1. Ocular hypotensive drugs and Antiglaucoma drugs
2. Ocular hypertension Ocular hypertension is an eye pressure
of greater than 21 mm Hg. An intraocular pressure of greater than
21 mm Hg is measured in one or both eyes.
3. Normal eye pressure Eye pressure is measured in millimeters
of mercury (mm Hg). Normal eye pressure ranges from 12-22 mm Hg,
and eye pressure of greater than 22 mm Hg is considered higher than
normal. When the IOP is higher than normal but the person does not
show signs of glaucoma, this is referred to as ocular
hypertension.
4. Glaucoma A common eye condition in which the fluid pressure
inside the eye rises to a level higher than healthy for that eye.
If untreated, it may damage the optic nerve, causing the loss of
vision or even blindness.
5. Symptoms and sign of glaucoma Intense pain. Redness of the
eye. Headache. Tender eye area. Seeing halos or 'rainbow-like'
rings around lights. Loss of vision in one or both eyes that
Progresses very quickly. Increase intraocular pressuse Glaucoma is
characterized by progressive damage to the optic nerves
6. Ocular hypotensive drugs Ocular hypotensive drugs are used
to reduced the intraocular pressure.
9. 1..Prostaglandins analogues: Prostaglandins analogues are
first line treatment for most patient with ocular hypertension and
open-angle glaucoma. Latanoprost the first commercially successful
prostaglandins for clinical used in treatment of glaucoma.
10. Latanoprost MOA: (Mechanism of action) It is a
prostaglandin (PG)F2 analog. It is believed to reduced the
intraocular pressure by increasing outflow of aqueous humor.
11. Uses/Indication: Used in treatment of open-angle glaucoma
or ocular hypertension in patient who are intolerant of other
intraocular pressure lowering medication. Lanatoprost may be used
alone or in combination with other antiglaucoma agents.
12. Open-angle glaucoma, also called chronic glaucoma Closed
angle glaucoma, also called acute glaucoma,
13. Adverse effect Blurred vision Ocular burning Ocular pain
Dry eyes Hyperlacrimation Photophobia Contraindication
Hypersensitive to drug, if inflammation occur.
14. 2..-blockers/-adrenergic antagonist Timolol: Timolol is a
beta-adrenergic blocking agent. Non-selective, antagonize beta-1
and beta-2. Like other beta-adrenergic blocking agents, it mainly
blocks the action of the sympathetic (adrenergic) nervous
system.
15. Mechanism of action Timolol causes a reduction of the
pressure within the eye (intraocular pressure). This effect is may
result from a reduction in production of the liquid (aqueous humor)
within the eye. The precise mechanism of this effect is not known.
The reduction in intraocular pressure reduces the risk of damage to
the optic nerve and loss of vision in patients with glaucoma.
16. Indication/use: Used for lowering intraocular pressure for
treatment of glaucoma, acute-angle glaucoma.
17. Contraindication: Hypersensitive to drug or class
Asthma/bronchial problem Bradycardia Severe heart block Severe COPD
Adverse effect Bradycardia Heart block Bronchospasm
18. 3..Adrenergic Agonist Since early 1920s Epinephrine used as
to reduced IOP.(non-selective adrenergic agonist) so currently used
2-receptor agonist are ,adrenergic agonist of choice for glaucoma.
Apraclonidine Brimonidine
19. Apraclonidine Mechanism of action: Selective -2
adrenoceptor agonist , derivative of antihypertensive agent
clonidine. Apraclonodine lowers the intraocular pressure by
decreasing aqueous production.
21. Mechanism of action It reversibly blocks the enzyme
carbonic anhydrase in the ciliary body and thus suppresses aqueous
humor production. The Aquous fluid rich in sodium and bicarbonate
ions is hyperosmotic as compared to plasma. Water is attracted to
the posterior chamber as a result of osmosis and the high
concentration of bicarbonate ions is diluted.
22. Uses /Indication: 1..Used in treatment of all type of
glaucoma. 2..Used in treatment of elevated IOP, Often reserved for
short-term IOP reduction only. 3..produce an additional decrease in
IOP ,when added to drug regimen ,including, Miotics, B- blockers
and prostaglandins.
23. Contraindication: Hypersensivity to drug. Pregnancy Severe
obstructive pulmonary disease
24. Side effect of Acetazolamide: Transient myopia Dermatitis
Hypokalemia Fatigue Weight loss
25. 5..Cholinergic Agonist(Miotics) Classification of
cholinergic agonist Direct acting: Acetylcholine Methacholine
Pilocarpine Carbachol
27. Mechanism of Action: Produce biological response similar to
those of acetylcholine. these drugs also known as
Parasympathomimetics or cholinomimetics. In clinical practice
referred as Miotics.
28. Direct Acting drugs: Activates cholinergic receptors
directly at neuroeffector junctions of iris sphincter muscle and
ciliary body. Indirect acting drugs: Exert their cholinergic effect
by inhibiting cholinesterase and increase amount available at
cholinergic receptors.
29. Pilocarpine An alkaloid of natural plant origin.
Pilocarpine is a direct acting cholinergic agonist.
30. Mechanism of action Pilocarpine is a direct acting
cholinergic parasympathomimetic agent which acts through direct
stimulation of muscarinic receptors and smooth muscle such as the
iris and secretory glands. Pilocarpine contracts the ciliary
muscle, causing opening of the trabecular meshwork spaces to
facilitate outflow of aqueous humor.
31. Uses/indication Most useful miotic for management of acute
angle closure glaucoma and many secondary glaucomas. Also used
along with other agents. At high IOP of 60mmHg, topical beta-
blockers,apraclonidine or systemic agents are indicated initially
to bring pressuse below 50mmHg.
32. Contraindication: Presence of cataract Patients younger
than 40 year of age Asthma or history of asthma
33. 6..Hyperosmotic agents These agents act by enhancing the
osmotic pres- sure of plasma with respect to intraocular structures
thereby setting an osmotic gradient. Consequently the fluid moves
from the eye to hyperosmotic plasma of ocular blood vessels,
thereby reducing the vitreous volume which is responsible for
lowering of IOP.
34. Hyperosmotic agents classification Include oral glycerin
and isosorbide orally, mannitol and urea intravenously.
35. Uses and indication The use of these drugs is currently
limited to short term emergency situations such as acute angle
closure glaucoma or pre- operative control of raised IOP.
36. Hyperosmotic agents These drugs are usually for people with
a severely high IOP that must be reduced immediately before
permanent, irreversible damage occurs to the optic nerve.
Hyperosmotic agents reduce IOP by lowering fluid volume in the
eye.
37. Side effects The side effects of these drugs include
nausea, vomiting, diuresis, headache, diarrhea, chills and
fever.