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GLAUCOMA - Coggle Diagram
GLAUCOMA
TREATMENTS
-Betaxolol Ophthalmic Solution 0.5%(Betoptic®)
- Betaxolol Ophthalmic Suspension 0.25%(Betoptic S®)
- Timolol Ophthalmic Solution 0.25, 0.5% (Istalol®)
- Timolol Ophthalmic Gel Forming 0.25%, 0.5% (Betimol®)
- Levobunolol Ophthalmic Solution 0.25%, 0.5% (Betagan®)
COMBINATION
- Dorzolamide HCI & Timolol Maleate (Cosopt®)
-Dorzolamide HCI & Timolol Maleate (Cosopt® PF)
-Brimonidine Tartrate & Timolol Maleate ophthalmic solution 0.2%/0.5%
(CombiganTM)
MECHANSIM OF ACTION
- decrease the production of aqueous humor
- decrease the pressure inside the eyes (IOP)
- slows down optic nerve damage which greatly decrease the rate of visions loss
NONSELECTIVE AND SELECTIVE
- Betaxalol ( Beta-1 selective blocker)
- Timolol, Levobunolol ( non selective beta blocker)
DRUG INTERACTION
- Antihypertensives are the most likely to interact with topical beta-
blockers.
- Systemic beta-blockers can exacerbate hypotension or bradycardia when combined with a topical beta-blocker. Monitor blood pressure and heart rate in glaucoma patients.
-Calcium channel blockers may interact with topical beta-blockers and cause irregular beat.
SIDE & ADVERSE EFFECT
1) OCULAR SIDE EFFECT
-Burning/stinging on instillation –most common
- Transient blurred vision, reversible myopia, foreign body sensation,photophobia, itching, and ocular irritation
2) SYSTEMIC SIDE EFFECT
- hypotension
- increase plasma cholesterol level
- headache, insomia, impotence
CONTRAINDICATION
- avoid in astma, COPD- Timolol& Levobunolol
- avoid in cardiogenic shock, sinus bradycardia, second or third degree AV block
RECOMMENDED DOSING
- Betaxolol Ophthalmic Solution 0.5%(Betoptic®)
-Betaxolol Ophthalmic Suspension 0.25%(Betoptic S®)
- Timolol Ophthalmic Solution 0.25, 0.5% (Istalol®)
- Levobunolol Ophthalmic Solution 0.25%, 0.5% (Betagan®)
- Timolol Ophthalmic Gel Forming 0.25%, 0.5% (Betimol®)
-
PROSTAGLANDIN ANALOG
MEDICATION USED TO TREAT GLAUCOMA
- Latanoprost Opthalmic Solution 0.005% (Xalatan®)
- ❑ Bimatoprost Ophthalmic Solution 0.03% (Lumigan®)
- Travoprost Ophthalmic Solution 0.004% (Travatan Z ®)
MECHANISM OF ACTION
- It reduces the intraocular pressure (IOP) by increasing the outflow of intraocular fluid (aqueous humor) from the eye.
SIDE AND ADVERSE EFFECT
1) LATANOPROST
- Increase in brown pigmentation of the iris, Blurred vision, Burning and stinging, Foreign body sensation, Itching, Punctate epithelial keratopathy, Conjunctival hyperemia, Upper respiratory tract infection/cold/flu, Dry eye, Excessive tearing, Eye pain, Photophobia.
2) BIMATOPROST
- Conjunctival hyperemia, Growth Ocular burning of eyelashes, Ocular pruritus, Ocular dryness, Visual disturbance.
3) TRAVOPROST
- Increased pigmentation of iris
- Ocular hyperemia, Decreased visual acuity, Ocular discomfort, Foreign body sensation, Pain, Pruritus, Abnormal vision, Blepharitis, Blurred vision, Cataract, Conjunctivitis, Dry eye, Iris discoloration, Photophobia
WARNING & PRECAUTIONARY
- Unopened bottle – store in refrigerator. Do not freeze
- Opened bottle – keep in refrigerator/room temperature for up to 6 weeks.
RECOMMENDED DOSING
1) LATANOPROST
Open-angle glaucoma or ocular hypertension:
- 1 gtt in affected eye(s) qDay (once a day) in evening; not to exceed once daily
- Give optimal effect in evening
2) BIMATOPROST (LUMIGAN/ LATISSE)
Elevated Intraocular Pressure:
- Lumigan (0.01%): 1 gtt in affected eye qDay in evening
3) TRAVOPROST ( TRAVATAN/BONDULC)
Open-Angle Glaucoma:
- Ophthalmic solution 0.004%: Instill 1 gtt in affected eye qDay
-
CHOLINERGIC AGONIST
MEDICATION USED
1) PILOCARPINE
- Pilocarpine ophthalmic solution 0.25%, 0.5%, 1%,2%,4%, 6%, 8%, 10%
- Pilocarpine ophthalmic gel 4 %
2) CARBACHOL
- Carbachol Ophthalmic Solution 4%
MECHANISM OF ACTION
1) PILOCARPINE
- Acts through direct stimulation of muscarinic receptors and smooth muscle including the iris and secretory glands.
- Produce miosis and contracts the ciliary muscle
- Causing increased tension on scleral spur and opening of trabecular meshwork spaces to facilitate outflow of aqueous humor
- Outflow resistance is reduced, lowering intraocular pressure (IOP).
2) CARBACHOL
- Acts through muscarinic and nicotinic receptor.
- It mimics the effects of Ach
- Causing miosis and a spasm of accommodation in which the ciliary muscle of the eye remains in a constant state of contraction
SIGNIFICANT INDICATION
1) PILOCARPINE
- used to treat glaucoma
- drug of choice for emergency lowering of intraocular pressure of both open-angle and angle-closure
2) CARBACHOL
- as a miotic agent to treat glaucoma by causing pupillary contraction and a decrease in intraocular pressure.
SIDE AND ADVERSE EFFECTS
- Dim vision, especially at night or in darkened areas such as movie theaters.
-This is due to constriction of the pupil. Miotics increase drainage of intraocular fluid by making the pupil size smaller, thereby increasing the flow of intraocular fluid from the eye.
- Others adverse effect: sweating, headache, flushing, dizziness, chills, nausea, urinary frequency, rhinitis, diaphoresis.
WARNING AND PRECAUTIONARY
- Bradycardia: Cholinergic agonists can slow the heart rate, posing a risk for individuals with pre-existing bradycardia or heart block.
- Gastrointestinal Issues: These drugs may cause nausea, vomiting, diarrhea, and abdominal cramps, necessitating caution in patients with gastrointestinal disorders
TYPES OF GLAUCOMA
1) CLOSED ANGLE GLAUCOMA
- Referred as acute glaucoma
- Usually caused by stress, impact injury or medication
- Pressure inside the anterior chamber increase suddenly because iris is pushed over the area where aqueous fluid normally drains
- Symptoms: intense headache, difficulty concentrating, bloodshot eyes and blurred vision
2) OPEN ANGLE GLAUCOMA
- Called as chronic simple glaucoma
- Most common type of glaucoma
- IOP develops more slowly.
- Called “open-angle” because iris does not cover the trabecular meshwork.