PPT Flashcards
treatment for open angle glaucoma?
first line - 360 selective laser trabeculoplasty
first line pharm is prostaglandin analogues
second line pharm are BB, carbonic anhydrase inhibitor and sympathomimetics
examples of prostaglandin analgoues
latanoprost
travoprost
moa of prostaglandin analogues?
increases uteroscleral outflow to decrease IOP
SE of prostaglandin analogues?
increased eyelash length
brown pigmentation of the eye
blurred vision
stinging/irritation of eye
caution of prostaglandin analogues?
may compromise respiratory function
interactions with prostaglandin analogues?
NSAIDs
use of other prostaglandins
examples of beta blockers used in glaucoma?
timolol and betaxolol
MOA of BB used for glaucoma?
timolol is non selective but betaxolol is selective for B1. both decrease aqueous humour production
examples of sympathomimetics used in glaucoma?
brimodine
moa of brimodine?
alpha 2 agonist which decreases aqueous hummer production and increases outflow
brimodine cautions?
Cerebral insufficiency; coronary insufficiency; depression; postural hypotension; Raynaud’s syndrome; severe cardiovascular disease; thromboangiitis obliterans
SE of brimodine?
common - Asthenia; drowsiness; dry eye; eye discomfort; eye disorders; eye inflammation; gastrointestinal disorder; hyperaemia; hypersensitivity; pulmonary reaction; sensation of foreign body; taste altered; vision disorders
rarer - hyperaemia
examples of carbonic anhydrase inhibitor?
dorzolamide
acetazolamide
benzolamide
example of miotic drug used to increase trabecular outflow/
pilocarpine
moa of pilocarpine?
acts on M3 receptor in iris muscle which contracts it n increases trabecular outflow
what % of pilocarpine is used in acute glaucoma?
4% in brown eyes and 2% in blue eyes
management of acute glaucoma?
lie pt on back
pilocarpine eyedrops
oral acetazolamide
analgesia and antiemetic if required
which BB is used for acute glaucoma?
timolol
MOA of carbonic anhydrase inhibitor for glaucoma?
inhibits CA which lowers blood pH, lowers bp, intracranial and intraoptic pressure
SE of acetazolamide?
low sodium and potassium, numbness, tinnitus, ataxia, depression, dizziness, fatigue, flushing, headache. nausea, paraesthesia, taste disturbance, loss of appetite
rare - Steven johnson syndrome
definitive Tx of acute glaucoma?
laser peripheral iridotomy
cautions for acetazolamide?
Renal impairment
Liver impairment
Allergies to sulphonamides
Adrenal insufficiency
Breast feeding mothers
what does acetazolamide interact with?
topiramate = metabolic acidosis
