Wk 15 - Hyperosmotics

Question 1

Hyperosmotic Clinical Use

Answer 1

Rapid reduction of elevated IOP in an emergency
= Acute angle-closure glaucoma
• Can be used when diamox is contraindicated due to sulfa allergy

Question 2

Hyperosmotic MOA

Answer 2

Increases blood serum osmolarity

• > Causes water to move from tissues into bloodstream
• Vitreal dehydration leads to reduced ocular volume and reduced IOP

Question 3

50% Glycerin (Osmoglyn)

Answer 3

Dosing: 1.5-3.0 mL/kg body weight
- Onset within 0.5 hour, max effect in 1-1.5 hours

Oral administration
o Lime flavored liquid
o Drink with crushed ice over 5-10 minutes
• Faster causes nausea

Caution in diabetics
o Large caloric load is metabolized into glucose
o Was contraindicated, now be sure to adjust diabetes medication

Systemic side effects
o	Nausea/vomiting
o	Diuresis, dehydration
o	Headaches, confusion
o	Congestive heart failure
o	Renal failure
o	Pulmonary edema

Contraindications
o Severe dehydration
o Heart, renal, or pulmonary disease
o Diabetes is a relative contraindication

Question 4

IV Hyperosmotics

Answer 4

Usually administered in hospital setting

Mannitol (Osmitrol)
o Safe for diabetics

Urea
o Rarely used
o Not safe for diabetics

Question 5

Topical Hyperosmotics

Answer 5

Clinical Use
• Treatment of corneal edema
• NOT used to treat glaucoma
o These don’t lower IOP

MOA
• Increase tonicity of tear film to draw water from the cornea

All formulations contain sodium chloride
a) Solution 2% or 5%
o	Dosing: 1-2 gtt q3-5 hours
o	5% somewhat more effective and prescribed more often
o	OTC
List
Adsorbonac - 2/5 - Alcon
Muro 128 - 2/5 -  B&L
Sochlor - 5 - OcuSoft

b) Ointment 5%
o	Dosing: qhs or q3-4 hours
o	Preservative free
o	OTC
List
Muro 128 = B&L
AK - NaCl = Akorn
Sochlor = OcuSoft

Side effects
• Burning, stinging, irritation
• Warn patient!