Common Drugs Use in Common Drugs Use in Ophthalmology - - PowerPoint PPT Presentation
Common Drugs Use in Common Drugs Use in Ophthalmology Ophthalmology Rungroj Lertvithayasakul, MD Rungroj Lertvithayasakul, MD Varintorn Chuckpaiwong, MD Varintorn Chuckpaiwong, MD Department of Ophthalmology, Ramathibodi Hospital Department
Rungroj Lertvithayasakul, MD Rungroj Lertvithayasakul, MD Varintorn Chuckpaiwong, MD Varintorn Chuckpaiwong, MD
Department of Ophthalmology, Ramathibodi Hospital Department of Ophthalmology, Ramathibodi Hospital School of Medicine, Mahidol University School of Medicine, Mahidol University , y , y
Local
Local
Topical
Intravitreous
Subconjunctival
Subtenon
Retrobulbar
Intracameral
Systemic
Systemic y
Blood aqueous barrier Blood aqueous barrier Blood retinal barrier Blood retinal barrier Blood retinal barrier Blood retinal barrier
50 µl per drop
Only 20 20 % of the administered % of the administered drugs is retained drugs is retained
One drop is enough. p g p g Volume of fluid held by cul-de-sac 7 – 10 µl
Lacrimal gland Lacrimal gland
Tear production: Tear production: 1 1. .2 2 µl /min µl /min
Turn over rate 16 % per min Remaining 4 min : 50 %
Nasal cavity Nasal cavity
10 min : 17 %
Nasal cavity Nasal cavity
Surface area of Surface area of 150 150 -
200 cm cm 2 ( ( 13 13 times of conjunctiva ) times of conjunctiva ) 200 200 times of cornea times of cornea
If the drug is If the drug is irritating to the eye irritating to the eye Dilution of drug Dilution of drug Overflow drainage Overflow drainage tat g to t e eye tat g to t e eye O e
O e
Digital pressure at medial canthal
Digital pressure at medial canthal area area
Keep eyes closed for
Keep eyes closed for 5 5 min after min after p y p y taking drops taking drops W it W it 10 10 i t b t d i t b t d
Wait
Wait 10 10 minutes between drops minutes between drops
Frequency ~ duration of action
Frequency ~ duration of action
Order of using ~ pH
Order of using ~ pH
Precorneal area Precorneal area Cornea Cornea Anterior Segment Anterior Segment Aqueous Humor Aqueous Humor
Factors that determine the amount of medication Factors that determine the amount of medication to penetrate the cornea to penetrate the cornea
Drug concentration
Viscosity
Viscosity
Lipid/water solubility H
pH
Surfactants
Reflex tearing
Preservative
Solution and suspension
Solution and suspension Oi t t Oi t t
Ointment
Ointment
Gel
Gel
Most commonly used Most commonly used y Advantages Advantages Easily instilled Easily instilled
Easily instilled
Less interfere to vision Fewer potential complications Fewer potential complications
Fewer potential complications Disadvantages Disadvantages Disadvantages Disadvantages
Short ocular contact time Imprecise and inconsistent delivery Imprecise and inconsistent delivery
Imprecise and inconsistent delivery
Frequent contamination P ibiliti f l i j ith th d ti P ibiliti f l i j ith th d ti
Possibilities of ocular injury with the dropper tip
Must be re Must be re-
suspended by shaking to provide an accurate dosage of drug an accurate dosage of drug g g g g
Consist of petrolatum and mineral oil
Consist of petrolatum and mineral oil
Increase contact time
Increase contact time
Increase contact time
Increase contact time
Disturb vision
Disturb vision
Polymer
Polymer-
based aqueous gels
Drug release occurs by diffusion and by erosion
Drug release occurs by diffusion and by erosion f th l f f th l f
Eye ointment Eye drop Eye ointment
The outer surface The outer surface dimensions of the tip dimensions of the tip affects drop size affects drop size p
Standard colors for drug labeling and bottle cap Standard colors for drug labeling and bottle cap g g p g g p Yellow Yellow Blue Blue B blocker B blocker Yellow Yellow, , Blue Blue B blocker B blocker Red Red Mydriatics and cycloplegics Mydriatics and cycloplegics Green Green Miotics Miotics Orange Orange Carbonic anhydrase inhibitors Carbonic anhydrase inhibitors Brown or tan Brown or tan Anti Anti-
infective agents Gray Gray NSAIDS NSAIDS Gray Gray NSAIDS NSAIDS Pink Pink Steroids Steroids
Cornea, conjunctiva
Cornea, conjunctiva
Irritate
Irritate 15 15 sec sec
Duration
Duration 15 15 min min
For FB removal, IOP measurement, etc.
For FB removal, IOP measurement, etc.
Complications : toxic to epithelium
Complications : toxic to epithelium
Complications : toxic to epithelium
Complications : toxic to epithelium Tetracaine hydrochloride (Tetracaine) Tetracaine hydrochloride (Tetracaine) 0 5% Tetracaine hydrochloride (Tetracaine) Tetracaine hydrochloride (Tetracaine) 0.5% Benoxinate hydrochloride (Novesine) Benoxinate hydrochloride (Novesine) 0.
.4 4% %
Including akinesia
Including akinesia g
For surgery
For surgery Complications: overdose systemic absorption Complications: overdose systemic absorption
Complications: overdose, systemic absorption
Complications: overdose, systemic absorption (respiratory distress, seizure) (respiratory distress, seizure) Lidocaine hydrochloride (Xylocaine) Lidocaine hydrochloride (Xylocaine) 1-
2 % % 1 1-
2 hr hr
Bupivacaine hydrochloride (Marcaine) Bupivacaine hydrochloride (Marcaine) 0.
.25 25-
0. .5 5% % 5-
7 hr hr
Stimulate dilator muscle
Stimulate dilator muscle
Complications: AACG, vasoconstriction
Complications: AACG, vasoconstriction For retinal examination surgery For retinal examination surgery
For retinal examination, surgery
For retinal examination, surgery Phenylephrine hydrochloride (Neosynephrine) Phenylephrine hydrochloride (Neosynephrine)
10 10% % 2 2-
3 hr hr
Inhibit constrictor m.and ciliary m. contraction
Inhibit constrictor m.and ciliary m. contraction
Complications: AACG, flushing
Complications: AACG, flushing
For ciliary spasm, refraction in children, retinal
For ciliary spasm, refraction in children, retinal y p y p exam exam
Atropine sulfate Atropine sulfate 1% % 2 2 wk wk Scopolamine hydrobromide Scopolamine hydrobromide 0. .25 25% % 3 3-
5 d p y p y Homatropine hydrobromide Homatropine hydrobromide 1-
2% % 1 1-
3 d Cyclopentolate hydrochloride (Cyclogyl) Cyclopentolate hydrochloride (Cyclogyl) 1% % 24 24 hr hr y p y ( y gy ) y p y ( y gy ) % Tropicamide (Mydriacyl) Tropicamide (Mydriacyl) 0. .5 5-
1% % 4 4-
5 hr hr
At i lf t At i lf t
Atropine sulfate
Atropine sulfate Cyclopentolate HCl Cyclopentolate HCl
Cyclopentolate HCl
Cyclopentolate HCl
Tropicamide
Tropicamide
Tropicamide
Tropicamide
Phenylephrine HCl
Phenylephrine HCl y p y p
Severity and progression
Severity and progression
Suspected organism & Sensitivity
Location & Penetration
Toxicity
Toxicity
Frequency and concentration
Polymyxin B Gramicidin Neomycin
Antibacterial
Antifungal
Antiviral
Anti parasitic
Antihistamine Antihistamine Vasoconstrictors Vasoconstrictors Antihistamine Antihistamine Vasoconstrictors Vasoconstrictors
Pheniramine maleate A t li HCl Phenylephrine HCl Naphazoline HCl Antazoline HCl Tetrahydrozoline HCl Antazoline HCl + Tetrahydrozoline HCl Pheniramine maleate + Naphazoline HCl
Cromolyn sodium
Lodoxamide
Lodoxamide
Olopatadine HCl
Anti
Anti-
inflammation
Suppress immune system and tissue reaction
Suppress immune system and tissue reaction pp y pp y
Precaution in treatment of infection especially
Precaution in treatment of infection especially viral and fungal infection viral and fungal infection viral and fungal infection viral and fungal infection Dexamethazone Dexamethazone 0 1% Dexamethazone Dexamethazone 0.1% Prednisolone acetate Prednisolone acetate 0.
.5 5%, %, 1 1% %
Fluorometholone Fluorometholone 0.
.1 1% %
Prednisolone (
Prednisolone ( 0 0. .5 5, , 1 1% ) % )
Dexamethasone (
Dexamethasone ( 0 0. .1 1%) %)
Fluorometholone (
Fluorometholone ( 0 0. .1 1 %) %)
Side effects G
Cataract
Exacerbation of infection
Supplement
Supplement
Increase contact time
Increase contact time
For dry eye, CL wearer
For dry eye, CL wearer
Frequency of usage ~ severity
Frequency of usage ~ severity
Preserve VS non preserve
Preserve VS non preserve