Overview

OCULAR PHARMACOLOGY
 Role of the Assistant
Pharmacology for Technicians
 Medication Check
 Patient Safety
Lynn Lawrence, CPOT, ABOC, COA, OSC  Reaction Prevention
 Drug Categories
 Drug Administration
 Vitamin Supplements
 Drug Instillation Procedure
 Drug Documentation

ROLE of the
ASSISTANT AND TECHNICIAN The Medication Check
 Accurate documentation/recording  For “Ophthalmic Use”, must be on the
 Patient Education…can assist in container
preventing mistakes  Check name
 NEVER Work in Doubt!
 Check dosage
 Check expiration date
 Read and re-read the medication
 Check for contamination
request
 Be careful with hand-offs/transfers!

 Patient Safety

The Patient Checks PATIENT CASE HISTORY

 Reason for visit
The best way to prevent an adverse reaction is to perform an excellent case Hx?
 Check patient’s current health condition
 Verify patient allergies
 Provider medication request  General Health
 Check visual acuity…always
 Medications
 Check IOP…always
 Do not leave the patient unattended and  Allergies
routinely monitor
 Check blood pressure before dilation

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 Critical checks
Current Medications
 Doctor’s request
 Name  Pupils
 Amount taken  PERRLA
 Frequency  Angles
 Prescribed for  Open/clear
 Prescribed by  Pressures
 Illegal drugs too!  Medications…always inspect medication
 Heart meds
Why is illegal drug use important?  Blood pressure…before dilation
 Current health

Blood Pressure Readings

 Please understand the
procedure  Normal
 Correct position  The “normal” for adults is approximately
 Explain it 120mmHg /between 70-80mmHg
 Perform it  Abnormal
 Document it  Mild Hypertension
 145-159mmHg/90-104mmHg
 No more than 3
 Severe Hypertension
attempts
 160mmHg or more/100mmHg or more
 Hypotension
What is the speed in which you regulate the release of pressure during the
 Below normal blood pressure
measurement

Tonometry
Pupil Testing

 Instruments  Explain test

 Proper lighting
 Applanation- Goldmann…touches patient
 Perform direct and
consensual
This is the industry gold std  Swinging flashlight
 Evaluate near response
What medication is used  Recording accuracy
during this test?

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Pupil Testing Pupil Testing

 Light the pupil for _____ seconds?

 Assure that the sensory pathway is working
 Direct/consensual responses to light
 Response to accommodation
 Anisocoria- unequal pupil sizes
 “cor” = pupil
 “aniso”=difference
 Hippus- “jumping” pupil
 Most commonly seen in younger patients

APD

Recording Verify Angle Depth

 P-pupils  When the doctor has
 E-equal seen the patient
 R-round
 When the doctor has
 R-react to
not seen the patient
 L-light
 A-accommodation
 -RAPD/-Marcus Gunn

Wash your hands!

Before and After Patient Care! Drop Instillation

 Clean hands
 Explain procedure
 Remember safety
 Inspect bottle
 Check expiration date
 Do not contaminate the
container
What is wrong with this picture?

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 TPA – vs DPA
Drops…
 Therapeutic Pharmaceutical
Application…when the problem is known and
you treat the condition

 Diagnostic Pharmaceutical
Application…when the problem is unknown
and you treat the symptoms

Pharmacology: Diagnostic Agents Pharmacology: Diagnostic Agents

Mydriatic Drugs Cycloplegic Drugs

 Phenylephrine (Neo-Synephrine, Mydfrin)  Tropicamide (Mydriacyl)

 Strength: 2.5%, 10%  Strength: 0.5%, 1%
 Effective: 4-6 hours  Effective: 5-6 hours
 Systemic Side Effects:  Systemic Side Effects: Uncommon
 Irregular heart beat, headache, hypertension,
cardiac arrest (very rare)
 Action: Stimulates the iris dilator muscle

Pharmacology: Diagnostic Agents Pharmacology: Diagnostic Agents

Cycloplegic Drugs Stains

 Cyclopentolate (Cyclogel)  Fluorescein…used to stain cornea surface

 Strength: 1.0% and 2.0%  Strips
 Effective 24 hours  Mixed with anesthetic
 Side Effects: Dry mouth, excitation, facial  Injected (angiography)
flushing, tachycardia, angle closure due to  Rose Bengal…used to stain dead cells
dilation
 Action: Paralyzes the sphincter muscle of the
iris (dilation) and the ciliary muscle (prevent
accommodation)

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 Pharmacology: Anesthetics Pharmacology: Therapeutic Agents

 Miotics
 Commonly used anesthetics:  Action: contraction of the iris sphincter
muscle (pupil constriction)
 Proparacaine 0.5%
 Use: lowering of intraocular pressure by
 Tetracaine 0.5%
improving drainage of the aqueous humor
 Lidocaine 1.0%-5.0% through the trabecular meshwork.
 Benoxinate plus fluorescein (Fluress)
 Proparacaine plus fluorescein (Fluoracaine)
What is the typical duration for routine anesthetics?

Pharmacology: Therapeutic Agents Pharmacology: Therapeutic Agents

 Glaucoma Treating Drugs  Glaucoma Treating Drugs

 Adrenergic-blocking agents  Alpha Agonists
 Timolol, Betaxolol, Levobunolol  Apraclonidine
 Adrenergic-stimulating agents  Brimonidine
 Epinephrine
 Protaglandin Analogs
 Dipiverfrin
 Bimatoprost
 Carbonic Anhydrase Inhibitors
 Latanoprost
 Acetazolamide
 Methazolamide  Travoprost
 Dorzolamide

Medication Application
Pharmacology: Therapeutic Agents Procedures
 Wash hands thoroughly before administration
 Antibiotics  Give medications with patient in inclined position…why?
 Antivirals  Tilt head backward or lie down and gaze upward/downward
 Antifungals  Gently grasp lower eyelid below eyelashes and pull the
eyelid away from the eye to form a pouch
 Corticosteroids…prevents swelling  Place dropper directly over the eye. Avoid contact of the
 Non-steroidal Anti-inflammatory Drugs (NSAIDS) dropper with the eye, finger or any other surface
 Decongestants  Release the lid slowly and close the eye
 Antihistamines  Occlude puncta for 2-3 minutes
 Mast Cell Stabilizers  Wait 5 minutes before administering a second medication or
drop
 Lubricants
 Dim room lighting can assist in reducing blink reflex

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Punctal Occlusion VITAMIN SUPPLEMENTS
 Prevent systemic
absorption
 Aids in reducing
reactions
 Patients with heart
condition must be
watched
 Close eyes for 2-3
minutes

CLASSIFICATIONS Topical Anesthetics

 Proparacaine
 Orals  Tetracaine
 Solutions  Cocaine

 Suspensions

 Ointments

 Pumps

 Implants

Mydriatics & Cycloplegics Dyes & Stains

 Tropicamide
 Phenylephrine 2.5-10%  Fluorescein
 Cyclogyl  Rose Bengal
 Atropine  Lissamine Green
 Homatropine  Fluress
 Scopalomine

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CLINICAL
THERAPEUTIC AGENTS
ADMINISTRATION
TPA – known problem
 Antibiotics
 Patient History  Anti-virals

 Clinical Procedures Which May  Drugs that lower IOP

Be Influenced by Medications  Anti-inflammatory agents

 Non-Steroidal

 Combinations

GLAUCOMA MANAGEMENT OCULAR INFLAMMATION

 Pilocarpine  Corticosteroids

 Beta-Blockers  Steroid-Antibiotic
Combinations
 Carbonic Anhydrase  Non-Steroidal Anti-inflammatory

Inhibitors Drugs (NSAIDS)

 Oral Analgesics
 Adrenergic Agonists

OCULAR INFECTIONS OCULAR ALLERGIES

 Topical Antibiotics  Artificial

Tears
 Oral Antibiotics  Antihistamine-Decongestants

 Anti-Viral  Corticosteroids

 Analgesics

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Other considerations CAP Colors
Cap Color Drug Class

 Eye color Tan Antibiotics, Antivirals, Antifungals

Pink Anti-inflammatory/Steroids treats allergic reactions, swelling,
 Chronic illnesses … diabetic pts redness (slows healing can cause cataracts and glaucoma). Do not
use on fungal infections
 Age Red Mydriatics/Cycloplegics (dilate pupil)
 Older patients take longer to dilate due to small Grey Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) control
pupils inflammation caused by ocular allergies without steroidal side-
effects
 Very young patients take longer due to trust Green Miotics (stimulates sphincter and causes pupil constriction)
 Ask the patient if they have ever been dilated Yellow or Blue Beta-Blockers traditionally used to treat glaucoma, reduce IOP by
decreasing aqueous humor
before
Purple Adrenic Agonists (reduce IOP)
Orange Carbonic Anhydrase Inhibitors (reduce IOP)
Turquoise Prostaglandin Analogues (reduce IOP by increasing aqueous
outflow)

Patient Instruction- Solutions

and Suspensions
IN-OFFICE PROCEDURES
 Wash hands thoroughly before administration
 Tilt head backward or lie down and gaze upward
 Gently grasp lower eyelid below eyelashes and pull
the eyelid away from the eye to form a pouch
 Place dropper directly over the eye. Avoid contact of
the dropper with the eye, finger or any other surface
 Release the lid slowly and close the eye
 Occlude punta for 2-3 minutes
 Wait 5 minutes before administering a second
medication or drop

Patient Instruction- Ointment

 Wash hands thoroughly
ABBREVIATIONS
 Tilt head backward or lie down and gaze upward
 Gently pull down the lower lid to form a pouch
 Place .25 to .50 inch of ointment with a sweeping
motion
 Close the eye for 1-2 minutes
 Temporary blurring of vision may occur.
 Remove excess ointment with a tissue
 Wait 10 minutes before applying the second
ointment

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Examples Examples- con’t
 ad lib- freely as needed  oint- ointment
 ac – before meals  q- every
 bid- twice a day  qh- every hour
 gtt- Drops  q4h- every four hours
 hs- at bedtime  qid- 4 times a day
 pc -after meals  sig- instructions
 po- by mouth  sol- solution
 prn- as needed  susp- suspension

Examples- con’t
HOW TO WRITE AN Rx

 tab- tablet
 tid- three times a day
 top- topically
 ung- ointment
 ut dict- as directed

What else?
Make sure that you include:
 Make sure that it is
 Full name of patient
legible!
 Address can be optional  Legal considerations
 Date of Rx  Never go beyond your
 Inscription: name of drug; concentration training
 Subscription: amount to be dispensed  Don’t rush patient
 Instructions: route of administration; number care
of drops or tablets; frequency of use; refill  Protect your patients
and your practice
 Documented training

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References and resources THANK YOU!
 Ophthalmic Drug Facts 2002 martralyn@msn.com
 Ophthalmic Medications and Pharmacology
 Review of Optometry: 2002 Clinical Guide to
Ophthalmic Drugs (Melton and Thomas) May
issue

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