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Ординатура / Офтальмология / Учебные материалы / Ocular Trauma - Principles and Practice.pdf

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Appendix 5

PHARMACOLOGY

Martin L. Heredia-Elizondo,

Tamer A. Macky, D. Virgil Alfaro, and Joel H. Herring

Drug	Preparation	Dose

ANESTHETICS
Lidocaine	0.5%, 1%, 1.5%, 2%, 4%, 10%, and 20% for	Extensive procedures: 10–20 mL of a 1%
	injection	solution*
		Minor surgery: 2–10 mL of a 0.5% solution.
	0.5%, 1%, 1.5%, and 2% with epinephrine	Extensive time: up to 20 mL of a 1% solution
	1:200,000 for injection	with epinephrine
		Maximum dose:
		with epinephrine (7 mg kg or 500 mg)
		without epinephrine (4.5 mg kg or 300 mg)
Procaine	1%, 2%, and 10% for injection	Extensive procedures: 6 10 mL of the 2%
		solution
		Minor surgery: 6 20 mL of the 1% solution
ANTIBIOTICS
Aminoglycosides
Amikacin	50 and 250 mg mL solution. (im and iv)	7.5 to 8.0 mg kg every 12 h (iv)
		0.2 to 0.4 mg in 0.1 mL for intravitreal injection
Gentamicin	2 mg mL solution (im, iv, and intrathecal)	1.5 to 2.0 mg kg every 8 h
	10 and 40 mg mL solution (im and iv)	0.1 mg in 0.1 mL for intravitreal injection
Neomycin	Neomycin sulfate 500 mg tablet	1 g every 4 h
	Neomycin-bacitracin-polymyxin ointment	One to four times daily
	Neomycin-dexamethasone 0.1% solution	Once or twice every h (topical)
Tobramycin	0.3% solution and ointment (topical)	Every 3–4 h (ointment)
	10 and 40 mg mL solution (im and iv)	1–2 drops every 4 h , or 2 drops once or twice
		every h for severe infections (topical)
Cephalosporins
Cefazolin	500 mg, 1 g, 10 g, and 20 g solution	133 mg mL topical (one drop every 4–6 h)
		100 mg mL subconjunctival
		2.25 mg intravitreal
		500 to 1000 mg every 6 h iv im
Ceftazidime	500 mg, 1 g, and 2 g solution	50 mg mL topical (one drop every 4–6 h)
		200 mg mL subconjunctival
		2.2 mg intravitreal
		1–2 g every 12 h iv im
		continued
*1% solution: 10 mg mL.		continued

446

		APPENDIX 5 PHARMACOLOGY • 447
Drug	Preparation	Dose

Ceftriaxone	250 mg, 500 mg, 1 g, 2 g, and 10 g solution	3 mg intravitreal
		1–2 g every 24 h iv im
Penicillins
Ampicillin	125 mg 5 mL and 250 mg 5 mL suspension	250–500 mg every 6 h (oral)
	(oral)
	250 mg capsule (oral)	50 mg mL topical (one drop every 4–6 h)
	125 mg, 250 mg, 500 mg, 1 g, and 2 g	50 mg mL topical (one drop every 4–6 h)
	solution (iv and im)	100 mg mL subconjunctival

5000 g intravitreal 1–3 g every 6 h (iv im)

Methicillin	1 g, 4 g, and 6 g powder
Oxacillin	250 mg and 500 mg capsule (oral)
	250 mg 5 mL solution (oral)
	500 mg, 1 g, and 2 g solution (iv)
Penicillin G	Benzathine: 600,000 U mL suspension (im)
	Potassium: 20,000 U mL suspension (iv,
	topical, subconjunctival)
	Procaine: 600,000 U mL susp (im)
Penicillin V	125 mg 5 mL and 250 mg 5 mL solution
	(oral)
	250 mg and 500 mg tablet
Sulfonamides
Sulfacetamide	10% suspension and ointment (topical)
	10%, 15%, and 30% solution (topical)
	Same preparations and steroid:
	Prednisolone 0.2% and 0.5%
	Prednisone 0.25%
	Fluorometholone 0.1%
Trimethoprim/	80 mg trimethoprim, 400 mg
sulfamethoxazole	sulfamethoxazole
combination	160 mg trimethoprim, 800 mg
	sulfamethoxazole
	40 mg trimethoprim, 200 mg
	sulfamethoxazole 5 mL oral
	suspension
	80 mg trimethoprim, 400 mg
	sulfamethoxazole/5 mL infusion.
Tetracyclines
Tetracycline	1% solution and ointment (10 mg per mL
	and g)
	125 mg 5 mL suspension and syrup
	250 mg and 500 mg capsules
	250 mg tablets
	250 mg and 500 mg sterile powder (iv)
	100 mg and 250 mg sterile powder (im)
Miscellaneous
Bacitracin	500 U g ophthalmic ointment
	50,000 U vial (injection)
	2500 U soluble tablet
Chloramphenicol	0.5% solution (5 mg mL) (topical)
	1.0 % ointment (10 mg mL) (topical)
	Capsules: 250 and 500 mg (oral)
	Palmitate: 150 mg mL suspension (oral)
	Sodium succinate: 1 g (100 mg mL)
	(injection)

1 g every 6 h (im, iv) Subconjunctival: 50–150 mg in 0.5 mL Intracameral: 1 mg in 0.2–0.5 mL

50 mg mL topical (one drop every 4–6 h) 75–100 mg subconjunctival

1 g every 6 h iv

Topical: 100,000–333,000 U mL

Subconjunctival: 0.5–1.0 million U Intravitreal: 2000 U

Oral: 400,000 U every 6 h iv: 2 to 6 million U every 4 h

250–500 mg every 6 h (oral)

One or two drops every 2 to 3 h

Ointment: one to four times daily

Tablet: 4 times daily

Tablet: 2 times daily

Suspension: 8 mg kg daily trimethoprim and 4 mg kg daily sulfamethoxazole in 2 divided doses

iv: 20 mg kg daily trimethoprim and 100 mg kg daily sulfamethoxazole

3–4 times daily

1–2 g daily adults and nonpregnant women, children aged more than 8 years should receive 25 to 50 mg kg daily in two to four divided doses

2–6 times daily (topical)

10,000 U 0.5 mL subconjunctival

1000 U kg daily in 2–3 doses, not exceed 100,000 U daily

One drop two to six times daily Every 3 h

1–3 g daily in systemic therapy (4g daily max)

continued

448 • APPENDIX 5	PHARMACOLOGY
Drug	Preparation	Dose

Clindamycin	Hydrochloride: 75, 150, and 300 mg	150 mg to 300 mg every 8 h (p.o.)
	capsules
	Phosphate: 150 mg mL solution	600 mg every 6 h (iv and im),
	(parenteral)	not to exceed 8 g daily
		1 mg for intravitreal injection
Erythromycin	0.5% ointment (5 mg g) (topical)	One to six times daily
	250, 333, and 500 mg tablets	250 mg to 500 mg every 6 h
	Estolate: 125 and 250 mg capsules	500 mg every 12 h
	125 and 250 mg mL suspension
	500 mg tablets
	Ethylsuccinate: 200 and 400 mg 5mL	600 mg every 8 h
	suspension or 400 mg tablets
	Stearate: 250 and 500 mg tablets	500 mg every 12 h
	Gluceptate: Powder 250 mg, 500 mg, and 1	1 to 4 g daily in iv
	g (iv)
	Lactobionate: Powder 500 mg and 1 g (iv)
Imipenem/Cilastatin	500–500 mg solution (injection)	500 mg 500 mg every 4 h, not to exceed 4 g daily
Polymyxin B	Ointment (in combination with other	Every half hour to hourly and then tapered
	antibiotics and/or steroids)	(topical)
	Sterile powder U Vial: 500,000	25,000 to 40,000 U kg daily for im
		15,000 to 25,000 U kg daily for iv
Vancomycin	500 mg, 1 g, and 10 g vials (iv)	1 g every 8 or 12 h
	1 g and 10 g (oral solution)	500 mg to 1 g every 6 h (oral)
	125 and 250 mg (powder)	25 mg 0.5 mL for subconjunctival injection
		1.0 mg in 0.1 mL for intravitreal injection
ANTIFIBRINOLYTICS
Aminocaproic acid	Tablets: 500 mg	50 mg kg every 4 h up to 30 g daily
	Syrup and injection: 250 mg mL
ANTIFUNGALS
Amphotericin B	50 mg (lyophilized)	0.005 mg intravitreal
		0.5–0.6 mg kg daily iv (maximum of 1.5 mg kg)
	3% ointment, cream, and lotion	3–4 times daily
Ketoconazole	1% and 3% solutions	1% solution subconjunctival
	200 mg tablets	200 mg daily
	2% cream and shampoo
Miconazole	10 mg mL sterile solution	300 mg daily (iv)
		1% solution (topical)
	2% cream and lotion	0.25 mg intravitreal
	2% cream and lotion
ANTIGLAUCOMA
Beta-blockers
Betaxolol	0.25% Suspension	One drop twice daily
	0.5% Solution
Carteolol	1% Solution	One drop twice daily
Timolol	0.25% Solution	One drop twice daily
	0.5% Solution	One drop once daily (gel)
CAIs
Acetazolamide	Oral tablets: 125 mg and 250 mg	250 mg to 1000 mg daily, in four divided doses
	Sustained-release capsules: 500 mg
	Lyophilized powder for iv injection: 500 mg
Dichlorphenamide	Tablets: 50 mg	25 to 50 mg, one to four times daily
Dorzolamide	2% solution	One drop three times daily in the affected eye
Methazolamide	Tablets: 25 mg and 50 mg	25 to 50 mg, two or three times daily
Miotics
Carbachol	0.01%, 0.75%, 1.5%, and 3% solution	0.75% to 3.0% solution three times daily
		0.01% solution intracamerally
Pilocarpine	0.5% to 10% solution, 4% usually maximal	0.5% to 4.0% aqueous solution four times daily
	4% gel	Once daily

continued

		APPENDIX 5	PHARMACOLOGY • 449
Drug	Preparation	Dose

	Ocusert: 20 g h and 40 g h	Once every 7 days
	sustained-release rate
Prostaglandins
Latanoprost	0.005% solution	Once daily
Sympathomimetics
Apraclonidine	0.5% and 1% solution	0.5% solution three times daily
Brimonidine	0.2% solution	One drop twice daily
Dipivefrin	0.1% solution	Once or twice daily
ANTI-INFLAMMATORY
Nonsteroids
Diclofenac	0.1% solution	One drop four times daily postoperatively
	Tablets: 25, 50, and 75 mg	25 to 50 mg three times daily
Flurbiprofen	0.03% solution	One drop every 30 minutes, for 2 h
	Tablets: 50 and 100 mg	preoperatively
Indomethacin	0.5% and 1% suspension	One drop four times daily
Ketorolac	0.5% solution	One drop three times daily
Suprofen	1.0% solution	One drop 1, 2, and 3 h preoperatively or every
		4 h while awake on the day of surgery
ANTI-IRON
Deferoxamine	500 mg solution (injection)	1 g initial dose; followed by 0.5 g every 4 h,
		not exceed 6 g daily (systemic)
		0.5 mL of a 10% solution twice a week
		(subconjunctival)
		10% in 1% methylcellulose four daily (topical)
ANTIMETABOLITES
5-Fluorouracil	500 mg 10 mL solution.	10 mg subconjunctival injection
		1 mg intravitreal injection
Daunorubicin HCl	5 mg mL solution (injection)	7.5 g mL solution infuse for 10 minutes

ANTITETANUS

Antitoxin	10,000, 15,000, and 50,000 units
	(syringe or vial)
Immune globulin	250 units (syringe or vial)
Tetanus toxoid	Adsorbed and ultrafined 5 Lf U solution
CYCLOPLEGICS
AND MYDRIATICS
Atropine	0.5% and 1% sterile solution and ointment
	0.1 mg mL solution (indictable)
	0.6 mg, 0.8 mg, and 1 mg tablets
Cyclopentolate	0.5%, 1%, and 2% solution (topical)
Homatropine	2% and 5% sterile ophthalmic solution
Phenylephrine HCL	2.5% and 10% ophthalmic solution
Tropicamide	0.5% and 1.0% ophthalmic solution
CYTOTOXIC
Azathioprine	50 mg tablets (oral)
	100 mg lyophilized powder (iv)
Cyclosporin	100 mg mL solution (oral)
	25 mg and 100 mg soft gelatin capsules (oral)
	50 mg and 1 mL vehicle (iv)
	1% and 2% solution (topical)

5000 to 10,000 U (prophylaxis)

40,000 to 100,000 U (iv treatment)

250 U (prophylaxis)

5000 to 10,000 U (im treatment)

Three injections of 0.5 mL; second injection 5 weeks after the first one, the third 6–12 months later

Three times daily (solution),

Once daily (ointment)

One drop three or four times daily Three times daily

One drop twice or three times daily

2–3 mg kg daily

2.5–5.0 mg kg daily

Topical solution 5 times daily

continued

450 • APPENDIX 5	PHARMACOLOGY
Drug	Preparation	Dose

Cyclophosphamide	25 mg and 50 mg tablets	1–2 mg kg daily
	100 mg, 200 mg, 500 mg, 1 g, and 3 g
	powder (im, iv)
Chlorambucil	2 mg sugar-coated tablets (oral)	0.1 mg kg daily
Methotrexate	2.5 mg tablets	Weekly dose of 2.5 mg to 7.5 mg in a single
	2.5 and 25 mg mL solution (im, iv,	or divided dose with a maximum dose
	intrathecal)	of 15 mg week
	20 mg, 50 mg, 100 mg, 250 mg, and 1 g
	powder (im, iv, intrathecal)
ENZYMES
Hyaluronidase	150 U mL solution	5–7 U per mL of anesthetic solution
Urokinase	5000 U, 9000 U, and 250,000 U, solution	Intravitreal: 25,000 U in 0.3 mL
		iv: 4400 U kg initially (90 mL h every 10 min,
		then 15 mL h every 12 h)
HYPEROSMOTICS
Glycerol	50% and 75% solution	1–1.5 g kg every 6 h
Isosorbide	45% solution	1.5 g kg every 6 h
Mannitol	10% and 20% solution	1–1.5 g kg (3–5 mL per minute)
Topical osmotic:
Glucose	40% and 50% solution	2–3 drops three times daily
Sodium chloride	2%, 5%, and 10% solution and ointment	Twice or three times daily
STERILIZING
AND DISINFECTING
Providone-iodine	Swab stick with 10% solution	Apply to procedure site as needed
STEROIDS

Betamethasone	3 mg mL suspension
	Tablet: 0.6 mg
	Syrup: 0.6 mg 5 mL

1 mg subconjunctival/Tenon, and transeptal Initial doses: 0.5 mg to 9 mg daily (systemic)

Dexamethasone	Alcohol: 0.1% suspension and 0.05%	Individualized dose (topical)
	ointment
	Sodium phosphate: 0.1% solution	Individualized dose (topical)
	and 0.05% ointment
	Sodium: 0.25 to 6 mg tablet	0.75 mg to 9 mg p.o. daily
	0.5 mg 5 mL oral suspension
	0.5 mg 5 mL solution
	Sodium phosphate: 4 to 24 mg mL	0.75 mg to 9 mg iv or im daily
	solution iv
	Acetate: 8 mg mL suspension im	4–8 mg subconjunctival/Tenon, and transeptal
	Acetate: 8 to 16 mg mL suspension	0.4 mg intravitreal
	Sodium phosphate: 4, 10, 24 mg mL	4 mg retrobulbar
	solution
Fluorometholone	0.25% and 0.1% suspension	Individualized dose (topical)
	0.1% ointment
Hydrocortisone	5 to 20 mg tablet	20 to 240 mg systemic therapy
	10 mg 5 mL suspension
	25 and 50 mg suspension im
	50 mg mL solution im/iv
	Sodium succinate: 100 to 1000 mg powder	50–125 mg subconjunctival/Tenon
Methylprednisolone	2 to 32 mg tablet	20 to 80 mg systemic therapy
	Sodium succinate: 40 to 1000 mg
	powder im iv
	Sodium succinate: 40 mg mL, 125 mg 2	40–125 mg subconjunctival/Tenon
	mL, 2g 30 mL solution
	Acetate: 20 to 80 mg mL depot suspension	40–80 mg 0.5 mL transeptal, retrobulbar

continued

		APPENDIX 5 PHARMACOLOGY • 451
Drug	Preparation	Dose

Prednisolone	Phosphate: 0.5% solution and 0.25%	Individualized dose (topical)
	ointment
	Acetate: 0.12% and 1.0% suspension	5 mg to 50 mg (systemic therapy)
	Sodium phosphate: 0.12, 0.5, and 1%
	solution
	1 to 5 mg tablet
	15 mg mL syrup
	Acetate: 25 to 100 mg mL suspension im
	Sodium phosphate: 20 mg mL solution
	im iv
Prednisone	1.0 to 50 mg tablet	1.0 to 1.5 mg kg initial dose (systemic therapy)
	5 mg mL oral solution
Triamcinolone	Diacetate: 4 mg mL syrup	4 mg to 48 mg daily (systemic)
	1 to 8 mg tablet
	40 mg mL suspension im
	25 and 40 mg mL suspension	40 mg subconjunctival/Tenon
	Acetonide: 10 and 40 mg mL suspension	40 mg transeptal
VISCOELASTICS
Chondroitin sulfate	4%	In surgery as needed
Hydroxypropyl	2%	In surgery as needed
methylcellulose
Sodium	1%, 1.4%, and 1.6%	In surgery as needed
hyaluronate

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