Portland Community College | Portland, Oregon

Upon successful completion, the student should be able to:

1. Use knowledge of ocular pharmacology to effectively educate patients and gain patient compliance in the clinic setting.
2. Recognize adverse reactions to ocular drugs and apply the appropriate response.
3. Safely administer ophthalmic pharmaceuticals under physician supervision.

The class will be presented by means of lecture/discussion, audio-visual presentations, handouts and demonstrations.
 

At the beginning of the course, the instructor will detail the methods used to evaluate student progress and the criteria for assigning a course grade. The methods may include one or more of the following tools: examinations, quizzes, homework assignments, research papers.

Course Content (Themes, Concepts, Issues and Skills)

1.      The student will demonstrate understanding of the following themes, issues, concepts, and development of the following skills:

Introduction to Medications

• Define and pronounce vocabulary terms
• List and briefly describe the uses, names (generic), classifications and types of drugs.
• Interpret abbreviations and symbols commonly used in written prescriptions.
• Describe normal tear pH and symptoms of higher and lower pH eye drops.
• List factors that may affect medication stability.
• Describe the need for preservatives in eye medications and name types preservatives.
• Describe proper technique for instillation of topical ophthalmic drops and ointment.
• List the advantages and disadvantages of methods of drug delivery including drops, ointment, gels, sustained release medications and other topic routes as well as injections and systemic medication.
• Describe the difference between solutions, emulsions and suspensions in eye drops.
• Explain the technique and rationale for using punctual occlusion.
• List the four parts of a written prescription for drugs.
• Demonstrate how to read the physicians written prescription.

AUTONOMIC NERVOUS SYSTEM

• List the two branches of the autonomic nervous system.
• Describe the effects of stimulation of both the sympathetic and parasympathetic systems.
• List the neurotransmitters responsible for each system.
• Terminology for drugs that stimulate, enhance or block the stimulation of each system.
• Uses of adrenergic agents in ophthalmology
• Uses of cholinergic agents in ophthalmology.

OPHTHALMIC DRUG IDENTIFICATION

• Commonly used cap colors in drug classification.
• Types, strengths, actions, contraindications and complications of anesthetics, mydriatics, cycloplegics, epinephrine, beta-blockers, miotics, steroids, antibiotics, carbonic anhydrase inhibitors, adrenergic agonists, vasoconstrictors, antihistamines, osmotic agents, non-steroidal anti-inflammatories.

DIAGNOSTIC PHARMACEUTICALS

• Differentiate between mydriatics and cycloplegics.
• List cycloplegics in order of decreasing strength.
• Medications in the diagnosis of Adie’s syndrome and Horners syndrome.
• Mydriatic reversal drops.
• List useful topical diagnostic dyes including fluorescein, rose Bengal, lisamine green, and trypan blue.
• List useful injectable diagnostic dyes including fluorescein, infracyanine green, and indocyanine green.
• List major indications for fluorescein angiography.
• List contraindications to angiography.
• List both mild and major reactions to fluorescein injection.
• List treatments for adverse reactions to fluorescein.

OCULAR LUBRICANTS, ARTIFICIAL TEARS, COUPLING SOLUTIONS, VISCO-ELASTICS

• Benefits and drawbacks of using preserved ocular lubricants and artificial tears.
• Commonly used artificial tears.
• Difference between artificial tears and ocular decongestants.
• Uses of gonioscopic solutions.
• Use of extra-ocular irrigating solutions in chemical exposure.
• Use of visco-elastic agents and intraocular irrigating solutions in intraocular surgery.

VASOCONSTRICTORS, ANTIHISTAMINES, MAST CELL STABILIZERS

• Allergic response, anaphylaxis, idiosyncratic response.
• Signs and symptoms of allergic response.
• Difference in usage and patient response when treating with antihistamines versus mast cell stabilizers.

CORTICOSTEROIDS

• Four cardinal signs of inflammation in the body.
• Four substances produced during inflammation.
• List uses of ophthalmic corticosteroids.
• Systemic side effects and complications of steroid use.
• Symptoms of steroid withdrawal.
• Reasons to taper steroid usage.
• Commonly used ophthalmic topical corticosteroids.
• Describe the body immulogical response

NSAIDS

• Commonly available oral OTC NSAIDS.
• Uses for oral OTC NSAIDS.
• Uses of ocular administration of NSAIDS
• List ocular NSAIDS

ANESTHETICS

• List 3 groups of anesthetics.
• Location of injection for retrobulbar block / peribulbar block.
• Use of topical anesthetic in an office setting/minor surgery suite, ambulatory surgical center and the hospital operating room.
• Anti-Infectives
• Difference between bactericidal and bacteriostatic antibacterials.
• Three common gram-positive bacteria in ocular infections.
• Three common gram-negative bacteria in ocular infections.
• Three additional infections treated with anti-biotics that are not classified as either gram-positive or gram-negative.
• Common side effect after oral antibiotic therapy.
• Three drugs classified as aminoglycosides.
• Two 4th generation fluoroquinolones.

       ANTI-VIRAL AND ANTI-FUNGAL THERAPY

• Four types of herpes virus.
• Main anti-viral therapeutics.
• First FDA approved anti-fungal for ophthalmic use.

GLAUCOMA MEDICATIONS

• Four different types of glaucoma medications example of each.
• Relationship of elevated intraocular pressure to damage of the nerve fiber layers at the optic nerve head.
• Types of glaucoma medications and their mechanism of action.
• Direct acting adrenergic drugs.
• Alpha 2 adrenergic drugs
• Beta-blockers.
• Contraindications to using beta-blockers and other glaucoma medications
• Serious side effects of cholinergics (miotics).
• Topical carbonic anhydrase inhibitors.
• Systemic carbonic anhydrase inhibitors.
• Use of hyperosmotic agent in the office setting.
• Oral hyperosmotics.
• Prostaglandin analogues and their side effects.
• Systemic side effects of topical beta-blockers.

SIDE EFFECTS, TOXICITY AND HYPERSENSITIVITY

• Ocular side effects of prednisone, chloroquine (Plaquenil) and other common drugs.
• Classification of drugs that can increase IOP.
• Technique used to avoid systemic absorption of ophthalmic medications.
• Systemic side effects of topical sulfa and other drugs

     RETINAL THERAPIES

• Wet versus dry ARMD.
• Currently available treatments for ARMD.
• Side effects of Visudyne therapy.
• Off-label use of mediation.
• Cystoid and other macular edema disorders
• Treatment of retinal arterial and vein disorders
• Treatment of retinal inflammations and tumors

     ACUTE DRUG REACTIONS AND EMERGENCIES

• First aid techniques for acute ophthalmic drug reactions.
• Items necessary on a crash cart.

     NUTRITIONAL SUPPLEMENTS FOR THE EYES

• Vitamin recommendations from the AREDS (Age Related Eye Disease Study).
• Vitamin supplements for eyes available OTC.
• Side effects of supplements

     PATIENT EDUCATION

• Punctal occlusion.
• Installation of drops and ointment
• Importance of compliance.