Cap Colors and Glaucoma Drop Overview

Question 1

Tan

Answer 1

Anti-infectives

Question 2

Pink

Answer 2

Anti-inflammatories / Steroids

Question 3

Red

Answer 3

Mydriatics / Cycloplegics

Question 4

Grey

Answer 4

NSAIDs

Question 5

Green

Answer 5

Miotics

-pilocarpine

Question 6

Light Blue / Yellow

Answer 6

Beta Blocker 0.25% / 0.5 %

• Betoptic = Betaxolol 0.25 susp has light blue cap
• Betimol, Istalol, and Timolol (0.5%) are yellow
• Carteolol (Ocupress - 1%) is yellow
• Ocudose is light blue / yellow depending on dose
• Timolol 0.25% is yellow

Question 7

Dark Blue

Answer 7

Beta Blocker Combos

• Cosopt (dorzolamide / timolol)
• Combigan (.2 brimonidine / .5 tim)

Question 8

Purple

Answer 8

Adrenergic Agonists

- apraclonidine, brimonidine

Question 9

Orange

Answer 9

CAIs

• acetazolamide, methazolamide
• dorzolamide, brinzolamide

Question 10

Turquoise

Answer 10

Prostaglandin Analogs

Question 11

Acute Treatment

Answer 11

Alpha 2 agonist
Apraclonidine
-acute angle closure ; 20-25% reduction ; TID alone, BID in combo

Miotic
Pilocarpine
-acute angle closure with IOP 60 or less , secondary / pigmentary glaucoma ; 15-25% reduction ; solution is q4h

Systemic CAI
acetazolamide, methazolamide
-acute angle closure , secondary glaucoma ; 40-50% reduction for aceta , Meth less effective, dropping with 3-6 mm Hg decrease ; A two 250 tabs q6h , M 25-100 mg q8h

Systemic Hyperosmotic
Glycerin, mannitol, urea
-rapid reduction in emergency like acute angle closure ; can be used when Diamox (acetazolamide) is contraindicated due to sulfa allergy ; 50% glycerin is oral, mannitol and urea are IV

Question 12

Chronic Treatment - First Line - Monotherapy

Answer 12

Prostaglandin Analog
latana, taflu, trava, bimataprost
-all decrease IOP by about 30% ; 1 gt qhs

Alpha 2 agonist
brimonidine
-primary open angle glaucoma ; 20-30% reduction ; TID alone, BID in combo

Beta Blocker
timolol maleate / hemihydrate
-POAG, steroid iop response, some secondary glaucomas
-qday in am, not effective overnight (would use CAI to help with that) ; gold standard for reduction

Beta Blocker + CAI Combos
Cosopt (2 dorzolamide / .5 timolol) - 27% reduction, BID
Combigan (.2 brimonidine / .5 timolol) - BID ; better reduction than either alone, though not as good as two separately taken - but better compliance

Alpha 2 agonist + CAI Combo
Simbrinza (1 brinzolamide / .2 brimonidine) -21-35% reduction ; TID alone

Question 13

Chronic Treatment - Added Therapy

Answer 13

Alpha 2 agonist
brimonidine
-primary open angle glaucoma ; 20-30% reduction ; TID alone, BID in combo

Prostaglandin Like
unoprostone
-3-4 mm Hg reduction ; BID

Topical CAI
dorzolamide, brinzolamide
-primary open angle glaucoma, ocular hypertension
D 20-25% reduction, TID alone, BID in combo
B 15-20% reduction, TID alone, BID in combo
-great addition to PGA therapy or beta-blocker therapy

Question 14

Preservative Free Meds

Answer 14

tafluprost
cosopt pf (dorz / tim)
ocudose pf (timolol)