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Lecture 14
Ocular Pharm
21
Medical
Professional
11/08/2008

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Term
Treatment for Bacterial Blepharitis, which is the most common causative agent is Staph. Aureus (S. epidermidis also ID as a cause)
Definition
Bacitracin
Term
Bacitiracin
Definition
Drug of choice for Staphlyococcus Aures, Prevents formation of polysaccharide chain (bactericidal); Gram + spectrum; also against Neisseriae but other gram – are resistant, systemically causes renal necrosis; Inhibits cell membrane synthesis;
Term
Erythromycin
Definition
Group of macrolides, Bacteriostatic, inhibits bacterial protein synthesis; Erythromycin Binds to 50s; Targets gram +; staphylococcus, Streptococcus, Mycobacterium Chlamydia, Poor activity against Haemophilus influenza; Resistance – 1. alteration in cell membrane permeability, and modification of 50s subunit binding site; Erythromycin is less toxic and should be given to children.
Term
Drug of choice for Bacterial Blepharitis (2-3 year)
Definition
Erythromycin (less toxic)
Term
What are the two types of MGD
Definition
Meibomian seborrhea – truly MGD no bacterial coloiniation; Meibomianitis (meibomitis) – overgrowth of bacteria as a consequence; MGD is a blockage of the meibomian gland ducts;
Term
Name the Tetracyclines
Definition
Tetracycline, Oxytetracycline, doxycicline, minocycline
Term
Tetractyclines
Definition
Basteriostatic, inhbit bacterial protein synthesis, binds to 30s subunit, Active against staphylococcus species and chlamydia,; No antiacids nor dairy products should be consumed; Not to be used at least 1 hour before a meal. Resistance includes impaired diffusion, bacteria protein synthesis interferes with binding, enzymatic inactivation. Dosage should be for Tetracycline 250 mg qid initially then qd, Doxycycline (DOC) 100 mg bid then 40 mg daily
Term
Tetracycline and Oxytetracycline
Definition
60-70% absorbed interfered by bivalent cations, and 40-80% are protein bound, which means the more protein bound the less therapeutic effect it will have
Term
Doxycycline and Minocycline
Definition
have 95% absorption, less food interference, less protein bound
Term
Adverse Effects for Tetracyclines
Definition
GI disturbances, Pseudomembranous Colitis, Teratogenic defects, Premature epiphysis closure (defective bone formation) and teeth discoloriation in children under 12 years old. Pseudo tumor cerebri.
Term
Alternative treatment for MGD
Definition
Macrolides (erythromycin is a macrolide)
Term
Macrolides
Definition
Treatment for MGD, bacteriostatic, action in alkaline environment, inhibits bacteria, protein synthesis, They bind to 50s of the ribosomal complex and it will stop the polypeptide chain
Term
Macrolides Kinetics
Definition
GI absorption is variable, does not cross BBB cerebral spinal fluid distribution, NO dosage required for kidney dysfunction, resistance includes the alteration in cell membrane permeability, modification of 50s subunit binding site.
Term
Types of Erythromycin
Definition
Erythromycin,Clarithromycin (biaxin), Azythromycin (Zythromax (Z-Pack)
Term
Erythromycin uses
Definition
Oral:base - base, estolate (best stability), sterate, and ethylsuccinate (drug of choice for the erythromycin, really good absorption, not as toxic and no GI upset), Staph. and Strep., Mycobacterium, Chlamydia; IV Lactobionate: Legionaire’s disease (legionella pneumophilia, Mycoplasma pneumonia; Poor Activity against Haemophilus
Term
Clarithyromycin (biaxin)
Definition
synthetic form of erthyromycin (an added methyl group), GI stable, same spectrum as erythromycin, excretion is biliary and renal, cost effective
Term
Azythromycin (Zythromax (z-pack))
Definition
semi-synthetic form of erythromycin by adding a methylated nitrogen group, better spectrum (haemophilus) than the other macrolides and better activity, ½ life is approximate 2-4 days, not metabolized by cytochrome P-450, Not particularly used for MGD, a lot more expensive
Term
Adverse effects for Macrolides
Definition
GI disturbances, Pseudomembranesous colits, Cholestatic hepatitis (erythromycin estolate), drug interaction with drugs metabolized by cytochrome P-450 except azythromycine
Term
External Hordeolum
Definition
focal infection of the glands of Zieiss and Moll most often caused by S. Aureus
Term
Treatments for External Hordeolum
Definition
1. Bacitracin, 2. Polymyxin B/bacitracin Ointment (a. a cationic surfactant that interacts with the phospholipids of the bacterial cell membrane, thus disrupting its osmotic, b. very active against gram negative organisms, very active against gram negative organisms (pseudomonas, haemophilis, C. Topical adverse reactions are infrequent and mild (SPK, allergic reaction)
Term
Treatment of Choice for MGD
Definition
Tetracylcines
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