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

Ciprofloxacin Hydrochloride

43

baseline was reported in 17 of 70 (24%) patients at the 5 mg/

kg maintenance dose. Severe hypotony (IOP of 0–1 mmHg)

was reported in three patients. Risk of ocular hypotony may

be increased in patients with preexisting diabetes mellitus.

Anterior uveitis/iritis—Has been reported in clinical trials and

during postmarketing; reported in 15 of 135 (11%) patients

receiving 5 mg/kg maintenance dosing. Treatment with topi-

cal corticosteroids with or without topical cycloplegic agents

may be considered. Patients should be monitored for signs

and symptoms of uveitis/iritis. Nonocular: Other systemic

adverse reactions—fever, infection, pneumonia, dyspnea,

nausea, vomiting, nephrotoxicity, neutropenia, Fanconi‘s syn-

drome, proteinuria, metabolic acidosis. Cases of metabolic

acidosis in association with liver dysfunction and pancreatitis

Pregnancy Category

resulting in death have been reported.

C.

Drug Interactions

Other drugs toxic to the kidneys should not be taken conco-

mitantly.

Brand Name

Ciloxan.

Class of Drug

Antibiotic. Interferes with DNA gyrase.

Indications

Solution: Corneal ulcers—caused by P. aeruginosa, S. marce-

scens*, S. aureus, S. epidermidis, S. pneumoniae, VGS*. Con-

junctivitis—caused by H. influenzae, S. aureus, S. epidermidis,

S. pneumoniae. Ointment: bacterial conjunctivitis caused by

susceptible strains of the following microorganisms: Gram-

positive—S. aureus, S. epidermidis, S. pneumoniae, VSG; gram-

negative—H. influenzae. (*Efficacy for this organism was stu-

Dosage Form

died in fewer than ten infections.)

Topical ophthalmic solution 0.3%. Topical ophthalmic oint-

Dose

ment 0.3%.

Solution: Corneal ulcers—2 drops to affected eye every

15 min for the first 6 h and then 2 drops every 30 min for the

remainder of the first day. On the second day, 2 drops to af-

fected eye hourly. On the third through 14th day, 2 drops

to affected eye every 4 h. Treatment may be continued after

14 days if corneal re-epithelialization has not occurred. Bac-

terial conjunctivitis—1–2 drops every 2 h while awake for 2

days, and 1 or 2 drops every 4 h while awake for the next 5

days. Ointment: 1-cm (approx. ½-in.) ribbon three times per

day to the affected eye(s) on the first 2 days, then apply a

1-cm (approx. ½-in.). ribbon two times per day for the next 5

days.

Ciprofloxacin Hydrochloride

45

Brand Name

Cleocin; Pediatric.

Class of Drug

Antibiotic.

Indications

Anaerobes: serious respiratory tract infections (RTIs), such as

empyema, anaerobic pneumonitis, and lung abscess; serious

skin and soft tissue infections; septicemia; intra-abdominal

infections, such as peritonitis and intra-abdominal abscess

(typically resulting from anaerobic organisms resident in the

normal gastrointestinal tract); infections of the female pelvis

and genital tract, such as endometritis, nongonococcal tu-

boovarian abscess, pelvic cellulitis, and postsurgical vaginal-

cuff infection. Streptococci: serious RTIs, serious skin and soft

tissue infections. Staphylococci: serious RTIs, serious skin and

Dosage Form

soft tissue infections. Pneumococci: serious RTIs.

See section on Oral Antibiotics (e.g., Cefuroxime).

Dose

Adults: Serious infections—150–300 mg every 6 h. More se-

vere infections—300–450 mg every 6 h. Pediatric patients:

Serious infections—8–16 mg/kg per day (4–8 mg/lb per day)

divided into three or four equal doses. More severe infec-

tions—16–20 mg/kg per day (8–10 mg/lb per day) divided

Contraindications

into three or four equal doses.

In patients with a history of hypersensitivity to preparati-

ons containing clindamycin or lincomycin.Most significant:

Crohn‘s disease, C. difficile colitis, ulcerative colitis. Significant:

severe hepatic disease. Possibly significant: atopic dermatitis,

Warnings

diarrhea, severe renal disease.

Because therapy has been associated with severe colitis that

may end fatally, it should be reserved for serious infections

where less toxic antimicrobial agents are inappropriate. It

should not be used in patients with nonbacterial infections,

Adverse Reactions

such as most URTIs.

Gastrointestinal: abdominal pain, pseudomembranous colitis,

esophagitis, nausea, vomiting, and diarrhea. Hypersensitivity

reactions: Generalized mild to moderate morbilliform-like

(maculopapular) skin rashes are the most frequently repor-

ted. Vesiculobullous rashes, as well as urticaria, have been

observed. Rare instances of erythema multiforme, some

resembling Stevens–Johnson syndrome, and a few cases of

anaphylactoid reactions have also been reported. Skin and

mucous membranes: pruritus, vaginitis, and rare instances of

exfoliative dermatitis have been reported. Liver: jaundice and

Colchicine

47

norepinephrine by adrenergic nerve terminals producing

sensitization to catecholamines, causing vasoconstriction

and mydriasis. Cocaine causes sloughing of the corneal epi-

thelium, causing clouding, pitting, and occasionally ulcerati-

Pregnancy Category

on of the cornea. The drug is not meant for ophthalmic use.

C.

Drug Interactions

When mixed with other stimulants, including some over-the-

counter cold medications, this drug can dangerously raise

blood pressure. There is a danger in taking cocaine with any

drug that is intended to affect heart rhythm or with drugs

that raise sensitive to seizures (high doses of caffeine). This

combination may cause heart attack. MAOIs increase the

drug’s effect, making overdose more likely.

Brand Name

Colchicine.

Class of Drug

Plant alkaloid. Inhibits neutrophil chemotaxis by inhibiting

Indications

microtubule polymerization.

Gout. Drug of choice for familial Mediterranean fever. Effec-

tive in a variety of dermatologic and systemic diseases, such

as psoriasis, Adamantiades–Behçet disease, prophylaxis of

recurrent ocular and systemic manifestations of Adamantia-

Dosage Form

des–Behçet disease.

Oral tablets: 0.5 mg, 0.6 mg. Sterile solution for i.v. injection:

Dose

0.5 mg/ml.

1–2 mg/day or 0.5–0.6 mg orally two to three times/day.

Contraindications

In patients who have serious gastrointestinal, renal, hepatic,

or cardiac disorders, especially in the presence of combined

kidney and liver disease. Administer with great caution in the

elderly. In patients with hypersensitivity reaction to the drug.

Should not be used during pregnancy and used with caution

Warnings

when administered to nursing mothers.

Has a very narrow therapeutic window. Can cause fetal harm

when administered to a pregnant woman: if used during

pregnancy, or if the patient becomes pregnant while taking

it, the woman should be apprised of the potential hazard to

the fetus.Mortality related to overdosage: cumulative i.v. doses

above 4 mg have resulted in irreversible multiple organ failu-

Adverse Reactions

re and death.

Side effects are dose dependent. Gastrointestinal distur-

bances may lead to electrolyte imbalance (nausea/vomiting,

abdominal cramping, hyperperistalsis, watery diarrhea). Alo-

pecia, agranulocytosis (rare), leukopenia, aplastic anemia,

thrombocytopenia, muscular weakness, myopathy, periphe-

Corticosteroids

49

renal function increases the possibility of apnea and neuro-

Adverse Reactions

muscular blockade following administration.

Gastrointestinal: gastrointestinal upset. Nervous system: ting-

ling of extremities and tongue, slurred speech, dizziness,

vertigo, paresthesia. Integumentary: generalized itching, ur-

ticaria, rash. Body as a whole: fever. Laboratory deviations: in-

creased BUN, elevated creatinine, decreased CrCl. Respiratory

system: respiratory distress, apnea. Renal system: nephrotoxi-

Pregnancy Category

city, decreased urine output.

C.

Drug Interactions

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

However, colistin sulfate is excreted in human milk. Therefore,

caution should be exercised when colistimethate sodium is

administered to nursing women. In clinical studies, colistime-

thate sodium was administered to the pediatric population

(neonates, infants, children, adolescents). Although adverse

reactions appear to be similar in the adult and pediatric po-

pulations, subjective symptoms of toxicity may not be repor-

ted by pediatric patients. Close clinical monitoring of pedia-

tric patients is recommended.

Class of Drug

Anti-inflammatory. Immunosuppressant. Cytoplasmic stero-

id receptor complexes bind to DNA glucocorticoid response

elements (GREs) and control the transcription of specific ge-

Indications

nes.

Uveitis.

Dosage Form

Oral: prednisone. IV: methylprednisone dexamethasone.

Dose

Oral: prednisone 0.5–1.5 mg/kg per day tapered over weeks

to months as inflammation is controlled, or add steroid-spa-

ring agent if more than10–20 mg/day is needed to control

inflammation. IV: megadose for severe life-threatening or vi-

sion-threatening uveitis, methylprednisolone 250–1,000 mg/

Contraindications

day for up to 3 days.

Warnings

Avoid prolonged use, especially in children, in whom growth

Adverse Reactions

retardation can occur quite rapidly.

Adrenal suppression and insufficiency, altered mood or men-

tation, systemic hypertension, elevated blood sugars, hypo-

kalemia, leukocytosis, weight gain, myopathy, osteoporosis.

Monitor blood pressure, serum electrolytes, fasting glucose

Pregnancy Category

level; monitoring and preventive measures for osteoporosis.

B.

Cyclopentolate Hydrochloride

51

concentration; to minimize absorption, apply pressure over

the nasolacrimal sac for 2–3 min and observe infant closely

for at least 30 min. Individuals with heavily pigmented irides

Contraindications

may require higher strengths.

Should not be used when narrow-angle glaucoma (NAG) or

anatomical narrow angles are present or where there is hy-

Warnings

persensitivity to the product or any of its components.

May cause CNS disturbances.This is especially true in younger

age groups but may occur at any age, especially with stron-

ger solutions. Premature and small infants are especially pro-

ne to CNS and cardiopulmonary side effects from systemic

absorption. To minimize absorption, use only 1 drop of 0.5%

concentration per eye followed by pressure applied over the

nasolacrimal sac for 2–3 min; observe infants closely for at

least 30 min. Patient should be advised not to drive or enga-

Adverse Reactions

ge in other hazardous activities while pupils are dilated.

Ocular: increased IOP, burning, photophobia, blurred vision,

irritation, hyperemia, conjunctivitis, blepharoconjunctivitis,

punctate keratitis, synechiae. Systemic: Has been associated

with psychotic reactions and behavioral disturbances, usually

in children, especially with 2% concentration. These distur-

bances include ataxia, incoherent speech, restlessness, hal-

lucinations, hyperactivity, seizures, disorientation as to time

and place, and failure to recognize people. Produces reac-

tions similar to those of other anticholinergic drugs, but the

CNS manifestations as noted above are more common. Other

toxic manifestations of anticholinergic drugs are skin rash, ab-

dominal discretion in infants, unusual drowsiness, tachycar-

dia, hyperpyrexia, vasodilation, urinary retention, diminished

gastrointestinal motility, and decreased secretion in salivary

and sweat glands, pharynx, bronchi, and nasal passages. Se-

vere manifestations of toxicity include coma, medullary para-

Pregnancy Category

lysis, and death.

C.

Drug Interactions

May interfere with the antiglaucoma action of carbachol or

pilocarpine; also, concurrent use of these medications may

antagonize the antiglaucoma and miotic actions of ophthal-

mic cholinesterase inhibitors. Increased susceptibility to cyc-

lopentolate has been reported in infants, young children, and

children with spastic paralysis or brain damage. Therefore,

cyclopentolate should be used with great caution in these

patients. Feeding intolerance may follow ophthalmic use of

this product in neonates. It is recommended that feeding be

withheld for 4 h after examination. Do not use in concentrati-

ons higher than 0.5% in small infants.

Brand Name

Cyclomydril (cyclopentolate HCl, phenylephrine HCl).

Class of Drug

Cycloplegic/mydriatic. Anticholinergic, alpha-adrenergic

Indications

agonist.

For the production of mydriasis.