Therapeutics - Glaucoma 2
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What is the brand name for Brinzolamide?
What is the brand name for Dorzolamide HCl?
When are oral carbonic anhydrase inhibitors (-zolomide) indicated for open angle glaucoma?
When patients fail on or cannot tolerate other agents
Is a CAI in combo for open angle glaucoma more efficacious?
No information available
What is the most common reason for DCing oral CAIs?
What are the common AEs for oral CAIs?
- Metabolic acidosis
- Paresthesias –tickling sensation
- Renal calculi
- Bone marrow depression
Why are CAIs not first line for Open angle glaucoma?
Metabolic acidosis AE
What groups should you use caution in when treating with Oral CAIs for the treatment of open angle glaucoma?
Elderly, Sulfa allergy, respiratory acidosis, pulmonary disorders, renal calculi, electrolyte imbalance, renal/hepatic disease, DM
What medications cautioned with oral CAIs in the treatment of open angle glaucoma?
- Diuretics (may lead to HYPOkalemia)
- Salicylates (increase risk of acidosis)
What are the oral CAIs available for open angle glaucoma?
- Acetazolamide (Diamox Sequels)
What is the dosage form for Acetazolamide (Diamox Sequels)?
What is the dosage form for Methazolamide?
What is the MOA for Cholinergics in the treatment of open angle glaucoma?
- Parasympathomimetic effects causing miosis (Pupillary cosntriciton)
- Opens TM
What is the place of therapy for Cholinergics in the treatment of open angle glaucoma?
3rd and 4th line agents
Why are Cholinergics not commonly used for open angle glaucoma?
Frequent dosing and significant ADEs
What is one of the more significant ADEs for Cholinergics in the treatment of open angle glaucoma?
Excessive miosis leading to Closed angle glaucoma and papillary block
What are the Cholinergics available for open angle glaucoma?
- Carbachol (Miostat)
- Pilocarpine (Isopto Carpine and Pilopine HS)
- Echothiophate iodide (Phospholine Iodide)
What is the brand name for Carbachol?
What is the brand name for Pilocarpine?
Isopto Carpine and Pilopine HS
What is the brand name for Echothiophate iodide?
What is the dosage form for Carbachol (Misostat)?
What is the dosage form for Pilocarpine (Isopto Carpine)?
1%, 2% and 4% solution
What is the dosage form for Pilocarpine (Phospholine Iodide)?
Which Cholinergic for the treatment of open angle glaucoma is not recommended for ambulatory care and why?
Carbachol (Miostat) because it is injected
What are the sympathomimetics for treatment of open angle glaucoma?
- Alpha 2 agonists: Apraclinidine and Brimonidine
- Non-specific agents: (Dipivefrin)
What are the Alpha 2 agonists for the treatment of open angle glaucoma?
- Apraclonidine HCl (iopidine)
- Brimonidine tartate (Alphagan P)
What are the non-specific alpha agonists for the treatment of open angle glaucoma?
- Dipivefrin HCl (Propine)
- Epinephrine (not available stateside)
What is the MOA of Alpha 2 agonists in the treatment of open angle glaucoma?
- Decrease AH production
- Brimonidine also increases AH outflow
What is the place in open angle glaucoma therapy of Alpha 2 agonists?
- Brimonidine = first line
- Apraclonidine = short term adjunctive therapy because efficacy wanes after 1 month
When should Alpha 2 agonists be used with caution in the treatment of open angle glaucoma?
- When used with depressants like alcohol, barbiturates, anti-anxiety and sedatives (sedation)
- MOAIs (hypertensive crisis)
What is the MOA of Epinephrine and Dipivefrin in the treatment of open angle glaucoma?
- Increase AH outflow through conventional and non-conventional pathways
- Long term use may decrease AH production
What is Dipevefrin?
Prodrug of epinephrine
Why is Dipevefrin rarely used to treat open angle glaucoma?
Frequent ocular ADEs and serious systemic SE
When is Dipevefrin used for open angle glaucoma?
Failure or intolerance for other options
What are the absolute CIs for Dipevefrin?
- Closed angle glaucoma
- Causes Mydriasis (opens iris up too much)
How can you improve efficacy and safety of ophthalmic open angle glaucoma drugs?
- Eyelid closure (ELC) – close eye for 2-3 minutes, tip head down and do not blink or squeeze eyelid
- Nasolacrimal occlusion (NLO) - Apply pressure to lacrimal duct to lessen systemic side effects
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