Glaucoma Meds Flashcards
Effects on aqueous humor flow
Beta receptor stimulation=increase in inflow
alpha adrenergic stimulation, alpha 2 adrenergic stimulation, beta receptor blocking, DA blocking, and adenylate cyclase stimulation = decrease aqueous inflow
Risk factors for open angle glaucoma
Main: elevated IOP, african or hispanic descent, FHX, older age, thinner central corneal thickness
Possible: systemic HTN, DM, myopia, low diastolic perfusion pressures
Drugs that may induce or potentiate glaucoma
Corticosteroids-ophthalmic, systemic, inhaled/nasal
opthalmic anticholinergics
vasodilators
cimetidine
Beta blockers for glaucoma
Timolol (Timoptic)
q12-24h dosing
IOP lowering 20-35%
MOA: decrease production of aqueous humor
nonselective is better than selective BBs
AE: minimal local AE(stinging, dry eyes, corneal anesthesia, blepharitis, blurred vision)
Systemic AE (decrease in HR and BP, bronchospasm, masked sx of hypoglycemia, CNS sedation
CI: asthma, hypoTN, bradycardia, unstable HF, 2nd or 3rd degree heart block; careful if on digoxin, amiodarone, diltiazem, or verapamil becuz HR is already decreased
Prostaglandin analogs in glaucoma
Travapost (Travatan)
q24h dosing
IOP lowering 28-30%
MOA: increase outflow of aqueous humor
AE: increase iris pigmentation, growth of eyelashes; less common dryness, visual disturbances, burning, eye pain
Comments: first line alt to BBs; replace contacts 15 min after dosing
Alpha2 adrenergic agonists
Brimonidine (Alphagan)
Q8-12h dosing
IOP lowering 14-25%
MOA: decrease production of aqueous humor
AE: local: blepharoconjunctivitis; systemic: HA, dry mouth, fatigue
Comments: typically used as adjunct in combo with other agents
Carbonic Anhydrase Inihbitors (CAIs)
Dorzolamid (Trusopt)
Q8-12h dosing
IOP lowering 17-20%
MOA: decrease production of aqueous humor
AE: burning, stinging, itching, dry eyes, bitter taste
CI: sulfa allergy
Comments: replace contacts 15 min after dosing
Oral CAIs
IOP lowering 20-30%
AE: malaise, fatigue, anorexia, wt loss, depression, decreased libido, blood dyscrasias
Comments: 30-60% of pts can tolerate it; reserved as third line therapy
BB/CAI combo
Dorzolamide/Timolol
q12h dosing
IOP lowering > any agent alone
MOA: decrease production of aqueous humor
AE: ocular burning, bitter taste; less common-blurred vision, superficial punctate keratitis
Comments: replace contacts after 15 min
Cholinergics
Pilocarpine (IsoptoCarpine)
q6-12h dosing
IOP lowering 20-30%
MOA: increase outflow of aqueous humor via ciliary muscle contraction
AE: miosis, frontal HA, browache, periorbital pain, eyelid twitching; systemic effects- diaphoresis, NVD, urinary infrequency, bradycardia, SLUD
Tx of angle closure glaucoma
Not common but emergency d/t vision loss
Tx with laser iridotomy and BB, a2 agonist, prostaglandin analog, systemic CAI, or hyperosmotics
