Update on Oral Medications - Pennsylvania Optometric Association
Update on Oral
Medications
Carlo J. Pelino, OD, FAAO
Cpelino@salus.edu
!"#$#%"$&'(")%&*)+,We have no relevant financial relationships
to disclose and no proprietary interest in
any product discussed in this presentation.
Joseph J. Pizzimenti, OD, FAAO
Pizzimen@nova.edu
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What pharmacotherapy
means to optometry
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The ability to use pharmaceutical agents
has enabled optometrists to become true
primary health care providers.
Principles of Pharmacology
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• Pharmacokinetics: What the body does to a drug
• Pharmacodynamics: What the drug does to the body
• Always keep in mind the contraindications, side effects and drug
interactions before starting medication.
• Drug risks vs. benefits
• Keep in mind the age and weight of the patient
• Consider starting with one half in the very young or very old
• Elderly may be on multiple meds – may lead to adverse reactions
• Allergy history
Principles of Pharmacology
• Drug
Metabolism – Most drugs metabolized by
liver enzymes
• Drug Excretion – The kidney is the major route
• Some drugs are excreted after metabolism
• Some drugs are excreted unchanged
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Each patient is unique.
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FDA Use-in-Pregnancy Ratings
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Levels of Immunity
Innate Immunity:
First line of defense = external barriers
(skin, mm, lashes)
Second line of defense = phagocytic cells,
proteins, inflammation, fever,
complement system, interferon
Third line of defense = Adaptive immunity
Protects only against a
certain type of pathogen
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Neutrophils / Macrophages
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Questions and Comments?
Types of Pain
Nociceptive
• Expected result from
tissue injury
• Normal neural transmission
Neuropathic
The World Health Organization Pain Ladder
Mild Pain
Oral NSAID , Non Opioid Analgesic
• Primary lesion in the CNS
Moderate
Oral Opioid
• Chronic
Severe
Parenteral Opioids (Morphine)
Intractable
Invasive therapy
• Localized, resolves
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What about Codeine ????
Must be metabolized to morphine to have analgesic
effect
Other metabolites cause nausea and dysphoria
10% of population can not metabolize, so no
analgesic effect
2% are ultra rapid metabolizers – prone to morphine
intoxication at normal doses
Common Opioid Side Effects
Nausea and vomiting
Constipation
Itchiness
Respiratory depression
Mental confusion
Hypersensitivity reactions
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