1 / 50

Drugs used in ophthalmology

Drugs used in ophthalmology. lek.med. Magdalena Mazurek Chair and Clinic of Ophthalmology with Department of Patophysilogy of Organ of Vision. How does a drug get inside the eye ?. 1. By blood  The blood-retinal barrier ( BRB) 2. Penetrates by the cornea

lot
Download Presentation

Drugs used in ophthalmology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Drugsusedinophthalmology lek.med. Magdalena Mazurek Chair and Clinic of Ophthalmology with Department of Patophysilogy of Organ of Vision

  2. Howdoes a druggetinsidetheeye? • 1. By blood The blood-retinal barrier (BRB) • 2. Penetrates by the cornea  Mainly by epithelium and endothelium of the cornea

  3. Route of administration • Given locally ( eye drops) – amount of drug in the anterior segment of the eye > given orally • Given locally– achieve therapeutic levels up to the ciliary body • Intraocular concentration : • subconjunctival injection > eye drops i ointment > orally

  4. Types of drugs -way of administration: • 1. Eye drop , suspension , emulsion • 2. Ointment and gel • 3. Inserts – i.e. Ocusert (Pilocarpine) – a drug container placed inside conjunctiva • 4. Therapeutic Contact Lenses (‘bandage’ lenses)

  5. Types of drugs -way of administration 5.Ion(t)ophoresis- technique using a small electric charge to deliver a medicine through the surface of cornea/ skin . Thedrugformschargedactiveagents ( kations, anions) which transport deaper . 6.Subconjunctival injection and periocularinjection 7. Anteriorchamberinjection 8. Intravitrealinjection

  6. Eye drops • After administration a smaller amount of drug is absorbed by the surface of the cornea, most of it reaches vascular system by the conjunctiva. • Only 1 drop because: • Volume of the conjunctival sac = 30 μl • Volume of 1 drop = 40-70 μl • If you administer more than one drug remember about intervals– time for penetration and absorbtion

  7. Eye drops • While giving drops that have systemic effects (β-blockers, adrenaline, pilocarpine ): • Patient should close his eyes after drug administration (it counteracts getting into the lacrimal sac by the canaliculi ) • Press in the place where lower canaliculus is located • It is possible to give the drug directly on the cornea.

  8. Ointments • Longer time of contact with the eyes surface • Often given before going to sleep (overnight) • They paste eyelashes together • They can cause reversible loss of visual acuity

  9. Groups of drugs: • 1. Drugs affecting the vegetative system • 2. Drugs used in glaucoma • 3. Anti-infectious drugs • 4. Anti-inflammatory drugs • 5. Anti-allergic drugs • 6. Drugs affecting metabolism of cells and their regeneration • 7. Lubricant Eye Drops ( ` fake tears ` ) • 8.Anaesthetics • 9. Disinfectant Drugs

  10. Drugsaffectingthevegetative system

  11. Substance Receptors Adrenaline α , β Noradrenaline α , β Fenylefryne α (non-selektive) Brimonidyne α2 Apraklonidyne α2 Sympathicomimetics

  12. Sympathicomimetics (mydriatica) • Stimulate receptor α + β: • Stimulate sympathetic nervous system • Dilate the pupil do not affect focusing (accommodation) • Tear adhesions apart • If the angle is closing they can cause its total closure and increased IOP • Neosynephrin sol. 2,5% 5% 10% • Adrenaline ( 0,001%) < 1 ml

  13. Counter-indications : • arythmia • hypertension, high blood pressure • pheohromoctyoma • IHD • Closed angle glaucoma Adverse effect • Anxiety, tremor • Dizziness ,headache • Tachycardia • Arythmia , acute chest pain • Allergy

  14. Sympaticolitics (β-blockers) • ↓IOP: • ↓ production of aqueous humour by the ciliary body • affect ultrafiltration • non-selective β-blockers (β1 + β2) • Karteolol, Timolol, Lewobunolol • selectywne β-blockers (β1) • Betaksolol

  15. β-blockery – indications • Glaucoma: • Open angle glaucoma • Closed angle glaucoma (with parasympathicomimetic) • Glaucoma in aphakic eyes Lowers elevated but also normal IOP Younger patients –stronger hypotension

  16. Side effects • conjunctival irritation, burning sensation, reversible loss of visual acuity,conjunctivitis,dry eyes,ptosis, constriction of vessels • bradycardia , arythmia, hypotension, stroke, cerebrovascular accident (CVA) , VASCULAR FAILURE • bronchospasm (except for betaksolol), difficulty in breathing , dizziness ,headache, depression,nausea • allergy

  17. Counter-indications : • Asthma • Lung diseases • Heart/ vascular failure • II /III degree AV block • Bradycardia • Allergy • ! Unstable diabetes ! • ! Pregnancy and Breastfeeding !

  18. β-blockers • Betaksolol (Betoptic) sol. 0,25% 0,5% • Timolol (Oftensin, Timoptic, Cusimolol) sol. 0,25% 0,5% • Karteolol (Arteoptic) sol. 1% 2% • Metipranolol (Betamann) sol. 0,1% 0,3%

  19. Parasympathicomimetic (miotics) • ↓IOP • Dilate veins  ↑aqueous outflow • Used in treatment of closed angle glaucoma • Pilocarpine sol. ung. 1% 2% 4% • Karbachol sol. 3%

  20. Parasympathicomimetic • Counter-indications: • Uveitis • Retinal Degenerative Diseases ( ↑ incidence of retinal detachment) • Heart diseases • Asthma • Hyperthyreosis • Peptic Ulcer Disease • Parkinson's disease

  21. Side effects: • Headache • Speeds up onset of cataract • Constricts pupils  poor night sight • Posterior synechiae • ↑ lacrimation • Systemic effects: bradycardia, hypotension, ↑Increased urination, production of saliva

  22. Parasympaticolytics (mydriatica et cycloplegica) • They block the parasympathetic system • Dilate the pupil affect accommodation • Atropine sol. 1% (children 0,25-0,5%) - 2weeks. • Homatropine sol. 1% -12 h. • Scopolamine sol. 0,25% -30 h. • Tropicamid sol. 0,5% 1% - 4 h. • Cyclopentolat sol. 0,5% 1% -24 h.

  23. Indications: • Helps with diagnosis (dilated pupil- fundus examination ) • Preparation for the eye surgery • In treatment of iriditis ,cyclitis • Corneal ulcers • Counter-indications : • Closed angle glaucoma • Diseases of urinary tract and prostate with urinary retention • Epilepsia • Allergy • < 1year old

  24. Parasympaticolytics can cause closure of the angle – acute glaucoma! • gonioscopy • If the angle is narrow : • 250 mg acetazolamide p.o. before dilation • Better use Neosynephrin

  25. Drugsusedinglaucoma

  26. α2-adrenomimetics i β-adrenolitics • Parasympathicomimetic • Carbonic anhydrase inhibitors • Prostaglandin analogues • Combinated drugs

  27. Carbonicanhydraseinhibitors • ↓ production of aqueous • ↑ urination (when longer used ↓K+) • Acetazolamide - Diuramid tabl. 250 mg - Diamox inj. i.v. 500mg • Diclofenamid (Diklofenamid) tabl. 50 mg • Dorzolamid - Trusopt sol. 2% - Azopt sol.1%

  28. Carbonicanhydraseinhibitors • Counter-indications : • Renal failure, liver failure , chronic respitarory diseases • Side effects: • Dizziness, headache, drowsiness , depression, dyspepsia, renal /urinary tract lithiasis , hypercaliemia i metabolic acidosis, paresthesia, itching /burning sensations of the eyes

  29. Prostaglandinanalogues • ↑ Outflow of aqueous humour • Ciliary body  sclera  lymphatic vessels • convenient in use – 1x day • Latanoprost (Xalatan) sol. • Travoprost (Travatan) sol. • Bimatoprost (Lumigan) sol.

  30. Prostaglandinanalogues • No systemic side effects • Should not be combined with Pilocarpine because it blocks uveoscleral outflow • Do not use in: allergy • Side effects: • change of iris color (darker ↑ melanine), burning sensation of the eyes , keratitis, palpebritis, growth of eyelashes • rare:headache ,nausea

  31. Combinateddrugs • If monotherapy does not help • Cosopt (Timolol + Dorzolamid) sol. • Fotil, Timpilo (Timolol + Pilocarpina) sol. • Normoglaucon (Metipranolol + Pilocarpina) sol. • Xalacom (Latanoprost + Timolol) sol. • DuoTrav (Travoprost + Timolol) sol.

  32. Anti-infectiousdrugs

  33. Antybiotics • To treat infectious diseases of the eye • Before/Postoperative prophylaxis • Best to do antibiogram • Used as eyedrops , ointments, injections

  34. Antybiotics • Aminoglycosides • Amikacin (Biodacin) sol. • Gentamycin 0,3% sol. ung. • Neomycyn ung. • Tobramycin (Tobrex) sol. ung. Tetracyclines • Oftalmolosa cusi tetracycline – ung. • Chloramphnicol • Oftalmolosa cusichloramfenicol – ung. • 1% sol.Detreomycini

  35. Antybiotics • Fluoroquinolones • Ciprofloksacin (Ciloxan, Proxacin) sol. • Norfloksacin (Chibroxin) sol. • Ofloksacin (Floxal) sol. ung. • Sulfonamids: • Sulfacetamid 10% sol. • Sulfadikramid (Irgamid) ung.

  36. Antiviraldrugs • Herpes zoster, HSV, CMV, EBV • NOT adenovirus infection (one of most common infections)!!!!!! • Acylovir (Cusiviral, Virolex, Zovirax) ung. tabl. • Vidarabine (Vira A) ung.

  37. Anti-inflammatorydrugs • Steroids • Nonsteroidal

  38. Hydrocortison 1(point of reference) Fluorometolon 1 Prednison 3,5 Prednisolon 4 Metyloprednisolon 5 Triamcinolon 5 Parametason 10 Fludrocortison 10 Deksametason 25-30 Betametason 30-40 Power of thesteroids

  39. Steroids – localuse : • Betametason (Betnesol) sol.0,1% • Deksametason (Dexamethason, Oftan Dexa) sol.0,1% • Fludrocortison (Continef) ung. • Fluorometolon (Flucon, Flarex) sol. • Hydrocortison (Hydrocortison dispersa, Ophticor H) ung. • Prednisolon (Prednisolonum) sol.

  40. NSAIDs • General inhibition of prostanoid biosynthesis • Often used : • Before/after surgery • Conjunctivitis, keratitis, scleritis ……. • After trauma • Prevent pupil dilation during operation • When steroids can`t be used • Diclofenac (Naclof) sol. • Flurbiprofen (Ocuflur) sol. • Indometacine (Indocollyre, Indocid) sol.

  41. Anti-allergic drugs

  42. Antihistaminedrugs • Emadastine (Emadine) sol. • Olopatadine (Opatanol) sol. Combined : • Alergoftal (Antazoline + nafazoline) sol. • Betadrin (Difenhydramine + nafazoline) sol. • Spersallerg (Antazoline + tetryzoline) sol. • Allergic conjunctivitis ….symptoms

  43. Anti-allergicdrugsother: • Natrii cromoglicas (Cromohexal, Opticrom, Polcrom, Vividrin, Cusicrom) sol. • Tilavist sol. • Alomide sol.

  44. Drugs affecting metabolism of cells and their regeneration

  45. Better corneal nutrition in dry eye syndrome, in eye burns , erosions ,corneal ulcers…. • Dexpantenol (Corneregel) żel • Solcoseryl – gel • Better metabolism of the lens and vitreous (↓ cataract onset) • Quinax sol. • Catalin sol.

  46. Lubricant Eye Drops ( `fake tears `)

  47. Lacrimal sol. • Artelac, Isopto-Tears, Methocel sol. • Vidisic gel • Oculotect, Vidisept sol. • Combined : • Dacrolux sol. • Tears Naturale, Tears Naturale Free sol. • ! Better without conservants!!!!

  48. Anaesthetics

  49. Given locally . • Do not use too long because they are toxic for corneal epithelium. • Bupivacainum inj. 0,25% 0,5% • Marcain inj. 0,25% 0,5% • Lignocainum, Lidocain, Xylocaine inj. 2% 4% • Alcaine sol.

  50. Thanx for listening!

More Related