Download Free Medical Ocular Pharmacology II PowerPoint Presentation

Ocular Pharmacology II PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical PowerPoint presentation titled "Ocular Pharmacology II” by Dr.Ajai Agrawal.

This medical PowerPoint presentation is about therapeutic agents for glaucoma, anti-inflammatory agents, tear substitutes, drugs and biological agents used in ophthalmic surgery and ocular toxicology.

Tags : Ocular Pharmacology, eye diseases, eye disorders, Ophthalmology, Ophthalmology PowerPoint presentation

Published on : Jun 20, 2023 | Views : 1099 | Downloads : 2

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Ocular Pharmacology -II Dr. Ajai Agrawal Additional Professor Department of Ophthalmology A.I.I.M.S., Rishikesh
Slide 2-

Learning Objectives At the end of this class students shall have a basic understanding of : Therapeutic agents for glaucoma Anti-inflammatory agents Tear substitutes Drugs and biological agents used in Ophthalmic surgery Ocular toxicology
Slide 3-

Overview
Slide 4-

Agents used for treatment of Open angle Glaucoma Prostaglandin analogues Beta receptor antagonists Alpha receptor agonists Carbonic anhydrase inhibitors
Slide 5-

Prostaglandin Analogs First- line medical therapy for Glaucoma PGF2α analogs - Good efficacy Once daily application Absence of systemic side effects 1.Latanoprost 2. Travoprost 3.Bimatoprost Facilitate aqueous outflow through uveoscleral outflow pathway
Slide 6-

Prostaglandin Analogs Side effects Ocular irritation & pain Blurring of vision Increased iris pigmentation Macular edema
Slide 7-

β Adrenergic blockers Nonselective β blockers – Timolol maleate - Levobunolol - Metipranolol - Carteolol β -1 antagonist - Betaxolol
Slide 8-

Mechanism of Action of β Blockers Lower IOP by reducing aqueous formation -- Down regulation of adenylylcyclase due to β2 receptor blockade in ciliary epithelium -- Reduction in ocular blood flow
Slide 9-

Adverse Effects of Ocular β Adrenergic blockers Ocular Stinging, redness & dryness of eye Corneal hypoesthesia Allergic blepharoconjunctivitis Blurred vision Systemic Bronchospasm in asthmatics & COPD patients Bradycardia & accentuation of Heart block Minimization of systemic adverse effects
Slide 10-

Alpha Adrenergic agonists Brimonidine (Alpha-2 agonist)(0.1%,0.2%) Usually used as an add on agent Mainly reduces aqueous production Also increases uveoscleral outflow To be used cautiously in children and elderly as it may cause fatigue and drowsiness.
Slide 11-

Carbonic anhydrase Inhibitors (CAI) Systemic -Acetazolamide Topical CAI – Dorzolamide , Brinzolamide Inhibits carbonic anhydrase (isoenzyme II) on ciliary body epithelium → Reduces formation of bicarbonate ions → Reduces fluid transport → Reduces aqueous formation → Decrease IOP Use – Only as add on drug to topical β blockers or PG analogs Systemic CAI – Final medication option before resorting to laser or incisional surgical treatment
Slide 12-

Carbonic anhydrase Inhibitors (CAI) Side effects Paresthesia Frequent urination GI disturbances Hypokalemia
Slide 13-

Topical Miotics Only of historical importance in open angle glaucoma - Ciliary muscle contraction - Increase drainage through trabecular meshwork Drug----Pilocarpine 1,2,4%. Less useful drug – Numerous side effects & three to four times a day dosing
Slide 14-

Stepped Medical Approach to Treatment of Open Angle Glaucoma
Slide 15-

Angle closure Glaucoma Hypertonic Mannitol ( 20%) IV infusion 1.5 -2 g/kg 2. Acetazolamide - 0.5 g oral 3. Miotic - Pilocarpine (1-4%) 4. Timolol 0.5 % - instilled 12 hourly. Definitive treatment – Surgical/ Laser iridotomy
Slide 16-

ppt slide no 16 content not found
Slide 17-

stimulus Phospholipase A2 Lipoxygenases Leukotrienes Steroids NSAIDS
Slide 18-

Corticosteroids CLASSIFICATION Short acting Hydrocortisone, Cortisone, Prednisolone Intermediate acting Triamcinolone, Fluprednisolone Long acting Dexamethasone ,Betamethasone
Slide 19-

Therapeutic Uses of Topical steroids Significant ocular allergy Anterior uveitis Postoperative inflammation following refractive, corneal & intraocular surgery To reduce potential scarring of surgical site (After Glaucoma filtering surgery ) NEVER GIVE STEROIDS IF YOU ARE SUSPECTING ACTIVE INFECTION
Slide 20-

Steroids in ocular conditions…… Systemic steroids & by sub-Tenon’s capsule injection – Posterior Uveitis Intravitreal injection – -- Age-related Macular degeneration (ARMD) -- Diabetic Retinopathy -- Cystoid Macular Edema (CME) Parenteral steroids followed by tapering oral doses – Optic Neuritis
Slide 21-

ALLERGIC CONJUNCTIVITIS
Slide 22-

SCLERITIS
Slide 23-

ANTERIOR UVEITIS
Slide 24-

OPTIC NEURITIS
Slide 25-

Toxicity of Steroids Posterior subcapsular cataracts Secondary infections Secondary open-angle glaucoma 4. Delayed wound healing “ Soft steroids (e.g., Loteprednol ) reduce the risk of elevated IOP ”
Slide 26-

SYSTEMIC side effects of steroids Peptic ulcer Hypertension Increased blood sugar Osteoporosis Mental changes Activation of tuberculosis and other infections
Slide 27-

Topical NSAIDs & their Ocular Uses
Slide 28-

Tear Substitutes Hypotonic or isotonic solutions – Eg: Carboxymethylcellulose Polyvinyl alcohol Polyethylene and propylene glycol Indications Ocular irritation in various diseases Dry eye disease
Slide 29-

Therapeutic Uses of Tear Substitutes Ocular diseases – Allergic conjunctivitis - Blepharitis - Corneal dystrophies - Chemical Burns Systemic diseases – Sjogren’s syndrome - Rheumatoid arthritis - Vitamin A deficiency - Stevens-Johnson syndrome
Slide 30-

Immunosuppressive & Antimitotic Agents Agents commonly used – 1. 5-fluorouracil 2. Mitomycin C Used In Glaucoma surgery, to improve success of filtration surgery by limiting postoperative wound-healing process. In corneal surgery, to reduce risk of scarring after excision of pterygium
Slide 31-

Immunomodulatory Agent Topical Cyclosporine – Approved for the treatment of chronic dry eye associated with inflammation -Decreases inflammatory markers in lacrimal gland & increases tear production
Slide 32-

Ocular diagnostic drugs Fluorescein dye Available as drops or strips Uses: To stain corneal abrasions applanation tonometry detecting wound leak fluorescein angiography Caution: Stains soft contact lens Fluorescein drops can be contaminated by Pseudomonas sp.
Slide 33-

Ocular diagnostic drugs Rose bengal stain Stains devitalized epithelium Uses: severe dry eye, herpetic keratitis
Slide 34-

Anaesthetics In Ophthalmic Procedures Proparacaine & tetracaine drops – Uses – Tonometry Gonioscopy Removal of foreign bodies, sutures on conjunctiva and cornea Adverse effects: toxic to corneal epithelium allergic reaction (rarely)
Slide 35-

Drugs & Biological Agents Used in Ophthalmic Surgery
Slide 36-

ppt slide no 36 content not found
Slide 37-

Botulinum Toxin Type A
Slide 38-

Ophthalmic Effects of Selected Vitamin Deficiencies & Zinc Deficiency
Slide 39-

Ophthalmic Effects of Selected Vitamin Deficiencies & Zinc Deficiency
Slide 40-

Ocular Toxicology
Slide 41-

Toxicology All opthalmic medications – Potentially absorbed into systemic circulation – Undesirable systemic side effects Eg. Timolol (single eye drop) - Death Local toxic effects – Hypersensitivity reactions -- Preservatives in eye drops & contact lens solutions – Benzalkonium chloride – Punctate Keratopathy Thimerosal – Hypersensitivity reactions
Slide 42-

Complications of topical administration Mechanical injury from the bottle e.g. corneal abrasion Pigmentation: epinephrine-adrenochrome Ocular damage: e.g. topical anesthetics, benzylkonium Hypersensitivity: e.g. atropine, neomycin, gentamicin Systemic effect: topical phenylephrine can increase BP
Slide 43-

Amiodarone A drug for treatment of cardiac arrhythmia Causes optic neuropathy (mild decreased vision, visual field defects, bilateral optic disc swelling) Also causes corneal vortex keratopathy (corneal verticillata) which is whorl-shaped pigmented deposits in the corneal epithelium
Slide 44-

Digitalis A drug for treating cardiac failure Causes chromatopsia (objects appear yellow) with overdose
Slide 45-

Chloroquines E.g. chloroquine, hydroxychloroquine Used in malaria, rheumatoid arthritis, SLE Cause vortex keratopathy (corneal verticillata) which is usually asymptomatic but can present with glare and photophobia Also cause retinopathy (bull’s eye maculopathy)
Slide 46-

Chorpromazine An antipsychotic drug Causes corneal punctate epithelial opacities, lens surface opacities Rarely symptomatic Reversible with drug discontinuation
Slide 47-

Thioridazine A psychiatric drug Causes a pigmentary retinopathy after high dosage
Slide 48-

Diphenylhydantoin An epilepsy drug Causes dosage-related cerebellar-vestibular effects: Horizontal nystagmus in lateral gaze Diplopia, ophthalmoplegia Vertigo, ataxia Reversible with discontinuation of the drug
Slide 49-

Topiramate A drug for epilepsy Causes acute angle-closure glaucoma (acute eye pain, redness, blurred vision, haloes). Treatment is by cycloplegia and topical steroids (rather than iridectomy) with the discontinuation of the drug
Slide 50-

HMG-CoA reductase inhibitors (statins) Cholesterol lowering agents E.g. pravastatin, lovastatin, simvastatin, fluvastatin, atorvastatin, rosuvastatin Can cause cataract in high dosages specially if used with erythromycin
Slide 51-

Ethambutol An anti-tubercular drug Causes a dose-related optic neuropathy Usually reversible but occasionally permanent visual damage might occur
Slide 52-

Systemic Agents with Ocular Side Effects
Slide 53-

Systemic Agents with Ocular Side Effects……..
Slide 54-

Visual field constriction Cataract
Slide 55-

Thank you