Pharmacology eye disorders


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Pharmacology eye disorders

  1. 1. EYE DISORDERS Pharmacology PHM 212 DONE BY: AMEENAH KHAN 09/0509/1391
  2. 2. AMBLYOPIA <ul><li>It is a condition that occurs in children when one eye has poorer vision than the other. </li></ul><ul><li>It is commonly known as lazy eye. </li></ul>
  3. 3. SYMPTOMS <ul><li>Mild: not aware since vision in normal eye is stronger thus it is diagnose until later. </li></ul><ul><li>Severe: </li></ul><ul><ul><li>most notably poor depth perception , </li></ul></ul><ul><ul><li>poor spatial acuity , </li></ul></ul><ul><ul><li>low sensitivity to contrast </li></ul></ul><ul><ul><li>&quot;higher-level&quot; deficits to vision such as reduced sensitivity to motion . </li></ul></ul>
  4. 4. CAUSES OF AMBLYOPIA <ul><li>Nearsightedness or astigmatism in one eye. When the child's brain is confronted with both a blurry image and a clear image, it will begin to ignore the blurry image. If this continues, the vision in the defected eye will start to deteriorate even further. </li></ul><ul><li>Strabismus or ocular misalignment prevents the eyes from focusing together on an image. This causes double vision. In order to combat this, the child's brain generally chooses to ignore the image from the deviated eye, causing the vision in that eye to eventually deteriorate </li></ul>
  5. 5. DIAGNOSIS <ul><li>Pediatricians or vision programs will check three aspects of your child's eye health: </li></ul><ul><li>That your child's eyes let light all the way through </li></ul><ul><li>That both eyes see equally well </li></ul><ul><li>That the eyes are moving normally. </li></ul><ul><li>If there's a problem in any of those three areas, the pediatrician may recommend a visit to an eye specialist. </li></ul>
  6. 6. TREATMENT <ul><li>Common treatment for amblyopia is to force the brain to start using the &quot;bad&quot; eye by putting a patch over the &quot;good&quot; eye. </li></ul><ul><li>In cases of mild amblyopia, the doctor might recommend using an eye drop called atropine in the &quot;good&quot; eye instead of a patch. Atropine makes it impossible for that eye to focus close-up, forcing the &quot;bad&quot; eye to do most of the work while the child is playing with toys, eating, drawing or reading. </li></ul><ul><li>If there is something blocking light from getting into the eye, the doctor might recommend surgery to remove the blockage. </li></ul><ul><li>If strabismus is preventing the eyes from moving together correctly, your doctor might recommend surgery on the muscles of the eye. </li></ul><ul><li>And if the focus of one eye is very different from the other, eyeglasses or contact lenses might be necessary. </li></ul>
  7. 7. ATROPINE <ul><li>A topically applied muscarinic antagonist, which blocks the action of acetylcholine. This results in paralysis of the iris sphincter and resultant pupillary dilation. Paralysis of the ciliary muscles also occurs, which inhibits accommodation and relieves pain in iridocyclitis. The medication is dispensed in a topical formulation, either an ointment or a solution. </li></ul>
  8. 8. Mechanism of Action <ul><li>Muscarinic effects: Atropine works by competitively occupying muscarinic receptor sites, thus reducing the effects of excessive acetylcholine on these sites brought about by cholinesterase inhibition. </li></ul>
  9. 9. DOSAGE <ul><li>Adult </li></ul><ul><ul><li>1 gtt in the fornix in affected eye 1-3 times qd, then taper as necessary </li></ul></ul><ul><li>Pediatric </li></ul><ul><ul><li>1 gtt in the fornix in affected eye qd </li></ul></ul>
  10. 10. DRUG INTERACTION <ul><li>Atropine is an alkaloid (a family of chemicals with pharmacologic activity and a common structure) that affects the nervous system. It is found in deadly nightshade (Atropa belladonna) and other plants. Some effects of atropine include blurred vision, dilated pupils, constipation, dry mouth, and dry eyes. </li></ul><ul><li>Coadministration with other anticholinergics have additive effects; pharmacologic effects of atenolol and digoxin may increase with atropine; antipsychotic effects of phenothiazines may decrease with this medication; tricyclic antidepressants with anticholinergic activity may increase effects of atropine. </li></ul>
  11. 11. Summary of Interactions with Vitamins, Herbs, and Foods <ul><li>Avoid: Tannin-containing herbs* such as green tea, black tea, uva ursi, black walnut, red raspberry , oak, and witch hazel </li></ul><ul><li>Reduced drug absorption/bioavailability —Avoid these supplements when taking this medication since the supplement may decrease the absorption and/or activity of the medication in the body. </li></ul>
  12. 12. Summary of Interactions with Vitamins, Herbs, and Foods <ul><li>Depletion or interference; </li></ul><ul><li>Side effect reduction/prevention; </li></ul><ul><li>Supportive interaction; </li></ul><ul><li>Adverse interaction- None known </li></ul>
  13. 13. Interactions with Herbs <ul><li>Tannin-containing herbs Tannins are a group of unrelated chemicals that give plants an astringent taste. Herbs containing high amounts of tannins which may interfere with the absorption of atropine taken by mouth. </li></ul>
  14. 14. PREVENTION <ul><li>Early recognition and treatment of amblyopia in children can help to prevent permanent visual deficits. </li></ul><ul><li>All children should have a complete eye examination at least once between age three and five to avoid the risk of allowing unsuspected amblyopia to go beyond the age where it can be treated successfully. </li></ul>
  15. 15. BLEPHARITIS <ul><li>Medical term for inflammation of the eyelids </li></ul><ul><li>It is not contagious. </li></ul><ul><li>And generally does not cause any permanent damage to eyesight. </li></ul><ul><li>Another term for blepharitis is granulated eyelids. </li></ul>
  16. 16. Cause of blepharitis <ul><li>A malfunction of the oil glands of the eye lids. </li></ul><ul><li>When these oil glands produce too much, too little, or the wrong types of oils, the eyelid margins can become inflamed, irritated, and itchy. </li></ul><ul><li>Blepharitis that are due to disorders of the lid margin around the lashes include seborrheic blepharitis, which is similar to dandruff of the scalp, and infection of the lash base by Staphylococcal bacteria. </li></ul>
  17. 17. Cause of blepharitis <ul><li>Allergies </li></ul><ul><li>A primary infection of the eyelids by bacteria or infestation of the lashes by tiny mites or head lice . </li></ul>
  18. 18. Symptoms and Signs <ul><li>Itchy eyelids , </li></ul><ul><li>dryness of the eyes , </li></ul><ul><li>burning, gritty, sandy sensation in the eyes </li></ul><ul><li>foreign-body sensation (the feeling that something &quot;may be in the eye&quot;) </li></ul><ul><li>crusting of the eyelids, </li></ul><ul><li>irritation, </li></ul><ul><li>decreased comfort while wearing contact lenses, and </li></ul><ul><li>sensitivity to light. </li></ul>
  19. 19. DIAGNOSIS <ul><li>Usually diagnosed by a physician </li></ul><ul><li>The physical examination should place special emphasis on evaluation of the eyelids, lid margins, base of the lashes, oil gland openings, tear quantity and quality, and front surface of the eyeball using a slit lamp, which allows a magnified view with sufficient illumination. </li></ul>
  20. 20. TREATMENT <ul><li>Good eyelid hygiene and a regular cleaning routine can control blepharitis. This includes frequent scalp and face washing, using warm compresses to soak the eyelids, and doing eyelid scrubs. </li></ul><ul><li>Limiting or stopping the use of eye makeup when treating blepharitis is often recommended, as its use will make lid hygiene more difficult. </li></ul><ul><li>If you wear contact lenses, you may have to temporarily discontinue wearing them during treatment. </li></ul>
  21. 21. TREATMENT <ul><li>In cases where a bacterial infection is the cause, various antibiotic drops or ointment and other medications may be prescribed along with eyelid hygiene. </li></ul><ul><li>Depending on the degree of inflammation of the lid margin, a combination of topical antibiotic and steroid drops or ointments can be prescribed by your physician. </li></ul><ul><li>If the blepharitis is due to allergy, efforts should be made to identify and reduce the exposure to the offending agent. Prescription and over-the-counter drop or oral antihistamines may be used </li></ul>
  22. 22. CORTISPORIN® Cream (neomycin and polymyxin B sulfates and hydrocortisone acetate) Cream, USP <ul><li>topical antibacterial cream. </li></ul><ul><li>Neomycin sulfate is the sulfate salt of neomycin B and C, which are produced by the growth of Streptomyces fradiae Waksman (Fam. Streptomycetaceae).. The structural formulae are: </li></ul><ul><li>Polymyxin B sulfate is the sulfate salt of polymyxin B1 and B2, which are produced by the growth of Bacillus polymyxa (Prazmowski) Migula (Fam. Bacillaceae). The structural formulae are : </li></ul>
  23. 23. <ul><li>Hydrocortisone acetate is the acetate ester of hydrocortisone, an anti-inflammatory hormone . Its structural formula is: </li></ul><ul><li>The base is a smooth vanishing cream with a pH of approximately 5.0 </li></ul>
  24. 24. DOSAGE AND ADMINISTRATION <ul><li>A small quantity of the cream should be applied 2 to 4 times daily, as required. </li></ul><ul><li>The cream should, if conditions permit, be gently rubbed into the affected areas. </li></ul>
  25. 25. SIDE EFFECTS <ul><li>Neomycin occasionally causes skin sensitization. </li></ul><ul><li>Ototoxicity and nephrotoxicity have also been reported. </li></ul><ul><li>Local adverse reactions have been reported with topical corticosteroids, especially under occlusive dressings: burning, itching , irritation, dryness, folliculitis, hypertrichosis. </li></ul>
  26. 26. Pred G (gentamicin sulfate and prednisolone acetate) Suspension <ul><li>PRED-G® sterile ophthalmic suspension is a topical anti-inflammatory/anti-infective combination product for ophthalmic use. </li></ul><ul><li>Gentamicin sulfate is the sulfate salt of gentamicin C1, gentamicin C2, and gentamicin C1A which are produced by the growth of Micromonospora purpurea . </li></ul>
  27. 27. INDICATIONS <ul><li>PRED-G® suspension is indicated for steroid-responsive inflammatory ocular conditions for which a corticosteroid is indicated and where superficial bacterial ocular infection or a risk of bacterial ocular infection exists. </li></ul><ul><li>Ocular steroids are indicated in inflammatory conditions of the palpebral and bulbar conjunctiva , cornea , and anterior segment of the globe where the inherent risk of steroid use in certain infective conjunctivitides is accepted to obtain a diminution in edema and inflammation . They are also indicated in chronic anterior uveitis and corneal injury from chemical, radiation , or thermal burns or penetration of foreign bodies. </li></ul><ul><li>The use of a combination drug with an anti-infective component is indicated where the risk of superficial ocular infection is high or where there is an expectation that potentially dangerous numbers of bacteria will be present in the eye. </li></ul><ul><li>The particular anti-infective drug in this product is active against the following common bacterial eye pathogens: Staphylococcus aureus, Streptococcus pyogenes , Streptococcus pneumoniae , Enterobacter aerogenes, Escherichia coli , Haemophilus influenzae, Klebsiella pneumoniae, Neisseria gonorrhoeae, Pseudomonas aeruginosa , and Serratia marcescens . </li></ul>
  28. 28. DOSAGE AND ADMINISTRATION <ul><li>Instill one drop into the conjunctival sac two to four times daily. During the initial 24 to 48 hours, the dosing frequency may be increased, if necessary, up to 1 drop every hour. Care should be taken not to discontinue therapy prematurely. </li></ul><ul><li>Not more than 20 milliliters should be prescribed initially </li></ul>
  29. 29. <ul><li>Stinging/burning of the eyes for 1 to 2 minutes may occur when this medication is applied. </li></ul><ul><li>This includes: </li></ul><ul><li>Keeping your hands and face clean. </li></ul><ul><li>Avoiding rubbing your eyes with dirty fingers, a soiled handkerchief, etc. </li></ul><ul><li>Removing all eye makeup before bedtime. </li></ul>SIDE EFFECTS PREVENTION
  30. 30. CATARACT <ul><li>It is a clouding of the lens in the eye that affects vision. </li></ul><ul><li>It is related to aging. </li></ul><ul><li>A cataract can occur in either or both eyes. It cannot spread from one eye to the other. </li></ul>
  31. 31. CAUSES OF CATARACT <ul><li>As we age, proteins of the lens clump together and start clouding a small area of the lens. </li></ul><ul><li>It may be that the protein in the lens just changes from the wear and tear it takes over the years. </li></ul><ul><li>Smoking </li></ul><ul><li>Diabetes. </li></ul>
  32. 32. TYPES OF CATARACTS <ul><li>Secondary cataract. Cataracts can form after surgery for other eye problems, such as glaucoma . Cataracts also can develop in people who have other health problems, such as diabetes . Cataracts are sometimes linked to steroid use. </li></ul><ul><li>Traumatic cataract. Cataracts can develop after an eye injury, sometimes years later. </li></ul><ul><li>Congenital cataract. Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may be so small that they do not affect vision. If they do, the lenses may need to be removed. </li></ul><ul><li>Radiation cataract. Cataracts can develop after exposure to some types of radiation. </li></ul>
  33. 33. SYMPTOMS <ul><li>Cloudy or blurry vision. </li></ul><ul><li>Colors seem faded. </li></ul><ul><li>Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights. </li></ul><ul><li>Poor night vision. </li></ul><ul><li>Double vision or multiple images in one eye. (This symptom may clear as the cataract gets larger.) </li></ul><ul><li>Frequent prescription changes in your eyeglasses or contact lenses. </li></ul>
  34. 34. DIAGNOSIS <ul><li>Visual acuity test. This eye chart test measures how well you see at various distances. </li></ul><ul><li>Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours. </li></ul><ul><li>Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test. </li></ul>
  35. 35. TREATMENT <ul><li>The symptoms of early cataracts may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. </li></ul><ul><li>Surgery </li></ul>
  36. 36. Phenylephrine HCl (Neo-Synephrine) <ul><li>NEO-SYNEPHRINE hydrochloride, brand of phenylephrine hydrochloride ophthalmic solution, is a sterile solution used as a vasoconstrictor and mydriatic for use in ophthalmology. </li></ul><ul><li>Hydrochloride is a synthetic sympathomimetic compound structurally similar to epinephrine and ephedrine. </li></ul>
  37. 37. <ul><li>Phenylephrine hydrochloride has the following structural formula: </li></ul>
  38. 38. INDICATIONS <ul><li>NEO-SYNEPHRINE hydrochloride is recommended for use as a decongestant and vasoconstrictor and for pupil dilatation in uveitis ( posterior synechiae), wide angle glaucoma , prior to surgery , refraction , ophthalmoscopic examination, and diagnostic procedures. </li></ul>
  39. 39. DOSAGE AND ADMINISTRATION <ul><li>Adults </li></ul><ul><ul><li>Instill 1 drop of 2.5% solution in each eye. Dilation lasts from 1 to 3 h. </li></ul></ul>
  40. 40. DRUG INTERACTIONS <ul><li>As with all other adrenergic drugs, when NEO-SYNEPHRINE 10 percent ophthalmic solutions or 2.5 percent ophthalmic solution is administered simultaneously with, or up to 21 days after, administration of monoamine oxidase (MAO) inhibitors, careful supervision and adjustment of dosages are required since exaggerated adrenergic effects may occur. </li></ul><ul><li>The pressor response of adrenergic agents may also be potentiated by tricyclic antidepressants, propranolol, reserpine, guanethidine, methyldopa, and atropine-like drugs. </li></ul><ul><li>It has been reported that the concomitant use of NEO-SYNEPHRINE 10 percent ophthalmic solutions and systemic beta blockers has caused acute hypertension and, in one case, the rupture of a congenital cerebral aneurysm . NEO-SYNEPHRINE may potentiate the cardiovascular depressant effects of potent inhalation anesthetic agents. </li></ul>
  41. 41. Prevention <ul><li>regular eye exams, </li></ul><ul><li>quit smoking, and </li></ul><ul><li>eating foods rich in antioxidants </li></ul>
  42. 42. CORNEAL DISEASE <ul><li>If your cornea becomes damaged through disease, infection, or injury, the resulting scars can interfere with vision by blocking or distorting light as it enters the eye. </li></ul>
  43. 43. SYMPTOMS <ul><li>Pain </li></ul><ul><li>Blurred vision </li></ul><ul><li>Tearing </li></ul><ul><li>Redness </li></ul><ul><li>Extreme sensitivity to light </li></ul><ul><li>Corneal scarring </li></ul>
  44. 44. CONDITIONS THAT CAN DAMAGE THE CORNEA <ul><li>Keratitis </li></ul><ul><li>Ocular Herpes (Herpes of the Eye ) </li></ul><ul><li>Herpes Zoster (Shingles) </li></ul><ul><li>Corneal Dystrophies: </li></ul><ul><ul><ul><ul><ul><li>Keratoconus </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Fuchs' Dystrophy </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Lattice Dystrophy </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Map-Dot-Fingerprint Dystrophy </li></ul></ul></ul></ul></ul>
  45. 45. DIAGNOSIS <ul><li>Corneal disease can only be diagnosed after a thorough examination by an ophthalmologist </li></ul>
  46. 46. PREVENTION <ul><li>Infectious corneal disease caused from bacteria and viruses can be prevented by protecting the eye from injury and limiting physical contact with people who have contagious forms of conjunctivitis. </li></ul><ul><li>Avoid sharing eye makeup, contact solution, lens cases, and eye drops with people who are infected and wash your hands thoroughly with soap and warm water for at least 15 seconds after contact with an infected person. </li></ul><ul><li>Although corneal disease resulting from hereditary factors, like dystrophies, cannot be prevented, vision can be preserved by early detection and treatment. </li></ul><ul><li>Symptoms may disappear with treatment, but a corneal transplant may be required. </li></ul>
  47. 47. KERATITIS <ul><li>This is an inflammation of the cornea that sometimes occurs with infection after bacteria or fungi enter the cornea. These microorganisms can enter the eye after deep injury, causing infection, inflammation, and ulceration of the cornea. </li></ul>TYPICAL KERATITIS RED EYE KERATITIS
  48. 48. Ocular Herpes (Herpes of the Eye) <ul><li>This is a viral infection of the eye that may reoccur. </li></ul>
  49. 49. Herpes Zoster (Shingles) <ul><li>Shingles is a recurrence of the chickenpox virus in people who have already had the disease. After having chickenpox, this virus usually remains inactive within the nerves of the body. It can later travel down these nerves, infecting specific parts of the body, like the eye. </li></ul>
  50. 50. Keratoconus <ul><li>A type of corneal dystrophy </li></ul><ul><li>It a progressive disease where the cornea thins and changes shape </li></ul>
  51. 51. Map-Dot-Fingerprint Dystrophy <ul><li>It is the abnormal appearance of the basement membrane of the epithelium of the cornea. As this membrane that separates the epithelium and stroma grows irregularly (thicker in some places, thinner in others), findings in the cornea appear, resembling maps, dots and small fingerprints. </li></ul>
  52. 52. Fuchs' Dystrophy <ul><li>It is the gradual deterioration of endothelial cells for no apparent reason. As these cells thin over time, the cornea is less capable of removing water form the stroma, causing it to swell and distort vision. </li></ul>
  53. 53. Lattice Dystrophy <ul><li>Lattice dystrophy is a condition characterized by an accumulation of abnormal protein fibers, throughout the middle and anterior stroma. </li></ul>
  54. 54. HYPEROPIA <ul><li>Also known as farsightedness </li></ul><ul><li>It is a problem where one cannot see up-close objects </li></ul>
  55. 55. <ul><li>It is a refractive error </li></ul><ul><li>Glasses, </li></ul><ul><li>contact lenses, or </li></ul><ul><li>refractive surgery </li></ul>SYMPTOMS Headaches Eye strain Difficulty concentrating or focusing on nearby objects Fatigue or headache after performing a close task DIAGNOSIS Eye exam CAUSE TREATMENT
  56. 56. IRITIS <ul><li>Iritis is an inflammatory condition of the colored portion (the iris which surrounds the pupil) of the eye. </li></ul>
  57. 57. CAUSE <ul><li>An infection of the eye or inflammation from trauma may cause iritis. </li></ul><ul><li>Iritis may also be a complication of many diseases such as juvenile rheumatoid arthritis , ankylosing spondylitis , tuberculosis , sarcoidosis , and collagen vascular diseases such as lupus . </li></ul>
  58. 58. SIGNS AND SYMPTOMS <ul><li>Iritis appears as a red, painful eye which may be accompanied by blurred vision and sensitivity to light. </li></ul><ul><li>In addition, the pupil of the affected eye may be smaller than that of the healthy eye. </li></ul>
  59. 59. DIAGNOSIS <ul><li>ophthalmologist </li></ul><ul><li>After measuring the vision, the eye is inspected with a slit lamp (biomicroscope) where microscopic cells are seen in the front part of the eye. </li></ul>
  60. 60. TREATMENT <ul><li>Usually treat the underlying cause e.g infection </li></ul><ul><li>Anti-inflammatory cortisone (steroid) eye drops, often accompanied by drops to enlarge (the pupil). </li></ul>
  61. 61. Cyclopentolate 0.5-2% (Cyclogyl) <ul><li>It is a Cycloplegics agent that causes nerve impulses to the pupillary sphincter and ciliary muscles, easing pain and photophobia. </li></ul>
  62. 62. DOSAGE <ul><li>Adult </li></ul><ul><ul><li>1 gtt tid </li></ul></ul><ul><li>Pediatric </li></ul><ul><ul><li>Administer as in adults </li></ul></ul>
  63. 63. Prednisolone acetate 1% (AK-Pred, Pred Forte) <ul><li>Topical anti-inflammatory agent for ophthalmic use. </li></ul><ul><li>It is a Topical steroids that decrease inflammation. </li></ul><ul><li>Structure: </li></ul>
  64. 64. INDICATIONS <ul><li>PRED FORTE® is indicated for the treatment of steroid-responsive inflammation of the palpebral and bulbar conjunctiva , cornea , and anterior segment of the globe. </li></ul>
  65. 65. DOSAGE AND ADMINISTRATION <ul><li>Shake well before using. </li></ul><ul><li>Instill one to two drops into the conjunctival sac two to four times daily. During the initial 24 to 48 hours, the dosing frequency may be increased if necessary. </li></ul>
  66. 66. SIDE EFFECTS <ul><li>Adverse reactions include, in decreasing order of frequency: </li></ul><ul><li>elevation of intraocular pressure ( IOP ) with possible development of glaucoma and infrequent optic nerve damage, </li></ul><ul><li>posterior subcapsular cataract formation, delayed wound healing. </li></ul><ul><li>visual disturbance (blurry vision); </li></ul><ul><li>foreign body sensation ; </li></ul><ul><li>allergic reactions. </li></ul>
  67. 67. CONJUNCTIVITIS <ul><li>Pink eye, or conjunctivitis is redness and inflammation of the membranes (conjunctiva) covering the whites of the eyes and the membranes on the inner part of the eyelids. </li></ul>
  68. 68. CAUSES <ul><li>INFECTIOUS </li></ul><ul><ul><li>Viral pink eye </li></ul></ul><ul><ul><li>Bacterial pink eye </li></ul></ul><ul><ul><li>Chlamydia pink eye </li></ul></ul><ul><li>NON-INFECTIOUS </li></ul><ul><ul><li>Allergic pink eye </li></ul></ul><ul><ul><li>Chemical pink eye </li></ul></ul><ul><ul><li>Underlying diseases Subconjuctival hemorrhage </li></ul></ul>
  69. 69. TREATMENT <ul><li>Moist warm compresser </li></ul><ul><li>Eyedrops </li></ul>
  70. 70. PREVENTION <ul><li>Infectious pink eye is contagious so </li></ul><ul><ul><li>avoid touching the eye area and </li></ul></ul><ul><ul><li>wash your hands frequently, particularly after applying medications to the eye area. </li></ul></ul><ul><ul><li>Never share towels or handkerchiefs, and </li></ul></ul><ul><ul><li>throw away tissues after each use. </li></ul></ul><ul><ul><li>Disinfecting surfaces like countertops, sinks, and doorknobs </li></ul></ul>
  71. 71. AzaSite (azithromycin ophthalmic solution) <ul><li>It is a 1% sterile aqueous topical ophthalmic solution of azithromycin formulated in DuraSite® (polycarbophil, edetate disodium, sodium chloride). </li></ul><ul><li>AzaSite is an off-white, viscous liquid </li></ul><ul><li>Structure: </li></ul>
  72. 72. INDICATIONS <ul><li>AzaSite is indicated for the treatment of bacterial conjunctivitis caused by susceptible isolates of the following microorganisms: </li></ul><ul><li>CDC coryneform group G* Haemophilus influenzae Staphylococcus aureus Streptococcus mitis group Streptococcus pneumoniae </li></ul>
  73. 73. DOSAGE AND ADMINISTRATION <ul><li>The recommended dosage regimen for the treatment of bacterial conjunctivitis is: Instill 1 drop in the affected eye(s) twice daily, eight to twelve hours apart for the first two days and then instill 1 drop in the affected eye(s) once daily for the next five days. </li></ul>
  74. 74. SIDE EFFECTS <ul><li>Eye irritation </li></ul><ul><li>Burning </li></ul><ul><li>Stinging </li></ul>
  75. 75. Presbyopia <ul><li>Presbyopia is part of the natural aging process of the eye, and can be easily corrected. </li></ul><ul><li>Technically, presbyopia is the loss of the eye's ability to change its focus to see objects that are near. </li></ul><ul><li>It is not a disease </li></ul><ul><li>Presbyopia occurs when the eye's lens loses flexibility. </li></ul>
  76. 76. SYMPTOMS <ul><li>Blurred vision at a normal reading distance </li></ul><ul><li>The need to hold reading material at arm's length </li></ul><ul><li>Headaches from doing close work </li></ul>DIAGNOSIS <ul><li>Eye exam </li></ul>
  77. 77. TREATMENT <ul><li>It cannot be cured </li></ul><ul><li>However, use of: </li></ul><ul><ul><li>prescription glasses, </li></ul></ul><ul><ul><li>contact lens, </li></ul></ul><ul><ul><li>reading glasses, </li></ul></ul><ul><ul><li>progressive addition lenses, or </li></ul></ul><ul><ul><li>bifocals can help correct the effects of presbyopia </li></ul></ul>
  78. 78. Strabismus <ul><li>Also known as crossed eyes,or Esotropia is a condition in which the eyes don't look towards an object together. One of the eyes may look in or out, or turn up or down. The eye turning can occur all of the time or only sometimes, such as during stressful situations or illness. </li></ul>
  79. 79. CAUSE <ul><li>congenital strabismus- where persons born with such a disorder </li></ul>
  80. 80. TREATMENT <ul><li>Physical therapy of eye muscle </li></ul><ul><li>Vision therapy </li></ul><ul><li>Surgery </li></ul>
  81. 81. ULTIVA® (remifentanil hydrochloride) for Injection <ul><li>It is a sterile, nonpyrogenic, preservative-free, white to off-white lyophilized powder for intravenous (IV) administration after reconstitution and dilution. </li></ul>
  82. 82. INDICATIONS <ul><li>ULTIVA is indicated for IV administration: </li></ul><ul><li>As an analgesic agent for use during the induction and maintenance of general anesthesia for inpatient and outpatient procedures. </li></ul><ul><li>For continuation as an analgesic into the immediate postoperative period in adult patients under the direct supervision of an anesthesia practitioner in a postoperative anesthesia care unit or intensive care setting. </li></ul><ul><li>As an analgesic component of monitored anesthesia care in adult patients. </li></ul>
  83. 83. DOSAGE AND ADMINISTRATION <ul><li>ULTIVA is for IV use only. Continuous infusions of ULTIVA should be administered only by an infusion device. The injection site should be close to the venous cannula and all IV tubing should be cleared at the time of discontinuation of infusion . </li></ul>
  84. 84. CONTRAINDICATIONS <ul><li>Due to the presence of glycine in the formulation, ULTIVA is contraindicated for epidural or intrathecal administration. ULTIVA is also contraindicated in patients with known hypersensitivity to fentanyl analogs. </li></ul>
  85. 85. Chalazion <ul><li>A chalazion is a tiny lump of the upper or lower eyelid caused by inflammation of a gland of the lid. </li></ul><ul><li>It may be soft and fluid-filled or firmer. </li></ul><ul><li>A chalazion is also referred to as a meibomian cyst , tarsal cyst , or conjunctival granuloma . </li></ul>
  86. 86. CAUSES <ul><li>The narrow opening through which a meibomian gland secretes its material can become clogged from narrowing of the opening or hardening of the sebaceous liquid near the opening. </li></ul><ul><li>If this occurs, the gland will have a backup of the material it secretes and it will swell. </li></ul>
  87. 87. SYMPTOMS <ul><li>Thickening of the walls of the gland </li></ul><ul><li>Leakage of oil into the lid itself, causing inflammation both within the gland and the eyelid. </li></ul>
  88. 88. TREATMENT <ul><li>Warm compresses to the eyelid to promote healing and circulation of blood to the inflamed area. </li></ul><ul><li>An antibiotic drop or ointment to be used immediately after the compresses </li></ul><ul><li>Surgery </li></ul>
  89. 89. Triamcinolone (Amcort) <ul><li>For inflammatory dermatosis responsive to steroids; decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability </li></ul>
  90. 90. DOSAGE <ul><li>Adult </li></ul><ul><ul><li>0.1-0.2 mL of 40 mg/mL </li></ul></ul><ul><li>Pediatric </li></ul><ul><ul><li>Not established </li></ul></ul><ul><li>Injected directly into chalazion's center; second injection may be necessary after a few weeks for larger chalazia </li></ul>
  91. 91. PREVENTION <ul><li>Proper care of eyes should be taken </li></ul><ul><li>It means he/she should perform proper cleansing of the eyelid. </li></ul><ul><li>Cleansing the eyelash area with baby shampoo will help reduce clogging of the ducts. </li></ul>
  92. 92. Blindness <ul><li>Blindness is defined as the state of being sightless. </li></ul><ul><li>A blind individual is unable to see. </li></ul><ul><li>In a strict sense the word blindness denotes the condition of total blackness of vision with the inability of a person to distinguish darkness from bright light in either eye </li></ul>
  93. 93. TYPES OF BLINDNESS <ul><li>Color blindness :- Is the inability to perceive differences between some of the colors that others can distinguish. </li></ul><ul><li>Night blindness:-Is a difficulty in seeing under situations of decreased illumination. </li></ul><ul><li>Snow blindness:-Is loss of vision after exposure of the eyes to large amounts of ultraviolet light. </li></ul>
  94. 94. CAUSES <ul><li>diabetes , </li></ul><ul><li>macular degeneration , </li></ul><ul><li>traumatic injuries. </li></ul><ul><li>infections, </li></ul><ul><li>cataracts , </li></ul><ul><li>glaucoma , </li></ul><ul><li>inability to obtain any glasses. </li></ul>
  95. 95. SIGNS AND SYMPTOMS <ul><li>discomfort in the eyes, </li></ul><ul><li>awareness of the eyes, </li></ul><ul><li>foreign body sensation, and </li></ul><ul><li>pain in the eyes or discharge from the eyes may be present or absent, depending on the underlying cause of the blindness. </li></ul>
  96. 96. DIAGNOSIS <ul><li>Blindness is diagnosed by visual acuity testing in each eye individually and by measuring the visual field or peripheral vision. </li></ul>
  97. 97. TREATMENT <ul><li>The treatment of blindness depends on the cause of blindness. </li></ul><ul><li>Many people who have poor vision as a result of a refractive error, merely prescribing and giving glasses will alleviate the problem </li></ul><ul><li>Nutritional causes of blindness can be addressed by dietary changes. </li></ul><ul><li>Cataract patients may undergo surgery to restore their sights </li></ul><ul><li>Inflammatory and infectious causes of blindness can be treated with medication in the form of drops or pills. </li></ul>
  98. 98. PREVENTION <ul><li>Most traumatic causes of blindness can be prevented through instruction in eye protection. </li></ul><ul><li>Nutritional causes of blindness are preventable through proper diet. </li></ul><ul><li>Most cases of blindness from glaucoma are preventable through early detection and appropriate treatment. </li></ul><ul><li>Visual impairment and blindness caused by infectious diseases have been greatly reduced through international public-health measures. </li></ul><ul><li>The majority of blindness from diabetic retinopathy is preventable through careful control of blood-sugar levels, exercise , avoidance of obesity and smoking , and emphasis on eating foods that do not increase the sugar load (complex, rather than simple carbohydrates). </li></ul>
  99. 99. TIMOPTIC® <ul><li>Ophthalmic Solution 0.25% AND 0.5% TIMOPTIC* (timolol maleate ophthalmic solution) is a non-selective beta-adrenergic receptor blocking agent. </li></ul><ul><li>Optically active drug </li></ul><ul><li>It is a white, odorless, crystalline powder which is soluble in water, methanol, and alcohol. </li></ul><ul><li>Structure: </li></ul>
  100. 100. INDICATIONS <ul><li>TIMOPTIC Ophthalmic Solution is indicated in the treatment of elevated intraocular pressure in patients with ocular hypertension or open-angle glaucoma . </li></ul>
  101. 101. DOSAGE AND ADMINISTRATION <ul><li>Starting dose is one drop of 0.25 percent TIMOPTIC in the affected eye(s) twice a day. </li></ul><ul><li>If the clinical response is not adequate, the dosage may be changed to one drop of 0.5 percent solution in the affected eye(s) twice a day. </li></ul>
  102. 102. DRUG INTERACTIONS <ul><li>Although TIMOPTIC used alone has little or no effect on pupil size, mydriasis resulting from concomitant therapy with TIMOPTIC and epinephrine has been reported occasionally. </li></ul><ul><li>Beta-adrenergic blocking agents : Patients who are receiving a beta-adrenergic blocking agent orally and TIMOPTIC should be observed for potential additive effects of beta-blockade, both systemic and on intraocular pressure . The concomitant use of two topical beta-adrenergic blocking agents is not recommended. </li></ul><ul><li>Calcium antagonists : Caution should be used in the coadministration of beta-adrenergic blocking agents, such as TIMOPTIC, and oral or intravenous calcium antagonists because of possible atrioventricular conduction disturbances, left ventricular failure, and hypotension. In patients with impaired cardiac function, coadministration should be avoided. </li></ul>
  103. 103. <ul><li>Catecholamine-depleting drugs : Close observation of the patient is recommended when a beta blocker is administered to patients receiving catecholamine-depleting drugs such as reserpine, because of possible additive effects and the production of hypotension and/or marked bradycardia, which may result in vertigo, syncope, or postural hypotension . </li></ul><ul><li>Digitalis and calcium antagonists : The concomitant use of beta-adrenergic blocking agents with digitalis and calcium antagonists may have additive effects in prolonging atrioventricular conduction time. </li></ul><ul><li>CYP2D6 inhibitors : Potentiated systemic beta-blockade (e.g., decreased heart rate , depression) has been reported during combined treatment with CYP2D6 inhibitors (e.g. quinidine, SSRIs) and timolol. </li></ul><ul><li>Clonidine : Oral beta-adrenergic blocking agents may exacerbate the rebound hypertension which can follow the withdrawal of clonidine. There have been no reports of exacerbation of rebound hypertension with ophthalmic timolol maleate. </li></ul>
  104. 104. Xalatan® <ul><li>Ophthalmic solution 0.005% (50 µg/mL Latanoprost is a prostaglandin F2α analogue. </li></ul><ul><li>Structure: </li></ul><ul><li>Latanoprost is a colorless to slightly yellow oil that is very soluble in acetonitrile and freely soluble in acetone, ethanol, ethyl acetate, isopropanol, methanol and octanol. It is practically insoluble in water. </li></ul>
  105. 105. INDICATIONS <ul><li>XALATAN Sterile Ophthalmic Solution is indicated for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension. </li></ul>
  106. 106. DOSAGE AND ADMINISTRATION <ul><li>The recommended dosage is one drop (1.5 ìg) in the affected eye(s) once daily in the evening. If one dose is missed, treatment should continue with the next dose as normal. </li></ul>
  107. 107. DRUG INTERACTIONS <ul><li>In vitro studies have shown that precipitation occurs when eye drops containing thimerosal are mixed with XALATAN. If such drugs are used they should be administered at least five (5) minutes apart. </li></ul>
  108. 108. Glaucoma <ul><li>Glaucoma is a disease of the major nerve of vision, called the optic nerve </li></ul><ul><li>Glaucoma is characterized by a particular pattern of progressive damage to the optic nerve that generally begins with a subtle loss of side vision (peripheral vision). </li></ul>
  109. 109. CAUSE <ul><li>Elevated pressure in the eye is the main factor leading to glaucomatous damage to the eye (optic) nerve. </li></ul>
  110. 110. TYPES OF GLAUCOMA <ul><li>open-angle glaucomas :-are conditions of long duration (chronic) </li></ul><ul><li>closed-angle (angle closure) glaucomas:-which include conditions occurring suddenly (acute) </li></ul>
  111. 111. DIAGNOSIS <ul><li>ophthalmologist </li></ul><ul><li>TESTS:- </li></ul><ul><ul><li>Tonometry determines the pressure in the eye by measuring the tone or firmness of its surface. </li></ul></ul><ul><ul><li>Pachymetry determines the thickness of the cornea </li></ul></ul><ul><ul><li>Gonioscopy is done by numbing the eye with anesthetic drops and placing a special type of thick contact lens with mirrors inside on the eye. </li></ul></ul><ul><ul><li>Ophthalmoscopy is an examination in which the doctor uses a handheld device to look directly through the pupil (the opening in the colored iris) into the eye. </li></ul></ul><ul><ul><li>Visual Field testing actually maps the visual fields to detect any early (or late) signs of glaucomatous damage to the optic nerve. </li></ul></ul>
  112. 112. TREATMENT <ul><li>Although nerve damage and visual loss from glaucoma cannot usually be reversed, glaucoma is a disease that can generally be controlled. </li></ul><ul><li>That is, treatment can make the intraocular pressure normal and, therefore, prevent or retard further nerve damage and visual loss. </li></ul><ul><li>Treatment may involve the use of eye drops, pills (rarely), laser, or surgery. </li></ul>
  113. 113. <ul><li>Medications (eye drops) </li></ul><ul><ul><li>Beta-adrenergic antagonists act against, or block, adrenalin-like substances. These drops work in the treatment of glaucoma by reducing the production of the aqueous humor. </li></ul></ul><ul><ul><li>These medications include timolol (Timoptic), levobunolol (Betagan), carteolol (Ocupress), and metipranolol (Optipranolol). </li></ul></ul>
  114. 114. BETAGAN® (levobunolol hydrochloride) Ophthalmic Solution USP with C Cap® Compliance Cap <ul><li>BETAGAN® (levobunolol hydrochloride ophthalmic solution USP) sterile is a noncardioselective beta-adrenoceptor blocking agent for ophthalmic use. </li></ul><ul><li>Structure: </li></ul>Levobunolol HCl
  115. 115. INDICATIONS <ul><li>BETAGAN® ophthalmic solution has been shown to be effective in lowering intraocular pressure and may be used in patients with chronic open-angle glaucoma or ocular hypertension. </li></ul>
  116. 116. DOSAGE AND ADMINISTRATION <ul><li>The recommended starting dose is one to two drops of BETAGAN® ophthalmic solution 0.5% in the affected eye(s) once a day. </li></ul><ul><li>Typical dosing with BETAGAN® 0.25% is one to two drops twice daily. </li></ul><ul><li>In patients with more severe or uncontrolled glaucoma , BETAGAN® 0.5% can be administered b.i.d. </li></ul>
  117. 117. DRUG INTERACTIONS <ul><li>Although BETAGAN® ophthalmic solution used alone has little or no effect on pupil size, mydriasis resulting from concomitant therapy with BETAGAN® and epinephrine may occur. </li></ul><ul><li>Close observation of the patient is recommended when a beta-blocker is administered to patients receiving catecholamine-depleting drugs such as reserpine, because of possible additive effects and the production of hypotension and/or marked bradycardia, which may produce vertigo, syncope, or postural hypotension . </li></ul><ul><li>Patients receiving beta-adrenergic blocking agents along with either oral or intravenous calcium antagonists should be monitored for possible atrioventricular conduction disturbances, left ventricular failure and hypotension. In patients with impaired cardiac function, simultaneous use should be avoided altogether. </li></ul>
  118. 118. <ul><li>The concomitant use of beta-adrenergic blocking agents with digitalis and calcium antagonists may have additive effects on prolonging atrioventricular conduction time. </li></ul><ul><li>Phenothiazine-related compounds and beta-adrenergic blocking agents may have additive hypotensive effects due to the inhibition of each other's metabolism. </li></ul><ul><li>Risk of anaphylactic reaction: While taking beta-blockers, patients with a history of severe anaphylactic reactions to a variety of allergens may be more reactive to repeated challenge, either accidental, diagnostic, or therapeutic. Such patients may be unresponsive to the usual doses of epinephrine used to treat allergic reaction . </li></ul>
  119. 119. TREATMENT CONT`D <ul><li>Prostaglandin analogs </li></ul><ul><ul><li>These drops work in glaucoma by increasing the outflow (drainage) of fluid from the eye. </li></ul></ul><ul><ul><li>These medications include latanoprost (Xalatan), travoprost (Travatan), and brimatoprost (Lumigan). </li></ul></ul>
  120. 120. Mannitol (mannitol) Injection, Solution <ul><li>Mannitol I.V. (Mannitol Injection, USP) is a sterile, nonpyrogenic solution of mannitol in water. </li></ul><ul><li>Mannitol Injection, USP is a parenteral obligatory osmotic diuretic </li></ul><ul><li>Structure: </li></ul>
  121. 121. INDICATIONS <ul><li>Mannitol I.V. (Mannitol Injection, USP) is indicated for the following purposes in adults and pediatric patients. </li></ul><ul><ul><li>Therapeutic Use </li></ul></ul><ul><ul><ul><li>Promotion of diuresis in the prevention or treatment of the oliguric phase of acute renal failure before irreversible renal failure becomes established. </li></ul></ul></ul><ul><ul><ul><li>Reduction of intracranial pressure and brain mass. </li></ul></ul></ul><ul><ul><ul><li>Reduction of high intraocular pressure when the pressure cannot be lowered by other means. </li></ul></ul></ul><ul><ul><ul><li>Promotion of urinary excretion of toxic materials. </li></ul></ul></ul><ul><ul><li>Diagnostic Use </li></ul></ul><ul><ul><ul><li>Measurement of glomerular filtration rate. </li></ul></ul></ul>
  122. 122. TREATMENT CONT`D <ul><li>There are several forms of laser therapy for glaucoma. </li></ul><ul><ul><li>Laser iridotomy </li></ul></ul><ul><ul><li>Laser trabeculoplasty </li></ul></ul><ul><ul><li>Laser cilioablation </li></ul></ul><ul><ul><li>Glaucoma surgery </li></ul></ul><ul><ul><ul><li>Trabeculectomy </li></ul></ul></ul><ul><ul><ul><li>Aqueus shunt devices (Glaucoma implants or tubes) </li></ul></ul></ul><ul><ul><ul><li>Viscocanalostomy </li></ul></ul></ul>
  123. 123. DOSAGE AND ADMINISTRATION <ul><li>Mannitol I.V. (Mannitol Injection, USP) should be administered only by intravenous infusion </li></ul><ul><li>The usual adult dosage ranges from 50 to 200 g in a 24-hour period, but in most instances an adequate response will be achieved at a dosage of approximately 100 g/24 hours. </li></ul><ul><li>The rate of administration is usually adjusted to maintain a urine flow of at least 30 to 50 mL/hr. </li></ul>
  124. 124. DRUG INTERACTIONS <ul><li>Additives may be incompatible. </li></ul><ul><li>When introducing additives to the flexible container, use aseptic technique, mix thoroughly and do not store. </li></ul><ul><li>Do not place 25% Mannitol Injection, USP in polyvinylchloride bags; a white flocculent precipitate may form from contact with PVC surfaces. Parenteral drug products should be inspected visually for particulate matter and discoloration; whenever container and solution permit. </li></ul>
  125. 125. Myopia (or nearsightedness) <ul><li>People who have myopia or nearsightedness have difficulty seeing distant objects, but can see objects that are near clearly. </li></ul>
  126. 126. CAUSE <ul><li>Refractive error -light rays bend incorrectly into the eye to transmit images to the brain </li></ul>
  127. 127. SYMPTOMS <ul><li>headaches, </li></ul><ul><li>eyestrain, </li></ul><ul><li>squinting or </li></ul><ul><li>fatigue when driving, playing sports, or looking more than a few feet away. </li></ul>
  128. 128. DIAGNOSIS <ul><li>Standard eye exams given by an eye doctor </li></ul>
  129. 129. TREATMENT <ul><li>Glasses, </li></ul><ul><li>contact lenses, or </li></ul><ul><li>refractive surgery can correct myopia </li></ul><ul><ul><li>Photorefractive keratectomy. </li></ul></ul><ul><ul><li>Laser-assisted in situ keratomileusis. </li></ul></ul><ul><ul><li>Corneal rings. </li></ul></ul>
  130. 130. Astigmatism <ul><li>Astigmatism is characterized by an irregular curvature of the cornea. This type of disorder is also known as a refractive error. </li></ul>
  131. 131. Causes <ul><li>Astigmatism can be hereditary and is often present at birth. It can also result from pressure from the eyelids on the cornea, incorrect posture or an increased use of the eyes for close work. </li></ul>
  132. 132. Symptoms of Astigmatism <ul><li>People with undetected astigmatism often experience headaches, fatigue, eyestrain and blurred vision at all distances. While these symptoms may not necessarily be the result of astigmatism, you should schedule an eye exam if you are experiencing one or more symptoms. </li></ul>
  133. 133. Diagnosis <ul><li>A thorough eye exam. </li></ul>
  134. 134. Treatment <ul><li>Corrective lenses (eyeglasses or contact lenses). </li></ul><ul><li>Refractive surgery. </li></ul>
  135. 135. Prevention <ul><li>Astigmatism cannot be prevented. It appears to run in families and is present from birth. </li></ul>
  136. 136. Optic neuritis <ul><li>Optic neuritis is inflammation of the optic nerve, the structure that connects the eye to the brain. </li></ul><ul><li>Optic neuritis typically affects young adults ranging from 18-45 years of age, with a mean age of 30-35 years. </li></ul><ul><li>There is a strong female predominance. </li></ul>
  137. 137. CAUSES <ul><li>The precise cause of optic neuritis is unknown, but it is thought to be a type of autoimmune disorder that may be triggered by a viral infection. </li></ul><ul><li>Some autoimmune conditions that may cause optic neuritis are: </li></ul><ul><ul><li>neuromyelitis optica </li></ul></ul><ul><ul><li>multiple sclerosis </li></ul></ul><ul><li>Bacterial Infections, including Lyme disease , tuberculosis , cat scratch fever , toxoplasmosis and syphilis , or </li></ul><ul><li>Viral infections such as HIV ( human immunodeficiency virus ), hepatitis B , and herpes zoster can cause optic neuritis. </li></ul><ul><li>Bacterial meningitis , encephalitis , and sinusitis (all especially in children) may cause optic neuritis or optic nerve damage. </li></ul>
  138. 138. SYMPTOMS <ul><li>Vision loss, frequently maximal within one or two days and varying from a small area of blurring to complete blindness </li></ul><ul><li>Distorted vision, reduced color vision, loss of contrasts, and washed out or less vivid vision than normal. </li></ul>
  139. 139. SIGNS <ul><li>Reduced visual accuracy (acuity), </li></ul><ul><li>a measurable change in peripheral vision, </li></ul><ul><li>decreased perception of brightness in the affected eye, and a change in color vision (often out of proportion to loss of visual acuity). </li></ul>
  140. 140. DIAGNOSIS <ul><li>A complete medical examination, including chemical analysis of the blood can help rule out related diseases. </li></ul><ul><li>Tests may include visual acuity testing, pupillary testing, visual field testing, color vision testing, and visualization of the optic disc by direct and indirect ophthalmoscopy. </li></ul>
  141. 141. TREATMENT <ul><li>If a definite cause (such as infection or underlying other disease) is determined, appropriate therapy for that cause can be instituted. </li></ul><ul><li>In optic neuritis of undetermined cause or related to multiple sclerosis, vision often returns to normal within two to 12 weeks with no treatment but may also advance to a permanent state of partial or complete visual loss. </li></ul><ul><li>Treatment with steroid medications (cortisone medications such as prednisone [Deltasone, Orasone, Prednicen-M, Liquid Pred] and methylprednisolone , [Solu-Medrol]) may speed up vision recovery. Although treatment with steroids have little effect on the final visual outcome in patients with optic neuritis, patients treated initially with intravenous (IV) steroids have about one-half the risk of developing multiple sclerosis in two years as untreated patients do. This effect disappears by the third year of follow up. In addition, patients treated with IV steroids have fewer repeated attacks of optic neuritis than untreated patients. </li></ul><ul><li>Ophthalmologists treat patients with optic neuritis with either IV -- followed by oral steroids -- or no treatment at all. For those who are treated, the regimen typically includes three days of IV steroids, followed by about 11 days of oral steroids. </li></ul><ul><li>When optic neuritis is associated with MRI lesions suggestive of multiple sclerosis (MS), immunomodulator or immunosuppressive therapy may be prescribed to reduce the incidence of future attacks </li></ul>
  142. 142. METHYLPREDNISOLONE SODIUM SUCCINATE - INJECTION <ul><li>BRAND NAME(S): Solu-Medrol </li></ul><ul><li>This medication is used to treat various conditions such as severe allergic reactions, arthritis , blood diseases, breathing problems, certain cancers, eye diseases, intestinal disorders, and skin disease </li></ul><ul><li>It is a corticosteroid hormone (glucocorticoid) </li></ul><ul><li>Structure: </li></ul>
  143. 143. DOSAGE AND ADMINISTRATION <ul><li>This preparation may be administered by intravenous injection, by intravenous infusion, or by intramuscular injection </li></ul><ul><li>In high dose corticosteroid therapy should be continued only until the patient's condition has stabilized; usually not beyond 48 to 72 hours. </li></ul>
  144. 144. DRUG INTERACTIONS <ul><li>Aminoglutethimide: </li></ul><ul><ul><li>Aminoglutethimide may lead to a loss of corticosteroid - induced adrenal suppression. </li></ul></ul><ul><li>Amphotericin B injection and potassium - depleting agents: </li></ul><ul><ul><li>When corticosteroids are administered concomitantly with potassium - depleting agents (i.e., amphotericin - B, diuretics), patients should be observed closely for development of hypokalemia . There have been cases reported in which concomitant use of amphotericin B and hydrocortisone was followed by cardiac enlargement and congestive heart failure. </li></ul></ul><ul><li>Antibiotics: </li></ul><ul><ul><li>Macrolide antibiotics have been reported to cause a significant decrease in corticosteroid clearance (see DRUG INTERACTIONS, Hepatic Enzyme Inhibitors ). </li></ul></ul><ul><li>Anticholinesterases: </li></ul><ul><ul><li>Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating corticosteroid therapy. </li></ul></ul><ul><li>Anticoagulants, oral: </li></ul><ul><ul><li>Coadministration of corticosteroids and warfarin usually results in inhibition of response to warfarin, although there have been some conflicting reports. Therefore, coagulation indices should be monitored frequently to maintain the desired anticoagulant effect. </li></ul></ul><ul><li>Antidiabetics: </li></ul><ul><ul><li>Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required. </li></ul></ul><ul><li>Antitubercular drugs: </li></ul><ul><ul><li>Serum concentrations of isoniazid may be decreased. </li></ul></ul>
  145. 145. <ul><li>Cholestyramine: </li></ul><ul><ul><li>Cholestyramine may increase the clearance of corticosteroids. </li></ul></ul><ul><li>Cyclosporine: </li></ul><ul><ul><li>Increased activity of both cyclosporine and corticosteroids may occur when the two are used concurrently. Convulsions have been reported with this concurrent use. </li></ul></ul><ul><li>Digitalis glycosides: </li></ul><ul><ul><li>Patients on digitalis glycosides may be at increased risk of arrhythmias due to hypokalemia. </li></ul></ul><ul><li>Estrogens, including oral contraceptives: </li></ul><ul><ul><li>Estrogens may decrease the hepatic metabolism of certain corticosteroids, thereby increasing their effect. </li></ul></ul><ul><li>Hepatic Enzyme Inducers (e.g., barbiturates, phenytoin, carbamazepine, rifampin): </li></ul><ul><ul><li>Drugs which induce cytochrome P450 3A enzyme activity may enhance the metabolism of corticosteroids and require that the dosage of the corticosteroid be increased. </li></ul></ul><ul><li>Hepatic Enzyme Inhibitors (e.g., ketoconazole, macrolide antibiotics such as erythromycin and troleandomycin): </li></ul><ul><ul><li>Drugs which inhibit cytochrome P450 3A4 have the potential to result in increased plasma concentrations of corticosteroids. </li></ul></ul>
  146. 146. <ul><li>Ketoconazole: </li></ul><ul><ul><li>Ketoconazole has been reported to decrease the metabolism of certain corticosteroids by up to 60%, leading to an increased risk of corticosteroid side effects. </li></ul></ul><ul><li>Nonsteroidal anti - inflammatory agents (NSAIDS): </li></ul><ul><ul><li>Concomitant use of aspirin (or other nonsteroidal anti - inflammatory agents) and corticosteroids increases the risk of gastrointestinal side effects. Aspirin should be used cautiously in conjunction with corticosteroids in hypoprothrombinemia. The clearance of salicylates may be increased with concurrent use of corticosteroids. </li></ul></ul><ul><li>Skin tests: </li></ul><ul><ul><li>Corticosteroids may suppress reactions to skin tests. </li></ul></ul><ul><li>Vaccines: </li></ul><ul><ul><li>Patients on prolonged corticosteroid therapy may exhibit a diminished response to toxoids and live or inactivated vaccines due to inhibition of antibody response. Corticosteroids may also potentiate the replication of some organisms contained in live attenuated vaccines. Routine administration of vaccines or toxoids should be deferred until corticosteroid therapy is discontinued if possible </li></ul></ul>
  147. 147. PREVENTION <ul><li>In patients with an infectious cause of optic neuritis, eradication of the underlying infection will usually prevent further episodes. </li></ul><ul><li>In patients with a known immune disorder such as systemic lupus or vasculitis, treatment of the underlying disorder will usually prevent further episodes. </li></ul><ul><li>In patients with known multiple sclerosis, treatment of the multiple sclerosis may decrease the incidence of future attacks of multiple sclerosis, including optic neuritis. </li></ul>
  148. 148. Retinitis Pigmentosa <ul><li>Retinitis pigmentosa is the most common of a group of hereditary progressive retinal degenerations or dystrophies. There is considerable variation and overlap among the various forms of retinitis pigmentosa. </li></ul><ul><li>Common to all of them is progressive degeneration of the retina, specifically of the light receptors, known as the rods and cones. The rods of the retina are involved earlier in the course of the disease, and cone deterioration occurs later. </li></ul><ul><li>In this progressive degeneration of the retina, the peripheral vision slowly constricts and central vision is usually retained until late in the disease. </li></ul>
  149. 149. <ul><li>Retinitis pigmentosa lasts a lifetime, with blindness often occurring if one lives long enough. </li></ul><ul><li>Cataracts occur at a higher incidence in RP patients. </li></ul><ul><li>The ultimate complication of RP is blindness from loss of retinal function. </li></ul>
  150. 150. CAUSE OF RETINITIS PIGMENTOSA <ul><li>Retinitis pigmentosa is an inherited condition which involves both eyes. If it starts in one eye, the other eye usually develops the same condition in a number of years. </li></ul>
  151. 151. SYMPTOMS AND SIGNS <ul><li>Decreased vision at night or in low light </li></ul><ul><li>Loss of side (peripheral) vision </li></ul><ul><li>Loss of central vision (in advanced cases) </li></ul>
  152. 152. DIAGNOSIS <ul><li>It is primarily diagnosed by examination. </li></ul><ul><li>The ophthalmologist observes relatively characteristic bone spicule pigment during the fundus examination (looking at the back layers of the eye with the ophthalmoscope, an instrument allowing the visualization of the back of the eye by looking through the pupil). </li></ul>
  153. 153. <ul><li>Two tests are essential in the diagnosis and the follow-up exams. </li></ul><ul><li>Visual field testing will find defects in the peripheral (side vision) with the degree of loss related to defects in relation to the damage occurring in this disease. Over time, the visual field may reduce to a small central island of vision causing &quot;tunnel vision.&quot; The final progression may be the complete loss of the remaining central vision. </li></ul><ul><li>Electrophysiological testing by the ophthalmologist (often by referral to a university ophthalmology department, since very few private offices would have this equipment) is often diagnostic. Responses to flashes of light are measured via electrodes placed on the surface of the eye. It is a painless test. The electroretinogram (ERG), in conjunction with the visual field exam, will usually make the diagnosis. This will also determine if there is any cone involvement. </li></ul><ul><li>Recently, gene testing for defects is being done to clarify the basic cause for RP and assist in ultimately finding a treatment. </li></ul>
  154. 154. TREATMENT <ul><li>As of now there is no specific cure for retinitis pigmentosa. </li></ul><ul><li>For years, vitamin A therapy has been recommended for many RP patients. </li></ul><ul><li>Another study among adult patients with RP has shown that an omega-3-rich diet containing docosahexaenoic acid can further slow disease progression. </li></ul><ul><li>Such a diet includes one to two 3-ounce servings per week of oily fish such as salmon, tuna, herring, mackerel, or sardines. </li></ul><ul><li>Researchers estimated that the combination of vitamin A plus this diet could provide almost 20 additional years of useful vision for adults who start the regimen in their 30s. </li></ul>
  155. 155. AQUASOL A® Parenteral water-miscible vitamin A Palmitate <ul><li>AQUASOL A® Parenteral (water-miscible vitamin A Palmitate) provides 50,000 USP Units of vitamin A per mL as retinol (C20H30O) in the form of vitamin A palmitate, a light yellow to amber oil. </li></ul><ul><li>THIS IS A STERILE PRODUCT FOR INTRAMUSCULAR INJECTION </li></ul>
  156. 156. <ul><li>STRUCTURE: </li></ul><ul><li>Ordinarily oil-soluble, the vitamin A in this product has been water solubilized by special processing . </li></ul>
  157. 157. INDICATIONS <ul><li>Vitamin A injection is effective for the treatment of vitamin A deficiency . </li></ul><ul><li>The parenteral administration is indicated when the oral administration is not feasible as in anorexia , nausea , vomiting, pre- and postoperative conditions, or it is not available as in the &quot; Malabsorption Syndrome&quot; with accompanying steatorrhea. </li></ul><ul><li>Pediatric Use: Vitamin A treatment for deficiency states has been recognized as an especially effective and important therapy in the pediatric population. </li></ul>
  158. 158. DOSAGE AND ADMINISTRATION <ul><li>For intramuscular use. </li></ul><ul><li>I. Adults </li></ul><ul><ul><li>100,000 Units daily for three days followed by 50,000 daily for two weeks. </li></ul></ul><ul><li>II. Pediatric patients 1 to 8 years old </li></ul><ul><ul><li>17,500 to 35,000 Units daily for 10 days. </li></ul></ul><ul><li>III. Infants </li></ul><ul><ul><li>7,500 to 15,000 Units daily for 10 days. </li></ul></ul><ul><li>Follow-up therapy with an oral therapeutic multivitamin preparation, containing 10,000 to 20,000 Units vitamin A for adults and for pediatric patients over 8 years old, and 5,000 to 10,000 Units for infants and other pediatric patients under 8 years old, is recommended daily for two months. Low birth-weight infants may require additional vitamin A though the exact dosing in these pediatric patients has not been established. In malabsorption, the parenteral route must be used for an equivalent preparation. </li></ul><ul><li>Poor dietary habits should be corrected and an abundant and well-balanced dietary intake should be prescribed. </li></ul>
  159. 159. DRUG INTERACTIONS <ul><li>Women on oral contraceptives have shown a significant increase in plasma vitamin A levels. </li></ul><ul><li>Carcinogenesis: There are no studies that show that administration of vitamin A will cause or prevent cancer. </li></ul><ul><li>Nursing Mothers: The U.S. Recommended Daily Allowance (RDA) of vitamin A (5,000 Units) is recommended for nursing mothers. </li></ul>
  160. 160. RETINOBLASTOMA <ul><li>Retinoblastoma is a malignant tumor on the retina, the light-sensing part of the eye, and is highly curable if treated early. This type of cancer can be present in one or both eyes. </li></ul><ul><li>Retinoblastoma occurs most often in children 5 years and under. It rarely occurs in adults. </li></ul>
  161. 161. CAUSE <ul><li>Our eyes begin to develop very early in the womb. </li></ul><ul><li>Rapidly growing cells in the eye, called retinoblasts, will eventually mature and form the retina, the light-sensing part of the eye that is located in the back of the eye. </li></ul><ul><li>Sometimes, these specialized cells do not stop reproducing and form a tumor on the retina. These tumors may continue to grow, filling almost the entire vitreous humor (the jellylike substances the fills the eyeball). </li></ul><ul><li>These tumors can also break off and spread to other parts of the eye, and eventually outside to lymph nodes and other organs </li></ul>
  162. 162. Symptoms of Retinoblastoma <ul><li>Symptoms of retinoblastoma include: </li></ul><ul><ul><li>A pupil that appears white when light is shone into it, called leucocoria, may mean that a retinal tumor is present. Blood vessels in the back of the eye will normally reflect red. </li></ul></ul><ul><ul><li>The eyes may not move or focus in the same direction. </li></ul></ul><ul><ul><li>Eye pain </li></ul></ul><ul><ul><li>The pupil is constantly dilated. </li></ul></ul><ul><ul><li>Red eye(s) </li></ul></ul>
  163. 163. DIAGNOSIS <ul><li>An eye exam and imaging test given by an eye doctor can diagnose retinoblastoma. </li></ul><ul><li>Other tests may be conducted to determine the stage of the retinoblastoma, or how far it has spread. These tests include ultrasound , MRI scans, CT scans, bone scans, spinal tap, and bone marrow tests </li></ul>
  164. 164. Stages of Retinoblastoma <ul><li>Intraocular retinoblastoma. </li></ul><ul><ul><li>The earliest stage of retinoblastoma, found in one or both eyes. It has not yet spread to tissue outside of the eye. </li></ul></ul><ul><li>Extraocular retinoblastoma. </li></ul><ul><ul><li>This type of cancer has either spread outside of the eye or to other parts of the body. </li></ul></ul><ul><li>Recurrent retinoblastoma. </li></ul><ul><ul><li>The cancer has come back or spread in the eye or to other parts of the body after being treated. </li></ul></ul>
  165. 165. TREATMENT <ul><li>Because it is usually found before it spreads outside of the sclera (white of the eye), retinoblastoma is highly curable. There are also many types of treatment that can save sight in the eye affected by retinoblastoma. </li></ul><ul><li>Treatments are selected based on the stage of cancer at the time of diagnosis. Options include: </li></ul><ul><ul><li>Photocoagulation. A laser is used to kill blood vessels that feed the tumor. </li></ul></ul><ul><ul><li>Cryotherapy. Extremely low temperatures are used to kill cancer cells. </li></ul></ul><ul><li>Chemotherapy. Chemotherapy is a treatment given intravenously (injected into the vein), orally, or is injected into the fluid that surrounds the brain and spinal cord, called intrathecal chemotherapy. These powerful doses of cancer-killing medication help kill or slow the growth of multiplying cancerous cells. </li></ul><ul><li>Radiation therapy. Radiation may be given externally or internally. External-beam radiation therapy uses X-rays to kill cancer cells. Internal, or local radiation therapy, involves placing small amounts of radioactive material inside of or near the tumor to kill cancer cells. </li></ul><ul><li>Enucleation. Surgery to remove the eye. </li></ul>
  166. 166. PREVENTION <ul><li>Because heredity and age play such large roles in retinoblastoma, the best prevention is through early detection. All babies should have a general eye exam at birth and then again at six months. </li></ul><ul><li>The chance is 1 in 2 that a parent will pass on the DNA mutation that causes retinoblastoma. A blood test can be used to determine if this mutation is present. </li></ul><ul><li>For adults, prevention means getting a thorough regular eye examination at least once a year and more often, as recommended by your ophthalmologist, if you have a personal or family history of eye disorders or diabetes. </li></ul>
  167. 167. CYTOXAN® (cyclophosphamide) for Injection, USP <ul><li>It is a sterile white powder containing cyclophosphamide monohydrate. Cyclophosphamide is a synthetic antineoplastic drug chemically related to the nitrogen mustards. Cyclophosphamide is a white crystalline powder. </li></ul><ul><li>Structure: </li></ul>
  168. 168. INDICATIONS <ul><li>Malignant Diseases </li></ul><ul><li>CYTOXAN, although effective alone in susceptible malignancies, is more frequently used concurrently or sequentially with other antineoplastic drugs. The following malignancies are often susceptible to CYTOXAN treatment: </li></ul><ul><ul><li>Malignant lymphomas. </li></ul></ul><ul><ul><li>Multiple myeloma. </li></ul></ul><ul><ul><li>Leukemias. </li></ul></ul><ul><ul><li>Mycosis fungoides (advanced disease). </li></ul></ul><ul><ul><li>Neuroblastoma (disseminated disease). </li></ul></ul><ul><ul><li>Adenocarcinoma of the ovary . </li></ul></ul><ul><ul><li>Retinoblastoma. </li></ul></ul><ul><ul><li>Carcinoma of the breast. </li></ul></ul><ul><li>Nonmalignant Disease </li></ul><ul><li>Biopsy Proven &quot;Minimal Change&quot; Nephrotic Syndrome in Children </li></ul><ul><li>CYTOXAN is useful in carefully selected cases of biopsy proven &quot;minimal change&quot; nephrotic syndrome in children but should not be used as primary therapy . </li></ul>
  169. 169. DOSAGE AND ADMINISTRATION <ul><li>Treatment of Malignant Diseases </li></ul><ul><li>Adults and Children </li></ul><ul><ul><li>When used as the only oncolytic drug therapy, the initial course of CYTOXAN for patients with no hematologic deficiency usually consists of 40 to 50 mg/kg given intravenously in divided doses over a period of 2 to 5 days. Other intravenous regimens include 10 to 15 mg/kg given every 7 to 10 days or 3 to 5 mg/kg twice weekly. </li></ul></ul><ul><li>Oral CYTOXAN dosing is usually in the range of 1 to 5 mg/kg/day for both initial and maintenance dosing. </li></ul>
  170. 170. <ul><li>Treatment of Nonmalignant Diseases </li></ul><ul><li>Biopsy Proven &quot;Minimal Change&quot; Nephrotic Syndrome In Children </li></ul><ul><ul><li>An oral dose of 2.5 to 3 mg/kg daily for a period of 60 to 90 days is recommended. In males, the incidence of oligospermia and azoospermia increases if the duration of CYTOXAN treatment exceeds 60 days. Treatment beyond 90 days increases the probability of sterility. Adrenocorticosteroid therapy may be tapered and discontinued during the course of CYTOXAN therapy. </li></ul></ul>
  171. 171. DRUG INTERACTIONS <ul><li>The rate of metabolism and the leukopenic activity of cyclophosphamide reportedly are increased by chronic administration of high doses of phenobarbital. </li></ul><ul><li>Cyclophosphamide treatment, which causes a marked and persistent inhibition of cholinesterase activity, potentiates the effect of succinylcholine chloride . </li></ul><ul><li>Adrenalectomy </li></ul><ul><ul><li>Ajustment of the doses of both replacement steroids and cyclophosphamide may be necessary for the adrenalectomized patient. </li></ul></ul><ul><li>Wound Healing </li></ul><ul><ul><li>Cyclophosphamide may interfere with normal wound healing. </li></ul></ul>