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INTRODUCTION

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This chapter will be most useful after having a basic understanding of the material in Chapter 64, Ocular Pharmacology in Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12th Edition. In addition to the material presented here, the 12th Edition contains:

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  • A detailed description of the anatomy of the eye and extraocular structures

  • Table 64-1 Autonomic pharmacology of the eye and related structures

  • Table 64-8 Vitreous substitutes

  • The mechanism of action of vitamin A in retinal physiology and vision

  • Figure 64-7 Structural formula for β-carotene and structural formulas for the vitamin A family of retinoids

  • Table 64-9 Ophthalmic effects of selected vitamin deficiencies and zinc deficiency

  • Figure 64-8 Major steps in photoreceptor signaling

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LEARNING OBJECTIVES

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  • Understand the principles of using drugs to treat ophthalmic disorders.

  • Know the ocular toxicities of systemic drugs.

  • Know the mechanisms of action, clinical uses, and toxicities of ophthalmic drugs.

  • Describe how ophthalmic drugs administered topically can cause systemic side effects.

  • Understand the pathophysiology of glaucoma and the role of pharmacotherapy in its management.

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DRUGS INCLUDED IN THIS CHAPTERa

  • Abobotulinumtoxin A (DYSPORT)

  • Acetylcholine (MIOCHOL-E)

  • Apraclonidine (IOPIDINE)

  • Atropine (ATROPINE-CARE, ISOPTO ATROPINE)

  • Azelastine (OPTIVAR)

  • Bepotastine (BEPREVE)

  • Betaxolol (BETOPTIC, others)

  • Bevacizumab (AVASTIN)

  • Bimatoprost (LUMIGAN, LATISSE)

  • Brimonidine (ALPHAGAN, others)

  • Brinzolamide (AZOPT)

  • Bromfenac (XIBROM)

  • Carbachol (MIOSTAT, ISOPTOCARBACHOL, others)

  • Carteolol (OCCUPRES, others)

  • Chondroitin sulfate (VISCOAT)

  • Cromolyn sodium (CROLOM, others)

  • Cyanoacrylate tissue adhesive (ISODENT, DERMABOND, HISTOACRYL)

  • Cyclopentolate (CYCYLOGYL, others)

  • Cyclosporin A (RESTASIS)

  • Dexamethasone (DEXASOL, others)

  • Diclofenac (VOLTAREN, others)

  • Difluprednate (DUREZOL)

  • Dipivefrin (PROPINE, others)

  • Dorzolamide (TRUSOPT, others)

  • Echothiophate (PHOSPHOLINE IODIDE)

  • Emedastine difumarate (EMADINE)

  • Epinastine (ELESTAT)

  • Fibrinogen glue (TISSEEL, EVICEL)

  • Fluocinolone ophthalmic implant (RETISERT)

  • Fluorescein sodium

  • Fluorometholone (FML, others)

  • Fluorouracil

  • Flurbiprofen (OCUFEN, others)

  • Homatropine (ISOPTO HOMATROPINE, others)

  • Hyaluronate (HEALON, others)

  • Hydroxyamphetamine + topicamide (PAREMYD)

  • Hydroxypropyl cellulose ophthalmic insert (LACRISERT)

  • Hydroxypropylmethylcellulose

  • Indocyanine green

  • Ketorolac (ACULAR, others)

  • Ketotifen fumarate (ZADITOR, ALAWAY)

  • Latanoprost (XALATAN)

  • Levobunolol (BETAGAN, others)

  • Lodoxamide tromethamine (ALOMIDE)

  • Loteprednol (ALREX, LOTEMAX)

  • Metipranolol (OPTIPRANOLOL, others)

  • Mitomycin (MUTAMYCIN)

  • Naphazoline (AK-CON, ABALON, NAPHCON, others)

  • Nedocromil (ALOCRIL)

  • Nepafenac (NEVANAC)

  • Olopatadine (PATANOL, PATADAY)

  • Onabotulinumtoxin A (BOTOX)

  • Pegaptanib (MACUGEN)

  • Pemirolast (ALAMAST)

  • Phenylephrine + cyclopentolate (CYCLOMYDRIL)

  • Phenylephrine + scopolamine (MUROCOLL-2)

  • Polydimethylsiloxanes (ADATOSIL 5000)

  • Prednisolone (PRED FORTE, others)

  • Povidone iodine (BETADINE OPHTHALMIC)

  • Ranibizumab (LUCENTIS)

  • Rimexolone (VEXOL)

  • Scopolamine (ISOPTO HYOSCINE)

  • Tetrahydrozoline (ALTAZINE, MURINE, VISINE, others)

  • Timolol (TIMOPTIC, BETIMOL, others)

  • Travoprost (TRAVATAN, TRAVATAN Z)

  • Triamcinolone intravitreal formulations (TRIVARIS, TRIESENCE)

  • Tropicamide (MYDRIACYL)

  • Trypan Blue (VISIONBLUE, MEMBRANEBLUE)

  • Tyloxapol (ENUCLENE)

  • Verteporfin (VISUDYNE)

aDrugs included in this chapter have specific ophthalmic uses. Antimicrobial agents are listed in Tables 47-1,47-2,47-3. Their pharmacology is discussed in previous chapters.

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Table Graphic Jump Location
TABLE 47-1Topical Antibacterial Agents Commercially Available for Ophthalmic Use

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