OCULAR PHARMACOLOGY for ASSISTANTS AND TECHNICIANS

Maghan DasGeneric Bscn Sem IV

PharmacologyMa’m: Shabana

Maghan Das Parwani

ROLE of theASSISTANT AND TECHNICIAN

RecordingPatient EducationNEVER Work in Doubt!

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PATIENT CASE HISTORY

General HealthMedicationsAllergies

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VITAMIN SUPPLEMENTS

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CLASSIFICATIONS

SolutionsSuspensionsOintments

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DIAGNOSTIC AGENTS

Topical AnesthesticsMydriaticsCycloplegicsDyes/StainsFluressGonioscopic Solutions

DPA’s treat symptoms, unknown disease

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Topical Anesthetics

ProparacaineTetracaineCocaineAlcaine

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Mydriatics & Cycloplegics

Tropicamide Phenylephrine Cyclogyl Atropine Homatropine Scopalomine

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Dilation Hazards Cross Contamination

Narrow anterior chamber angle

Potential risk in dilating … opt vs oph

Plan for acute angle glaucoma attack

Make sure you are far enough away not toTouch the patient

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Dyes & Stains

FluoresceinRose BengalLissamine GreenFluress

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Gonioscopy Solutions

GoniosolGonioscopicCelluvisc

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CLINICAL ADMINISTRATION

Patient HistoryClinical Procedures Which May Be

Influenced by MedicationsThe ERx Option

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Ophthalmic Drug Complications Giving people medications may seem routine,

but there are possible negative consequences. Not all people are tolerant of all medications. If given a drug they can’t tolerate, a patient may have an allergic or toxic reaction. As an eye technician administering drugs to people on a daily basis, it’s important you understand and recognize what is occurring if a patient does have a reaction. You also need to understand how drugs affect the body’s autonomic nervous system (ANS), to include the sympathetic and parasympathetic divisions.

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THERAPEUTIC AGENTS

AntibioticsAnti-viralsDrugs that lower IOPAnti-inflammatory agentsNon-SteroidalCombinations

TPAs treat disease, known problem

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GLAUCOMA MANAGEMENT

PilocarpineBeta-BlockersCarbonic Anhydrase Inhibitors

Adrenergic AgonistsMaghan Das Parwani

OCULAR INFLAMMATION

CorticosteroidsSteroid-Antibiotic

CombinationsNon-Steroidal Anti-

inflammatory Drugs (NSAIDS)Oral Analgesics

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OCULAR INFECTIONS

Topical AntibioticsOral AntibioticsAnti-Viral Analgesics

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Antibiotic Biotic means

relating to, produced by, or caused by living organisms

The prefix anti "against" the referent of the stem to which the prefix is affixed

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OCULAR SURFACE

Artificial TearsLubricating OintmentsPunctal Occlusion

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OCULAR ALLERGIES

Artificial TearsAntihistamine-Decongestants

CorticosteroidsMaghan Das Parwani

Cap Color Code

Tan- antibiotics Pink- anti-inflammatory/steroids Red- mydriatics/cycloplegics Grey- NSAIDS Green- miotics Yellow or Blue- beta-blockers Purple- adrenic agonists Orange- carbonic anhydrase inhibitors Turquoise- Prostaglandin analoguesMaghan Das Parwani

IN-OFFICE PROCEDURES

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Patient Instruction- Solutions and Suspensions Wash hands thoroughly before administration Tilt head backward or lie down and gaze upward Gently grasp lower eyelid below eyelashes and pull

the eyelid away from the eye to form a pouch Place dropper directly over the eye. Avoid contact

of the dropper with the eye, finger or any other surface

Release the lid slowly and close the eye Occlude punta for 2-3 minutes Wait 5 minutes before administering a second

medication or dropMaghan Das Parwani

Patient Instruction- Ointment Wash hands thoroughly Tilt head backward or lie down and gaze upward Gently pull down the lower lid to form a pouch Place .25 to .50 inch of ointment with a sweeping motion Close the eye for 1-2 minutes Temporary blurring of vision may occur. Remove excess ointment with a tissue Wait 10 minutes before applying the second ointmentMaghan Das Parwani

Continuous release delivery A medication device placed in the eye and

lasting for a week is quite a benefit to patients who have

trouble keeping up with their drops. The most common of these devices is the Pilocarpine Ocusert®,

which permits continuous delivery of medication 24 hours a day for seven days.

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Retro-Bulbar Injection

Subconjunctival injections Injections may be administered under the

conjunctiva to deliver medications in large doses and longer

durations (fig. 4–4). The subconjunctival medication gains access to the eye by absorption into the

bloodstream through the episcleral and conjunctival vessels. Subconjunctival injections are used

primarily in the treatment of intraocular infection or acute uveitis cases.

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ABBREVIATIONS

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Examples

ad lib- freely as needed ac – before meals bid- twice a day gtt- Drops hs- at bedtime pc -after meals po- by mouth prn- as needed Maghan Das Parwani

Examples- con’t

oint- ointment q- every qh- every hour q4h- every four hours qid- 4 times a day sig- instructions sol- solution susp- suspensionMaghan Das Parwani

Examples- con’t

tab- tablet tid- three times a day top- topically ung- ointment ut dict- as directed

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Prescription abbreviationsAbbreviation

Meaning Abbreviation

Meaning

ac (ante cibum) before meals

q (quaque) every

ad lib (ad libitum) as much as wanted

qd (quaque die) every day

aq Water qh (quaque hora) every hour

bid (bis in die) twice a day

qid (quater in die) 4 times a day

gt; gtt (gutta; guttae) drop; drops

ql (quantum libet) as much as desired

h hora) hour qqh or q4h (quaque quarta hora) every four hours

hs (hora somni) at bedtime

qs quantity sufficient

mg Milligram Rx (recipe) prescriptionnon rep (non repetatur) do not

repeatSol solution

pc (post cibum) after meals

Tid (ter in die) three times a day

po (per os) by mouth, orally

ung (unguentum) ointment

prn (pro re nata) as needed

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Mydriatic Mydriasis is the dilation of the pupils, so,

logically, a mydriatic drug causes dilation. The main reason the eyes is dilated is to allow the doctor to perform a thorough exam of the posterior portion of a patient’s eyes. A big pupil allows a wider field of view and gives the examiner a chance to see the vast majority of the retina, rather than the very small amount seen in an undilated eye. Mydriasis is also useful in allowing you to take fundus photographs of the macula, optic nerve, and any retinal anomalies present.

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Beta-Blockers Beta-blockers are the current drugs of choice in

lowering IOP. Timoptic®, Betoptic®, and Betagan® are some of the most popular drugs being used to lower IOP today. Introduced in the late 1970s, they quickly became the initial drug of choice for lowering IOP.

One reason beta-blockers are so popular is, on average, they reduce IOP by 25 percent. Another reason is they can be used once or twice daily, unlike most previous medications that were used up to four times a day. Finally, most of the previous drugs used to lower IOP caused miosis (pupillary constriction), dim vision (due to constricted pupil size), eyebrow ache, and stimulation of accommodation (which can blur vision). Fortunately, beta-blockers work without these side effects. However, this does not mean they are perfect, as they also have some side effects.Maghan Das Parwani

Beta-Blocker Complications Beta-blockers block the beta–1 and beta–2

receptors from doing their jobs in the body. This is good because one of the jobs of the receptors involves maintaining normal production of aqueous humor. By slowing down aqueous production, the IOP can be lowered. The downside is some of the other jobs beta–1 and beta–2 receptors include proper heart rate and breathing.

Basically, if a patient systemically absorbs a beta-blocking medication, it slows the heart rate and makes breathing difficult. Not a great thing to have happening when you consider the age and general health of a lot of your glaucoma patients.

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Risk of Complications

Thus, patients with certain systemic diseases warrant special consideration by a doctor trying to decide whether the person should use beta-blockers or not. The following is a very general list of systemic conditions contraindicating beta-blocking medication usage.

• Asthma.• Heart or circulatory problems.• Chronic obstructive pulmonary disease

(COPD).

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In addition, patients already on systemic beta-blockers (e.g., Inderal® for high blood pressure) should be considered high-risk candidates for use of any of the beta-blocker medications. Patients may be better off using one of the cholinergic medications, carbonic anhydrase inhibitors, or prostaglandin inhibitors instead.

Some of the common side effects of beta-blockers (especially the more medication the patient systemically absorbs) are:• Bradycardia—the slowing down of the heart rhythm (leading to low blood pressure and dizziness).• Induced asthma.• Mood changes.

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Topical Steroids

Durezol Pred Forte Prednisone Omnipred Econopred

Avoid using steroids on viral infections

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Contraindications for Steroids Cataracts. Increased IOP. Fungal overgrowth. Delayed wound healing. Decreased wound healing. Decreased resistance to infection. Proliferation of herpes simplex virus

NOTE: Virtually all of these side effects are quite rare when the proper dosage of topical steroid is used in a short-term manner as prescribed by the doctor.Maghan Das Parwani

Topical NSAIDS

Bromday – Prolenza Nevanec

Used often for pre/post cataract surgery

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CAP ColorsCap Color Drug ClassTan Antibiotics, Antivirals, AntifungalsPink Anti-inflammatory/Steroids treats allergic reactions,

swelling, redness (slows healing can cause cataracts and glaucoma). Do not use on fungal infections

Red Mydriatics/Cycloplegics (dilate pupil)Grey Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) control

inflammation caused by ocular allergies without steroidal side-effects

Green Miotics (stimulates sphincter and causes pupil constriction)Yellow or Blue Beta-Blockers traditionally used to treat glaucoma, reduce

IOP by decreasing aqueous humorPurple Adrenic Agonists (reduce IOP)Orange Carbonic Anhydrase Inhibitors (reduce IOP)Turquoise Prostaglandin Analogues (reduce IOP by increasing aqueous

outflow)

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HOW TO WRITE AN Rx

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Medication Administration Read the doctors orders

Check the medication twice

Name Dosage Amount Expiration date

Wait 5 min between gtts

Punctal Occlusion

Put ung in last

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Preparation 1. Wash your hands. 2. Triple check the medication you are going to instill to ensure

it is what the doctor ordered. 3. Advise the patient of what you are going to do. 4. Recline the patient or gently tilt the patient’s head back.

Always ask the patient about neck or back problems before tilting his or her head. Do not tilt a Down’s syndrome patient’s neck due to the high risk of cervical fracture.

5. With one hand, hold the upper lid and, with a finger of the other hand (the one holding the little bottle of medication), pull down gently on the lower lid (fig. 4–1).

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6. Have the patient look down. 7. Keep the bottle about ½″ above the eye. This should be high

enough to avoid contamination by the patient’s eyelashes in the event the patient inadvertently blinks, while still allowing good control of where the drop goes. Now, squeeze the bottle to dispense a drop in the eye. Ideally, the drop hits just above the upper limbus, causing minimal reaction by the patient (since the very sensitive cornea isn’t hit directly), but allowing a good percentage of medication to flow across the cornea before it gets diluted by tears.

CAUTION: Keep the eye dropper tip well away from the eye so, even if the patient blinks, the lashes do not touch it. If the dropper tip comes into contact with the patient’s eyes, lids, or lashes, the bottle is considered contaminated and must be thrown away after you finish with the patient. Do not attempt to use it on another patient.

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Make sure that you include: Full name of patient Address can be optional Date of Rx Inscription: name of drug;

concentration Subscription: amount to be dispensed Instructions: route of administration;

number of drops or tablets; frequency of use; refill

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What else?

Make sure that it is legible!

Type in correctly

Verify

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Questions

What type of drug is used to lower IOP? A. Mydriactic B. Antibiotic C. Beta Blocker

How often is the following medications taken?

Maxitrol ophthalmic ung apply BID OU for 14 days:

A. Once a day B. Twice a Day C. Three times a Day

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Questions

What drug is used to stain the cornea? A. Mydriacyl B. Carbachol C. Flourescein

How often is the following medications taken?

Pred Forte ophthalmic 1gtt qid q 6h OD 7 days then 1gtt bid q 12h for 7 more :

****No help****

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Questions

What drug is used to destroy bacteria? A. Bromday B. Antibiotic C. Beta Blocker

What drug is used increase aqueous outflow? A. Vigamox B. Pilocarpine C. Mydriacyl

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Questions

What drug is used to dilate the pupil? A. Miotic B. Mydriacyl C. Beta Blocker

What drug is used as an anti-inflammatory? A. Durezol B. Vigamox C. Besivance

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Examples

ad lib- ________ ac – ________ bid- _________ gtt- _________ hs- _________ pc -__________ po- __________ prn- __________Maghan Das Parwani

Examples

ad lib- freely as needed ac – before meals bid- twice a day gtt- drops hs- at bedtime pc -after meals po- by mouth prn- as needed Maghan Das Parwani

References and resources

Ophthalmic Drug Facts 2002 Ophthalmic Medications and Pharmacology Review of Optometry: 2002 Clinical Guide to

Ophthalmic Drugs (Melton and Thomas) May issue

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THANK YOU!

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