BHS 254.1 – Course I
Notetaker: Laurel Hammang
Date: 08/15/13, 1st hour
Page1
We’ll go over systemic agents first, then all drugs needed to know as an OD.
We’ll learn every single ocular agent we can use as ODs, and those that are used to treat ocular conditions
that ophthalmologists can prescribe.
Under miscellaneous material on myico, pdf with a list of states in US and providences in Canada and
what ODs can prescribe in those states. Optometry is a legislative profession, meaning ODs require state
legislation that allows ODs certain privileges—different in each state. Be active in your local optometric
association to ensure you can do all things we’re trained in!
Clicker Questions: Drug of the Day
1. What type of pharmacologic agent is homatropine? Cycloplegic
2. What type of pharmacologic agent is Pred Forte (prednisolone acetate)? Anti-inflammatory
steroid
Continuing case study…
“Four days later…” (pg 2)
JR had increased IOP, possibly from uveitis
Steroid responder (prednisolone) a topic anti-inflammatory steroid can over time increase IOP. This
causes same problems as glaucomanerve damage, vision loss
Drug-induced glaucoma
Very high risk of toxicity with this type of drug
Timoptic XE (brand) (timolol (generic)): Antiglaucoma drug to decrease IOP
0.5% is highest concentration an OD would prescribe
Class: beta adrenergic receptor blocker
blocks beta receptors everywhere (non-selective)
Topical administration: less systemic effects
What does this do in the eye?
Block beta receptors at CB that when stimulated increase aqueous production
What else might happen?
Beta receptors in lungs: Increase respiration rate and depth, dilate bronchioles
Beta blockers would inhibit/constrict bronchioles
bad for asthma or other respiratory issues
Beta receptors in heart: Increase HR, BP, cardiac output
Beta blockers could kill a pt with congestive heart failure (requires faster HR to
keep pt alive, this drug would slow his HR)
HTN: beta blockers are frequently prescribed to lower BP
Why taper anti-inflammatory steroid? So inflammatory response doesn’t rebound
IOPs have increased 1 mo later
Timolol isn’t working, so try a new type in same category
Alphagan (brimonidine): alpha agonist- stimulates alpha adrenergic receptors (very selectiveagonist for alpha 2 only)
Alpha 2: stimulates alpha 2 receptors in ciliary body to decrease aqueous production
Complications for this new drug?
May overflow and stimulate some alpha 1 receptors, especially if treated systemically
Alpha 1: (trapicamide, phenylephrine) eyes may dilate, vasoconstriction, increase BP, HR
Conjunctival vessels may also constrict (“Visine to get the red out!”)
1 mo later, IOP increases even moreemergency!
Must decrease pressure quickly and figure out why it’s so high
Laser trabeculoplasty can be performed by some ODs in KY and OK only
Medical management by most ODs
Increase Timoptic: blocks aq production
Iopidine (apraclonidine), a higher concentration: blocks aq production
Trusopt (dorzolamide) topical drop to decrease aqueous production w/ a new
mechanism:
carbonic anhydrase enzyme inhibitor to block aqueous production by moving
bicarb ions from CB into aqueous humor to increase fluid secreted into aqueous
What else can we do?
Increase aqueous outflow!
Ie Xalatan: prostaglandin analog to increase outflow to decrease IOP
Much better approach/more effective for glaucoma patients, but it’s part of an
inflammatory process that would make JR’s anterior uveitis worsenot an option for JR
Other options:
Diamox (acetazolamide) (similar to dorzolamide): oral or injection gives a more
complete, faster response
Not good long term because main toxicity is “generally feeling lousy”
Recognize JR is a steroid responder, so stop Pred Forte, which is causing a build up of
crap in trabecular meshworkscavengers in TM activity is inhibited, outflow blocked
Lotemax (loteprednol): anti-inflammatory steroid instead of Pred Forte
Much, much less risk of increased IOP, but also not as effective
Ok for JR because his uveitis is improving
Also continue Diamox, Alphagan, Timoptic XE
*The more complicated the treatments, the less likely a patient complies.
Clicker Questions: Drug of the Day
1. What is the main reason homatropine was prescribed for this patient? To prevent Ciliary spasm.
2. What type of pharmacologic agent is Timoptic XE? Beta Adrenergic receptor blocker