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Echothiophate iodide(phospholine iodide)oSystemic carbonic anhydrase inhibitorsMOAlower IOP by decreasing production of aqueous humorUsesLong term management of open angle glaucoma (not first line)Adverse effectsNervous system oMalaise, anorexia, fatigue, paresthesiasGIoReduced appetite, N/V/D, weight lossTeratogenic Acid base disturbances (acidosis)Electrolyte imbalances (hypokalemia)NephrolithiasisPreparationsAcetazolamide (Diamox, diamox sequels, dazamide)Dichlorphenamide (daranide)
Methazolamide (neptazane)oTopical carbonic anhydrase inhibitorsPreferred over PO Dorzolamide (trusopt)UsesoReducing IOP in pts with open angle glaucoma and ocular HTNMOA lowers IOP by decreasing aqueous humor productionAdverse effectsoOcular stingingoBitter taste oAllergic rxns oBlurred vision, tearing, dry eyes, photophobia+ timolol = cosopt/cosopt PFBrinzolamide (azopt)Effective as dorzolamide and better toleratedUsesoTopical tx of elevated IOP in pts with open angle glaucoma and ocular HTN Adverse effectsoBlurred visionoBitter taste + brimonidine = simbrinza oAlpha 2 agonists Apraclonidine (Iodipine)TopicalMOA lowers IOP by decreasing aqueous humor production but also increase uveoscleral flowUsesoShort term therapy in open angle glaucoma in pts not responding to other agentsoPre-op for laser trabeculoplasty or iridotomy Tachyphylaxis and allergic rxns limit long term useSide effectsoHeadache, dry mouth/nose, altered taste, conjunctivitis, tearing, blurred vision, local allergic rxns Brimonidine (alphagan)Only topical approved for long term reduction of elevated IOP in pts with open angle glaucoma or ocular HTN Similar effects to timololCan cross BBBAdverse effectsoHypotensionoDrowsiness ofatigue+ timolol = combigan+ brinzolamide = simbrinzaoOsmotic agents Agents MannitolUreaglycerinIsosorbide MOA make plasma hypertonic to intraocular fluid, drawing water from eye Rapid/significant IOP reduction UsesEmergency tx of acute closed angle glaucoma
Open angle use limited to pre-op periodAdverse effects Thirst, confusion, headache, diuresis, acute HF, potential subdural hematomaGlycerol can effect diabetes controlCan get rebound IOP spikes oChoice of drugs Topicals that lower IOP mainstay Prostaglandin analog is preferred as first line monotherapyIf not totally effective add BB, topical anhydrase inhibitor, selective A2AIf PA fails, discontinue and use another drug Some pts might mot respond to one PA but will to anotherCycloplegics and mydriaticsoCycloplegic paralysis of ciliary muscleoMydriatics dilate pupil oUsesFacilitate ophthalmic exams and surgeriesoBoth drugs are anticholinergics and adrenergic agonists oAnticholinergic actionsBlockade of muscarinic receptors causes contraction of iris sphincters and contraction of ciliary musclesRelaxation of iris can lead to elevated IOPoAnticholinergic usesAdjunct to measurement of refractionFacilitates observation of eye’s interiorPrevents lens from changing configuration during examIntraocular examIntraocular surgery