Packet 3: CAI & PG analogs

Question 1

Acetazolamide: other name

Answer 1

Diamox or diamox Seqels

Question 2

Acetazolamide:

Answer 2

Systemic CAI’s

Question 3

Methazolamide: other name

Answer 3

Neptazane

Question 4

Methazolamide:

Answer 4

systemic CAI’s

Question 5

Dorzolamide: other names

Answer 5

Trusopt 2%

Question 6

Dorzolamide:

Answer 6

topically applied CAI’s

Question 7

Brinzolamide: other names

Answer 7

Azopt 1%

Question 8

Brinzolamide:

Answer 8

topical CAI

Question 9

Cosopt

Answer 9

Timolol .5% & Dorzolamide (trusopt) 2%

Question 10

Simbrinza

Answer 10

Brimonidine .2% (a2 agonist) & Brinzolamide: 1% (topical CAI)

Question 11

Effects of systemic CAI

Answer 11

decrease IOP

• no action in the normal eye
• metabolic acidosis

Question 12

What can you use in acute angle closure?

Answer 12

I.V. diamox

Question 13

What is diamox?

Answer 13

Acetazolamide

Question 14

what has less side effects? Acetazolamide or Methazolamide?

Answer 14

Methazolamide has less side effects

Question 15

How common are adverse effects with systemic CAI’s?

Answer 15

very common 30-80% - therefore very high drop out rate

Question 16

when can we see paresthesias?

Answer 16

systemic CAI

Question 17

what are other side effects of systemic CAI;s

Answer 17

headaches, drowsy, fatigue, dizzy, GI irritations, cramping, NVD, anorexia, muscle weakness, malaise, acidosis,

• myopia
• aplastic anemia (RARE)

Question 18

contraindications to systemic CAI

Answer 18

cirrhosis of liver, kidney dysfunction, SULFA, COPD, renal calculi, pregnancy, chronic non-congestive angle closure, HYPOKALEMIA

Question 19

Dorzolamide: compared to acetazolamide?

Answer 19

we only need 1/200th the conc. of dorzolamide topically to get the same concentration in the CB as acetazolamide. therefore less toxicities but also less effective.
- might be due to isozymes

Question 20

Dorzolamide: 2% at 3 x/day vs. 2% at 2x/ day

Answer 20

both showed about 22-24 % decrease in IOP

Question 21

when is the max effect of dorzolamide?

Answer 21

2 hours

Question 22

was there a decrease after 2 years with continuous use of dorzolamide?

Answer 22

yes, after 2 years there was still a 23% decrease

Question 23

Brinzolamide 1% effective compared to dorzolamide 2%

Answer 23

show to be equally effective

-therefore less dosage but still equally effective with less systemic toxicities

Question 24

Dorzolamide, timolol, and betaxolol, what is most effective?

Answer 24

timilol

Question 25

dorzolamide, brinzolamide, timolol: what is most effective?

Answer 25

timilol

Question 26

what is only available in suspension?

Answer 26

brinzolamide

Question 27

Toxicities with topical CAI's

Answer 27

Brinzolamide has more blurred vision and less ocular irrigation than dorzolamide:

Question 28

what controls nocturnal IOP better? b blockers or topical CAI;s?

Answer 28

CAI's can control nocturnal IOP better than b blockers

Question 29

Latanoprost: other name

Answer 29

Zalatan .005%

Question 30

Latanoprost:

Answer 30

PG f2a analog | -inactive prodrug (activated by the cornea)

Question 31

does latanoprost have good diurnal control?

Answer 31

yes, with bedtime administration

Question 32

what type of outflow does latanoprost effect?

Answer 32

uvealoscleral outflow

Question 33

how does latanoprost effect the outflow?

Answer 33

reduction in collagen levels in the ciliary muscle and sclera, increasing production of MMPs which will also decrease collagen levels

Question 34

what are PG derived from?

Answer 34

arachidonic acid

Question 35

toxicities of latanoprost:

Answer 35

blurred vision, burning, hyperemia, FBS, punctate keratopathy, increased iris pigmentation, increased growth and periocular pigmentation, CME (cystoid macular edema) and cataracts, aphakia -NOT HYPERPLASIA OF MELANIN

Question 36

Brimatoprost: other name

Answer 36

Lumigan .01%

Question 37

Is Brimatropost active or inactive?

Answer 37

its the only PG that is already active

Question 38

what is the only already activated PG?

Answer 38

Brimatoprost (Lumigan)

Question 39

Latisse

Answer 39

.003% PG analog - cosmoses for eyelash hypotrichosis

Question 40

Travoprost: other name

Answer 40

Travatan 0.004% solution

Question 41

Tafluprost: other name

Answer 41

Zioptan 0.0015%

Question 42

Travaprost:

Answer 42

PG analog: inactive prodrug

Question 43

Zioptan: what is it?

Answer 43

PG analog = Tafluprost

Question 44

Unoprostone: other name

Answer 44

Rescula 0.15%

Question 45

Rescula:

Answer 45

Unoprostone

Question 46

Which PG is discontinued?

Answer 46

Unoprostone/ Rescula

Question 47

5 new approaches to treatment against neuroprotection:

Answer 47

1. Aminogaunidine: only in animals 2. Brimonidine: a2 agonist 3. Memantine: NMDA blockers: decrease excitability and help prevent cell death 4. Reseveratrol: decreases cell death: anti-oxidant/ neuroprotective 5. Rho Kinase inhibitors: decrease tone in the contractile TM outflow and increase outflow

Question 48

inhibit NOS synthesis: =

Answer 48

neuro protection

Question 49

Mannitol: other name

Answer 49

Osmitrol I.V.

Question 50

what is an osmotic given via I.V.

Answer 50

Mannitol

Question 51

Adverse effects of Osmotic agents:

Answer 51

decrease CSF, headache, dry mouth, thirst, hyper osmotic coma (same as high glucose), CHF, pulmonary edema, muscle cramps and edema.

Question 52

maximum effect with mannitol?

Answer 52

30-60 min

Question 53

maximum effect in Glycerin:

Answer 53

about 60 minutes

Question 54

what is the safer osmotic?

Answer 54

glycerin

Question 55

glycerin: other name

Answer 55

osmoglyn

Question 56

how is osmoglyn given? I.V. or oral?

Answer 56

oral

Question 57

how do osmotic work?

Answer 57

dehydration of tissues including the vitreous and CSF

Question 58

what do effectiveness of osmotics work?

Answer 58

effect depends on the number of particles

Question 59

when do we use osmotic agents?

Answer 59

acute angle closure & pre/post surgery