Lab#9 & 10 Eye Drops Presentation to students of health college Sunday, May 22, 2010 by: TA/ Mohammad Al- Mermesh, BSc., PGC,

Pharmaceutical Requirements: Ophthalmic preparations requires: Sterility (by autoclave or bacterial filters) Preservations (e.g. benzalkonium chloride 0.004% – 0.01%) Isotonicity (0.9% NACL solution is isosmotic) Buffering (it affects solubility & stability of drugs)

Viscosity (by adding theckening agent e.g. methylcellulose 0.25%-1%)… optimal viscosity is in the range centipoise Ocular Bioavailability (affected by protein binding, drug metabolism, lacrimal drainage and others such as physico-chemical properties (lipophilicity) & product formulation) Ophthalmic preparation must be clear free from particulate matter (by visual inspection, filtration & gentle shaking before use) To be continued

Indications of ophthalmic preparations: Anesthetics –e.g. proparacaine Antibiotics & antibacterial agents- e.g. ofloxacin Antifungal agents- e.g. Amphotericin B Anti-inflammatory- e.g. Prednisolone Antiviral agents- e.g. Ganciclovir Astringents- e.g. Zinc sulfate B-adrenergic blocking agents- e.g. Timolol mleate Miotics and other Glaucoma agents- e.g. Pilocarpine Mydriatics and cycloplegics – e.g.Atropine or scopolamine Protectants & artificial tears – carboxymethyl cellulose Vasoconstrictors & ocular decongestants - oxymetazoline

O.d……………………..right eye O.s……………….………left eye O.u……………………..each eye O2..……………………both eyes

RxRx Vancomycin 500 mg hydrolyzed powder 2 vials WFI (water for injection,preservative free 10 ml Artificial tears eye drops solution 20.8 Prepare 15ml Calculations X vial 5ml 10.4 ml Storage: Rerigerator Vancomycin Eye Drops Package:15 ml artificial tears dropper bottle

Procedure: 1.Aseptically add 5 ml of preservative free water for injection to the vial containing 500 mg vancomycin powder, shake well & wait for the powder dissolution. 2. With a syringe a aseptically remove 4.6 ml from a 15 ml ophthalmic dropper bottle of artificial tears 3. Withdraw 4-6 ml from the vancomycin vial and add them to the artificial tears dropper, shake well to ensure mixing

Uses : Vancomycin is an antibiotic which is used in the treatment of serious staphylococall or other G+ve infections (for methicillin resistant staphylo-coccus aureus MRSA) 2 gtt BID o.u for 1/52 Sig.: 2 gtt BID o.u for 1/ drops Bid o.u for 1/52 Dose: 1-2 drops Bid o.u for 1/52 10 days Stability: 10 days

Vancomycin Eye drops 31 mg/ml Two drops to be installed in each eye twice daily for seven days Keep in Refrigerator Expiry after two weeks Name Exp.Date Red label

RxRx Amphotericin B Eye 50 mg vial 2 vials WFI (preservative) 20 ml Prepare 10 ml Calculations X vial 10 ml Amphotericin B Eye drops 5 mg/ml Storage: Refrigerator, protect from light and heat Package:10 ml, sterile plastic self-dropper

Procedure: 1.Within a laminar flow hood reconstitute Amphotericin B with 10 ml WFI, shake and wait until complete dissolution of the drug. 2. Transfer the solution to a sterile bottle with dropper.

Uses : It is antifungal antibiotic used for the treatment of fungal & yeast ophthalmic infection and corneal ulceration 2 gtt BID o.u for 1/52 or u.d Sig.: 2 gtt BID o.u for 1/52 or u.d 1-2 drops Bid for 7 days or u.d Dose: 1-2 drops Bid for 7 days or u.d 7 days Stability: 7 days

Amphotericin B Eye drops 5 mg/ml Two drops to be installed in each eye twice daily for one week or as directed Keep in Refrigerator Expiry after one week Name Date Red label

RxRx Benzocaine 10 ml Phenazone (antipyrine) 50 gm Glycerol ad 1000 ml Prepare 100 ml Calculations X vial 5 gm 100 ml Benzocaine Ear drops 1 % v/v

Procedure: 1.Mix Benzocaine, Antipyrine & Glycerol together and mix well until you obtain a clear solution 2. You can use gentle heat to dissolve these ingredients

Uses : Analgesic, anesthetic 3 gtt a.s Tid or PRN Sig.: 3 gtt a.s Tid or PRN 2-4 drops Tid or PRN Dose: 2-4 drops Tid or PRN Role of each ingredient: Benzocain: Analgesic, anesthetic (active ingredient) Antipyrine: Solubilizing agent for benazocaine Glycerol: Vehicle

Benzocaine Ear drops 1 % v/v Three drops to be installed in the left ear three times daily or when necessary daily or when necessary Name Date Red label

RxRx Phenol 160 gm Glycerol ad 1000 ml Prepare 100 ml Calculations X gm 100 ml Phenol Glycerin Ear drops 16 % w/v

Procedure: 1.Dissolve the phenol in glycerol 2. Use gentle heat if necessary

Uses :Disinfectant 1 gtt a.u Tid or u.d Sig.: 1 gtt a.u Tid or u.d 1-2 drops Tid for few days Dose: 1-2 drops Tid for few days

Phenol glycerin Ear drops 16 % w/v One drop to be installed in each ear three times daily or as directed daily or as directed Name Date Red label

Patient counseling Eye drops in multiple-application containers for normal use, should not be used more than 4 weeks, in hospital after one week after first opening, otherwise one single pack (outpatient, eye surgery, diagnostic dyes). A red eye, may be de to herpes simplex virus and a corticosteroid may aggravate the condition. Steroid glaucoma may follow the use of corticosteroid eye preparations A steroid cataract may follow prolonged use e.g. 15 mg prednisolone daily for several years. Antimuscarinics dilate the pupil and paralyse the ciliary muscle e.g, atropine (Long Acting) Glaucoma can be treated by drugs that reduce intra-ocular pressure Beta-blockers should not be used in patients with asthma or a history of obstructive airway disease unless no alternatives. Patient receiving prostaglandin analogues should be monitored for any changes in eye coloration e.g. Latanoprost or Trovoprost eye drops

Thank You