! Neuro Eye Pharm Flashcards
B blocking drugs
Betaxolol Timolol Metripranolol Levobunonol Carteolol
A2 adrenergic agonists
Apraclondine
Brimonidine
Prostagladin analogs
Latanoprost
Bimatoprost
Travoprost
Carbonic anhydrase inhibitors
Topical-brinzolamide, dorzolamide
Systemic-acetazolamide, methazolamide
Muscarinicagonists
Carbachol
Pilocarpine
Inhibitors of cholinesterase
Demecarium
Echothiophate
Iris circular muscle
Constricts pupil to cause miosis
Iris radial muscle
Dilated pupil to cause mydriasis
Effect is due to activation of a1 adrenergic receptors
Ciliary muscle
Causes accommodation of the eye to near vision
Opens up trabecular meshwork, improves outflow of aqueous humor into the canal of s helm, decreasing intraocular pressure
M3 receptors contract the muscle
Ciliary epithelium
Produces (secretes) aqueous humor
B receptor activation increases humor production
Ciliary body
Secretes aqueous humor
How does aqueous humor flow
Into space in front of iris through trabecular meshwork and exits via canal of schlemm
Blocking b adrenoreceptors associated with ciliary epithelium
Decreases secretion. Of aqueous humor
Blood vessels
In sclera arealso under autonomic control and influence aqueous drainag
B receptors and aqueous humor
Increase
A2 receptors and aqueous humor
Decrease
Carbonic anhydrase
Aqueous humor?
Contraction of ciliary muscle and aqueous humor 9muscarinic)
Improved outflow
Contraction of iris circulat muscle, (muscarinic)
Miosis an improved outflow
____ improves uveoscleral, or unconventional outflow
Prostagladin F2a
Contraction of iris radial muscle (a1), mydriasis
Decreased outflow (conventional outflow)
Glaucoma
Group of ocular disorders that lead to an optic neuropathy associated with loss of visual sensitivity and field
Whites or African Americans get glaucoma more
Blacks
Open or closed angle glaucoma more common
Open
When should a patient be treated for glaucoma
Increased IOP and optic disc changes and/or visual field defects
Goal of glaucoma treatment
Reduce IOP by 30% want is less than 21 mmHg
If two glaucoma meds are given. How far apart should administration be
Ten minutes
Does initial response to therapy dictate long term
No
If agents are to be changed
One day overlap
First line agents open angle glaucoma
Prostagladin analogues
B blockers-timolol
Brimonidine
Second line therapy open angle glaucoma
Pilocarpine
Apraclonidine
Topical carbonic anhydrase inhibitors
Last line therapy open angle glaucoma
Carbachol
Inhibitors of cholinesterase
Oral carbonic anhydrase
Why are B blockers used
Convince of dosing few side effects
Why is timolol the preferred beta blockers
Lacks local anesthetic effects (propranolol local anesthetic properties0
Generically available
Full antagonist
As effective as pilocarpine
MOAtimolol
Reducing the production of aqueous humor by the ciliary body by blocking B receptors
Adverse local effects of beta blockers
Stinging Dry eyes Blurred vision Blepharitis, keratiti, conjunctivitis -could be due to other things in the formulation and not the B blockers
Systemic adverse effects of b blockers
Can get systemic absorption
Heart-negative inotropy effect, bradycardia
Airway-bronchospasm
Hyperlipidemia
Exacerbation of hypoglycemia
May interact with orally given verapamil-increase risk of cardiac depression and heart block
Use with caution in patients with bradycardia, AV block heart failure, atherosclerosis, diabetes,
Prostagladin analogues
Latanoprost
Bimatoprost
Travoprost
Which prostagladin is most effective at lower IOP
Bimatoprost
Prostagladin analogues for IOP
More effective than B blockers
Given once daily at nighttime (1 drop)
Systemic side effects are not significant
Local side effects prostagladin analog
Corneal erosions
Conjunctival hypermedia
Iris hyperpigmentation(several months of therapy and is irreversible)
Hypertrichosis, hyperpigmentation around eye lashes and eyelids are reversible upon discontinuation of therapy
A2 agonists
Brimonidine-first line agent
Apraclonidine-frequent allergic reactions, development of tachyphylaxis
MOA a2 agonists
Decrease the rate of aqueous humor production
Adverse effects a2 agonists
Systemic-dizzy, Antigua, dry mouth, bradycardia, reduced blood pressure
Locals adverse effect a2 agonists
Allergic reaction (eyelid edema, itching, hypermedia)
How treat open angle glaucoma
- B blocker
- If intolerant to b blocker, use class alternative
- If contraindications to b blockers, switch to brimonidine or prostagladin
- If intolerance to prostagladin, use class alternative
- If contraindications to all first class agents,use topical carbonic anhydrase inhibitors (2nd line)
- if monotherapy fails, use a combo
- if intolerance or inadequate response to the combination therapy, use laser or a surgical procedure
Goal of treating closed angle glaucoma
Rapid reduction of IOP
Acute treat closed angle
Use systemic osmotic diuretics in preparation for surgery (IV mannitol)
Pilocarpine
Drug of choice for closed angle before surgery. It inducedmiosis
Surgical or laser iridectomy for closed angle
Produce a hole in the iris facilitating the humor outflow
What drugs are contraindicated in open angle
Glucocorticoids
Fenoldopam
Topical anti muscarinic drugs
Drugs contraindicated in closed angle (angle closure may be triggered by any drug that causes mydriasis)
Antimuscarinic drugs (topical, systemic)
Drugs with alpha adrenomimetics activity (topical)
Tricyclic antidepressants and serotonin-NE reuptake inhibitors (because of their potent antimuscarinic action)
