Glaucoma Drops Flashcards
Pilocarpine
- Decrease in IOP
- How many drops when pt has acute angle closure and exception
- Adverse effects
- Caution
- Contra
15-25% decrease
- 3 drops over 30 minutes UNLESS pressure is over 50.
- Browache, accomodatite spasm, misosis, shallowing of AC.
- Caution in people over 40, high myopia, history of uveitis.
- Pts with any glaucoma types other than OAG.
Ester and amide based prostaglandins
Ester based- Latanaprost, travaprost, tafluprost. Quickly hydrolyzed to active forms, don’t need as high of conc.
Amide based- Bimatoprost. Less hydrolyzed, need a higher concentration.
MOA of Latanoprostene Bunod
Releases NO that relaxes TM along with increasing uveal outflow.
Decreases IOP by 7.5-9mmHg
Dense prostaglandin receptors are located where
Ciliary muscle and iris sphincter
How do prostaglandins affect eye lashes
Hypertrichosis (eyelash change) and trichomegaly (increase in lash number) also increases pigment.
May change iris stromal pigmentation.
Latisse concentration
Bimatoprost 0.03%
No contraindications
Same SE as other prostaglandins
dose: Brush on eyelash base qd with applicator.
Rescula side effects, IOP decrease, and dose
3-4 mmHg drop
1 drop BID OU
Bruning, hyperemia
IOP decrease in Rhopressa and Rocklatan
Rhopressa is 25-30 %
Rocklatan is 34 %
Rocklatan includes
Rhopressa and latanoprost.
ROCK inhibitors
Onset of action
SE
30 minutes
Hyperemia from vasodilation
Dose of BB
1 drop qam or BID. Effective in blunting AM rise. RX OU and see back in 1 month.
How do topical and oral BB interact
Pt already taking oral BB? Topical will have a decreased effect
BB Ocular side effects
Hyperemia
Stinging
Hypoasthesia
Allergic rxn
What drop can be used off label to tx myokymia
BB stabilizes membrane stage 4
BB contra and caution
Contra- Heart or respiratory conditions
Caution- depression, diabetics.
**Always measure baseline pulse and BP before Rx.
Percentage of B2 and B1 receptors in the CB
75-90% B2
10-25% B1
Apraclonidine/Iopidine Contra Side effects Onset How does it effect Horners
Contra- allergic to clonidine, taking MAOIs
Side effects- FDA cat C, mydriasis, blanching.
Onset- 1 hour, 3 is max effect. Good to use for emergency closed angle in office.
A2>1
Horners- Reversal of anisocoria (will dilate horners pupil) and improve ptosis.
Adrenergic agonist IOP decrease
25% (same as BB, CAI topical is less, CAI oral is more)
Brimonidine/Alphagan P
- Preservative
- Contra
- caution
- Side effects
- Fun facts
- percentage dose
Purite preservative Contra under 2 Caution MAOI, tricyclics and CVD. Side effects: Miosis, blanching. A2>>>>A1 Neuroprotective mechanism 0.1% to 0.15% for Alphagan, 0.15% to 0.2% for brimonidine generic
Ocular and systemic side effects of adrenergic agonists
Ocular- Iopidine causes mydriasis, alphagan P causes miosis. Stinging Blanching Allergic rxn
Systemic-
Dry mouth, nasal congestion
Bradycardia and fatigue
Category C
Apraclonidine/Iopidine
Topical CAIs
Oral CAIs
caution in prostaglandin
Why is brinzolamide better than dorzolamide
Brinzolamide- BID, fewer side effects bc higher affinity to CAII. Suspension so stings less.
Dorzolamide- TID, more side effects bc not as high affinity, stings more.
Topical CAI
side effects
Contra
caution
Burning, blur, SPK, tearing, allergic reactions to sulfa, metallic taste, irreversible K edema in pts with endothelial compromise.
Contra in sulfa allergies or pts taking oral CAI
Caution in pregnancy (cat C), endothelial damage or renal.
Oral CAI
- use
- side effects
- contra
- caution
- Use: Short term emergency control of IOP
- Side effects: transient myopia, metallic taste, tinnitus, tingling, GI, blood clot.
- Contra in sulfa allergies, sickle cell, cirrhosis, chronic angle closure
- Caution: Pregnancy and children
Cosopt
Combigan
Simbrinza
Cosopt- dorzolamide and timolol
Combigan- Brimonidine and timolol
Simbrinza- Brinzolamide and Brimonidine
CAI MOA
Inhibitis CA II, which decreases bicarbonate, which decreases aqueous secretion.
