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41 Cards in this Set
- Front
- Back
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Alpha 2 Agonists
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Brimonidine
Aproclonidine (aka Iopidine) |
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Aproclonidine (Iopidine) profile
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-hardly used for POAG bc of allergy
-Tachyphylaxis (rapid development of tolerance) |
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Aproclonidine MoA
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- decrease AH production at the ciliary body
- late increase in uveoscleral outflow |
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Aproclonidine ocular SE
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- conjunctival blanching
- lid retraction - mydriasis |
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Aproclonidine systemic SE
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- dry mouth and nose
- taste abnormality |
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Aproclonidine Contraindications
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- Cardiovascular disease
- MAOIs - NSAIDs |
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Aproclonidine use other than for APOAG
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- used after surgery to control IOP spikes
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Brimonidine (Alphagan) Characteristics
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- more selective
- more lipid soluble - penetrates the CNS better - high melanin binding - neuroprotective (?) |
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Brimonidine MoA
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- same as aproclonidine
- decrease AH production at the ciliary body - late increase in uveoscleral outflow |
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Brimonidine ocular SE
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- conj blanching
- eyelid retraction - miosis |
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Brimonidine systemic SE
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- Dry mouth / nose
- dermatitis |
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Beta blockers include:
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- timolol
- betaxolol - levobunolol - metipranolol - carteolol |
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Timolol characteristics
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- non selective B antagonist
- MSA ? - No hypotensive effect @ night - Long acting - well tolerated - contralateral effect |
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Timolol MoA
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- decrease AH production by blocking beta adrenergic sites
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Timolol ocular SE
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- stinging
- punctate keratitis (maybe from preservatives?) - decreased corneal sensitivity - dry eyes - decrease ONH perfusion |
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Timolol systemic SE
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- respiratory distress
- asthma - cardiovascular - masked hypoglycemia - altered plasma lipids (decrease in HDL) |
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Timolol Contraindications
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- bronchial asthma
- labile diabetes - thyroid disease - cardiovascular disease? |
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Timolol Drug Interactions
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- Systemic beta blockers
- Ca2+ channel blockers - beta agonists - NSAIDs |
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Betaxolol Ocular SE
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- stinging
- punctate keratitis (maybe from preservatives?) - decreased corneal sensitivity - dry eyes - decrease ONH perfusion |
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Levobunolol Ocular SE
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- stinging
- punctate keratitis (maybe from preservatives?) - decreased corneal sensitivity - dry eyes - decrease ONH perfusion |
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Metipranolol Ocular SE
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- stinging
- punctate keratitis (maybe from preservatives?) - decreased corneal sensitivity - dry eyes - decrease ONH perfusion |
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Betaxolol Characteristics
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- selective beta 1 antagonist (cardioselective)
- MSA ? - Inactive metabolite (only one of bb) - neuroprotective - better for pts with asthma |
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Betaxolol MoA
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- decrease AH production by blocking beta adrenergic sites
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Betaxolol Systemic SE
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- respiratory distress
- asthma - cardiovascular - masked hypoglycemia - altered plasma lipids (decrease in HLD) |
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Betaxolol Contraindications
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- bronchial asthma
- labile diabetics - thyroid disease - cardiovascular disease ? |
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Betaxolol drug interactions
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- systemic beta blockers
- Ca2+ channel blockers - heart meds - beta agonists - NSAIDs |
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Levobunolol Ocular SE
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- stinging
- punctate keratitis (maybe from preservatives?) - decreased corneal sensitivity - dry eyes - decrease ONH perfusion |
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Levobunolol Systemic SE
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- respiratory distress
- asthma - cardiovascular - masked hypoglycemia - altered plasma lipids (decrease in HDL) |
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Levobunolol Drug Interactions
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same as timolol, metipranolol, and betaxolol
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Metipranolol characteristics
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- non-selective B antagonist
- active metabolite - long acting |
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Levobunolol characteristics
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- non selective bb
- active metabolite - MSA ? - long acting |
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carteolol characteristics
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- non selective bb
- active metabolite - ISA - MSA ? |
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Carbonic Anhydrase Inhibitors (CAIs) include
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- acetazolamide
- methazolamide - dichlorphenamide - dorzolamide - brinzolamide |
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Acetazolamide Characteristics
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- Potent inhibitor CAII
- Not metabolized - Highly protein bound - Alkalizes urine - hypotensive effect parallels plasma levels - hastens excretion of acidic drugs (increases its own secretion) - effective day and night |
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All CAIs MoA
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↓ Aqeous inflow (↓ edema) by inhibiting carbonic anhydrase (conversion of CO2 + H2O → H2CO3)
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All CAIs ocular SE
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- High intolerance (30-80%)
- Numbness, tingling - Metallic taste (also with topical CAIs) - Symptom complex - Transient myopia - Side effects are rare with topical CAIs but could include corneal edema |
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All CAIs contraindications
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- Allergies to sulfonamides
-Renal, liver disease - COPDs (asthma) - Hemoglobinopathies + hyphema - Pregnancy |
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All CAIs drug interactions
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- K+ depleting diuretics
- Digitalis - Amphetamines - TCAs - quinidine - Aspirin |
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Acetazolamide Special uses
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- IV acetazolamide in AACG in combo with timolol
- macular edema with RPE dysfunction (chronic uveitis, CME) |
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Methazolamide Characteristics
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- more potent
- Higher lipid solubility - Mostly inactivated by metabolism - Less binding to plasma protein - Less effect on acid-base balance - longer action due to reabsorption - one of the best tolerated - preferred for those with COPD and predisposition to renal calculi (kidney stones) |
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Dorzolamide & Brinzolamide characteristics
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- Very potent inhibitor CA II
- Enhanced corneal/scleral penetration |
