Pharm: Drugs used in Glaucoma - Konorev Flashcards
what is the favored b-blocker used for glaucoma?
- *timolol**
- lacks local anesthetic effects
- full beta-antagonist (reducing aqueous humor production)
- available as generic
- shown to be as effective as pilocarpine
what are the first line agents used to treat glaucoma?
- beta-blockers
- prostaglandin analogues (brimatoprost, latanoprost, travoprost)
- brimonidine (reduces IOP as effectively as timolol)
what are the second line therapies used to treat glaucoma?
- pilocarpine
- apraclonidine
- topical anhydrase inhibitors
what is the MOA of timolol?
reduces the production of aqueous humor by the ciliary body by blocking b-receptors
what are the adverse LOCAL effects of b-blockers on the eye?
- stinging
- dry eyes
- blurred vision
- blepharitis (inflam of eyelids)
what are the adverse SYSTEMIC effects of b-blockers on the eye?
- heart: negative inotropic effects, bradycardia
- airways: bronchospasm
- may interact w/ VERAPAMIL
what drug class more efficiently reduces IOP than b-blockers?
prostaglandin analogs
- brimatoprost, latanoprost, travoprost
MOA for which drug class?
- reduce IOP by increasing the uveoscleral and trabecular outflow of aqueous humor
prostaglandin analogs
- brimatoprost, latanoprost, travoprost
what drug class:
- given once daily, at night (1 drop)
- no significant systemic side effects
- local side effects: corneal erosions, conjunctival hyperemia, iris hyperpigmentation, hypertrichosis
prostaglandin analogs
- brimatoprost, latanoprost, travoprost
what drug MOA:
- decrease the rate of aqueous humor production
- as effective as timolol
brimonidine
what are the adverse effects of brimonidine?
- systemic: dizziness, fatigue, dry mouth, bradycardia, decreased BP
- local: allergic rxn (eyelid edema, itchingm hyperemia)
what is the first step in treating open angle glaucoma?
start with b-blocker
if intolerant of specific b-block, or contraindications, what med should you try next?
prostaglandins or brimonidine
if intolerance to all first class agents, what should you use next?
topical carbonic anhydrase inhibitors (second-line agents)
- if monotherapy fails, try combination therapy
what should you do if intolerance or inadequate response to combination therapy?
laser or surgical procedure
what are the goals of tx in CLOSED angle glaucoma?
rapid reduction of IOP
- acute: use system hyperosmotic diuretics in preparation for surgery (oral glycerin, IV mannitol)
what is the drug of choice before surgery for closed angle glaucoma?
pilocarpine: induces miosis (constriction)
what agents reduce humor production?
- b-blockers
- a2-agonists
- carbonic anhydrase inhibitors
what drugs induce/potentiate increased IOP in open angle glaucoma?
- glucocorticoids
- topical antimuscarinic drugs
what drugs induce/potentiate increased IOP in closed angle glaucoma?
angle closure may be triggered by any drug that causes MYDRIASIS (dilation)
- antimuscarinic drugs (topical)
- a1-adrenomimetic activity (topical)
what is the most effective prostaglandin analog at lowering IOP?
brimatoprost
