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Glaucoma Medication Catagories.pptx
- 2. What Are The Types?
- 3. Antiglaucoma/Ocular hypotensive Agents in Use Aqueous Suppressors Outflow Facilitators
- 4. Antiglaucoma/Ocular hypotensive Agents in Use – Timolol(Glucomol) – Betaxolol – Levobunolol(betagan) • 2-agonist – Brimonidine(Alphagan P/Z) – Apraclonidine • Prostamides: --- Bimatoprost Aqueous Suppressors Topical • -blockers Outflow Facilitators Topical • Cholenergics/Miotics – Pilocarpine(Pilocar) • Prostaglandin analogues – Latanoprost(Xalatan) – Travaprost(Travatan) Systemic • CAIs (Carbonic Anhydrase Inhibitors) – Dorzolamide. – Brinzolamide
- 5. Anti Glaucoma Drugs at a Glance forcirculation BetaBlockers Alpha Agonists CarbonicAnydrous Inhibitors Lipids Cholinergics Selective Non Selective Timolol/ Levobunolol Betaxolol Brimonidine Dorzolamide Brinzolamid e Latanoprost Travoprost Bimatoprost Pilocarpine Group sympathomi matics / adrenergic sympathomi matics / adrenergic sympathomim atics /adrenergic Prostaglandins Prostamide Parasympathomimatic s/Miotics MOA ReducesAq Humor Production ReducesAq Humor Production (DUAL) Reduces Aq Humor Production& Increase Uveoschleral outflow ReducesAq Humor Production ReducesAq Humor Production enhances uveoschlera loutflow enhances uveoschler aloutflow (DUAL) enhances uveoschleral &Trabecular Meshwork outflow increaseTrabecular MeshworkOutflow Efficacy appx20% appx.15% appx20% appx.15‐20% appx.15 ‐ 20% appx.25 ‐ 30% appx.25 ‐ 30% appx.25 ‐ 35% appx.15 ‐20% AdverseEffects allergy, drowsiness, parasthesia, headache, SPK,metalic taste Iris Pigmentatio n,Growth of Eyelashes, Hyperaemia Iris Pigmentati on,Growth of Eyelashes, Hyperaemi a Iris Pigmentatio n, Growth of Eyelashes, Hyperaemia Browache, accomodative spasms, headache,nightvision problems Contraindicatio ns cardiac Insufficiency &Asthma cardiac Insufficiency Inflammator yConditions Inflammato ry Conditions Inflammator y Conditions Dosage BID BID BID /TDS QID OD atnight OD atnight OD atnight QID Others Shown to be Neuroprotecti ve inanima studies opens anterior chamber anglehence preferredfor angle closure Glaucoma
- 6. Pharmacologic Agents for Glaucoma Management Dru g Name Brand Name Formulation Dosage Notes BETABLOCKERS Clinical effect: decreases production of AH One of the most commonly used medications for treatment Betaxolol hydrochlorid e Betoptic Betoptic S 0.25%, 0.5% solution 0.25% suspension 1-2 drops BID 1 drop BID Carteolol Ocupress 1% solution 1 drop BID Nonselective: timolol, levobunolol, metipranolol, carteolol Levobunolol hydrochlorid e Betagan 0.25%, 0.5% solution 1-2 drops Q day- BID Beta1- selective: betaxolol Metipranolol Optipranolol 0.3% solution 1 drop BID Timolol Betimol , Istalol, 0.25%,0.5% solution 0.25%,0.5% gel-forming solution 1 drop Q day-BID 1 drop Q day Contraindications: Timoptic Timolol- XE Glucomol 1. All beta-blockers: sinus bradycardia, atrioventricular block (second or third degree), heart failure, or cardiogenic shock. 2. Nonselective beta- blockers: asthma, COPD
- 7. Pharmacologic Agents for Glaucoma Management contd….. Drug Name Brand Name Formulation Dosage Notes PROSTAGLANDINS Clinical effect: increases uveoscleral outflow; Bimatoprost may have additional effect on outflow at trabecular meshwork. One of the most commonly used medications for treatment. Adverse events: Pigmentation of the eye and eyelid as the most common form of adverse effects, eyelash effects. Avoid in those with active intraocular inflammation. Bimatoprost Lumigan 0.03% solution 1 drop Q day Latanoprost Xalatan 0.005% solution 1 drop Q day Travoprost Travatan, Travatan Z 0.004% solution 1 drop Q day
- 8. Pharmacologic Agents for Glaucoma Management contd….. Circulation Drug Name Brand Name Formulation Dosage Notes Carbonic Anhydrase Inhibitors Clinical effect: decreases production of AH Topical: used as alternative to monotherapy or adjunctive therapy Oral: used as adjunctive therapy . Acetazolamide Diamox Sequels 250-mg, 500- mg tablet/ER capsules Max: 1 g Q 24 h Brinzolamide Azopt 1% susp 1 drop TID Dorzolamide hydrochloride Trusopt 2% solution 1 drop TID Adverse Events: Caution in those with sulfonamide allergies, renal insufficiency Avoid using concurrent ophthalmic and oral CAIs
- 9. Pharmacologic Agents for Glaucoma Management contd….. Drug Name Brand Name Formulation Dosage Notes Cholinergics Direct-acting agonists Clinical effect: increases AH outflow Good efficacy, but not commonly used due to frequent adverse effects and frequent dosing. Adverse events: Excessive miosis may induce angle-closure glaucoma secondary to pupillary block May produce systemic cholinergic effects Carbachol Miostat 0.01% solution 1 mL to anterior chamber of eye Pilocarpine Pilopine HS 4% gel 1/2-in ribbon on lower conjunctiva at bedtime Cholinergic inhibitor Echothiophat e iodide Phospholine Iodide 0.03%, 0.06%, 0.125%, 0.25% solution 1 drop BID
- 10. Pharmacologic Agents for Glaucoma Management contd….. Drug Name Brand Name Formulation Dosage Notes Clinical effects: increases AH uveoscleral outflow Apraclonidine efficacy wears off in <1 month Adverse Events: Rate of allergic reactions limits use of apraclonidine Sympathomimetics Alpha2-selective adrenergic agonists Apraclonidine hydrochloride Iopidine 0.5%, 1% solution 1-2 drops TID Brimonidine tartrate Alphaga n P/Z 0.1%, 0.15%, 0.2% solution 1 drop TID Nonspecific adrenergic agonists Dipivefrin hydrohloride Propine 0.1% solution 1 drop BID Epinephrine 0.5%, 1%, 2% 1-2 drops BID Max: maximum. Clinical effects: increases conventional outflow (primary); chronic use decreases AH production (secondary) Epinephrine formulation no longer available. Dipivefrin is a prodrug of epinephrine. Adverse Events: Limited use due to frequency of adverse effects.Monitor for angle-closure glaucoma,cardiovascular and metabolic effects AH: aqueous humor; Source: References 1,2. CAIs: carbonic anhydras e inhibitors ; COPD: chronic obstructiv e pulmonary disease; ER: extende d release; solution