Glaucoma Drugs Flashcards by Beth Wilkinson

What groups of drugs are used to treat glaucoma?

Miotics
Sympathomimetics
Beta blockers
Carbonic Anhydrase Inhibitors
Prostaglandin Analogues
Hyperosmotic agents

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What are miotics also known as?

Parasympathomimetics
Cholinergic agonists

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How do miotics reduce IOP?

Increase the rate of aqueous outflow by causing increased trabecular meshwork tension due to ciliary muscle contraction

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What is the aim of glaucoma meds?

To reduce IOP, resulting in the maintenance of the current level of vision (bc ganglion cell axons are not being damaged due to high IOP)

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What are the contraindications for using miotics?

Anterior uveitis
Iris-mounted IOL
Iridectomy
Prev RD
Secondary glaucoma with extensive obstruction of outflow

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What are the side effects of miotics?

Sweating
Bradycardia
Bronchospasm
Hypersalivation
Intestinal colic
Frontal headache
Pseudomyopia (if remaining accommodation)
Constricted visual field
Retinal detachment

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What is Pilocarpine available as and what’s its dose?

2% minims
1/2/4% bottles
3-6x daily

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What is Pilocarpine’s mode of action?

direct-acting cholinergic agonist

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What is sympathomimetics mode of action?

Selective or non-selective adrenergic agonists which reduce aqueous humour production and sometimes increase outflow via the uveoscleral route

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What are the contraindications for sympathomimetics?

Closed angle glaucoma (mydriatic so closes the angle further)

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Sympathomimetic

What is the mechanism for Brimonidine?

Highly selective alpha2 adrenergic agonist

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Sympathomimetic

What is Brimonidine available as? What’s it’s dose?

Name and concentration

Alphagan 0.2% solution
2x daily

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Sympathomimetic

What are the possible side effects of Brimonidine?

Hyperaemia
FB sensation
Stinging
Blurred vision
Dry mouth
Headache
Fatigue/drowsiness
Allergic reaction
Reduction in heart rate and BP

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Sympathomimetic

What is the mechanism for Apraclonidine?

Selective alpha2 adrenoceptor agonist

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Sympathomimetic

What is Apraclonidine available as? What is it mostly used for?

Name and concentration

Iopidine 1% solution
Short term treatment e.g. post surgery

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What is Beta blockers mode of action?

Beta receptor adrenergic antagonists which reduce aqueous humour secretion

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Where are beta1 receptors located?

Heart and kidney

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Where are beta2 receptors located?

Bronchi

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What are the systemic side effects of beta blockers?

Bradycardia
Reduced BP
Respiratory difficulty

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What are the contraindications for beta blockers?

Obstructive airway disease (e.g. asthma)
Bradycardia
Heart block/failure

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Beta blocker

Is Timolol selective?

No - blocks both beta1 and beta2

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What are the potential ocular side effects of beta blockers?

Stinging
Burning
Gritty sensation

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Beta blocker

What is Timolol available as? What’s the dose?

Name and concentration

Timolol 0.25%/0.5% drops (2x daily)
Timoptol 0.25%/0.5% gel (1x daily)
Tiopex 0.1% gel (1x daily)

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Beta blocker

Is Levobunolol selective?

No - blocks both beta1 and beta2

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# Beta blocker What is Levobunolol available as? What's the dose? | Name and concentration

Levobunolol 0.5% drops (1-2x daily) Betagan 0.5% with 1.4% PVA vehicle drops (1-2x daily)

What does a PVA vehicle do?

Increases the viscosity of the drop, increases contact time of the drug and therefore prolongs release time/effectivity time

# Beta blocker Is Betaxolol selective?

Yes - only blocks beta1

# Beta blocker What is Betaxolol available as? What's it's dose? | Name and concentration

Betoptic 0.5% drops or 0.25% Ophthalmic suspension (2x daily)

What combination preparations does Timolol come in?

Combigan (Brimodone 0.2%, Timolol 0.5%) CoSopt (Dorzolamide 2%, Timolol 0.5%) Azarga (Brinzolamide and Timolol) Ganfort (Bimatoprost and Timolol) Xalacom (Latanoprost 50mg/ml and Timolol 5mg/ml) Duotrav (Travoprost and Timolol)

How do Carbonic Anhydrase Inhibitors work?

Stop carbonic anhydrase (enzyme) catalysing bicarbonate formation which reduces aqueous humour production | Bicarbonate is an important component in aqueous humour formation

What can carbonic anhydrase inhibitors be used in combination with?

Beta blockers Sympathomimetics

# Carbonic anhydrase inhibitor Why is Acetazolamide only available as a systemic treatment?

Poor lipid solubility and corneal penetration

# Carbonic anhydrase inhibitor What is Acetazolamide available as? | Name and concentration

Diamox 250mg tablets Diamox SR 250mg sustained release tablets Intravenous powder

# Carbonic anhydrase inhibitor What are the side effects of Acetazolamide?

Metallic taste Digit numbness Malaise/fatigue Weight loss Reduced libido and impotence GI tract irritation Altered renal function

# Carbonic anhydrase inhibitor What are the contraindications for Acetazolamide?

Pregnancy Liver disease Kidney disorder

# Carbonic anhydrase inhibitor What is Dorzolamide available as? | Name and concentration

Trusopt 2% solution Cosopt 2% with 0.5% Timolol

# Carbonic anhydrase inhibitor What are the side effects of Dorzolamide?

Localised ocular irritation FB sensation Stinging Blurred vision Conjunctivitis/lid inflammation Corneal oedema

# Carbonic anhydrase inhibitor When might Dorzolamide be a useful option?

If beta blocker ineffective If beta blocker contraindicated (heart and lung disease)

# Carbonic anhydrase inhibitor What is Brinzolamide available as? What's it's dose? | Name and concentration

Azopt 10mg/ml drop suspension Azarga (with Timolol)

What is the model of action of Prostaglandin Analogues?

Promotion of aqueous humour drainage via uveoscleral route by remodelling ciliary muscle extracellular space. This reduces collagen levels in ciliary muscle and surrounding sclera, resulting in reduced resistance to aqueous outflow

# Prostaglandin Analogue What is Latanoprost available as? What's it's dose? | Name and concentration

Xalatan 50mg/ml solution (drops) 1x daily at night Xalacom 50mg/ml with Timolol 5mg/ml 1x daily in morning

# Prostaglandin Analogue What are the side effects of Latanoprost?

Darkening of iris, lids and lashes Thickening of lashes and increase in number Mild conjunctival hyperaemia

# Prostaglandin Analogue What pathologies are associated with Latanoprost and Travoprost?

Cystoid Macular Oedema Anterior Uveitis Mild punctate epithelial staining Dendritic corneal epitheliopathy Herpes simplex keratitis

# Prostaglandin Analogue What is Travoprost available as? | Name and concentration

Travatan 40mg/ml solution Duotrav (with Timolol)

# Prostaglandin Analogue What are the side effects of Travoprost and Bimatoprost?

Darkening of iris, lids and lashes Thickening of lashes and increase in number Mild conjunctival hyperaemia Headache Photophobia

# Prostaglandin Analogue What is Bimatoprost available as? What's it's dose? | Name and concentration

Lumigan 300mg/ml or 100mg/ml drops 1x daily Ganfort (with Timolol)

# Prostaglandin Analogue What other use does Bimatoprost have?

Cosmetic lash growth (in US)

# Prostaglandin Analogue What is Tafluprost available as? What's it's dose? | Name and concentration

Saflutan 15mg/ml drops (single dose units) 1x daily

For Prostaglandin Analogues, which side effects remain and which reverse?

Iris darkening can continue after ceasing of treatment Lash and lid darkening normally reverses once treatment stopped

How do Hyperosmotic agents work?

An increase in blood plasma osmolarity causes fluid to move into plasma from the eye (and rest of the body), reducing IOP.

# Hyperosmotic agents What is Mannitol available as? | Concentration and Administration

20% solution administered intravenously

What are hyperosmotic agents used for?

Severely high IOPs that need quick short term reduction e.g. Acute AC, pre-op IOP reduction, post penetrating trauma IOP reduction

# Hyperosmotic agents What is Glycerol available as? | Concentration and Administration

50% solution administered orally

# Hyperosmotic agents What is the onset and duration of Mannitol?

Onset: 30-60 mins Duration: Up to 6 hours

# Hyperosmotic agents What is the onset and duration of Glycerol?

Onset: 15-30 mins Duration: 4-5 hours

# Hyperosmotic agents What is Isosorbide available as? | Concentration and Administration

45% solution administered orally

# Hyperosmotic agents What is the onset and duration of Isosorbide?

Onset: 30-60 mins Duration: 5-6 hours

What are the side effects of hyperosmotic agents?

Nausea and vomiting Dehydration Headache Confusion/disorientation Diuresis Congestive heart failure (if pre-disposed heart issues)

# Sympathomimetic How much can Brimonidine reduce IOP by?

~6.5mmHg

# Beta Blocker What effect does Timolol have on IOP?

25% reduction for 24 hours

# Beta Blocker What effect does Levobunolol have on IOP?

25% reduction for 24 hours

# Beta Blocker What effect does Betaxolol have on IOP?

Lower reduction than Timolol after first month (IOP higher than pxs on Timolol), but same after 1 year

# Prostaglandin Analogue What effect does Latanoprost have on IOP?

25-30% reduction

Glaucoma Drugs Flashcards

(63 cards)