Pharmacological therapy: Ocular hypotensive lipids

Question 1

Why are ocular hypotensive agents considered a 1st line agent in some countries?

Answer 1

• safety + efficacy

- cost is not a major factor

Question 2

What are 4 available agents which are a SAHPRA indication for both POAG + ocular hypertension ?

Answer 2

1. Tafluprost - bensalkonium CL free soln
2. Latanoprost
3. Travoprost
   = analogues prostaglandin F2alpha + agonists prostanoid FP receptor
   = lower IOP = increase aq humour outflow through uveoscleral pathway
4. Bimatoprost

Question 3

MOA of bimatoprost

Answer 3

• prostamide analog
• lower IOP - activating prostamide -R in uveosclral pathway
• increase outflow through trabecular meshwork

Question 4

MOA of uveoscleral outflow

Answer 4

unkown

• stimulates prostanoid FP + prostamide - R in ciliary body
• remodelling extracellulae matrix
• permeable to aq humour
• increase aq humour outflow through ciliary muscles

Question 5

How are they adm and DOA?

Answer 5

• once daily at bedtime = NOT INCREASE TWICE DAILY = decrease effectiveness
• provide consistent reduction IOP over 24 hr period

Question 6

Side effects of ocular hypotensives

Answer 6

• well tolerated + rarely cause systemic side effects

Question 7

Local effects of ocular hypotensive lipids

Answer 7

1. Conjunctival hyperaemia - caused by vasodilatory effect scleral blood vessels
2. stinging on installation
3. increase in iris pigmentation - patients multicoloured irides on LT pg analog therpay
4. deepening of upper eyelid sulcus
5. hypertrichosis
6. darkening eye lashes

Question 8

MOA of increase in iris pigmentation as local effect

Answer 8

• mutlicoloured irides on LT pg analog therapy
• act on melanocytes of iris
• irides = darker = increased production melanin in iris
• only cosmetic effect - may affect product selection when choosing monocular therapy

Question 9

In which patients should OHL be used with caution?

Answer 9

1. worsen uveitis + herpetic keratitis
2. cystoid macular ordema - intraocular inflamm , aphakic, pseudophakic
   patients history intraoperative complications
   risk macular oedma

Question 10

What should patients be counselled on ?

Answer 10

• potential a/e
• appropriate adm
• latanoprost/ tafluprost = refrigerate unopened meds
• once latanoprost openes - stored room temp - 6w
• tafluprost - single use containers - stored at room tep upt 28D