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Opthalmology Drugs
VM 609 Midterm
60
Veterinary Medicine
Professional
09/03/2012

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Cards

Term
Pilocarpine
Definition
parasympathomimetic, miotic agent
mimic ACh with rapid penetration
topical that results in pupillary constriction, ciliary muscle contraction, and increased aqueous outflow
vasodilation
used to treat glaucoma
causes intraocular inflammation and it irritating
Term
Topical Organophosphate
Definition
miotic agent
anticholinestrase agent
prevents enzymatic degradation of ACh
Term
Latanoprost/Travoprost
Definition
miotic agent
prostagladin F2a analog
used for glaucoma
reduces intraocular pressure by increased outflow of aqueous through increased uveoscleral outflow
Term
Atropine
Definition
mydriatic agent
parasympatholytic agent/sympathomimetic
direct acting blocks the response of postganglionic cholinergic receptors to ACh
cycloplegic - paralyzes ciliary musculature to decrease intraocular pain
used for uveitis/pain
ciliary muscle contraction can cause pain
can increase change of secondary glaucoma in most species due to its cycloplegic effects
closes the drainage angle and decreases outflow
chronic cycloplegia in young animals can damage developing drainage angle
use ointment in cats to decrease hypersalivation
drops are very bitter tasting
can possible cause gut stasis in foals with overuse
Term
Tropicamide
Definition
mydriatic agent
synthetic parasympatholytic
weak cycloplegic
used for diagnostic evaluation
Term
Epinephrine
Definition
weak mydriatic
NOT cycloplegic
used for glaucoma therapy
causes constriction in ciliary vessels by effecting alpha receptors
decreases aqueous production and increases outflow
can be used to help differentiate conjunctivitis from scera infection
will constrict conjunctival vessels in 30 seconds but not sclera vessels
Term
Phenylephrine
Definition
direct acting sympathomimetic
can be used to help differentiate conjunctivitis from scera infection
will constrict conjunctival vessels in 30 seconds but not sclera vessels
can be used to help determine presence/location of Horner's syndrome
rapid mydriasis (within 15 minutes) indicates a postganglionic lesion
Term
Dipivefrin hydrochloride
Definition
epinephrine pro-drug
once in anterior chamber, acts like epinephrine
weak mydriatic
achieves better penetration of cornea than epinephrine
used for glaucoma
Term
Timolol maleate
Definition
nonselective beta blocker
blocks activation of adenylate cylcase
results in decreased formation of cAMP in ciliary body
reduces formation of aqueous humor
increases aqueous outflow
used for glaucoma
Term
Betaxolol
Definition
cardioselective beta blockers (beta 1)
blocks activation of adenylate cylcase
results in decreased formation of cAMP in ciliary body
reduces formation of aqueous humor
increases aqueous outflow
used for glaucoma
Term
Chloramphenicol
Definition
broad spectrum, bacteriostatic
fat soluble
penetrates cornea
owner must wear gloves when giving medication because can cause aplastic anemia in handlers
Term
Neomycin
Definition
aminoglycoside
broad spectrum, bacteriocidal
impairs protein synthesis
need to administer 2-3 times per day
#1 conjunctival irritant, ototoxicity
Term
Gentamycin
Definition
aminoglycoside
broad spectrum, bacteriocidal
Streptococcus, Staphylococcus, E. coli, Proteus, Pseudomonas aeroginosa
used topically and subconjunctivally for external ocular infections
renal toxicity with oral therapy
Term
Tobramycin
Definition
more effective against Pseudomonas than gentamicin
effective against gentamicin-resistant microbes
expensive
indiscriminant use may lead to resistance
Term
Bacitracin
Definition
polypeptide, bactericidal
poor corneal penetration
Gram + organisms
Term
Polymyxin B
Definition
polypeptide, bactericidal
poor penetration
gram negative bacilli and Pseudomonas
don't give subconjunctivally
Term
Triple Antibiotic Combination
Definition
neomycin, polymyxin, bacitracin
excellent first line of defense
erythromycin is often used in its place
Term
Tetracycline
Definition
broad spectrum
effective against Mycoplasma, Rickettsia, Chlamydia
used to treat Mycoplasma and Chlamydia conjunctivitis in feline and caprine species
doxycycline is drug of choice
oral doxycycline helps stabilize corneal collagenases
decreases corneal melting in corneal ulcers
Term
Penecilins
Definition
amoxicillin, ampicillin, clavamox
broad spectrum
steadily cross blood-aqueous barrier
used systemically
Term
Cephalosporins
Definition
broad spectrum
first generation cephalosporins
topically used for gram + resistant to other antimicrobials
can be used subconjunctivally
penetrates intact cornea
Term
Fluroquinolones
Definition
ciprofloxacin, levofloxacin, ofloxacin
broad spectrum
Gram + and Gram -
drug of choice for Streptococcus and Staphylococcus corneal,conjunctival, and intraocular infections
often start with this drug with infected cornea
excellent corneal penetration
enrofloxacin has been shown to cause retinal degeneration in cats
recommend dosage of 5mg/kg PO daily but can still happen at this dose
Term
Natamycin
Definition
polyene, antifungal
used mainly against Candida and Fusarium
only approved topical opthalmic antifungal agent
need to treat every 2-4 hours
Term
Voriconazole
Definition
triazole, imidazole
excellent corneal penetration
drug of choice for topical use in subpalpebral lavage unit
need to treat every 2-4 hours
Term
Itraconazole
Definition
imidazole
used topically
Term
Silver Sulfadiazine cream
Definition
bactericidal
Gram negative, Gram positive, yeast
treating burn wounds
not approved for trpoical ocular use but has been show effective for treating fungal keratitis
Term
Idoxuridine
Definition
alters viral replication by substituting for thymidine in viral DNA chain
need to administer every 2 hours
poor corneal penetration
Term
Trifluridine
Definition
antiviral potency is over twice that of idoxuridine
inhibits nucleic acid synthesis
need to administer 4-6 times a day
Term
Oral Lysine
Definition
decreases viral shedding of FHV in cats
competes with arginine which is necessary for viral replication
can be used chronically
Term
Topical Cidofovir
Definition
acyclic nucleoside analogue
given BID to TID
moderately expensive
Term
Systemic Famciclovir
Definition
safe and effective
pencyclovir prodrug
used for a few weeks
generic available
Term
Systemic Acyclovir and Valcyclovir
Definition
significant side effects
DON'T use in therapy of feline herpesvirus
Term
Corticosteroids Mechanism of Action
Definition
decrease cellular and fibrinous exudation and tissue infiltration
inhibit fibroblastic and collagen-forming activity
retard epithelial and endothelial regeneration
diminish post-inflammatory neovascularization
stabilize excessive permeability of inflamed capillaries
Term
Corticosteroids Use
Definition
topical administration provides highest drug concentrations in cornea and conjunctiva
acetate forms are more lipophilic and allow for better corneal penetration
subconjunctival injection provides greater local anti-inflammatory effect
posterior segment inflammation requires systemic corticosteroid therapy
topical therapy should be continued 2 weeks beyond resolution of clinical signs
Term
Corticosteroid Side Effects
Definition
delayed corneal healing
increased corneal collagenase activity
increased incidence of bacterial and mycotic keratitis
reduced baseline cortisol levels
suppression of adrenocorticotropic hormone responsive curve
altered carbohydrate metabolism
Term
NSAIDs Mechanism of Action
Definition
reduce prostaglandin synthesis by inhibiting production of cyclcooxygenase
inhibits produciton of endoperoxidases which are converted to prostaglandins and thromboxane
lipoxygenase pathway is unimpeded
products of lipoxygenase pathway enhance leukocyte response
Term
NSAIDs Side Effects
Definition
decrease renal blood flow
decrease glomerular filtration
decrease sodium and water excretion
gastrointestinal intolerance
ulceration and hemorrhage
Term
Deracoxib
Definition
COX-2 inhibitor
Term
Meloxicam
Definition
COX-2 inhibitor
Term
Flurbiprofen
Definition
COX inhibitor
Term
Diclofenac Sodium Solution
Definition
COX-inhibitor
used pre-operatively to stabilize blood aqueous barrier in inflammation
decreases production of ocular prostaglaninds
maintains pupil size in cataract surgery
used to treat anterior uveitis and keratitis
safe in presence of corneal ulceration
Term
Carbonic Anhydrase Inhibitors
Definition
CO2 + H2O --> H2CO3 --> H+ + HCO3-
blocks build up of CO2 (acidosis)
reduces aqueous humor production
used to treat glaucoma
inhibits CA activity in ciliary body and renal tubular epithelium
no increased intraocular pressure lowering effects when systemic CAIs are used in addition to topical CAIs
Term
Carbonic Anhydrase Side Effects
Definition
due to metabolic acidosis
panting
anorexia
vomiting
depression
hypokalemia
Term
Cosopt
Definition
dorzolamide hydrochloride and timolol
topical CAI + beta blocker
increased efficacy for treating glaucoma
Term
Dorzolamide hydrochloride
Definition
topical carbonic anhydrase inhibitor
decreases production of aqueous
reduced systemic side effects
Term
Pilocarpine (for lacrimation)
Definition
lacrimogenic agents
not very effective except with neurogenic keratoconjunctivitis sicca
emesis may occur
parasympathomimetic
mimic ACh with rapid penetration
topical that results in pupillary constriction, ciliary muscle contraction, and increased aqueous outflow
vasodilation
used to treat glaucoma
Term
Cyclosporin A
Definition
lacrimogenic agent
potent suppressor of T-cell growth factor and cytotoxic T-cell response
drug of choice in treatment of keratoconjunctivitis sicca
Term
Tacrolimus
Definition
lacrimogenic agents
used for cases not responsive to cyclosporin
T-cell suppressor
drug of choice in treatment of keratoconjunctivitis sicca
Term
Fluorescein Dye
Definition
demonstrates defects of corneal epithelium
demonstrates patency of lacrimal drainage system
does not penetrate intact corneal epithelium
rapidly diffuses into corneal stroma when an epithelial defect exists
iatrogenic spread of ocular infections (Pseudomonas aeruginosa) associated with use of dyes kept in solution
preservatives are inactivated fluorescein
use individual strips
Term
Rose Bengal Dye
Definition
selectively stains devitalized corneal and conjunctival epithelium
long-lasting
Term
Topical Anesthetics
Definition
reversibly blocks conduction of nerve fibers by displacing calcium at binding sites in cell membranes
exist in ionized and nonionized forms
alkaline state increases membrane permeability
less effective in inflamed tissue with more acidic pH
effective in 30 seconds to 3 minutes
facilitates tonometry, corneal scrapings, conjunctival scrapings,subconjunctival injections
microbial cultures should be taken prior to application of topical anesthetics
Term
Proparacaine
Definition
topical anesthetic
used sparingly for painful eyes
animal may scratch off corneal epithelium because feels no pain
may inhibit mitosis of corneal cells
Term
Systemic Osmotic Agents
Definition
used for treatment of acute primary glaucoma
decrease intraocular pressure by increasing osmotic pressure of plasma relative to that of aqueous and vitreous so fluid is drawn out of eye
osmotic diuretics and CAIs are only ones effective in treatment of glaucoma
Term
Mannitol
Definition
systemic osmotic agent
drug of choice
give slow bolus IV
vomiting and acute congestive heart failure if given too rapidly
withhold water 3-4 hours after administration
Term
Glycerin
Definition
systemic osmotic agent
given orally
withhold water 3-4 hours after administration
don't use in diabetics
Term
2%-5% NaCl Solution/Ointment
Definition
topical osmotic agent
for moderate to severe chronic corneal edema
local irritation
Term
Autogenous Serum-Anticollagenase
Definition
use own animal's serum
drug of choice to treat melting corneal ulcer
only lasts 5-7 days in fridge
Term
Tetracycline/Doxycycline
Definition
anticollagenase
decreases corneal melting
Term
EDTA
Definition
anticollagenase when used topically
Term
Viscoelastic solutions
Definition
used during anterior segment surgery
coats artifical lens implant and maintains integrity of anterior chamber
prevents inadvertent contact with endothelium, angle structures, and vitreous face with surgical instruments
Term
Tissue-Type Plasminogen Activator
Definition
endogenous enzyme
binds fibrin and induces fibrinolysis at site of clot
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