2020–2021 BCSC Basic and Clinical Science Course™
2 Fundamentals and Principles of Ophthalmology
Part V: Ocular Pharmacology
Chapter 16: Ocular Pharmacotherapeutics*
Highlights
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Off-label drug use is common in ophthalmology. Certain off-label uses are even the predominant treatment options or standard of care for some conditions.
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Compounded pharmaceuticals are used to treat numerous ophthalmic diseases. Practicing ophthalmologists should be up-to-date with current state and federal pharmacy regulations concerning compounded pharmaceuticals.
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The drugs carbachol, 0.01%, and acetylcholine, 1%, are administered intracamerally to induce miosis. Acetylcholine is faster acting; however, carbachol is 100 times more effective and longer lasting. In addition, carbachol can lower intraocular pressure.
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There is no evidence that the ophthalmic administration of fluoroquinolones affects weight-bearing joints in the pediatric population.
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Topical povidone-iodine solution (5%) is the only drug that has had a significant effect on postsurgical endophthalmitis. Povidone-iodine can be safely given to patients with an allergy to contrast agents or shellfish; these patients have likely developed hypersensitivity reactions to specific proteins of the food itself (eg, seafood) or to the contrast medium rather than to the iodine in the compound.
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Topical proparacaine reportedly does not inhibit the growth of Staphylococcus, Candida, or Pseudomonas; thus, it may be preferred to other drugs for corneal anesthesia before scraping a corneal ulcer for a culture.
* This chapter may include information on pharmaceutical applications that are not considered community standard, that are approved for use only in restricted research settings (ie, investigational drugs), or that reflect indications not approved in US Food and Drug Administration (FDA) labeling (ie, off-label use). For example, many ophthalmic uses of medications, including most antibiotics and antifungal drugs compounded for systemic treatment of ocular infections such as keratitis and endophthalmitis, are off-label. Many antifungal drugs are used off-label on the basis of in vitro and animal data because human data for unusual infectious agents are often limited. The FDA has stated that it is the responsibility of the physician to determine the FDA status of each drug or device he or she wishes to use and to use it with appropriate, informed patient consent in compliance with applicable law. (The legal aspect of medical therapy varies by country and region. For example, the General Medical Council [GMC] in the United Kingdom recognizes that a physician has a moral duty toward all of his or her patients that may affect the choice of appropriate medical therapy under tight budgetary restrictions.)
The reader is encouraged to consult the books and website given in the following reference list for more information on many of the topics covered in this chapter.
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Bartlett JD, Jaanus SD, eds. Clinical Ocular Pharmacology. 5th ed. St Louis: Butterworth-Heinemann/Elsevier; 2008.
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Brunton LL, Hilal-Dandan R, Knollmann BC, eds. Goodman & Gilman’s The Pharmacological Basis of Therapeutics: Digital Edition. 13th ed. New York: McGraw-Hill; 2018.
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Fraunfelder FT, Fraunfelder FW. Drug-Induced Ocular Side Effects. 7th ed. New York: Elsevier; 2014.
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Murray L, ed. Physicians’ Desk Reference. 72nd ed. Montvale, NJ: Thomson PDR; 2018.
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Physicians’ Desk Reference for Ophthalmic Medicines. 42nd ed. Montvale, NJ: Thomson PDR; 2012.
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U.S. Food and Drug Administration. Drugs@FDA: FDA approved drug products. www.accessdata.fda.gov/scripts/cder/drugsatfda/. Accessed February 2, 2019.
Excerpted from BCSC 2020-2021 series: Section 2 - Fundamentals and Principles of Ophthalmology. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.