Ординатура / Офтальмология / Английские материалы / Drugs in Ophthalmlogy_Fong, Law, Schmidt-Erfurth_2006

Ticarcillin disodium

195

Brand Name

Ticar.

Class of Drug

Antibiotic.

Indications

Septicemia—including bacteremia caused by beta-lacta-

mase-producing strains ofKlebsiella spp.*, E. coli*, S. aureus*,

P. aeruginosa* (or other Pseudomonas spp.*). LRIs—caused

by beta-lactamase-producing strains of S. aureus, H. influen-

zae*, Klebsiella spp.*. Bone and joint infections—caused by

beta-lactamase-producing strains of S. aureus. Skin and skin

structure infections—caused by beta-lactamase-producing

strains of S. aureus, Klebsiella spp.*, E. coli*. UTIs (complicated

and uncomplicated)—caused by beta-lactamase-producing

strains of E. coli, Klebsiella spp., P. aeruginosa* (or other Pseu-

domonas spp.*), Citrobacter spp.*, E. cloacae*, S. marcescens*,

S. aureus.* Gynecologic infections—endometritis caused by

beta-lactamase-producing strains of Bacteroides melanino-

genicus*, Enterobacter spp. (including E. cloacae*), E. coli, K.

pneumoniae*, S. aureus, or S. epidermidis. Intra-abdominal

infections—peritonitis caused by beta-lactamase-producing

Dosage Form

strains of E. coli, K. pneumoniae, B. fragilis*.

Dose

Adult minimum:maximum: 4.0 g:24.0g.

Contraindications

In patients with a history of hypersensitivity reactions to any

of the penicillins. Significant: infectious mononucleosis, renal

Warnings

disease, C. difficile colitis.

Serious and occasionally fatal hypersensitivity (anaphylactic)

reactions have been reported in patients on penicillin the-

rapy. These reactions are more likely to occur in individuals

with a history of penicillin hypersensitivity and/or a history

of sensitivity to multiple allergens. There have been reports

of individuals with a history of penicillin hypersensitivity

who have experienced severe reactions when treated with

cephalosporins. Before initiating therapy, careful inquiry

should be made concerning previous hypersensitivity re-

actions to penicillins, cephalosporins, or other allergens. If

an allergic reaction occurs, therapy should be discontinued

and the appropriate therapy instituted. Serious anaphylactic

reactions require immediate emergency treatment with

epinephrine. Oxygen, intravenous steroids, and airway ma-

nagement, including intubation, should also be provided as

Adverse Reactions

indicated.

Most frequent: diarrhea, headache, nausea, oral candidiasis,

vomiting, vulvovaginal candidiasis. Less frequent: allergic re-

actions, anaphylaxis, dyspnea, exfoliative dermatitis, facial

edema, hypotension, pruritus, serum sickness, skin rash, ur-

ticaria. Rare: drug toxin-related hepatitis, C. difficile colitis, in-

Tissue Plasminogen Activator

197

Respiratory: bronchospasm, respiratory failure, dyspnea,

nasal congestion, cough. Gastrointestinal: nausea, diarrhea,

dyspepsia, anorexia. Systemic: including dry mouth; angioe-

dema; urticaria; rash; depression; increase in signs and symp-

toms of myasthenia gravis; paresthesia; somnolence; insom-

nia; nightmares; behavioral changes; psychic disturbances,

including confusion, hallucinations, anxiety, disorientation,

nervousness; asthenia/fatigue and chest pain; alopecia and

psoriasiform rash or exacerbation of psoriasis; systemic lupus

erythematosus; retroperitoneal fibrosis; decreased libido; im-

Pregnancy Category

potence; Peyronie‘s disease.

C.

Drug Interactions

Because of the potential for serious adverse reactions in nur-

sing infants, a decision should be made whether to disconti-

nue nursing or to discontinue the drug, taking into account

the importance of the drug to the mother. Safety and efficacy

in pediatric patients have not been established.

Brand Name

Alteplase (off-label).

Class of Drug

Tissue plasminogen activator produced by recombinant DNA

Indications

technology.

Experimental: tissue plasminogen activator (TPA) and gas

tamponade for subretinal central hemorrhage; treatment of

fibrinous reaction after surgery.

Dosage Form

Solution for intraocular use 500 U/µg.

Dose

Fibrinous reaction after surgery: 1,500–12,500 U. Subretinal

Contraindications

central hemorrhage: 2,500–12,500 U

In patients hypersensitive to the product or any of its compo-

Adverse Reactions

nents.

Most common complication is bleeding.

Pregnancy Category

C.

Drug Interactions

It is not known whether this drug is excreted in human milk.

Safety and effectiveness in pediatric patients have not been

established.

Trifluridine

199

in patients with active intraocular inflammation. Macular

edema, including cystoid macular edema, has been reported

during treatment with prostaglandin F-2 (alpha) analogues.

These reports have mainly occurred in aphakic patients,

pseudophakic patients with a torn posterior lens capsule, or

patients with known risk factors for macular edema. Solution

Adverse Reactions

should be used with caution in these patients.

Most frequent: Ocular—ocular hyperemia, increased pigmen-

tation of the iris and periorbital tissue, increased pigmentati-

on and growth of eyelashes; these changes may be perma-

nent. Decreased visual acuity, eye discomfort, foreign-body

sensation, pain, pruritus, abnormal vision, blepharitis, blurred

vision, cataract, cells, conjunctivitis, dry eye, eye disorder, fla-

re, iris discoloration, keratitis, lid-margin crusting, photopho-

bia, subconjunctival hemorrhage, tearing, angina pectoris.

Nonocular—anxiety, arthritis, back pain, bradycardia, bron-

chitis, cold syndrome, depression, dyspepsia, gastrointestinal

disorder, headache, hypercholesterolemia, hypertension, hy-

potension, infection, pain, prostate disorder, sinusitis, urinary

Warnings

incontinence, UTI.

Has been reported to cause changes to pigmented tissues:

The most frequently reported have been increased pigmen-

tation of the iris and periorbital tissue (eyelid) and increased

pigmentation and growth of eyelashes. These changes may

Pregnancy Category

be permanent

C.

Drug Interactions

It is not known whether this drug or its metabolites are ex-

creted in human milk. Safety and effectiveness in pediatric

patients have not been established.

Brand Name

Viroptic.

Class of Drug

Antiviral.

Indications

Indicated for the treatment of primary keratoconjunctivitis

and recurrent epithelial keratitis due to herpes simplex virus

Dosage Form

types 1 and 2.

Topical ophthalmic solution 1%.

Dose

1 drop onto the cornea of affected eye(s) every 2 h while awa-

ke for a maximum daily dosage of 9 drops until the corneal

ulcer has completely re-epithelialized. Following re-epithe-

lialization, treatment for an additional 7 days of 1 drop eve-

ry 4 h while awake for a minimum daily dosage of 5 drops is

recommended. If there are no signs of improvement after 7

days of therapy or complete re-epithelialization has not oc-

Trypan Blue

201

Brand Name

Mydriacyl; Opticyl.

Class of Drug

Cycloplegic, mydriatic.

Indications

Dilation of the pupil; used before eye examinations, such as

cycloplegic refraction and examination of the fundus of the

Dosage Form

eye. May also be used before and after surgery.

Topical ophthalmic drops, tropicamide solution 0.5, 1%.

Dose

Cycloplegic refraction: Adults—1 drop of 1% solution, repea-

ted once in 5 min. Children—1 drop of 0.5–1% solution, re-

peated once in 5 min. Fundus examination: Adults and child-

Contraindications

ren—1 drop of 0.5% solution 15–20 min before examination.

In patients with a known hypersensitivity to the product or

Warnings

any of its components.

Infants and young children and children with blond hair or

blue eyes may be especially sensitive to the effects of tropica-

mide. This may increase the chance or severity of some of the

side effects during treatment. May worsen brain damage (in

children), Down syndrome (in children and adults), or glauco-

Adverse Reactions

ma or spastic paralysis (in children).

Light sensitivity; stinging; blurred vision; headache, clum-

siness, unsteadiness; confusion; fast heartbeat; flushing or

redness of face; hallucinations; increased thirst or dryness of

mouth; skin rash; slurred speech; swollen stomach in infants;

unusual behavior, especially in children; unusual drowsiness,

Pregnancy Category

tiredness, or weakness.

C.

Drug Interactions

Studies on effects in pregnancy have not been done; has not

been reported to cause problems in nursing babies.

Brand Name

Vision Blue.

Class of Drug

Stain.

Dosage Form

Solution.

Dose

For inner-limiting membrane staining:After pars plana vitrec-

tomy and induction of posterior vitreous detachment: 0.5 ml

trypan blue 0.06% in phosphate-buffered saline (PBS) injec-

ted over the posterior pole in an air-filled eye. For lens capsule

staining: 0.5 ml trypan blue 0.06% in PBS injected over the

Warnings

anterior capsule in an air-filled anterior chamber.

Contains chemical known to cause cancer.

Brand Name

Rescula.

Class of Drug

Glaucoma. Prostaglandin analog.

Indications

For the reduction of elevated IOP in patients with OAG or

ocular hypertension who are intolerant of or insufficiently

Dosage Form

responsive to another IOP-lowering medication.

Topical ophthalmic drops: unoprostone isopropyl ophthal-

Dose

mic solution 0.15%.

1 drop two times per day.

Contraindications

In patients with a known hypersensitivity to unoprostone

isopropyl, benzalkonium chloride, or any other components

of this product. Should be used with caution in patients with

Warnings

active intraocular inflammation (e.g., uveitis).

Has been reported tocause changes to pigmented tissue;

Adverse Reactions

these changes may be permanent.

Ocular: burning, stinging, dry eyes, itching, increased length

of eyelashes, and conjunctival injection (hyperemia), abnor-

mal vision, eyelid disorder, foreign-body sensation, lacrima-

tion disorder, blepharitis, cataract, conjunctivitis, corneal

lesion, discharge from the eye, eye hemorrhage, eye pain,

keratitis, irritation, photophobia, vitreous disorder, acute ele-

vated IOP, color blindness, corneal deposits, corneal edema,

corneal opacity, diplopia, hyperpigmentation of the eyelid,

increased number of eyelashes, iris hyperpigmentation, iritis,

optic atrophy, ptosis, retinal hemorrhage, visual-field defect.

Nonocular: flu-like syndrome, allergic reaction, back pain,

bronchitis, cough, dizziness, headache, hypertension, insom-

Pregnancy Category

nia, pharyngitis, pain, rhinitis.

C.

Drug Interactions

It is not known whether topical ocular administration could

result in sufficient systemic absorption to produce detectable

quantities in human milk. Safety and effectiveness in pedia-

tric patients have not been established.

Brand Name

Valtrex.

Class of Drug

Antiviral.

Indications

Herpes zoster (shingles), treatment or suppression of genital

herpes in immunocompetent individuals, suppression of re-

current genital herpes in HIV-infected individuals, cold sores

Dosage Form

(herpes labialis).

Oral.

Dose

Herpes zoster: 1 g orally three times per day for 7 days; initiate

therapy at the earliest signs or symptoms and is most effecti-

ve when started within 48 h of the onset of zoster rash. Geni-

tal herpes: Initial episode—1 g two times per day for 10 days;

most effective when administered within 48 h of the onset of

the earliest signs or symptoms. Recurrent episodes—500 mg

two times per day for 3 days; initiate therapy at the first signs

or symptoms of an episode. Suppressive therapy—1 g once

per day in patients with normal immune function. In pati-

ents with a history of nine or fewer recurrences per year, an

alternative dose is 500 mg once per day. Safety and efficacy

beyond 1 year have not been established. In HIV-infected

patients with CD4 cell count ≥100 cells/mm3, recommended

dosage for chronic suppressive therapy of recurrent genital

herpes is 500 mg two times per day. Safety and efficacy bey-

ond 6 months in patients with HIV infection have not been

established. Cold sores (herpes labialis): 2 g two times per day

for 1 day taken about 12 h apart; initiate therapy at the ear-

liest signs or symptoms (e.g., tingling, itching, burning).

In patients with reduced renal function, reduction in dosa-

ge is recommended. Patients requiring hemodialysis should

receive the recommended dose after hemodialysis. Supple-

mental doses should not be required following chronic am-

bulatory peritoneal dialysis and continuous arteriovenous

Contraindications

hemofiltration/dialysis.

In patients with a known hypersensitivity or intolerance to

Warnings

the product or any of its components or to acyclovir.

TTP/HUS, in some cases resulting in death, has occurred in

patients with advanced HIV disease and also in allogeneic

bone marrow transplant and renal transplant recipients par-

ticipating in clinical trials at doses of 8 g per day. Acute renal

failure and central nervous system symptoms have been re-

ported in patients with underlying renal disease who have

received inappropriately high doses for their level of renal

function. Similar caution should be exercised when adminis-

tering to geriatric patients and patients receiving potentially

Adverse Reactions

nephrotoxic agents.

General: headache, fatigue, dizziness, facial edema, hyperten-

sion, tachycardia. Allergic: acute hypersensitivity reactions,

including anaphylaxis, angioedema, dyspnea, pruritus, rash,

urticaria. CNS: aggressive behavior; agitation; ataxia; coma;