Dementia and Glaucoma Pharm Flashcards
Acetylcholinesterase Inhibitors General Characteristics
Contraindications (2) Adverse Effects (4) Warnings (2)
Bradycardia or Cardiac conduction effects
Use with drugs that cause bradycardia or alter AV node
Nausea
Vomiting
Diarrhea
Weight loss
Monitor weight while on drug
Titrate dose up if re-initiating drug after stopping
Donepezil
MOA, Dosing Frequency, Formulations (2) Indication, Contraindication, Adverse Effects (2)
Acetylcholinesterase inhibitor
Once daily
Tablet
Oral Dissolving Sublingual Tablet
Alzheimer’s Dementia
Piperidine derivative allergy
AchE effects
Insomnia
Galantamine
MOA, Dosing Frequencies (2) Formulations (3) Indication, Warnings (3)
Acetylcholinesterase inhibitor
Twice daily (tablet, liquid) Once daily (capsule)
Tablet
Liquid solution
Capsule
Alzheimer’s Dementia
Bromide allergy
GI Ulcers
Bladder outflow obstruction
COPD/Asthma
Rivastigmine
MOA, Dosing Frequency, Formulations (3) Indications (2) Contraindication
Acetylcholinesterase Inhibitor
Twice daily
Capsule
Liquid solution
Transdermal patch**
Alzheimer’s Dementia
Parkinson’s Dementia
Carbamate allergy
AchE Renegerator
Example, MOA, Indications (2) Drug Combination (3)
Pralidoxime
Remove phosphorous group from AchE active site
AchE inhibitor overdose
Regenerating AchE in cases of severe adverse effects
Atropine
Pralidoxime
Benzodiazepine
Memantine
MOA (3) Indication, Adverse Effects
NMDA glutamate receptor antagonist
Binds intra-pore Magnesium site
Only works under conditions of excessive NMDA stimulation
Adjunct to AchE inhibitors for Dementia
(or solo if adverse effects intolerable)
Limited adverse effects
Open Angle Glaucoma Pathologic Features (4)
Increased Intraocular Pressure
Optic neuropathy
Retinal neuron apoptosis
Axonal degeneration
Narrow Angle Glaucoma Pathologic Features (2) Anatomical Predispositions (3) Types with Descriptions (2)
Intermittent blockage of trabecular meshwork by iris
Fluctuating intraocular pressure
Shallow anterior chamber
Narrow cornea/iris angle
Tight contact of pupil and lens
With Pupillary block
Tight contact of iris and lens pushes iris forward to block outflow
Without Pupillary block
Ciliary processes push iris forward to block outflow
Beta Blockers Used In Glaucoma
Examples (5) Mechanism of Action (2)
First line agents for glaucoma
Timolol (most used) Betaxolol Metipranolol Levobunolol Carteolol
Reduce aqueous humor production from ciliary body
Local anesthetic effect with timolol
Beta Blockers Adverse Effects
Local (4) Systemic (4) Drug Interaction
Eye stinging
Dry eyes
Blurred vision
Blepharitis, Keratitis, Conjunctivitis
Bradycardia
Bronchospasm
Hyperlipidemia
Hypoglycemia
Verapamil
Prostaglandin Analogs Used in Glaucoma
Examples (3) MOA (2) Dosing, Side Effects (4)
Bimatoprost (most effective)
Litanoprost
Travoprost
Decreases IOP by increased uveoscleral outflow
More efficiently reduce IOP than Beta blockers
Once daily drops at night
Corneal erosions
Conjunctival hyperemia
Iris hyperpigmentation (irreversible)
Hypertrichosis (reversible eyelid pigment)
Bromonidine
Mechanism of Action (2) Adverse Effects (6)
alpha-2 Agonist
Decrease rate of aqueous humor production
Dizzy Fatigue Dry Mouth Bradycardia Hypotension Local allergic reaction
Closed Angle Glaucoma Treatments
Acute (2), Pre Surgery, Humor Decreasers (3) Surgery
Oral Glycerin
IV Mannitol
Pilocarpine (induces miosis)
Beta blockers
Bromonidine
Carbonic Anhydrase Inhibitors
Iridectomy: hole in iris for outflow
Drugs Contraindicated in Glaucoma Open Angle (2) Closed Angle (3)
Glucocorticoids
Topical Antimuscarinics
Topical Antimuscarinics
Topical alpha-1 Agonists
SNRI Antidepressents (antimuscarinic)
