Vision Change Case 3 - Faculty Comments for Question 6

Faculty Comments - Vision Change Case 3 - Answer 6:

Question 6: What are the classes of drugs that can be used for glaucoma?

Answer:

Class Mechanisms Examples Side Effects Notes

Topical B-adrenergic antagonists Decrease aqueous humor secretion. timolol, levobunolol, metipranolol and arteolol bradycardia, heart block, decreased BP, bronchospasm, mood changes, lightheadedness, syncope, corneal anesthesia, impotence. There is also Betaxolol that is more (Beta1, fewer pulmonary complications in patients with a history of lung disease.)

Adrenergic Agonists Increased aqueous outflow;
Decreased aqueous secretion Epinephrine, dipivefrin; apraclonidine Epi/dipi: tachycardia, HA, Increased BP, arrhythmias, nervousness, red eyes.
Apraclonidine: irritation, topical sensitivity, vasovagal attacks

Cholinergic agonists Direct (~ACh) and Indirect (~ acetylcholinesterase inhibitor);Increased aqueous outflow Direct: pilocarpine
Indirect: carbachol Browache, induced myopia, retinal detachment, parasympathetic stimulation.

Systemic Carbonic Anhydrase Inhibitors Decreased aqueous formation Acetazolamide, methazolamide Transient paresthesias, diuresis, N, malaise, loss of appetite, kidney stones, hypokalemia, rarely aplastic anemia.

Topical Carbonic Anhydrase Inhibitors Decreased aqueous formation Dorzolamide No systemic. Allergic conjunctivitis, GI disturbances, bitter taste.

Hyperosmotic agents Create osmotic gradient and move fluid Mannitol, glycerin, isosorbide. HA, confusion, exacerbations of CHF, subdural and subarachnoid hemorrhage. Used less commonly

Prostaglandin receptor agonist Increase outflow Latanoprost Conjunctival hyperemia, punctate epithelial erosions, Increased pigmentation of the iris New: long duration of action.

Return to Vision Change Case 3, Question 6

Penn State Milton S. Hershey Medical Center Š2004
This page was last updated on November 13, 2003
Contact Us

Class	Mechanisms	Examples	Side Effects	Notes
Topical B-adrenergic antagonists	Decrease aqueous humor secretion.	timolol, levobunolol, metipranolol and arteolol	bradycardia, heart block, decreased BP, bronchospasm, mood changes, lightheadedness, syncope, corneal anesthesia, impotence.	There is also Betaxolol that is more (Beta1, fewer pulmonary complications in patients with a history of lung disease.)
Adrenergic Agonists	Increased aqueous outflow; Decreased aqueous secretion	Epinephrine, dipivefrin; apraclonidine	Epi/dipi: tachycardia, HA, Increased BP, arrhythmias, nervousness, red eyes. Apraclonidine: irritation, topical sensitivity, vasovagal attacks
Cholinergic agonists	Direct (~ACh) and Indirect (~ acetylcholinesterase inhibitor);Increased aqueous outflow	Direct: pilocarpine Indirect: carbachol	Browache, induced myopia, retinal detachment, parasympathetic stimulation.
Systemic Carbonic Anhydrase Inhibitors	Decreased aqueous formation	Acetazolamide, methazolamide	Transient paresthesias, diuresis, N, malaise, loss of appetite, kidney stones, hypokalemia, rarely aplastic anemia.
Topical Carbonic Anhydrase Inhibitors	Decreased aqueous formation	Dorzolamide	No systemic. Allergic conjunctivitis, GI disturbances, bitter taste.
Hyperosmotic agents	Create osmotic gradient and move fluid	Mannitol, glycerin, isosorbide.	HA, confusion, exacerbations of CHF, subdural and subarachnoid hemorrhage.	Used less commonly
Prostaglandin receptor agonist	Increase outflow	Latanoprost	Conjunctival hyperemia, punctate epithelial erosions, Increased pigmentation of the iris	New: long duration of action.