Anti Viral Drugs in Ophthalmology

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This presentation gives an overview of the current anti-viral drugs used in ophthalmology.

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Anti Viral Drugs in Ophthalmology

  1. 1. Dr. Ankit M. Punjabi DOMS (Final Year), Dept of Ophthalmology, KIMS Hospital, Bangalore Karnataka, INDIA Email: drankitalways@gmail.com
  2. 2. <ul><li>Smallest living unit </li></ul><ul><li>Nutrition from host </li></ul><ul><li>Difficult to Rx </li></ul><ul><li>Difficult to diagnose </li></ul>
  3. 3. <ul><li>DNA Viruses </li></ul><ul><li>Herpes group </li></ul><ul><li>HSV & HZV </li></ul><ul><li>CMV </li></ul><ul><li>Adeno viruses </li></ul><ul><li>Variola & Vaccinia </li></ul><ul><li>Molluscum contagiosum </li></ul><ul><li>HPV </li></ul>
  4. 4. <ul><li>RNA Viruses </li></ul><ul><li>Picorna viruses </li></ul><ul><li>Measles </li></ul><ul><li>Mumps </li></ul><ul><li>Rubella </li></ul>
  5. 5. <ul><li>Adsorption </li></ul><ul><li>Entry </li></ul><ul><li>Uncoating </li></ul><ul><li>Transcription </li></ul><ul><li>Virus component synthesis </li></ul>
  6. 7. <ul><li>Ist Generation drugs </li></ul><ul><li>Idoxuridine </li></ul><ul><li>Vidarabine </li></ul><ul><li>Trifluorothymidine </li></ul><ul><li>Cytarabine </li></ul>
  7. 8. <ul><li>2 nd Generation Drugs </li></ul><ul><li>Acyclovir </li></ul><ul><li>Bromo vinyl deoxyuridine </li></ul><ul><li>Interferons </li></ul><ul><li>Famiclovir </li></ul><ul><li>Vabaciclovir </li></ul><ul><li>Foscarnet </li></ul><ul><li>Ganciclovir </li></ul>
  8. 9. <ul><li>Zidovudine </li></ul><ul><li>Sorvudine </li></ul>
  9. 11. <ul><li>Thymidine analogue </li></ul><ul><li>Activated by cellular & viral kinase </li></ul><ul><li>Incorporation into viral genome </li></ul><ul><li>Faulty virus synthesis </li></ul>
  10. 12. <ul><li>TOXICITY </li></ul><ul><li>SPK </li></ul><ul><li>Indolent ulceration </li></ul><ul><li>Delayed epithelial healing </li></ul><ul><li>Stromal opacification </li></ul><ul><li>Chemosis </li></ul><ul><li>Hyperaemia </li></ul><ul><li>Follicles </li></ul>
  11. 13. <ul><li>Eyelid edema </li></ul><ul><li>Meibomian gland plugging </li></ul><ul><li>Punctal occlusion </li></ul><ul><li>DOSE </li></ul><ul><li>0.1% e/d and 0.5% e/o </li></ul>
  12. 14. <ul><li>Idurin 0.1% </li></ul><ul><li>Ridinox 0.1% </li></ul><ul><li>Toxil 0.1% </li></ul>
  13. 15. <ul><li>Acute and Recurrent Herpetic keratoconjuctivitis </li></ul><ul><li>Keratitis </li></ul><ul><li>Purine nucleoside analogue </li></ul><ul><li>Phosphorylation by host kinases </li></ul>
  14. 16. <ul><li>Chain terminator for new viral DNA </li></ul><ul><li>Doesnot require viral thymidine kinase </li></ul><ul><li>Not effective against RNA viruses </li></ul>
  15. 17. <ul><li>Side effects </li></ul><ul><li>Irritation </li></ul><ul><li>SPK </li></ul><ul><li>Pain </li></ul><ul><li>Photophobia </li></ul><ul><li>Punctal occlusion </li></ul><ul><li>Secondary glaucoma </li></ul><ul><li>Corneal vascularisation </li></ul>
  16. 18. <ul><li>Fluorinated pyrimidine </li></ul><ul><li>Thymidine analogue </li></ul><ul><li>Phosphorylated to active form </li></ul><ul><li>More conc. In infected cells </li></ul><ul><li>Drug of choice for HSV Keratitis </li></ul><ul><li>Water and lipid soluble </li></ul><ul><li>Drug of choice for HSV </li></ul>
  17. 19. <ul><li>Side Effects </li></ul><ul><li>Burning & Stingy sensation </li></ul><ul><li>Hyperaemia </li></ul><ul><li>Keratitis sicca </li></ul><ul><li>Delayed wound healing </li></ul><ul><li>Raised IOP </li></ul>
  18. 20. <ul><li>DOSE </li></ul><ul><li>1% Solution </li></ul><ul><li>6 – 9 times till epithelium heals </li></ul><ul><li>then, 1 drop 4 times/day for week </li></ul>
  19. 21. <ul><li>Acyclic nucleoside analogue of Guanosine </li></ul><ul><li>Selective for herpes infected cells </li></ul><ul><li>Thymidine kinase & DNA polymerase </li></ul><ul><li>Chain termination </li></ul><ul><li>Oral, Topical, Intravenous administration </li></ul>
  20. 22. <ul><li>DOSE </li></ul><ul><li>Topical – 3% Ointment </li></ul><ul><li>Systemic – 1g/ 24 hr for 10 days </li></ul><ul><li>200mg, 400mg, 800mg Tablets </li></ul><ul><li>Intravenous </li></ul><ul><li>5 mg/ kg 8 hrly for 5 – 10 days </li></ul>
  21. 23. <ul><li>INDICATIONS </li></ul><ul><li>Primary HSV </li></ul><ul><li>Infectious epithelial keratitis </li></ul><ul><li>HSV iritis & blepharitis </li></ul><ul><li>Risk of recurrence of infectious ds. </li></ul><ul><li>Post PK for HSV </li></ul><ul><li>ARN </li></ul><ul><li>Immunosuppressed patients </li></ul>
  22. 24. <ul><li>SIDE EFFECTS </li></ul><ul><li>SPK </li></ul><ul><li>Burning sensation </li></ul><ul><li>GIT disturbances, nausea, diziness </li></ul><ul><li>Renal dysfunction </li></ul><ul><li>Iv rashes, fall in BP </li></ul>
  23. 25. <ul><li>Acivir </li></ul><ul><li>Cyclovir </li></ul><ul><li>Ocuvir </li></ul><ul><li>Syslovir </li></ul><ul><li>Virucid </li></ul><ul><li>Zovirax ophthalmic oint. </li></ul>
  24. 26. <ul><li>Guanine analogue </li></ul><ul><li>Structurally related to acyclovir </li></ul><ul><li>CMV retinitis </li></ul>
  25. 27. <ul><li>INDICATIONS </li></ul><ul><li>CMV Retinitis </li></ul><ul><li>Prevention in immunosuppresed patients </li></ul><ul><li>C/I </li></ul><ul><li>Hyperesensitivity to acyclovir or ganciclovir </li></ul>
  26. 28. <ul><li>DOSE </li></ul><ul><li>CMV retinitis </li></ul><ul><li>Induction regime </li></ul><ul><li>5mg/kg every 12 hrs for 14-21 days </li></ul><ul><li>Maintenance regime </li></ul><ul><li>5 mg/kg/hr once daily/ week </li></ul><ul><li>or </li></ul><ul><li>6 mg/kg once daily 5 days /week </li></ul>
  27. 29. <ul><li>Oral, for maintenance only </li></ul><ul><li>1000 mg 3 times daily </li></ul><ul><li>or </li></ul><ul><li>500 mg 6 times daily every 3 hrs. </li></ul>
  28. 30. <ul><li>Prevention </li></ul><ul><li>5 mg/Kg every 12 hrs for 7 –14 days </li></ul><ul><li>Then, 5 mg/kg once daily / week </li></ul><ul><li>or </li></ul><ul><li>6 mg/Kg once daily 5 days / week </li></ul>
  29. 31. <ul><li>Ganciclovir intravitreal implant </li></ul><ul><li>Rx of CMV retinitis </li></ul><ul><li>4.5 mg of drug </li></ul><ul><li>Released over 6 – 8 months </li></ul><ul><li>Stored at 15 – 30 * C </li></ul>
  30. 32. <ul><li>Glycoproteins </li></ul><ul><li>Host cell in response to viral infection </li></ul><ul><li>Broad antiviral, Immunomodulator </li></ul><ul><li>& Anti-proliferative </li></ul><ul><li>Three types </li></ul>
  31. 33. <ul><li>INDICATIONS </li></ul><ul><li>Herpes Zoster </li></ul><ul><li>AIDS related Kaposi’s sarcoma </li></ul><ul><li>DOSE </li></ul><ul><li>30 – 400 million/ml once or twice a day for 2 weeks </li></ul>
  32. 34. <ul><li>Adverse effects </li></ul><ul><li>Fever, chills, Myalgia </li></ul><ul><li>Bonemarrow depression </li></ul><ul><li>Neurotoxicity </li></ul><ul><li>Hypersenstivity </li></ul>
  33. 35. <ul><li>Tri-sodium salt of phosphoformic acid </li></ul><ul><li>Inhibits viral DNA replication </li></ul><ul><li>Acyclovir and Ganciclovir resistant </li></ul><ul><li>Renal excretion </li></ul>
  34. 36. <ul><li>DOSE </li></ul><ul><li>60 mg/Kg every 8 hrs for 2 –3 weeks </li></ul><ul><li>Maintenance </li></ul><ul><li>90 – 120 Mg/Kg over 2 hrs once daily </li></ul>
  35. 37. <ul><li>Bromovinyl deoxyuridine </li></ul><ul><li>HPMPC </li></ul>

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