OC Pharm Mt II

Patients with glaucoma should not use ocular decongestants without the advice of an eye doctor because these medications can increase intraocular pressure, which is already elevated in glaucoma. This can potentially worsen the condition and lead to further damage to the optic nerve. Therefore, it is important for glaucoma patients to consult with their eye doctor before using any ocular decongestants to ensure that it is safe for their specific condition.

Pts SHOULD occlude puncta btw drops in and to wit several minutes btwn drops in order to maximize the amount of med reaching target receptors and to minimize systemic absorption.

Concern with corneal perforation

MOA: binds to 50s ribosomal subunit of susceptible micorbes to interfere with PROTEIN SYNTEHSIS

The maximum amount of time one should use an ocular decongestant without seeing an eye doctor is 48 hours. This is because prolonged use of ocular decongestants can lead to rebound congestion, where the blood vessels in the eyes become dependent on the medication and worsen the symptoms. It is important to consult an eye doctor if the symptoms persist beyond 48 hours to ensure proper treatment and avoid any potential complications.

The PREG category for antihistamines is not provided in the question. Therefore, it is not possible to determine the correct answer or provide an explanation.

Prostaglandins are the 1st DOC for tx'ing Glaucoma due to: 1) ease of use (1x daily), 2) good safety profile, 3) superior efficacy

Steroids are more effective in ACUTE cases..degenerative diseases are usually refractory to steroids

p. 110

The lacrimal gland is responsible for producing tears, which help to keep the ocular surface lubricated and protected. In cases of dry eye, there is an underlying inflammatory process that affects the ocular surface and the lacrimal gland. This inflammation can lead to a decrease in tear production and clearance, resulting in the symptoms of dry eye.

Some people who are allergic to penicillins may also have a cross-reactivity to cephalosporins. This means that if they are exposed to cephalosporins, they may experience an allergic reaction similar to the one they would have with penicillins. This cross-reactivity occurs because penicillins and cephalosporins have a similar chemical structure. However, it is important to note that not all individuals with a penicillin allergy will necessarily have a cross-reactivity to cephalosporins, as the percentage is relatively low at around 3-5%.

This can SLOW epithlelialization by more than 50%

Onset: 1-7 d after starting therapy
Resolves: 2 weeks
Does not affect clinical course or outcome, but prescribers should note that streptococcal corneal ulcers are often resistant to ciprofloxacin.

IOP elevation RARELY occurs within in first 2 hours unless the pt is a STEROID RESPONDER
Withdrawal of the steroid usually results in return to baseline IOP within 2-4 weeks

Corneal ulcers are commonly caused by bacterial infections, and 75% of the time, these infections are associated with gram-positive bacteria. Gram-positive bacteria have a thick peptidoglycan layer in their cell walls, which makes them more resistant to antibiotics and more likely to cause infections. Therefore, it is likely that corneal ulcers are primarily caused by gram-positive bacteria.

e.g. Latanoprost and Travoprost

If target pressures not met, re-edu pt, have pt demonstrate instillation techniques and punctal occlusion. Schedule pt for a re-check

Suspensions remain in cul-de-sac for longer periods of time and thereby increase the amount of time that the drug remains in contact with the surface of the eye.

Antihistamines have sedating effects, which can make them effective for promoting sleep. While they are not recommended as a sleeping aid, they are often used in elderly individuals who may have difficulty sleeping. Therefore, the statement that antihistamines are often used as a sleeping aid, especially in the elderly, is true.

NSAIDs, or nonsteroidal anti-inflammatory drugs, can indeed decrease the effectiveness of hypertension medications and cause vasoconstriction of renal vessels. This is because NSAIDs inhibit the production of prostaglandins, which play a role in maintaining blood flow to the kidneys and regulating blood pressure. By inhibiting prostaglandins, NSAIDs can lead to vasoconstriction and reduced blood flow to the kidneys, potentially worsening hypertension. Additionally, NSAIDs can interfere with the effectiveness of certain antihypertensive medications, making them less effective in controlling blood pressure. Therefore, it is true that NSAIDs can decrease the effectiveness of HTN meds and cause vasoconstriction of renal vessels.

Diclofenac and Ketorolac have their own specific ADEs (p. 93)

aqueous deficient dry eye is secondary to disorder of the lacrimal gland funciton or failure of lacrimal fluid transfer

evaporative dry eye demonstrates normal lacrimal function, but MGD or increased palpebral fissure width leads to increased evaporation or an anomaly of tear distribution

Use of topical antibiotics may contraindicate (due to sensitization) the drug's later systemic use in serious infections. Topical preparations containing antibiotics not ordinarily administered systemically are preferred. (p. 125)

MOA: interfere with DNA replication by inhibiting DNA gyrase

Anti-A Component: PHENIRAMINE or ANTAZOLINE

1-2 gtt upto QID x 48 hours max

The PREG category for NSAIDs is category C.

Currently no ORAL corticosteroids in OD SOP

Mneumonic: PemiroLAST is the LAST MCS you want to take if you're prego

Both Rimexolone and Loteprednol have less effect on IOP, however only Loteprednol is is approved for SAC

Epinastine CANNOT cros the BB so there are minimal risks of CNS effects

MAOIs (Monoamine oxidase inhibitors) are contraindicated when using antihistamines. This is because MAOIs can inhibit the breakdown of histamine in the body, leading to an accumulation of histamine and potentially causing adverse effects such as increased sedation, drowsiness, and anticholinergic effects. It is important to avoid combining these medications to prevent potential interactions and side effects.

Systane is the correct answer because it is a popular artificial tear that contains polyquaternium as a preservative. Polyquaternium is commonly used as a preservative in eye drops to prevent bacterial growth and maintain the sterility of the solution. Soothe XP, Refresh, and Tears Again are not known to contain polyquaternium as a preservative.

C (corticosteroid) = C

The PREG cat for Restasis is C.

p. 82 --> Stabalize MCSs by inhbitig the degranulation of sensitized MCs after exposure to specific antigen. This prevent the release of histamine and other mediators involved in allergic rxns (they do NOT have the

This is true for ORAL steroids, but not likely necesssary with topical formulations

p. 110

Nedocromil is the mast cell stabilizer with the fastest onset of action.

Flurometholone is Rx only

Diclofenac and Ketorolac are both drugs that can be used off-label for the topical treatment of cystoid macular edema (CME) after cataract surgery. These drugs belong to the class of nonsteroidal anti-inflammatory drugs (NSAIDs) and can help reduce inflammation and swelling in the eye, which can contribute to the development of CME. While the other options, Flurbiprofen and Bromfenac, are also NSAIDs, they are not commonly used for the off-label treatment of CME after cataract surgery.

In cases of persistent corneal ulceration where a steroid has been used or is being used, one should suspect fungal invasion. Steroids can suppress the immune response, making the cornea more susceptible to fungal infections. Fungal invasion can cause prolonged ulceration and may require specific antifungal treatment.

not-available-via-ai

Ktotifen is the only anti-H/MCS that was presented in lecture that is available OTC; all others (Azelastine, Epinastine, and Olapatdine) are by Rx only

e.g. cellulose esthers (methylcellulose, hydroxypropylcelluluse) and viscoelastic agents (sodium hyaluronate, sodium chondroitin)

- dissolve in water to produce varying degress of VISCOSITY
- lack of toxicity+ viscous props + beneficial effects on TF stability = useful in ATs

p. 78 --> caution in pts with narrow angles or hx of glc

Nepafenac has a lower incidence of bleeding compared to Ketorolac & Diclofenac

SCL wearers experienced redness and irritation with Diclofenac & Ketorolac

The reason steroids aren't used for mild ocular allergies is because other modalities (with less ponteially serious comlications) are effective and widely available

Pure mast cell stabilizers are used for seasonal conjunctivitis and VKC (vernal keratoconjunctivitis). Mast cell stabilizers work by preventing the release of histamine and other inflammatory mediators from mast cells, which are involved in the allergic response. Seasonal conjunctivitis, also known as hay fever or allergic conjunctivitis, is an allergic reaction to airborne allergens such as pollen. VKC is a chronic allergic condition that primarily affects children and is characterized by inflammation of the conjunctiva. Therefore, pure mast cell stabilizers are effective in managing the symptoms of both seasonal conjunctivitis and VKC.

The correct answer is Loteprednol. This drug is the second most commonly prescribed by ODs after Fluroquinolones.