Ocular allergy are a group of external ocular conditions resulting from one or more types of hypersensitivity reactions to allergens.
Anti Allergic eye drops are liquid medicine used to treat symptoms of eye allergies.
Ocular allergy are a group of external ocular conditions resulting from one or more types of hypersensitivity reactions to allergens.
Anti Allergic eye drops are liquid medicine used to treat symptoms of eye allergies.
The skin is the largest organ of the body, with a total area of about 20 square feet. The skin protects us from microbes and the elements, helps regulate body temperature, and permits the sensations of touch, heat, and cold
Eye is a complex system in itself .Most privileged organ as well as the most difficult to deliver the drug in eye. Blood ocular barrier is the main culprit in making the ocular drug delivery in the posterior segment ,one of the most challenging task for the ophthalmologist & the pharma personnel.
OCULAR PHARMACOLOGY :
what is pharmacology ?
what is drug ?
what is pharmacokinetics & pharmacodynamics ?
what is drug half life period ?
what are the common drugs used in eye / ophthalmology ?
what is ADE ( adverse drug effect ) ?
Simple eye education for EHW, Ophthalmic eye student, school eye education & first - second year optometry students only .
The skin is the largest organ of the body, with a total area of about 20 square feet. The skin protects us from microbes and the elements, helps regulate body temperature, and permits the sensations of touch, heat, and cold
Eye is a complex system in itself .Most privileged organ as well as the most difficult to deliver the drug in eye. Blood ocular barrier is the main culprit in making the ocular drug delivery in the posterior segment ,one of the most challenging task for the ophthalmologist & the pharma personnel.
OCULAR PHARMACOLOGY :
what is pharmacology ?
what is drug ?
what is pharmacokinetics & pharmacodynamics ?
what is drug half life period ?
what are the common drugs used in eye / ophthalmology ?
what is ADE ( adverse drug effect ) ?
Simple eye education for EHW, Ophthalmic eye student, school eye education & first - second year optometry students only .
Slides are prepared as per INC Syllabus Unit V Drugs used on Respiratory systems and it is most benefited for 2nd yr B sc Nursing students and faculty of the subject.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lecture on Ocular Pharmacology & Therapeutics For 4th Year MBBS Undergraduate Students By Prof. Dr. Hussain Ahmad Khaqan
1. Ocular Pharmacology & Therapeutics
Prof. Dr. Hussain Ahmad Khaqan
MD
FRCS(Glasgow)
FCPS(Ophth.)
FCPS(Vitreo Retina)
MHPE (KMU)
CICO(UK)
CMT(UOL)
Fellowship in Medical Retina (LMU, Munich)
Fellowship in Vitreo Retinal Surgery (LMU, Munich)
Consultant Ophthalmologist & Retinal Surgeon
Professor of Ophthalmology
Lahore General Hospital, Lahore
Ameer Ud Din Medical College, Lahore
Post Graduate Medical Institute, Lahore
Shaukat Khanum Memorial Cancer Hospital & Research Centre ,Lahore
2. TOPICAL Continue
• Only around 1-10% of most topical agents are
absorbed into the eye. Absorption is dependent on
ocular contact time, drug concentration, and tissue
permeability. Small lipophilic drugs pass through the
cornea, whereas larger hydrophilic drugs are generally
absorbed through conjunctiva and sclera. Topical
agents may be in aqueous solution (comfortable, no
blurring but very short ocular contact time), in
suspension (longer ocular contact time, but bottle
must be shaken and may get FB sensation), or in
ointment (liquefy at body temperature, longest ocular
contact time but blurs vision)
3. TECHNIQUE
• Ensure that patients know how to instill any topical medication, and
that they can physically manage it.
• If reliable self administration is not possible ensure that there is
somebody who can assist them
• Consider ways of making it easier eg. Lying flat, mirror positioning,
or eye-drop dispensers. Small bottles and single use vials tend to be
particularly difficult for the frail and elderly
• Leave atleast 5 min between instilling topical medication
• Keep the eye closed and put pressure over the lacrimal sac for 1-2
min to try to increase ocular and reduce systemic absorption
TOPICAL Continue
4. SUBCONJUNCTIVAL INJECTION
Technique
• Ensure adequate anesthesia (e.g. a couple of drops of
amethocaine).
• Under direct vision (or slit-lamp or operating
microscope) lift an area of conjunctiva to form a small
bleb and slowly inject (sharp needle).
Medications
• This route is most commonly used for post-operative
injections of corticosteroids and antibiotics, but may be
used in acute anterior segment inflammation to deliver
mydriatics and corticosteroids.
5. SUBTENON AND PERIBULBAR INJECTIONS
Medications
• Although primarily used for ocular anesthesia (e.g.
lidocaine, bupivacaine), these routes may be used for
delivering corticosteroids in posterior segment
inflammation, exudation, or macular edema.
Subtenon and peribulbar corticosteroids
Drug Dose
Triamcinolone acetate 40 mg
Methylprednisolone 40 mg
6. INTRAVITREAL INJECTION Continue
Technique
• This should be performed with appropriate anesthesia
under sterile condition, usually in theatre. It is either
performed immediately after a core vitrectomy to
administer intravitreal antibiotics (for endophthalmitis)
or may be used for delivering corticosteroids to treat
posterior segment exudation or macular edema.
• Insert a 25-gauge half-inch needle entering 3.5-4mm
post-limbus (if phakic) or 3.0 to 3.5 mm(if
aphakic/pseudophakic) and directed into the vitreous.
At the time of injection the needle tip should be clearly
visualized through the pupil
7. Medications
INTRAVITREAL INJECTION
Intravitreal antimicrobials
Drug Dose Reconstituted to
Vancomycin 1mg 0.1 ml
Amikacin 0.4mg 0.1 ml
Ceftazidime 2mg 0.1 ml
Amphotericin 5-10µg 0.1 ml
Ganciclovir 400µg 0.1 ml
Intravitreal corticosteroids
Drug Dose Reconstituted to
Triamcinolone acetate 2-4 mg 0.05 mg-0.1 ml
8. TOPICAL ANTIBIOTICS Continue
Anti-bacterials
Generic Forms Pres-free Frequency Proprietary
Chloramphenicol G or minims 0.5%
Oc 1%
Available G: see below
Oc: 3-4x/d
Chloromycetin
Ciprofloxacin G 0.3% No <=4x/h initially Ciloxan
Framycetin Oc 0.5% No Soframycin
Fusidic acid Gel 1% No 2x/d Fucithalamic
Gentamicin G or minims 0.3%
Special preparation of
1.5%
Available Garamycin
Genticin
Neomycin G 0.5%
Oc 0.5%
No Neosporin (neomycin/gramicidin/polymyxin B
sulphate)
Ofloxacin G 0.3% No Exocin
Polymyxin B sulphate Combination only
G or Oc 10000µ/ml
No Polyfax(PBS/ bacitracin)
Polytrim (PBS/trimethoprim)
Propamidineisethionate G 0.1%
Oc 0.15%
No G: 4x/d brolene
Frequency: BNF recommends for antibacterial eyedrops that they are administered at least every 2 h then reduce frequency as infection is controlled and
continue for 48h after healing. For ointments BNF recommends that they are used at night (with drops used during the day) or 3-4x/d if used alone.
9. Anti-fungals
Generic Forms Frequency
Amphotericin G 0.15% <= q 1h initially for fungal
keratitis reducing as
infection is controlled
Clotrimazole G 1%
Econazole G 1%
Flucytosine G 2%
Itraconazole G 1%
Miconazole G 1%
Natamycin G 5%
Anti-virals
Generic Forms Pres-free Frequency Proprietary
Acyclovir Oc 3% No 5x/d until
healed then
5x/d for 3 d
Zovirax
Ganciclovir Gel 0.15% No 5x/d until
healed then
3x/d for 1 wk
Virgin
Trifluoridine 1% No 9x/d viroptic
TOPICAL ANTIBIOTICS
10. TOPICAL ANTI-INFLAMMATORY AGENTS
Continue
Corticosteroids
Corticosteroids
Generic Forms Pres-free Frequency Proprietary
Betamethasone G 0.1%
Oc 0.1%
No G ≤ jourly Betnesol
Bista-
methasone
Dexamethason
e
G or minim
0.1%
Available ≤ half hourly Maxidex
Fluorometholo
ne
G 0.1% No ≤ hourly FML
Hydrocortisone
acetate
G 1%
Oc 0.5%
No
Prednisolone G or minim
0.5%
G 1%
Available ≤ hourly Predsol
Pred forte
Rimexolone G 1% No ≤ hourly Vexol
Frequency: potency and frequency of cortricosteroids should be titrated against degree
of inflammation in order to achieve control whilst minimizine side-effects
11. TOPICAL ANTI-INFLAMMATORY AGENTS
Corticosteroid/antibiotic combination
Corticosteroid Antibiotic Forms Frequency Proprietary
Betamethason
e 0.1%
Neomycin
0.5%
G ≤ 6x/d Betnesol N
Vista-
methasone N
Dexamethaso
ne 0.1%
Neomycin
0.35%
Polymyxin B
sulphate
G or Oc ≤ 6x/d Maxitrol
Tobramycin
0.3%
tobradex
Dexamethaso
ne 0.05%
Framycetin
0.5%
Gramicidin
0.005%
G or Oc ≤ 4x/d Sofradex
Predsol 0.5% Neomycin
0.5%
G ≤ 6x/d Predsol-N
12. ANTI-HISTAMINES AND OTHER
ANTI-INFLAMMATORY AGENTS Continue
Anti-histamines and other anti-allergic agents
Generic Forms Pres-free Frequency Proprietary
Antihistamine
Antazolinesulphate G No 2-3x/d Otrivine/antristine
Azelastine
hydrochloride
G No 2-4 x/d upto 6
wks
Optilast
Ketotifen G No 2 x/d Zaditen
Levocarbistine G No 2-4 x/d Livastin
Olopatadine G No 2 x/d upto 4
months
opatanaol
Others
Emedastine G No 2x/d Emadine
Lodoxamide G No 4x/d Alamide
Nedocromil sodium G No 2-4 x/d Rapitil
Sodium cromoglycate G No 4x/d Opticrom and
others
13. Other anti-inflammatory agents (NSAIDS type)
Generic Forms Pres-free Frequency Proprietary
Diclofenac
sodium
G 0.1% Available Single Voltarolophtha
Voltarolophtha
multi
Flurbiprofen
sodium
G 0.03% No Single ocufen
Ketorolac G 0.5% No 3 x/d acular
ANTI-HISTAMINES AND OTHER
ANTI-INFLAMMATORY AGENTS
14. TOPICAL GLAUCOMA MEDICATIONS
Continue
• Beta-blockers
Generic Forms Pres-free Frequency Proprietary
Betaxolol G 0.25% or 0.5% No 2x/d Betoptic
Carteolol
hydrochloride
G 1% No 2x/d Teoptic
Levobunolol G 0.5% No 1-2 x/d Betagan
Metipranolol G 0.1% Yes
Timolol maleate G 0.25% or 0.55%
Gel 0.1%
Gel 0.25% or 0.5%
Available
No
No
2 x/d
1x/d
1x/d
Timoptol
Nyogel
Timoptol-LA
15. • Prostaglandin analogue
TOPICAL GLAUCOMA MEDICATIONS
Continue
Generic Forms Pres-free Frequency Proprietary
Bimatoprost G 300µg/ml
0.03%
No 1x/d Lumigan
Latanoprost G 50µg/ml
0.005%
No 1x/d Xalatan
Travoprost G 40µg/ml
0.004%
No 1x/d travatan
16. • Sympathomimetics
• Carbonic anhydrase inhibitors
TOPICAL GLAUCOMA MEDICATIONS
Continue
Generic Forms Pres-free Frequency Proprietary
Apraclonidine G 0.5% or 1% No Single-3x/d for
<1 month
Iopidine
Brimonidine
tartrate
G 0.2% No 2x/d Alphagan
Dipivefrine
hydrochloride
G 0.1% No 2x/d Propine
Generic Forms Pres-free Frequency proprietary
Brinzolamide G 10mg/ml No 2-3 x/d Azopt
Dorzolamide G 2% No 3x/d or 2x/d of
with βblocker
trusopt
17. • Miotics
Generic Forms Pres-free Frequency proprietary
Carbachol G 3% No < 4x/d Isoptocarbachol
Pilocarpine G 0.5, 1, 2, 3 or
4%
Minims 2 or 4%
Gel 4%
Available <4x/d
1x/d
pilogel
TOPICAL GLAUCOMA MEDICATIONS
Continue
18. • Combination drops
Generic Forms Pres-free Frequency proprietary
Timolol +
brimonidine
G timolol 0.5%
Brimonidine 0.2%
No 2x/d Combigan
Timolol +
dorzolamide
G timolol 0.5%
Dorzolamide 2%
No 2x/d Cosopt
Timolol + latanoprost G timolol 0.5%
Latanoprost 0.005%
No 1x/d Xalacom
TOPICAL GLAUCOMA MEDICATIONS
19. TOPICAL MYDRIATICS
Generic Forms Pres-free Frequency proprietary
Antimuscarinic
Atropine
sulphate
G 0.5% or 1%
Minims or Oc
1%
Available Single- 1x/d Isopto
atropine
Cyclopentolate
hydrochloride
G or minims
0.5%
Available Single -3x/d Mydrilate
Homatropinehy
drobromide
G 1% No Single- 4x/d
Tropicamide G 0.5%
Minims 0.5%
or 1%
Available Single Mydriacyl
Sympathomimet
ic
Phenylephrine
G 10%
Minims 2.5%
or
Available
Single – 3x/d
20. TOPICAL ANAESTHETICS
Generic Forms Pres-free Frequency proprietary
Oxybuprocaine
hydrochloride
Minim 0.4% Yes Single Minim
(benoxinate)
Proxymetacaine
hydrochloride
Minim 0.5% Yes Single Minim
Tetracaine
hydrochloride
Minim 0.5%
or 1%
Yes Single Minim
(amethocaine)
Combinations with fluorescein
Proxymetacaine and
fluorescein
Minim
P(o.5%)
F (0.25%)
Yes Single Minim
Lidocaine and
fluorescein
Minim L
(4%)
F (0.25%)
Yes Single Minim
21. TOPICAL TEAR REPLACEMENT Continue
Generic Forms Pres-free Frequency proprietary
Low viscosity
Hypromellose G 0.3%, 0.5% or 1% Available As required e.g. hourly Isopto plain
Isopto alkaline
Tears natural
Artelac SDU
Hydroxyl-ethylcellulose Minims 0.44% Yes As required Minims artificial tears
Polyvinyl alcohol G 1% or 1.4% Available As required Hypotears
Sno tears
Liquifilm
Liquifilm PF
Sodium chloride G 0.9%
Minims 0.9%
Available As required Minims saline
Medium viscosity
Carbomer 980 Gel 0.2% Available ≥4x/d Gel/tears
Liposic
Viscotears
Viscotears PF
Carmellose G 1% Yes ≥4x/d Celluvisc
High viscosity
Liquid paraffin Oc 30% or 42.5% Yes Nocte Lubri-tears
Lacri-lube
Yellow soft paraffin Oc 80% Yes Nocte Simple eye ointment
23. SYSTEMIC MEDICATION: GLAUCOMA Continue
• Systemic medication may be required to lower
intraocular pressure in the acute setting (e.g.
angle closure glaucoma) or if topical
treatment alone has failed. It is also
commonly used prophylactically post-
procedure (e.g. acetazolamide after cataract
surgery). Acetazolamide may also be used in
the treatment of raised intracranial pressure
secondary to idiopathic intracranial
hypertension.
24. Drug Dose Rout
e
Contraindications Side-effects
Acetazolamid
e
0.25-1g per
day in
divided doses
IV/PO Sulphonamide
allergy, salt
imbalance, renal
impairment, hepatic
impairment
Nausea, vomiting,
diarrhea,
paresthesia,
rashes, polyuria,
hypokalemia, salt
imbalance, mood
changes, blood
disorders
Mannitol 20% 1-2 g/kg over
45 mins
single dose
IV Cardiac failure Fluid overload
Fever
Glycerol 1g/kg in 50%
lemon juice
single dose
PO Diabetes mellitus hyperglycemia
SYSTEMIC MEDICATION: GLAUCOMA
25. SYSTEMIC CORTICOSTEROIDS: GENERAL
Continue..
Indications and mechanism
• In severe ophthalmic inflammation systemic
corticosteroids may be required.
Corticosteroids are anti-inflammatory but at
higher doses are immunosuppressive. The
immunosuppressive role of corticosteroids is
via inhibition of NF-kB transcription factor
signaling so blocking the production of IL-2
and other pro-inflammatory cytokines.
26. Routes of administration
• Oral: the preferred corticosteroid is usually prednisolone.
This may be started at 1mg/kg and then titrated down as
inflammation is controlled and/or steroid sparing agents
are added. Two forms are available: enteric and non-enteric
coated. The enteric-coated form is associated with fewer
upper gastrointestinal side-effects but its absorption may
be less predictable. It is best given in the morning
(coincides with physiological morning cortisol peak)
• Intravenous: the preferred corticosteroid is usually
methylprednisolone. This may be given as a single 500-
1000mg dose or ‘pulsed’ eg three doses of 500-1000 mg on
consecutive or alternate days given in a 100 ml of normal
saline over a minimum of 1h.
SYSTEMIC CORTICOSTEROIDS: GENERAL
Continue..
27. • Efficacy
SYSTEMIC CORTICOSTEROIDS: GENERAL
Continue..
Corticosteroids: equivalent anti-inflammatory
disorders
Prednisolone 5mg is equivalent to:
Dexamethasone 750µg
Betamethasone 750µg
Methylprednisolone 4mg
Triamcinolone 4mg
hydrocortisone 20mg
28. Contraindications
• Systemic infection (unless covered with appropriate antibiotics)
Monitoring
• Pre-treatment
• Due to the profound effects of corticosteroids a short pre-treatment
review is advised. This includes selected medical history (varicella status,
TB status, pre-existing diabetes/impaired glucose tolerance, hypertension)
and examine (weight, BP, glucose). If there is any possibility of TC, CXR
should be performed.
During treatment
• BP, weight, glucose every 3 months
• Lipids every 1 yr
• Bone density (DXA scan) if steroid course > 3 months; repeated scans may
be needed for monitoring bone density in at risk individuals
SYSTEMIC CORTICOSTEROIDS: GENERAL
Continue..
29. SYSTEMIC CORTICOSTEROIDS: GENERAL
Corticosteroid side-effects
Endocrine Adrenal suppression (risk of addisonian crisis with withdrawal), cushing’s
syndrome, weight gain, moon-face
Gastrointestinal Nausea, indigestion, peptic ulcer, pancreatitis
Musculo-skeletal Myopathy, osteopenia, osteoporosis, avascular necrosis
Skin Atrophy, bruising, stria, acne, hirusitism
Hematological Leukocytosis, immunosuppression
Biochemical Fluid/electrolyte disturbance
Psychiatric Mood disturbance, insomnia, psychosis
Neurological Increased ICP, papilledema, worsening of epilepsy
Cardiovascular Myocardial rupture after recent MI
Ophthalmic Increased IOP, posterior subcapsular cataracts, worsening of infection
(e.g. viral or fungal keratitis)
30. OTHER SYSTEMIC
IMMUNOSUPPRESSANTS Continue
Indications and mechanism
• Although corticosteroids are usually the drug of
choice in severe systemic or ocular inflammation,
other immunosuppressants have an important role
either as second-line agents in unresponsive cases or
in permitting reduction/withdrawal of corticosteroids
to minimize their side-effects.
31. Drug Dose Route Mechanism
Antimetabolite
Azathioprine
Methotrexate
Mycophenolate
50-150mg/d
7.5 mg/wk
1-2g/d
PO
PO/IM
PO
Antimetabolite: inhibits purine metabolism
Antimetabolite: inhibits dihydrofolatereductase
Antimetabolite: inhibits purine metabolism
Transcription factor inhibitors
Ciclosporin 2-5mg/kg/d PO NF-AT transcription factor inhibitor: inhibits IL-2
+other cytokines
Tacrolismus 0.1-0.3 mg/d PO NF-AT transcription factor inhibitor: inhibits IL-2 +
other cytokines
Cytotoxics
Cyclophosphamide 2-3 mg/kg/d PO/IV Alkylating agent: DNA cross-linking blocks cell
replication
Biologics
Infliximab
Etanercept
Interferon-α
3-5 mg/kg every 4-8
wks
25 mg twice per week
Depends on
preparation
IV
SC
SC/IV
Anti-TNF: chimeric antibody against TNF-α
Anti-TNF: Fc fusion protein which binds
extracellular TNF-α
Antiviral and anti-tumor: decreases NK cell
activity
OTHER SYSTEMIC
IMMUNOSUPPRESSANTS Continue
32. Cautions
• These immunosuppressive agents should, however
only be administered by someone with appropriate
experience in their use and with adequate
monitoring. Patients education is essential. This will
include the potential side-effects, necessary
precautions (e.g. contraception during and for a
period after taking most of these agents) and
warning symptoms which would require urgent
medical review.
OTHER SYSTEMIC
IMMUNOSUPPRESSANTS
33. IMMUNOSUPPRESSANTS AND
THEIR SIDE-EFFECTS Continue..
Drug Side-effects (selected) Suggested monitoring
Antimetabolites
Azathioprine Bone marrow suppression, GI upset,
secondary malignancies, alopecia
Pre-treatment: check TPMT levels (low levels
increase risk of bone marrow suppression) FBC
stat, weekly for 408 wks then at least every 3
months
Methotrexate Hepatotoxicity, bone marrow suppression, GI
upset
FBC, U+E, LFT stat, weekly until dose stable, then
every every 2-3 mths. Commonly folate (1mg/d or
5 mg/wk) is given concurrently
Mycophenolate Bone marrow suppression, GI upset,
secondary malignancies
FBC stat, weekly for 4 wks, then fortnightly for 8
wks, then monthly for first year
Transcription factor inhibitors
Ciclosporin Nephrotoxicity, hypertension, hepatotoxicity,
gingival hyperplasia, hypertrichosis
U+E. LFT, BP stat, fortnightly for 4 wks then every
4-6 wks
Tacrolismus Nephrotoxicity, hypertension, neurotoxicity,
hepatotoxicity
U+E, LFT, BP stat, fortnightly for 4 wks then every
4-6 wks
34. Cytotoxic
Cyclophosphamide Bone marrow suppression, hemorrhagic
cystitis, GI upset
Intensive specialist supervision required:
includes FBC (+ differential), LFT weekly for 4
wks then every 2-4 wks
Biologics
Infliximab Human antichimeric antibodies serum
sickness,tuberculosis reactivation
Pre-treatment: rule out TB infection
FBC (+ differential), U+E, LFT stat, for nightly
for 4 wks them every 4-6 wks
Etanercept Tuberculosis reactivation
Hypersensitivity reactions
Pre-treatment: rule out TB infection
FBC (+ differential), U+E, LFT stat, fortnightly
for 4 wks then every 4-6 wks
Interferon-α Leukopenia, depression, tuberculosis
reactivation, flu-like symptoms,
nephrotoxicity, hepatotoxicity
FBC (+ differential), U+E, LFT stat, fortnightly
for 4 wks then every 4-6 wks
Regular review of mental state
IMMUNOSUPPRESSANTS AND
THEIR SIDE-EFFECTS
38. Combination of intravitreal antivirals
200µg/0.1 ml of trifluridine
400µg/0.1 ml of hydroxyacyclovir
200µg /0.1 ml of acyclovir
20µg/0.1 ml of vidarabine
Combination in vitrectomy infusion solutions
60µg/ml of trifluridine
20µg/ml of hydroxyacyclovir
40µg/ml of acyclovir
8µg/ml of vidarabine
NONTOXIC DOSES OF INTRAVITREAL
ANTIVIRAL DRUGS Continue