The #8 medication in Dr. Grogg's "Optometry Big 10" is a pain management drug. She would love to say that she keeps a Schedule 3 narcotic in her black bag, but she does not. (Indiana optometrists currently are not allowed to prescribe Schedule 3 narcotics). Dr. Grogg appreciates working with physicians at the Indiana University Health Center who will prescribe pain medications for her patients even though after observing her patients who have been given pain management drugs, she questions how much good they actually do for corneal pain. She believes bandage contact lenses are better pain management. Some patients, however, are comforted in knowing that they have pain medication, so she does give it out on occasion.

Because she cannot have a Schedule 3 narcotic in her black bag, Dr. Grogg instead chooses Ultracet as her #8 drug. Ultracet is an opioid (37.5 mg Tramadol) plus 325 mg of acetaminophen (Tylenol). Indications: Short-term (5 days) management of acute pain ii tabs q 4-6 hrs.

Ultracet's sister drug Ultram (50 mg Tramadol) doesn't contain Tylenol.

For those optometrists practicing outside of Indiana (and hopefully for those in Indiana some day) . . .
Lortab

Lortab is a Schedule 3 narcotic. It is always written as a fraction: amount of narcotic over amount of acetaminophen. Most common dosage is 2.5/500.

• Opiod plus analgesic
• Lortab 2.5/500: Hydrocodone bitartrate 2.5 mg plus acetaminophen 500 mg
• Indications: moderate to moderate-severe pain
• Other dosages: 5/500; 7.5/500; 10/500
• Sig: 1 or 2 tabs q 4-6 hrs as needed for pain
• Interactions: Alcohol, CNS depressants, MAOIs, tricyclic antidepressants, anticholinergics
• Adverse reactions: Dizziness, CNS depression, respiratory depression, GI upset, constipation, urinary retention

Dr. Grogg has found that drug-seeking behavior is more common than she ever imagined. Eye pain should be easily verifiable. She has seen many contact lens overwear patients who ask for pain medicine. Be careful with the patient who consumed alcohol the night before, slept in his/her contact lenses, and sustained a corneal injury from overwearing the contact lenses. If the patient still has alcohol in his/her system, Lortab can suppress the CNS further.

Tylenol with Codeine #3

• Opioid (codeine phosphate 30 mg) plus analgesic (acetaminophen 300 mg)
• Adverse reactions: dizziness, sedation, nausea, vomiting, constipation, urinary retention, rash

Prescription Writing Tips

Check boxes for number of pills prescribing (state law in Indiana) Consider writing out number given Never more that 5 refills (probably not relevant to ODs) Not valid after 6 months

Corneal Abrasion/Erosion

Patients with corneal abrasions or erosions typically present with pain, photophobia, and tearing. Common culprits in cases of corneal abrasion/erosion include tree branches, fingernails, and paper cuts. When questioning the patient for past ocular history, be sure to find out whether the patient has a history of recurrent erosions, ABMD, etc. When examining the patient: Always get a best visual acuity Look for loose epithelium, small particles If indicated, evert the eyelids Anticipate a subclinical anterior uveitis

Corneal Abrasion/Erosion Treatment

• Topical antibiotic
• Homatropine: 2-4 gtts in office is important to do. This may need to be continued on an in-office basis for 2-3 days. You could also prescribe Homatropine 5% i gtt TID-QID x 3-4 days.
• Topical NSAID may be considered for pain management. A topical NSAID can be used in office for initial pain management treatment and can be used in lieu of oral pain medication management.