Unit 3-Ocular Pharmacology Flashcards
Pilocarpine
Drug class
Direct Muscarinic agonist
Pilocarpine
Mechanism
Pupillary constriction, increased aqueous outflow
Pilocarpine
Uses
Treatment of glaucoma (both open angle and acute closed angle); cataract surgery
Pilocarpine
Side effects
- Decreased vision when patient has cataracts due to miosis and headache
- Bronchospasm, salivation, nausea, vomiting,
diarrhea, abdominal pain, tenesmus, lacrimation, sweating - Used less frequently today due to side effects
Echothiophate
Drug class
Indirect muscarinic agonist
Echothiophate
Mechanism
Irreversibly binds cholinesterase
Echothiophate
Uses
Treatment of glaucoma
Echothiophate
Side effects
- Bronchospasm, salivation, nausea, vomiting,
diarrhea, abdominal pain, tenesmus, lacrimation, sweating - Used less frequently today due to side effects
Atropine
Drug class
Antimuscarinic
Atropine
Mechanism
Pupillary dilatation; paralysis of ciliary body
Atropine
Uses
Improve discomfort during active eye inflammation (uveitis)
Atropine
Side effects
- Ataxia, nystagmus, restlessness, mental confusion, hallucination, violent and aggressive behavior, insomnia, photophobia, urinary retention
- Very long acting so not used unless severe inflammation
Scopalamine
Drug class
Antimuscarinic
Scopalamine
Mechanism
Pupillary dilatation; paralysis of ciliary body
Tropicamide
Drug class
Antimuscarinic
Tropicamide
Mechanism
Pupillary dilatation; paralysis of ciliary body
Tropicamide
Uses
Most commonly used cycloplegia for eye exams
(due to short half life)
Tropicamide
Side effects
Ataxia, nystagmus, restlessness, mental confusion, hallucination, violent and aggressive behavior, insomnia, photophobia, urinary
retention
Edrophonium
Drug class
Nm agonist
Edrophonium
Mechanism
Destroys acetylcholinesterase
Edrophonium
Uses
Diagnoses Myasthenia Gravis
Epinephrine
Drug class
Direct adrenergic agonist
Epinephrine
Mechanism
Dilation of episcleral vessels –> increased aqueous outflow
Epinephrine
Side effects
Extrasystoles, palpitation, hypertension, myocardial infarction, trembling, paleness, sweating
Hydroxyamphetamine
Drug class
Indirect adrenergic agonist
Hydroxyamphetamine
Mechanism
Releases NE
Hydroxyamphetamine
Uses
Separates 1st and 2nd from 3rd order neuron dysfunction in Horner’s syndrome; positive dilation means 1st or 2nd order, an ominous sign
Cocaine
Drug class
Indirect adrenergic agonist
Cocaine
Mechanism
Prevent reuptake of NE
Cocaine
Uses
Use initially to confirm diagnosis of Horner’s Syndrome (pupil will not dilate)
Phenylephrine
Drug class
Direct α1-agonist
Phenylephrine
Uses
Dilate pupil for eye exam and cataract surgery
Phenylephrine
Side effects
- Extrasystoles, palpitation, hypertension, myocardial infarction, trembling, paleness, sweating
- Caution in elderly patients: at 10% can cause cardiac side effects
Brimondine tartrate
Drug class
Direct α2-agonist
Brimondine tartrate
Mechanism
Suppresses aqueous humor production through action of cAMP in non-pigmented ciliary epithelium
Brimondine tartrate
Uses
Primary agent for treatment of glaucoma
Brimondine tartrate
Side effects
May cause follicular conjunctivitis; use with MAOi can cause fatigue/drowsiness
Timolol
Drug class
β-blocker
Timolol
Mechanism
Reduce intraocular pressure by reducing aqueous production at the ciliary process
Timolol
Uses
Second line treatment of glaucoma
Timolol
Side effects
- Bradycardia, hypotension, syncope, palpitation, congestive heart failure, bronchospasm, mental confusion, depression,
fatigue, lightheadedness, hallucinations, memory impairment, sexual dysfunction, hyperkalemia - Contraindicated in CHF, asthma;
- bradycardia over time may produce tachyphylaxis
Levobunolol
Drug class
β2-blocker
Levobunolol
Mechanism
Reduce intraocular pressure by reducing aqueous production at the ciliary process
Levobunolol
Uses
Second line treatment of glaucoma
Levobunolol
Side effects
Bradycardia, hypotension, syncope, palpitation, congestive heart failure, bronchospasm, mental confusion, depression,
fatigue, lightheadedness, hallucinations, memory impairment, sexual dysfunction, hyperkalemia
Betaxolol
Drug class
β1-blocker
Betaxolol
Mechanism
Reduce intraocular pressure by reducing aqueous production at the ciliary process
Betaxolol
Uses
Second line treatment of glaucoma
Latanoprost
Drug class
Prostaglandin analog
Latanoprost
Mechanism
Increase uveoscleral outflow
Latanoprost
Uses
Primary agent for treatment of glaucoma
Travoprost
Drug class
Prostaglandin analog
Travoprost
Mechanism
Increase uveoscleral outflow
Travoprost
Uses
Increase uveoscleral outflow
more effective in African Americans
Travoprost
Side effects
Eyelash growth, change in iris color
May cause cystoid macular edema in cataract surgery;
Bimatoprost
Drug class
Prostaglandin analog
Bimatoprost
Mechanism
Increase uveoscleral outflow
Bimatoprost
Uses
Primary agent for treatment of glaucoma
Bimatoprost
Side effects
Eyelash growth, change in iris color
May cause cystoid macular edema in cataract surgery and activate herpes
Unoprostone isopryl
Drug class
Prostaglandin analog
Unoprostone isopryl
Mechanism
Increase uveoscleral outflow
Unoprostone isopryl
Uses
Glaucoma
(Least effective)
Unoprostone isopryl
Side effects
Eyelash growth, change in iris color
Nifedipine
Drug class
Ca-channel blocker
Nifedipine
Mechanism
Increases ocular perfusion at nervehead
Nifedipine
Uses
Low-tension glaucoma
(not widely used)
Dorzolamide
Drug class
Carbonic anhydrase inhibitor
Dorzolamide
Mechanism
Reduce aqueous production via interfere with the active transport of Na through Na-K-ATPase pump
Dorzolamide
Uses
Second line glaucoma therapy
Dorzolamide
Side effects
Red eyes, lid allergies
Contraindicated in sulfonamide allergies
Acetazolamide
Drug class
Carbonic anhydrase inhibitor
Acetazolamide
Mechanism
Reduce aqueous production via interfere with the active transport of Na through Na-K-ATPase pump
Acetazolamide
Uses
Oral agent used for advanced glaucoma and with cataract surgery
Used only if other topical therapy fails.
Acetazolamide
Side effects
Paresthesia, fatigue, drowsiness, depression, diarrhea, metaboliv acidosis, electrolyte changes
Anaphylaxis, blood dyscrasias
Brinzolamide
Drug class
Carbonic anhydrase inhibitor
Brinzolamide
Mechanism
Reduce aqueous production via interfere with the active transport of Na through Na-K-ATPase pump
Brinzolamide
Uses
Second line glaucoma therapy
Brinzolamide
Side effects
Red eyes, lid allergies