Do You Know Your Drugs? Laurie L. Sorrenson,, OD, FAAO www.lakelinevision.com 1/108
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Statins Lipitor, Mevacor or Altocor, Zocor, Pravachol, Lescol, Crestor 6
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LDL Triglycerides HDL 8
Decreases Blood Clot formation Blood clots at site of plaque rupture = cause of most heart attacks! 9
heart and liver 10
Side Effects 11
Lipitor 12
cataracts and ophthalmoplegia 13
Lipitor (atorvastatin) Mevacor or Altocor (lovastatin) Zocor (simvastatin) Pravachol (pravastatin) Lescol (fluvastatin), Crestor (rosuvastatin) 14
Anti Hypertensives 15
ACE inhibitors (Angiotensin converting Enzyme) HBP, Diabetes and CHF 16
Captopril (trade name Capoten), the first ACE inhibitor Zofenopril Enalapril (Vasotec/Renitec) Ramipril (Altace/Tritace/Ramace/Ramiwin) Quinapril (Accupril) Perindopril (Coversyl/Aceon) Lisinopril (Lisodur/Lopril/Novatec/Prinivil/Zestril) Benazepril (Lotensin) Fosinopril (Monopril) 17
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Anti Hypertensives 19
Diuretics Hydrochlorothiazide HCTZ Furosemide Lasix 20
Ca+ Channel Blocker Norvasc Amlodipine Verapamil (Calan) Diltiazem (Cartiz) Nifedipine (Adalat) 21
Beta Blockers 22
Which groups are at higher risk for Hypertension? A. Hispanic women and men B. All Blacks and Caucasian men C. Caucasian women over 30 D. Black and Caucasian women 23
Answer: B B. Blacks of both sexes and Caucasian males have a higher incidence of significant hypertension. 24
Taking BP > 1 hr after caffeine >30 mins after smoking Bladder = 2/3 length of the arm Rest >5 mins Cuff at level of heart Deflated at rate of 2 3 mmhg/sec. 2 3 measurements averaged 25
#3 $$ Inhibits blood clots (clopidogrel) 26
RA, Psoriatic Arthritis, Ankylosing Spondylitis #7 $$ 27
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Question: Most commonly prescribed antidepressants are: 29/108
Depression OCD Anxiety disorders 30
Mental Disorders Leading cause of disability in US and Canada ages 15 44. The World Health Organization. The World Health Report 2004: Changing History, Annex Table 3: Burden of disease in DALYs by cause, sex, and mortality stratum in WHO regions, estimates for 2002. Geneva: WHO, 2004. 31
Common mental disorders Major Depressive Disorder Bipolar Disorder Schizophrenia Anxiety disorders including obsessive compulsive, generalized anxiety disorder, phobias, post traumatic stress disorder and panic disorder. 32
Who experiences clinical depression more often? 33
2x more often 80% treatable 34
Major Depressive Disorder Leading cause of disability in the U.S. for ages 15 44. Affects 6.7 percent of the U.S. population age 18 and older in a given year. Median age at onset is 32. 35
Bipolar Disorder 2.6 percent of population (>17yo) The median age = 25 years. Manic/Depressive Lithium Lamictal, Seroquel or Abilify 36/108
#5 $$ #12 $$ 37
Schizophrenia Most common psychotic condition and affects about 1% of the earth s population. Accounts for 40% of all long term hospitalization. 38
Schizophrenia Teens or early 20's 20's or early 30's Age of Onset 39
Anxiety Disorders Generalized Anxiety Disorder Panic Disorder Post Traumatic Stress Disorder Obsessive Compulsive Disorder Phobia 40
Anxiety Disorders 18.1 % (>17yo), in a given year, have an anxiety disorder.1 Frequently co occur with depressive disorders or substance abuse.1 3/4 first episode before age 22 41
Interesting Facts 1/3 w/panic Disorder Agoraphobia PTSD within 3 months 19% of Vietnam Vets had PTSD 42
Side Effects of Anti Depressants 43
Which is Schedule II?? A. Percodan B. Vicodin C. Tylenol #3 D. Darvon (propoxyphene) 44
A. Percodan Percodan oxycodone 45
Vicodin by any other name Anexsia Bancap HC Ceta Plus Co Gesic ComfortPak Dolagesic Dolorex Forte Duocet Hy Phen Hycet Hydrocet Hydrogesic Liquicet Lorcet Lorcet Plus Lorcet HD Lortab Margesic H Maxidone Norco Stagesic Vanacet Vicodin Vicodin ES Vicodin HP Xodol Zydone 46
Tylenol NO. 3 with Codeine APAP 300 mg, caffeine 15 mg, with codeine 30 mg Hydrocodone/APAP Vicodin 5.0mg/500mg Vicodin ES 7.5mg/750mg Vicodin HP 10mg/660mg 47
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Acid Reflux H 2 Receptor Blockers Pepcid Ac (OTC) Zantac (OTC) 49
Proton Pump Inhibitors Prilosec (OTC) Aciphex Kapidex Nexium Prevacid Protonix 50
Antibiotics Azithromycin #6 Amoxicillin #7 51
2008 #11 $$ Not OTC 52
What warning should you give a female patient when prescribing antibiotics? 53
Use Back Up Birth Control 54
Diabetes Metformin (Glucophage) #11 Actos = #9 in $ Byetta (Exenatide)) 55
What is the #1 factor in predicting whether or not a patient will have retinopathy? A. Severity of the disease B. How long the disease has been present C. Sex D. Pt managing their diabetes by self testing 2x a day and injections 2x a day. 56
C. Duration of the disease. Although studies have showed that hypercontrol can delay the onset of retinopathy. 57
Diabetes Control & Complications Trial (1440 patients IDDM) Intensive group: 4 insulin shots self testing 4 6 times a day. HbA1c of 7% Control group: 2 insulin shots self testing 2x a day. HbA1c of 9% 58
Results After 8 years Intensive group Retinopathy by 76% Nephropathy by 65% Neuropathy by 55% 59/108
UK (4000 NIDDM) Blood glucose (HBA1c of 7%) HBP <144/82 60
Results 32% decrease risk of all diabetes related deaths 44% decreased risk of stroke 56% decreased risk of heart failure 37% decreased risk for microvascular complications 1% HbA1c complications 25% 61
Which of the following is not a symptom of Type I Diabetes Mellitus? A. Weight increase B. Increased urination (polyuria) C. Thirst (polydipsia) D. Hunger E. Weight Loss 62/108
A. Weight increase The earliest symptom of elevated blood sugar is polyuria. 63
Diabetes Mellitus Life long disease Type I Pancreas does not produce enough insulin Type II Cells unable to use insulin efficiently 64/108
Which type of Diabetes is more common? A. Type I IDDM B. Type II NIDDM 65/108
B. Type II NIDDM Type II 90% type II. Strong genetic predisposition for type II diabetes 66
Risk Factors 67
Other Risk Factors Type II Race/ethnicity (African Americans, Hispanic Americans, Native Americans) Hypertension HDL <35 &/or triglycerides >250 Hx of gestational diabetes or babies over 9 pounds. 68
Asthma #4 $$ #6 $$ 69
fluticasone and salmeterol Candida Albicans Growth effects Glaucoma & Cataracts 70
montelukast 71
Albuterol 72
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Question: What is the big advantage of the second generation antihistamines? 74
little or no drowsiness 75
Erectile Dysfunction Drugs Viagra 30 minutes 4 hours Levitra 30 minutes 5 hours Cialis 15 minutes 36 hours 76
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Allergy Sufferers 50% of the population has allergies 83% of allergy sufferers experience ocular symptoms Ocular Symptoms No Ocular Symptoms
Ocular Allergy Signs & Symptoms Itching Chemosis Eyelid swelling Redness Tearing
Overview of Ocular Allergy Active ocular allergy is a specific form of inflammatory ocular surface disease Cross linking of IgE molecules by external allergens Leads to mast cell degranulation
Mast Cells Primary cell 50 million in eye
Allergic Response IgE
Allergic Response and Ocular Symptoms Itching Induced by histamines Hyperemia, Chemosis, Lid Swelling, Tearing Induced by other mediators PGD 2, TNF α, LTs, PAF, Tryptase, etc. Also induced by histamines Abelson M. Allergic Diseases of the Eye. Philadelphia, PA: W.B.Saunders Co; 2000.
Perennial Allergic Conjunctivitis 70% to 80% allergic to dust mite droppings
Systemic Allergy Medications Loratadine (Claritin) Cetirizine HCl (Zyrtec) Fexofenadine HCl (Allegra) Dry the eye Can worsen ocular symptoms
What s a better option?
Study
Thyroid 88
Thyroxine (T4) 89
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What type of drug was in the top 5 drugs prescribed for over 10 years until 2002? Hormone Replacement Therapy 91/108
What SEVEN ophthalmic drugs were in the top 200 by sales in 2008?? 92
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What % of topical ophthalmic antibiotics are for surgical prophylaxis?? 94
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Newer Ocular Medications 96
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1% azithromycin Vehicle: DuraSite.003% BAK Indication: bacterial conj. >1yo Dosing: BID x 2 days, then qd x 5 days 98
Blepharitis and Meibomitis 99
Bepreve (bepotastine) Mast cell stabilizer BID Improves allergic rhinitis symptoms? 25% mild taste 100
Benzalkonium Chloride (BAK) Concentration BAK Concentration Bepreve (BID) 0.005% Elestat (BID) 0.01% Pataday (QD) 0.01% Patanol (BID) 0.01% Differences in safety relative to BAK concentration have not been evaluated in a head to head clinical trial BEPREVE [package insert]. Irvine, CA: ISTA Pharmaceuticals, Inc; 2009. Elestat [package insert]. Irvine, CA: Allergan. 2008. Patanol [package insert]. Fort Worth, TX: Alcon Labs. 2007. Pataday [package insert]. Fort Worth, TX: Alcon Labs. 2008.
First with NO previous systemic use. 102
Besivance Vehicle: DuraSite BAK.01% Indication: Bacterial conj. >1yo Dosing: TID x 7 days 10 ml bottle (60 days) 103
Durezol (difluprednate) Steroid drop Inflammation and Pain associated with Eye Surgery Alcon acquired from Sirion 104
Zirgan (ganciclovir gel) Herpetic Keratitis Alcon acquired from Sirion Now B&L has it! June 4, 2010! 105
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Phase 4 trials 107
Zymaxid Allergan.5% gatifloxacin.005% BK ph = 5.4 108
Vigazera.5% moxifloxacin Ph 6.8 Zexio increase penetraion Bid x 7 days for > 1 month old 109
Amiodarone Suppresses ventricular arrhythmias 110
Ask what dose aspirin! 111
Laurie Sorrenson, OD, FAAO www. LakelineVision.com Sorrenson@att.net