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HYPEROSMOTIC AGENTS
HYPEROSMOTIC AGENTS ORAL:
1.ORALGLYCEROL
2. ISOSORBIDE
INTRAVENOUS:
1.MANNITOL
2.UREA
INTRODUCTION:
• Hyperosmotic agents are being used since 25 years
• They are of great value in reducing the intraocular pressure preoperatively
• And in transient glaucomas like glaucoma in traumatic hyphemas
MECHANISM OF ACTION:
• Increase the osmolity of plasma leading to absorption of water from ocular tissues,this process is
transient till the osmotic equilibrium is reestablished
• It may also decrease the aqueous humour production through central nervous system pathway
• Ideal hyperosmotic agents should have low molecular weight and should remain in the extra cellular
fluid space
• The drug should not enter into the eye
ORAL AGENTS(INTRO):
• They are administered easily
• They are safe in patients with borderline cardiac status
• But they are slow in their action
• Drug absorption is also variable
• And so it is less predictable
1. ORAL GLYCEROL:
• Most widely used drug
• Usually administered as 50% solution in a dose of 1.5 to 3ml/kg
• Glycerol has an intense sweet taste
• It remains in the extracellular space and poorly penetrate the eye
• Repeated doses can be given but some patients develop vomiting
• Diabetic patients may have problem due to caloric value ,osmotic diuresis and dehydration
• Glycerol is metabolized in liver and produces 4.32 Kcal/g
2. ISOSORBIDE:
• It is an effective oral hyperosmotic agent administered as 45% solution
• It is different from isosorbide dinitrate which is a drug used in angina
• isosorbide is a dihydric alcohol derived from sorbitol
• It is less likely to produce nausea and vomiting but it produces diarrhea
• It doesn’t provide calories
• Therefore it is quite safe in diabetic patients
• Dose- 1.5 to 4ml/kg
3. ETHYL ALCOHOL:
• Because of unwanted central nervous system effect this agent is not used clinically
• Ethylalcohol produces hypotonic diuresis by inhibiting production of antidiuretic
hormone
• Dose of absolute alcohol is 1.0 to 1.8 ml/kg body weight
• And it is diluted with appropriate mixtures
INTRAVENOUS AGENTS:
• They are rapid in action and more effective
• They are usually administered over 45 to 60 minutes
1. MANNITOL:
• 20% concentration of mannitol is less irritating to the blood vessels
• And it is the agent of choice for intravenous theraphy
• It is not metabolized and is excreted unchanged in urine
DOSE
• 2.5 to 7ml/kg of 20% solution is given intravenously
• It is not necessary to administer the full dose of the drug
• When the IOP falls to the desired level the infusion can be terminated
• Onset of action is in 30 minutes
• Duration of action is 6 hours
ADVANTAGES:
• It penetrate the eye poorly and mannitol is quite useful in inflammed eyes
• Extravasation of the drug from intravenous line will not cause necrosis
• More effective and it has rapid action
• Can be used in diabetic patients
• It is not contraindicated in renal failure patients
DISADVANTAGES:
• There is greater likelihood of cellular dehydration because of its confinement to the
extracellular space
• Cardiovascular overload and pulmonary oedema are more common
2. UREA:
• It is less effective than mannitol
• It penetrates the eye readily
• It is administered as 30% solution
• Dose of 2 to 7ml/kg
DISADVANTAGES:
• When the drug is cleared from circulation rebound increase intraocular pressure is possible
• Old solutions decompose to ammonia.urea is contraindicated in renal failure
• Only the fresh solutions are used and it should be warmed to compensate for the endothermic
reaction of dissolving drug
• If the drug extravasates it can cause thrombophlebitis and skin necrosis
Because of the side effects it is used less frequently than mannitol
USES
1. ANGLE CLOSURE GLAUCOMA:
• In addition to miotic,beta-blocker and oralglycerol,IV mannitol can terminate the acute attack in
most of te cases
2. SECONDARY GLAUCOMA:
• In this glaucoma hyperosmotic patients are used to prepare the patient for surgery and to prevent
optic nerve damage
• In many instances the glaucoma is transient as in trauma,laser iridectomy,laser trabeculoplasty
etc
• In these transient conditions hyperosmotic agents can be given two to four times per day
3. CILIARY GLAUCOMA(MALIGNANT):
• In malignant glaucoma hyperosmotic agents are very useful
• They are administered in conjunction with phenylephrine,atropine,beta-blockr and acetazolamide
• Hyperosmotic agents absorb water from vitreous and vitreous face is moved backward
• Normal aqueous from posterior to anterior chamber is regained
PRECAUTIONS:
• Hyperosmotic patients should administer with caution in patients with cardiac,renal and hepatic
disease
• Cellular hydration in cerebral tissue can cause disorientation
• Suddural haematoma is due to shrinkage of cerebral cortex and stretching of vessels resulting in
rupture and hematoma formation
• Many of the side effects are dose related and minimum needed dose is used to avoid them
THANK YOU

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Hyperosmotic agents

  • 2. HYPEROSMOTIC AGENTS ORAL: 1.ORALGLYCEROL 2. ISOSORBIDE INTRAVENOUS: 1.MANNITOL 2.UREA
  • 3. INTRODUCTION: • Hyperosmotic agents are being used since 25 years • They are of great value in reducing the intraocular pressure preoperatively • And in transient glaucomas like glaucoma in traumatic hyphemas
  • 4. MECHANISM OF ACTION: • Increase the osmolity of plasma leading to absorption of water from ocular tissues,this process is transient till the osmotic equilibrium is reestablished • It may also decrease the aqueous humour production through central nervous system pathway • Ideal hyperosmotic agents should have low molecular weight and should remain in the extra cellular fluid space • The drug should not enter into the eye
  • 5. ORAL AGENTS(INTRO): • They are administered easily • They are safe in patients with borderline cardiac status • But they are slow in their action • Drug absorption is also variable • And so it is less predictable
  • 6. 1. ORAL GLYCEROL: • Most widely used drug • Usually administered as 50% solution in a dose of 1.5 to 3ml/kg • Glycerol has an intense sweet taste • It remains in the extracellular space and poorly penetrate the eye • Repeated doses can be given but some patients develop vomiting • Diabetic patients may have problem due to caloric value ,osmotic diuresis and dehydration • Glycerol is metabolized in liver and produces 4.32 Kcal/g
  • 7. 2. ISOSORBIDE: • It is an effective oral hyperosmotic agent administered as 45% solution • It is different from isosorbide dinitrate which is a drug used in angina • isosorbide is a dihydric alcohol derived from sorbitol • It is less likely to produce nausea and vomiting but it produces diarrhea • It doesn’t provide calories • Therefore it is quite safe in diabetic patients • Dose- 1.5 to 4ml/kg
  • 8. 3. ETHYL ALCOHOL: • Because of unwanted central nervous system effect this agent is not used clinically • Ethylalcohol produces hypotonic diuresis by inhibiting production of antidiuretic hormone • Dose of absolute alcohol is 1.0 to 1.8 ml/kg body weight • And it is diluted with appropriate mixtures
  • 9. INTRAVENOUS AGENTS: • They are rapid in action and more effective • They are usually administered over 45 to 60 minutes
  • 10. 1. MANNITOL: • 20% concentration of mannitol is less irritating to the blood vessels • And it is the agent of choice for intravenous theraphy • It is not metabolized and is excreted unchanged in urine DOSE • 2.5 to 7ml/kg of 20% solution is given intravenously • It is not necessary to administer the full dose of the drug • When the IOP falls to the desired level the infusion can be terminated • Onset of action is in 30 minutes • Duration of action is 6 hours
  • 11. ADVANTAGES: • It penetrate the eye poorly and mannitol is quite useful in inflammed eyes • Extravasation of the drug from intravenous line will not cause necrosis • More effective and it has rapid action • Can be used in diabetic patients • It is not contraindicated in renal failure patients
  • 12. DISADVANTAGES: • There is greater likelihood of cellular dehydration because of its confinement to the extracellular space • Cardiovascular overload and pulmonary oedema are more common
  • 13. 2. UREA: • It is less effective than mannitol • It penetrates the eye readily • It is administered as 30% solution • Dose of 2 to 7ml/kg
  • 14. DISADVANTAGES: • When the drug is cleared from circulation rebound increase intraocular pressure is possible • Old solutions decompose to ammonia.urea is contraindicated in renal failure • Only the fresh solutions are used and it should be warmed to compensate for the endothermic reaction of dissolving drug • If the drug extravasates it can cause thrombophlebitis and skin necrosis Because of the side effects it is used less frequently than mannitol
  • 15. USES 1. ANGLE CLOSURE GLAUCOMA: • In addition to miotic,beta-blocker and oralglycerol,IV mannitol can terminate the acute attack in most of te cases 2. SECONDARY GLAUCOMA: • In this glaucoma hyperosmotic patients are used to prepare the patient for surgery and to prevent optic nerve damage • In many instances the glaucoma is transient as in trauma,laser iridectomy,laser trabeculoplasty etc • In these transient conditions hyperosmotic agents can be given two to four times per day
  • 16. 3. CILIARY GLAUCOMA(MALIGNANT): • In malignant glaucoma hyperosmotic agents are very useful • They are administered in conjunction with phenylephrine,atropine,beta-blockr and acetazolamide • Hyperosmotic agents absorb water from vitreous and vitreous face is moved backward • Normal aqueous from posterior to anterior chamber is regained
  • 17. PRECAUTIONS: • Hyperosmotic patients should administer with caution in patients with cardiac,renal and hepatic disease • Cellular hydration in cerebral tissue can cause disorientation • Suddural haematoma is due to shrinkage of cerebral cortex and stretching of vessels resulting in rupture and hematoma formation • Many of the side effects are dose related and minimum needed dose is used to avoid them