Therapeutic Prescribing for OCANZ: Essential Medications and Guidelines

Therapeutic prescribing is a significant component of Australian optometry practice and the OCANZ examination. This guide covers essential medications and prescribing principles.

Therapeutic Endorsement in Australia

What It Means

• Authority to prescribe Schedule 4 medications
• Broader scope of ocular disease management
• Expected competency for most positions

PBS Prescribing

• Access to subsidised medications
• Authority required for some items
• Specific prescribing criteria

Key Medication Classes

1. Ocular Antibiotics

Topical Antibiotics

Medication	Spectrum	Common Use
Chloramphenicol	Broad	Bacterial conjunctivitis
Chlorsig	Broad	First-line, surface infections
Ciprofloxacin	Fluoroquinolone	Corneal ulcers
Moxifloxacin	4th gen FQ	Severe infections
Ofloxacin	Fluoroquinolone	Corneal infections
Tobramycin	Aminoglycoside	Pseudomonas

Prescribing Considerations

• Chloramphenicol: First-line for bacterial conjunctivitis
• Reserve fluoroquinolones for serious infections
• Consider resistance patterns
• Duration typically 5-7 days

2. Anti-Inflammatory Agents

Corticosteroids

• Prednisolone acetate 1%: Standard potency
• Fluorometholone: Lower potency, longer-term
• Dexamethasone: High potency

Prescribing Cautions

• Monitor IOP
• Avoid in epithelial herpes
• Limit duration when possible
• Tapering protocols

NSAIDs

• Ketorolac: Pain relief, post-operative
• Diclofenac: Inflammation
• Nepafenac: Macular oedema prevention

3. Antiallergy Medications

Mast Cell Stabilisers

• Sodium cromoglycate
• Lodoxamide

Antihistamines

• Olopatadine: Dual action
• Ketotifen: Available OTC
• Azelastine

Prescribing for Allergic Conjunctivitis

1. Assess severity
2. Remove allergen if possible
3. Cold compresses, lubricants
4. Topical antihistamine/mast cell stabiliser
5. Consider short-term steroid for severe

4. Glaucoma Medications

Prostaglandin Analogues

• Latanoprost: First-line, once daily
• Bimatoprost: Potent, cosmetic effects
• Travoprost: Alternative option

Beta Blockers

• Timolol: Twice daily
• Betaxolol: Cardioselective
• Contraindications: Asthma, COPD, bradycardia

Carbonic Anhydrase Inhibitors

• Dorzolamide: Topical
• Brinzolamide: Better tolerated
• Acetazolamide: Oral for acute

Alpha Agonists

• Brimonidine: Additive therapy
• Apraclonidine: Short-term use

Prescribing Principles

1. Start with prostaglandin analogue
2. Add medications if target not reached
3. Consider combination drops
4. Monitor for side effects

5. Dry Eye Medications

Lubricants

• Hypromellose: Basic lubrication
• Carmellose: Longer lasting
• Hyaluronic acid: Enhanced retention
• Lipid-based: MGD

Prescription Options

• Cyclosporine 0.05% (Restasis): Inflammation
• Lifitegrast: T-cell inhibitor
• Autologous serum: Severe cases

6. Antivirals

Herpes Simplex

• Aciclovir ointment: Epithelial HSK
• Oral aciclovir/valaciclovir: Stromal, recurrence

Herpes Zoster

• Oral antivirals essential
• Early treatment crucial
• Higher dosing than HSV

7. Mydriatics and Cycloplegics

Diagnostic

• Tropicamide 0.5%, 1%: Short-acting
• Phenylephrine 2.5%, 10%: Sympathomimetic
• Cyclopentolate: Cycloplegia

Therapeutic

• Atropine 1%: Uveitis
• Homatropine: Intermediate

Clinical Scenarios

Acute Bacterial Conjunctivitis

1. Confirm bacterial (purulent discharge)
2. Chloramphenicol drops QID x 5-7 days
3. Hygiene advice
4. Review if no improvement

Corneal Ulcer

1. Scraping for culture if central/severe
2. Intensive fluoroquinolone (hourly initially)
3. No patching
4. Daily review
5. Consider referral for severe

Anterior Uveitis

1. Steroid drops (frequency depends on severity)
2. Mydriatic/cycloplegic
3. Monitor IOP
4. Investigate cause
5. Consider referral

Allergic Conjunctivitis

1. Allergen avoidance
2. Cold compresses
3. Antihistamine drops
4. Consider mast cell stabiliser
5. Short-term steroid if severe

Acute Glaucoma

1. Recognise emergency
2. Oral acetazolamide if no contraindications
3. Topical IOP-lowering
4. Urgent referral
5. Analgesia, anti-emetics

PBS and Prescribing

Authority Scripts

Some medications require:

• STREAMLINED authority
• Written authority
• Phone approval

Common PBS Items for Optometry

• Latanoprost
• Timolol
• Chloramphenicol
• Ciprofloxacin (corneal ulcer)
• Aciclovir

Examination Tips

Know for OCANZ

1. First-line treatments
2. Contraindications
3. Side effects
4. When to refer
5. PBS prescribing rules

Common Questions

• What would you prescribe for...?
• What are the contraindications?
• When would you refer?
• How would you monitor?

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Therapeutic prescribing knowledge is essential for the OCANZ exam and Australian optometry practice. Regular review of guidelines and updates is recommended.