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Ocular Pharmacology
Pharmacology Module 2
49
Medical
Graduate
06/24/2009

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Term
What pharmacological property is unique about eyedrops?
Definition
unique pharmacokinetics
Term
What are 4 major uses for eye drops?
Definition
dry eyes. allergy/inflammation. glaucoma. infection.
Term
What is noteworthy about the volume of eyedrop topical application?
Definition
tear volume ~ 0.007. 1 drop = 0.05
Term
What does topical application of eyedrops stimulate?
Definition
tear rate
Term
How does nasolacrimal occlusion affect eyedrop absorption?
Definition
decreases systemic absorption; increases drug absorption (in eye)
Term
After 12 mo of topical timolol tx, 14.4% of pts required drugs for what side effect? Of these pts, what percent had no hx of this prior to timolol? What was the adjusted hazard ration after 12 mo tx? How did the risk change after 12 mos?
Definition
airway obstruction. 9.9%. 2.29 for pts w/no hx of airway obstruction. risk did not increase further after 12 mos.
Term
What type of drug might be used in the eye to improve the drug's effect?
Definition
prodrugs- conversion of inactive drugs to active form
Term
What are 4 effects of prodrugs when used in eye medications?
Definition
enhance corneal absorption. prolong duration of action. minimize systemic effects. reduce ocular adverse effects.
Term
How might peptide prodrugs enhance corneal absorption in eye?
Definition
peptide drugs- protect against proteoytic degredation
Term
How might prodrugs prolong duration of action in eye?
Definition
increase lipophilicity to form drug depot; increases doa for timolol 2-4x
Term
How might the following drug for the eye minimize systemic effects:  diplefrin?
Definition
prodrug:  diplefrin- diplavalyl ester of epinephrine (reduce dose 10x)
Term
How might diplvefrin for the eye reduce ocular adverse effects?
Definition
prodrug:  diplvefrin- decrease hyperemia, foreign body sensation, follicular conjunctivitis. prostaglandins.
Term
What are 6 additional factors that affect absorption?
Definition
volume, surface tension, osmolality, pH, viscosity, suspensions
Term
How might surfactants affect absorption in eye medications?
Definition
affect surface tension
Term
How might hyper vs. hypotonic factors affect absorption of eye medications?
Definition
osmolality: increased in dts, hyperthyroidism, long term contact lens wear.
Term
How might little buffering capacity with co2 vs. bicarb affect absorption of eye medications?
Definition
high pH- dts, ocular rosacea, lacrimal stenosis, cataract extraction, newborns. low pH in contact lens wearers
Term
What type of ocular dysfunction may require drugs for ocular surface health, comfort, and visual acuity?
Definition
drugs for dry eye (dysfuntional tear syndrome)
Term
What layer minimizes evaporation (of tears in eye)?
Definition
lipid layer from meibomian gland
Term
What are tears?
Definition
complex aq mixture of proteins and electrolytes secreted by lacrimal glands
Term
How wide is the range of osmolarity and pH (in tears)?
Definition
narrow range
Term
Do tears include antimicrobials or growth factors?
Definition
yes
Term
What stabilizes and helps spread tear film?
Definition
mucins
Term
What secretes mucins?
Definition
conjunctival goblet cells
Term
What drugs induce ocular toxicity by affecting tear secretion?
Definition
anticholinergics, antihistamines, beta-blockers, isotretinoin, oral contraceptives
Term
Besides drug induced ocular toxicity, what are 4 other causes of dry eyes?
Definition
menopause. lasik. contact lens. environmental pollution.
Term
What might be a problem with tx dry eyes by minimizing adverse environmental conditions, medications, and visual strain?
Definition
practicality
Term
What might be a problem with tx dry eyes w/artificial tears?
Definition
sx relief only
Term
Why might topical cyclosporine be chosen to tx dry eyes?
Definition
increases natural tear production, good safety profile
Term
What might some problems be with choosing topical steroids to tx dry eyes?
Definition
topical corticosteroids useful only for short periods b/c of side effects
Term
What might be a problem with treating dry eyes w/secretagogues and nutritional supplements?
Definition
clinical benefit yet to be demonstrated
Term
What might be a problem with tx dry eyes w/punctal occlusion to conserve tears?
Definition
can cause decrease in tear production
Term
What are 7 ways dry eyes are tx?
Definition
A. modify environment, habits. B. artificial tears. C topical cyclosporine. D. topical steroids. E. secretagogues. f. nutritional supplements/vitamins. g. punctal occlusion.
Term
What is the difference between artificial and natural tears?
Definition
artificial tears contain electrolytes but they lack the complex mixture of proteins, mucins, and other factors found in normal healthy tears.
Term
What might be a problem w/taking otc fatty acid supplements for dry eyes?
Definition
not regulated by fda; composition might be suspect
Term
What effect did linoleic plus gamma-linoleic acids in tablets on pts' sx, tear production, and break-up time?
Definition
improved sx, lissamine green staining. no effect on tear production or break-up time.
Term
What might be a problem with possible adjunctive therapy for dry eyes?
Definition
does not address primary tear film disfunction.
Term
What are 7 classes of medications for tx of allergic conjunctivitis?
Definition
decongestant, decongestant/antihistamine, antihistamine, mast cell stabilizer, dual-acting antihistamine/mast cell stabilizer, corticosteroid, nonsteroidal anti-inflammatory drug
Term
To what class would the following tx for allergic conjunctivitis belong: visine?
Definition
decongestant
Term
To what class would the following tx for allergic conjunctivitis belong: naphcon-A, vasocon-A, visine-A?
Definition
decongestant/antihistamine
Term
To what class would the following tx for allergic conjunctivitis belong: emadine?
Definition
antihistamine
Term
To what class would the following tx for allergic conjunctivitis belong: alamast, alocril, alomide, crolom?
Definition
mast cell stabilizer
Term
To what class would the following tx for allergic conjunctivitis belong: alrex/lotemax?
Definition
corticosteroid
Term
To what class would the following tx for allergic conjunctivitis belong: acular?
Definition
nsaid
Term
What are the primary, secondary, and tertiary tx for glaucoma?
Definition
primary: prostaglandins. secondary: beta-blockers. tertiary: prodrugs (adrenergic agents).
Term
How do therapeutic drugs for glaucoma aim to adjust flow of aq humor?
Definition
increase outflow of aq humor; decrease formation of aq humor
Term
Optic neuropathy and IOP both have a role in what illness?
Definition
glaucoma
Term
Describe the pH of the following: dts, ocular rosacea, lacrimal stenosis, cataract extraction, newborns.
Definition
high pH
Term
Describe the pH of contact lens wearers.
Definition
low pH
Term
What is changed in the following conditions: dts, hyperthyroidism, long term contact lens wear
Definition
osmolality: increased
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