after open good for 6-wks.
MOA: increase aqueous outflow, are cholinergic agents.
Caution in retinal detachment or corneal abrasion.
The opposite class mydriatic (pupil dilation) agents: anticholinergic eyedrops used in eye doctors’ office as a dilation agent to exam the back of retina. (opposite of myosis - pupil constriction).
Patient education
Suspensions need to be shaken a few times; solution is homogenously mixed and no need to be shaken.
keeping the eye closed for at least one minute after instilling. Wait at least 5 mins to instill the second eye drop.
Remove contact lens before prostaglandin analog drops (Travatan, Lumigan, Xalatan) because it contains preservative can be absorbed by the lenses and cause them to be discolored. Wait 15 mins to re-insert.
Conjunctivitis
A clear, thin membrane called conjunctiva covers eyeball. Can be irritated by bacteria, virus, allergens. Sometimes called "pink eye".
OTC
Visine (naphazoline/pheniramine)
Naphazoline is a decongestant used to relieve redness, puffiness due to allergies or irritations.
Contraindicated with glaucoma/ heart disease/HTN (all vascular conditions, should avoid decongestants because they are vasoconstrictors), enlarged prostate (BPH).
Remove contact lenses, to avoid accumulation of preservative benzalkonium chloride. Should not be used > 3 days (a decongestant with sympathomimetic property).
Antihistamine ketotifen (Zaditor, Alaway)
NSAID
Ketorolac (Acular)
Mast cell stabilizer
Cromolyn (Intal), this is also used in asthma, please refer to asthma chapter.
Cyclosporin (Restasis): takes 1 month to see effect
an emulsion applied twice daily (remove contact lenses before use) and separate from artificial tears by 15 minutes.
Xiidra (Lifitegrast)
Blepharitis (eyelid inflammation)
Warm compress is first line. (Not cold compress)
Bacitracin or erythromycin ung, BID-QID.
Mydriacryl (tropicamide)
Used for pupil dilation during eye examination (anticholinergic property causes mydriasis), other eye drops include: atropine, cyclopentolate.
This is the opposite of the one of the above classes used to treat glaucoma “miotics”.
Quiz
Which of the following medications is likely to cause a darkening of the iris of the eye?
Brimonidine
B.Carbachol
C.Dorzolamide
D.Travoprost
E.Timolol
Latisse belongs to which of the following drug classes?
A.α 2 agonist
B.Antihistamine
C.β -blocker
D.Cholinergic agonist
E.Prostaglandin analog
Which of the following agents is a carbonic anhydrase inhibitor?
Apraclonidine
Brinzolamide
Betaxolol
Brimonidine-timolol
Bimatoprost
A patient with glaucoma has a history of anaphylaxis when taking trimethoprim/sulfamethoxazole. Which of the following medications should be avoided in this patient?
A.Brimonidine
B.Betaxolol
C.Brimonidine-timolol
D.Brinzolamide-brimonidine
E.Latanoprost
Which of the following medications can be used to clear impacted cerumen in the ear?
Ciprodex otic suspension
Carbamide peroxide
Latanoprost
Tolfacitinib
Improper administration of Restasis can lead to infections, some of which have caused vision loss. Which of the following statement/s are true concerning Restasis? (Select ALL that apply.)
The correct dosing is one drop BID, approximately twelve hours apart.
One vial should be immediately discarded after each use. Do not keep any leftover medication.
It could take 3 to 6 months after beginning therapy to notice an increase in tear production.
The most common side effect is a temporary burning sensation.
The active ingredient is pilocarpine.
D.Travoprost, an ophthalmic prostaglandin analog, is likely to cause darkening of the iris, increased pigmentation of the eyelid and eyelashes.
E.Latisse (bimatoprost), is a prostaglandin analog, can be used to treat eye lash hypotrichosis.
B.Brinzolamide is a carbonic anhydrase inhibitor. Apraclonidine is an α 2-agonist. Brimonidine-timolol is a combination that contains an α 2-agonist and a β -blocker. Bimatoprost is a prostaglandin analog.
B.Carbonic anhydrase inhibitors— brinzolamide and dorzolamide— are sulfa derivatives and should be avoided in patients with a history of anaphylaxis to sulfa products (e.g., trimethoprim/sulfamethoxazole).
B.Carbamide peroxide can be used to clear impacted cerumen (ear wax) in the ear. Tolfacitinib is used to treat rheumatoid arthritis.
ABCD. The most common side effect is a temporary burning sensation. Other side effects include eye redness, discharge, watery eyes, eye pain. Most patients notice an increase in tear production in about a month, some report that it may take much longer. Restasis (cyclosporin) is an emulsion applied twice daily and separate from artificial tears by 15 minutes.
