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Ocular Pharma # 11


What is the glaucoma triad? IOP, Optic Nerve Damage, VF Damage
What are the two ways that drugs reduce IOP? Decrease aqueous production / Increase aqueous outflow
What are the main 5 classes of glaucoma drugs? Prostaglandin Analogues, Beta Blockers, Alpha Agonists, Calcium Anhydrous Inhibitors, Hyperosmotics, Cholinergics (seldom used)
What are the four sympathetic receptors? Alpha 1, Alpha 2, Beta 1, Beta 2
Stimulation of the Alpha receptors causes ___________. Increase aqueous outflow (Alpha agonists)
Stimulation of Beta receptors causes _____________________. Decrease in aqueous production.
Cholinergics are not used in glaucoma today because of what serious ocular side effects? Extreme miosis, iris cysts, retinal detachment, cataracts, myopia, headaches
Name two direct acting Cholinergics used in surgery? Carbachol (Miostat) and Acetylcholine (Miostat)
What are the two direct acting Cholinergics used for and what are their differences? To produce miosis at the end of cataract surgery. Carbachol is longer acting.
Name the 2 Alpha Adrenergic Agonists drugs. Brimonidine (Alphagan) and Apraclonidine (Iopidine)
What are the side effects of Alpha Adrenergic Agonist drugs? Apraclonidine has the most incidence of side effects. 75% develop allergy, most lose effect with time, red eyes, dry eyes, dry mouth, bad taste, fatigue. Side effects are much less with Brimonidine.
What is Aproclonidine used for? To reduce pressure spikes at laser surgery and to test for Horner's Syndrome.
Name several Beta Blockers. Timolol, Betaxolol, Carteolol, Levobunolol, Metipranolol
What are the systemic side effects of Beta Blockers and when are they contraindicated? Slow the heart and breathing, depression, deceased libido, dry eye, contraindicated or used with utmost caution in CV disease, asthma, COPD, Arrythmias, Bradycardia.
Name several Prostaglandin Analogues. Latanoprost, Bimatoprost, Travoprost, Tafluprost
What are the side effects of Prostaglandin Analogues and when should they be used with caution? Red eye, dry eye, sting, growth and pigmentation of lashes, iris pigmentation, PAP, URI and flu symptoms. Use with caution with ocular inflammation (uveitis, CME)
What are the advantages of Prostaglandin Analogues? Most effective in lowering pressure and fewer side effects
Name a CAI drug. Topical: Dorzolamide and Brinzolamide. System: Acetazolamide and Methazolalmide
What are the side effects of CAI drugs? Topical: dry eye, itching, redness, bitter taste. Systemic: renal stones, sulfa allergy, depression, impotence, tingling of extremities (very common), metallic taste, GI upset. 50% will need to DC (discontinue) within months of Rx.
What do CAI drugs have a cross-allergy with? Sulfa
Name several oral hyperosmotic agents. Glycerine (Glyrol, Osmoglyn) and Isosorbide
What is Isosorbide used? In Diabetes
Name I.V. Hyperosmotic agent? Mannitol
What other drugs can be given I.V. for acute glaucoma? Acetazolamide (Diamox)
Can you name which classes of drugs DECREASES aqueous production? Beta Blockers and CAI
Which classes INCREASE aqueous OUTFLOW? Alpha Agonists, Prostaglandin Analogues, and Cholinergics
What are the combination drugs in Cosopt and Combigan? Cosopt: Timolol and Dorzolamide (CAI) Combigan: Timolol and Alphagan (Brimonidine- and Alpha Agonist)
If medical therapy for glaucoma fails, what are other possible choices? SLT, ALT, Surgery- Trabeculectomy, Shunts, Inserts
Why are Epinephrine drugs not used today for glaucoma? Ineffective, too many side effects (Sympathomimetic), red eyes, conjunctival deposits.
What color top for the Beta Blockers? Usually Yellow. Blue sometimes
What drugs are used for oral reduction of IOP (Two classes)? Hyperosmotics (Glycerine and Isosorbide) and CAI agents (Dorzolamide, Brinzolamide, Acetazolamide, Methazolalmide)
Which glaucoma drug may have neuro-protective properties? Brimonidine (Alphagan)
What are the side effects of hyperosmotic agents? Headache, nausea, and vomiting when given orally.
Name possible causes of poor patient compliance. Too many drops to manage, forget, can't afford new drops.
Created by: Leequa