Pharamacological therapy: Cholinergic agent

Question 1

What are cholinergic agents?

Answer 1

• parasympathiomimetics/ miotics
• 4th line to treat POAG
• direct/ indirect acting chlingeric agents

Question 2

MOA of Pilocarpine

Answer 2

• stimulates M3- receptors of ciliary body
• constriction ciliary muslce
• widening spaces in trabecular meshwork
  = increases in aq humour outflow + reduces IOP

Question 3

adm and avabilability of Pilocarpine

Answer 3

• 4 times daily - IO P lowering only lasts 6hrs

- 1% 2% 4% concentrations

Question 4

Will higher concentrations be needed ?

Answer 4

• patients with dark irides to obtain adequate IOP reduction

Question 5

Pilocarpine in PACG

Answer 5

• NB to delay until IOP controlled
• worsen angle closure by causing anterior displacement of lense
• pilocarpine can be given to break pupillary block
• instil one drop twice in an hr

Question 6

Adverse effect of pilocarpine

Answer 6

• induce miosis
  contraction ciliary muscle cause lense to displace forward = accomodation spasm + myopia = brow ache
• pupillary constriction = night vision

Question 7

Who should pilocarpine be avoided in ?

Answer 7

• severe myopia - increases risk retinal detachment

Question 8

Systemic effects pilocarpine

Answer 8

• N, V, D

- bradycardia