Test Pharm Notes
Glaucoma Drugs (con't)
Mechanism of action
1. Inc corneoscleral outflow
Cholingeric agonists (pilocarpine)
2. Dec aq production
alpha agonists, beta blockers, CAIs
3. Inc uveoscleral outflow
PGs, alpha agonists
Rarely a primary medication, ~18% IOP
reduction; CA act in ciliary body epi (non
CAIs
pigmented & pigmented) --> bicarbonate -->
inc aq prod by inc Cl- and Na+ into posterior
chamber
1. Brinzolamide 1% (Azopt)
2. Dorzolamide 2% (Trusopt)
Oral CAIs
1. Acetazolamide (Diamox)
Given w/ liquid during acute angle closure
attacks, quick absorption into GI tract
2. Methazolamide (Neptazane)
Contraindication (s)
Sulfa allergies (CAIs are sulfa based), COPD,
pregnancy, liver dz, renal dz
Common: metallic taste, tingling in hands and
Side effect (s)
feet, metabolic acidosis (d/t dec in bicarbonate -> dec pH)
Most serious: aplastic anemia,
thrombocytopenia, agranulocytosis
Fatal: bone marrow suppression & aplastic
anemia
Other: malaise, weight loss, impotence,
depression, diarrhea, myopic shifts
First line tx for POAG, ~30% IOP reduction
(highest of all glc drugs), acts on PGF2a
Prostaglandin analogs
receptors on ciliary muscle --> reduction of
neighboring collagen (via metalloproteinases) -> dec resistance of uveoscleral
Dosage
qhs (better diurnal control)
1. Latanoprost (Xalatan 0.005%)
2. Travoprost (Travatan 0.004%)
3. Bimatoprost (Lumigan 0.3%)
Contraindication (s)
Conjunctival hyperemia worse, pruritis more
frequent
CME (cataract surgery post-op), active
inflammation, h/o HSV keratitis
Iris heterochromia (permanent), inc
Side effect (s)
pigmentation & growth of lashes
(phospholipase C activated), skin darkening
around the eyes, conjunctival hyperemia