Glabe, David

Hua, Len

English

CommonKnowledge

Pacific University 
CommonKnowledge 
Student Scholarship (COO) College of Optometry 
5-3-2011 
20 Oral Drugs in Optometry -- A Practitioner's Reference 
David Glabe 
Pacific University 
Len Hua 
Pacific University 
Recommended Citation 
Glabe, David and Hua, Len, "20 Oral Drugs in Optometry -- A Practitioner's Reference" (2011). Student 
Scholarship (COO). 2. 
https://commons.pacificu.edu/coostu/2 
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20 Oral Drugs in Optometry -- A Practitioner's Reference 
Keywords 
Oral Drug, Eye Disease, Optometry, AREDS, Omega-3 
Disciplines 
Optometry 
Comments 
This poster can be printed on 8.5" x 11" use 'scale to fit'. 
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20 Oral Drugs in Optometry—A Practitioner’s Reference 
 
David K. Glabe, BS and Len Hua, PhD OD 
Pacific University of Oregon College of Optometry 
Augmentin 
Amoxicillin/Clavulanate potassium  
250, 500 mg tabs 
 
 
Class: Antibacterial, penicillin 
Use: Bacterial infections, incl. hordeolum, 
preseptal cellulitis, dacryocystitis, pro-
phylaxis 
Dosage: 500 mg q8h x 7-10d 
CI: Cholestatic jaundice, mononucleosis, 
hypersensitivity to drug, Caution in he-
patic, renal impairment 
SE: Anaphylactic reaction, diarrhea, N/V, 
rash, urticaria 
Mechanism: Inhibits bacterial cell wall 
synthesis; clavulanate is a beta-lactamase 
inhibitor 
Azithromycin 
250, 500 mg tabs 
 
Class: Antibiotic, macrolide 
Use: Inclusion conjunctivitis, hordeolum 
Dosage: (Inclusion conj.): 1000 mg single dose; 
(Hordeolum): 250mg bid x 1d, then qd x 4d 
CI: Known hypersensitivity to erythromycin, 
any macrolide or ketolide antibiotic 
SE: N&V, diarrhea, abdominal pain 
Notes: Caution in patients with impaired he-
patic function; azithromycin may exacerbate 
myasthenia gravis. Patients should not take Al 
or Mg-containing antacids concurrently with 
azithromycin. May enhance effects of oral anti-
coagulants; use caution in patients on digoxin, 
ergotamine or dihydroergotamine, terfenadine, 
cyclosporine, hexobarbital and phenytoin, as 
possible drug interactions have been observed 
but not studied.  
Pregnancy: Category B 
Dicloxacillin 
250, 500 mg tabs 
 
Class: Antibiotic, penicillin 
Use: Preseptal cellulitis, acute phase dacryo-
cystitis and canaliculitis, internal hordeolum, 
prophylaxis 
Dosage: 250 mg qid x 7-10d, or 500 mg bid x 
7-10 d 
CI: penicillin allergy 
SE: GI upset 
Notes: Dicloxacillin is a penicillinase-
resistant penicillin with a good safety profile. 
It is very inexpensive, with a 10-day course 
costing less than $10. 
Doxycycline 
20, 50, 100 mg tabs or capsules 
 
Class: Antibiotic, tetracycline 
Use: MGD, recurrent hordeola, rosacea, dry eye 
Dosage: (MGD): 20-100 mg bid x 1 mo or 
longer if warranted. If MGD secondary to 
rosacea, extend to 6 weeks followed by 1-3 mo 
taper or maintain on 40-50 mg qd dose indefi-
nitely; (Dry Eye): 50 mg qd x several mo as 
warranted; (RCE): 50 mg bid x 2 mo along with 
topical steroid gtts tid x 2-3 wks 
CI: Children <8 yo, pregnant or lactating 
women. 
SE: Photosensitivity, GI upset, diarrhea 
Notes: Take on empty stomach, avoid dairy 
products. Avoid sun exposure, as tetracyclines 
will increase risk and severity of burns. Longer-
acting and improved safety profile versus tetra-
cycline. 
Mechanism: Decreases lipase prod. of Staph. 
epidermidis to allow stabilization of tear film. 
Anti-inflammatory activity via IL-1 suppres-
sion. Inhibits MMP-9, an enzyme responsible 
for damage to corneal epithelial basement 
membrane. 
 
Erythromycin 
250mg, 500mg tabs, suspension 
 
Class: Antibiotic, anti-inflammatory, mac-
rolide 
Use: Inclusion conjunctivitis, MGD 
Dosage: (Inclusion conj.): 500 mg qid x 
3wks; (MGD): 500mg bid x 1-3 mo 
CI: Hypersensitivity to macrolides; caution in 
myasthenia gravis, hepatic impaitment, car-
diomyopathy, bradycardia 
SE: Diarrhea, hepatic impairment, QT prolon-
gation, anaphylaxis, pancreatitis 
Notes: Use for meibomianitis is second-line if 
tetracyclines are contraindicated;  interacts 
with many drugs, incl. antihistamines, theo-
phylline, digoxin, warfarin, lovastatin, pheny-
toin and carbamazepine. Safe in children and 
pregnant women. 
Mechanism: Inhibits bacterial protein synthe-
sis by binding 50s subunit. 
Tetracycline 
250, 500 mg capsule 
 
Class: Antibiotic, tetracycline 
Use: MGD, recurrent hordeola, rosacea 
Dosage: (MGD): 250 mg qid x 1 mo or longer 
if warranted. If MGD secondary to rosacea, 
extend to 6 weeks followed by 1-3 mo taper 
or maintain on 250 mg qd dose indefinitely. 
CI: Children <8 yo, pregnant or lactating 
women, renal insufficiency – consider use of 
doxycycline or dose adjustment 
SE: Photosensitivity, GI upset, diarrhea 
Interactions: Depresses prothrombin activity – 
use caution in patients on anticoagulants. May 
interfere with antibacterial effects of penicil-
lins. Antacids impair absorption. 
Notes: Take on empty stomach, avoid dairy 
products. Avoid sun exposure, as tetracyclines 
will increase risk and severity of burns. Short-
est-acting of the tetracyclines 
Mechanism: Decreases lipase prod. of Staph. 
epidermidis to allow stabilization of tear film. 
Anti-inflammatory activity via IL-1 suppres-
sion. Inhibits MMP-9, an enxyme responsible 
for damage to corneal epithelial basement 
membrane. 
Acyclovir 
Zovirax 
400, 800 mg tabs; 200 mg caps; suspension 
 
Class:Antiviral 
Use: Herpes simplex infections, incl. 
keratitis and post-herpetic neuralgia; Her-
pes zoster infections. 
Dosage: (H. simplex): Adults: 400 mg 5x/
day x 7-10d for acute episode, 400 mg bid 
x 1yr for prevention of recurrence; Chil-
dren <12yo: 20 mg/kg q6h x 7-10d; (H. 
zoster): 800 mg 5x/d x 7-10d 
CI: Renal insufficiency – dosages may be 
adjusted if needed 
SE: GI upset, headache, skin rash 
Notes: Most effective when used within 72 
h of onset of symptoms. May be substituted 
with valacyclovir at 1000 mg tid dose. 
Shown to help prevent additional episodes 
in recurrent disease. 
Mechanism: Guanosine analog interrupts 
viral DNA synthesis via viral DNA poly-
merase. 
Pregnancy: Category B – secreted in 
breast milk 
Prednisone 
1, 2.5, 5, 10, 20, 50 mg tabs 
 
 
Class: Anti-inflammatory, Steroid 
Use: Contact dermatitis, temporal arteri-
tis, Bell’s palsy 
Dose: 60 mg qd x 3-4 days 
CI: Active peptic ulcer; precaution in 
PUD, TB, active infection, pregnancy, 
and psychosis 
SE: Increased IOP, cataract, Cushing’s, 
hyperglycemia, hypokalemia, hyperten-
sion, peptic ulcer, pseudotumor cerebri, 
osteoporosis, decreased wound healing, 
fluid retention 
Acetazolamide 
Diamox 
125, 250, 500 mg 
 
Class: Anti-glaucoma agent, carbonic anhy-
drase inhibitor 
Use: Acute angle closure, reduction of IOP 
when other methods are ineffective 
Dosage: (Acute angle closure): 500 mg PO; 
(chronic glaucoma): 250 mg q6h 
CI: Hypokalemia, hyponatremia, acidosis, cir-
rhosis; caution in diabetes, gout, and sulfona-
mide allergy 
SE: Fatigue, change in taste, N/V, diarrhea, 
transient myopia, photosensitivity 
Notes: Reduces IOP by 30-40% 
Mechanism: Inhibits carbonic anhydrase and 
production of aqueous. 
Guaimax-D  
1200 mg guaifenesin/120 mg  
pseudoephedrine tabs 
 
Class: Expectorant, decongestant 
Use: relief of congestion due to viral URI and 
conjunctivitis 
Dosage: 1 tab bid x 10d 
CI: Severe hypertension, coronary artery dis-
ease, MAOI use within 14 d; caution in pa-
tients with hypertension (meds will be antago-
nized), diabetes, cardiovascular disease, nar-
row angle glaucoma, elderly, prostatic hyper-
trophy, and hyperthyroid. 
SE: Nervousness, insomnia, headache, GI up-
set, urinary retention 
Notes: Taken at breakfast and dinnertime; 
avoid hs due to insomnia. 
Tylenol 
Acetaminophen 
325 mg tabs 
 
Class: Non-narcotic analgesic 
Use: Mild-moderate ocular pain not well man-
aged by topical drugs; corneal abrasion, PRK, 
FB, trauma, post-surgical procedures, herpes 
zoster neuralgia 
Dosage: 500-1000mg q4-6h as needed 
CI: Chronic alcohol abuse, hepatic impairment, 
G6PD deficiency 
SE: Liver toxicity and hematologic effects at 
high dosages, nausea, rash 
Mechanism: Poorly understood 
Ibuprofen 
200, 400, 600, 800 mg tabs;  
200 mg chewable tabs; 200 mg caps 
 
Class: Non-narcotic analgesic, NSAID 
Mechanism: prevent firing of peripheral pain 
receptors via COX inhibition, resulting in re-
duction of prostaglandins 
Use: Mild-moderate ocular pain not well man-
aged by topical drugs; corneal abrasion, PRK, 
FB, trauma, post-surgical procedures, herpes 
zoster neuralgia 
Dosage: 200-400 mg q4h as needed 
CI: Known allergic reaction to NSAIDs, se-
verely compromised cardiovascular or renal 
health 
SE: GI disturbance, prolonged bleeding time, 
renal function disruption, headache 
Notes: Monitor closely in patients with dimin-
ished renal function; elderly patients are more 
susceptible to serious GI bleeding. 
Pregnancy: Category C prior to 30 wks gesta-
tion, D at or after 30 wks gestation; not rec-
ommended in lactating women. 
Lortab 
Hydrocodone bitartrate/Acetaminophen 
2.5/500, 5/500, 7.5/500, 10/500 mg tabs 
 
Class: Narcotic/non-narcotic combination an-
algesic 
Use: Moderate-severe pain 
Dosage: 1-2 tabs q4-6h prn 
SE: Respiratory depression, hepatotoxicity, 
dependency, agranulocytosis, thrombocyto-
penia, lightheadedness, dizziness, drowsiness, 
rash, itching 
CI: Caution in hepatic or renal impairment, 
hypothyroid, G6PD deficiency, concurrent use 
of depressants 
Notes: Use caution in patients with recent al-
cohol consumption. 
Tylenol 3 
Acetaminophen/Codeine 
 300/30 mg tabs 
 
Class: Narcotic/non-narcotic combination 
analgesic 
Use: Moderate-severe pain 
Dosage: 1-2 tab q4-6h 
CI: Respiratory depression; caution in 
G6PD deficiency, seizures, hypothyroid, al-
cohol abuse, hepatic and renal impairment. 
SE: Respiratory depression, CNS depres-
sion, hepatotoxicity, light-headedness, diz-
ziness, abdominal pain, vomiting, rash. 
Notes: Take with meals. 
Vicodin 
        Acetaminophen/Hydrocodone  
500/5 mg tabs 
 
Class: Narcotic/non-narcotic combination 
analgesic 
Use: Moderate to severe pain 
Dosage: 1-2 tab q4-6h prn 
CI: Caution in hepatic or renal impair-
ment, chronic alcohol abuse, hypothyroid, 
G6PD deficiency. 
SE: Respiratory depression, hepatotoxic-
ity, dependency, agranulocytosis, throm-
bocytopenia, lightheadedness, dizziness, 
drowsiness, rash, itching. 
Allegra 
Fexofenadine 
30, 60, 180 mg tabs 
 
Class: Anti-allergy, 2nd-generation antihista-
mine 
Use: Seasonal allergic rhinitis 
Dosage: 180 mg qd or 60mg bid 
SE: HA, dyspepsia, fever, cough, myalgia 
CI: Hypersensitivity; caution in renal impair-
ment or PKU 
Notes: Do not take with fruit juice 
Zyrtec 
Cetirizine  
10 mg tabs 
 
Class: Anti-allergy, antihistamine 
Use: Seasonal allergic rhinitis 
Dosage: 1 tab/cap qd prn 
SE: bronchospasm, hypersensitivity rxn, cho-
lestasis, seizures, anemia, thrombocytopenia, 
syncope, hypotension, drowsiness, fatigue, di-
arrhea. 
CI: Hypersensitivity to hydroxyzine; caution 
in use of CNS depressants, hepatic or renal 
impairment. 
AREDS  
OTC tabs, capsules 
 
 
Class: Vitamin Supplement 
Use: Prevention of advanced or exudative 
forms of AMD 
Dosage: 500 mg vitamin C, 400 IU vitamin E, 
15 mg beta-carotene, 80 mg zinc, 2 mg copper 
qd 
SE: GI upset, genitourinary complications, yel-
lowing of skin 
CI: Use caution in chronic disease and in pa-
tients taking multiple medications; avoid beta-
carotene in smokers or former smokers. 
Notes: AREDS formulation is shown to benefit 
only those with intermediate AMD in one or 
both eyes, or advanced AMD in one eye only. 
L-lysine 
OTC 250, 500, 1000 mg tabs or capsules 
 
 
Class: Amino Acid Supplement 
Use: Herpes simplex keratitis 
Dosage: 3000-9000 mg qd for active infec-
tion; 1250 mg qd for prevention of recurrence 
CI: Use caution in patients on antibiotics – in 
very high (10-30 g) doses, lysine may in-
crease toxicity of aminoglycosides 
SE: GI upset may occur in very high doses 
Notes: Do not take with milk. 
Mechanism: Interferes with viral replication. 
Omega-3 Fatty Acids 
OTC tabs, capsules in various doses 
 
 
Class: Fatty Acid Supplement 
Use: Dry eye 
Dosage: 2000 mg qd 
CI: If derived from fish oil, use caution in 
diabetics (may alter control of blood sugar) 
and patients on anticoagulants (may enhance 
effect) 
SE: GI upset 
Notes: Very slow onset therapy – may take 3-
4 months of supplementation before effect is 
noticed. Avoid omega-3s derived from fish 
liver, as these include vitamins A and D which 
may have additional side effects in higher 
concentrations 
Mechanism: decreases inflammation, en-
hances tear production, thins meibomian se-
cretions 
Notes: 
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References  
1. www.drugs.com 
2. www.rxlist.com 


20 Oral Drugs in Optometry -- A Practitioner\u27s Reference

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20 Oral Drugs in Optometry -- A Practitioner\u27s Reference

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