Glaucoma

Dipivefrin 

Prodrug of ephinephrine

causes vasoconstriction

decreased aqueous humor production

decreases intraoccular pressure

It is converted to epinephrine upon penetration of the cornea.

Glaucoma Drug

Apraclonidine

Alpha- 2 Adrenergic Agonist

prevention and treatment of postsurgical intraocular pressure 

Decreases production of aq?

Glaucoma Drug

Brimonidine

Alpha-adrenergic Agonist

decreasing synthesis of aqueous humor,

increasing outflow 

 inhibit the activity ofadenylate cyclase. This reduces cAMP and hence aqueous humour production by the ciliary body.

Glaucoma Drug

Betaxolol

Beta1 Blocker

Decreases production of aq. (aqueous humor

Glaucoma Drugs

Carteolol

non-selective beta blocker

Decreases aq production

Glaucoma drug

Levobunolol

Non-selective beta blocker

Decreases aq. production

Once daily dosing

Glaucoma Drug

Metipranolol

Non-selective Beta blocker

Decrease aq. production

Glaucoma Drug

non-specific beta adrenergic receptor blocker

Decreases aq production

Once-daily dosing

Glaucoma Drug

Acetazolamide

Carbonic Anhydrase Inhibitor

Decrease aq production

Glaucoma Drug

Brinzolamide

CAIs

Decrease aq production

Ophthalmic suspension

Better ocular tolerability 

2-3 daily

Glaucoma Drug

Dorzolamide

CAIs

Decrease aq. production

Opthalmic solution

Glaucoma Drug

Methazolamide

CAIs

Decreases aq production

Glaucoma Drug

Carbachol

Mitorics- Direct

Increase outflow

Glaucoma drug

Pilocarpine

Miotic Direct 

Increases outflow

Glaucoma Drug

Physostigmine

Miotic- ChE ihibitor

Increase outflow

Glucaoma drug

Echothiophate

Miotic ChE inhibitor

Increases outflow

Glaucoma 

Latanoprost

Prostaglandin 

Increase outflow

Glaucoma Drug

Bimaprost

Prostaglandin

Increases outflow

Glaucoma Drug

Travoprost

Prostaglandin

Increases outflow

Glaucoma Drug

Unoprostone

Prostaglandin

Increases outflow

Glaucoma  

Cosopt

Combo of dorzolamide and timolol

carbonic anhydrase inhibitors and beta blocker

Decreases aq production

Glaucoma Drug

Combigan

brimonidine and timolol combo

Brimonidine-alpha-agonist that reduces the amount of fluid in the eye

Timolol- beta-blocker that also reduces pressure inside the eye

Glaucoma Drug

Mannitol

 Hyperosmotic agent

Dehydrate virteous humor

Lowers IOP by creating osmotic gradient btwn ocular fluid and plasma

Glycerol

Dehyrdates aq production

Hyperosmotic agent

Glaucoma

Beta-Blocker 

Reduces IOP via reduction of aq ~25%

Use 0.25% with light color iris

0.05% with dark iris

Best used in the morning

Dont use with ASTHMA

Beta Blocker- Yellow or Blue cap

Epinephrine- Red

Alpha-2 Adrenergic Agonist

CAIs- Orange cap

Mitotics- Direst- Green

Miotics- Indirect-Green

Prostaglandins- Teal Cap

Suffix: PROST

Decreases IOP by 30%

Cons: Cost

Conjunctival injection

Can caue hyperigmentation 

May be used in conjunction w/ Beta blocker

Carbonic Anhydrase Inhibitors

Increases CSF and aq production 

Crosses cornea and sclera

Reduces IOP

Alpha- adrenergic Agonist

Main SE: hyperemia

Common add-on drug to a prostaglandin

Direct

1. Philocarpine

Indirect

1. Physostigmine

2. Echothiophate

Cycloplegics (accommodation paralysis and mydriasis- block iris and CB movement)

Atropine

Homatropine

Scopolamine

Cyclopentolate

Tropicamide

SE: blurred VA, dry mouth, flushing, hyperthermia, urinary retention

Mydriatics

Phyenylephrine- Direct acting sympathominetics

Hydroxyamphetamine - Indirect

Cocaine- Indirect

Anti-Mydriatics

Dapiprazole (Rev-Eys/ Bu-Rev)

Alpha adrenergic antagoinst

H2- Histamine receptor antagonists

-tidine

Cimetidine

Famotidine

Nizatidine

Ranitidine

Proton Pump Inhibitors

-prazole

Omeprazole

Esomerprazole

Iansoprazole

Pantoprazole

Rabeprazole

Prodrug- inhibits final step to dimish acid secretion

Proton pump inhibitor SE

nausea

Diarrhea

Headache

Gi Distrubance

Bone Fractures

Problems with absorbing V. B12

Antacids

 Do not decrease acid secretion

Neautralize intragastric HCL

Cholride salts + insoluble carbonates

Mucosal protectants

Prostaglandins

Inhibits histamine-stimulated acid secretion

Increases mucosal defence

Works well in acidic environment

Misoprostol

Avoid PPI 

SE. Uterine contractions 

What is the triple therapy?

eliminates bacterial flora- that keeps fungus in check

Black tounge and stool

clarithromycin & amoxicillin or metronidazole & a PPI

Anticoagulants

Warfarin

Pentoxifylline

Heparine

Ardeparin

Antiplatelts (in arteries)

Aspirin

Clopidogrel

Ticlopidine

Dipyridamole

Thrombolytics

Sterptokinase

Urokinase

Angiotensin-Converting Enzyme Inhibitors

-april/opril

Decreases bp by ace inhibitor

Captopril

Enalapril

Lisinopril

Ramipril

SE: dry cough, hyperkalemia, skin rash, fever, hypotension

Angio 2 blocker

Fibric Acid Derivatives

Cause a decline in plasma triglycerides

Clofibrate, fenofibrate, ciprofibrate, bezafibrate, gemfibrozil

HMG- CoA reductase Inhibitors

-Statins

Inital choice drug for treatment of hypercholesterolemia

Inhibit activity of HMG-CoA reductase

SE: Hepatotoxicity + myopathy

Bile acid sequestrants

Cholestyramine, Colestipol

Bind fat with biles salts, liver ↑convertion of cholesterol to bile acid, removed LDL

Impair absop. of lipid vit, drus like: digoxin, furosemide, thiazides, coumarin, some statins

Niacin

Lowers VLDL, LDL, total cholesterol

Most potent for increasing plasma HDL levels

SE: flushing + itching

Anti Hyperlipidemic Drugs

HMG CoA reduc. Inhin-- ↓(4)LDL, ↑(2)HDL,↓(2)TG

Fibrates-↓(1)LDL, ↑(3)HDL,↓(4)TG

Niacin-↓(2)LDL, ↑(4)HDL,↓(3)TG

Bile seq-↓(3)LDL, ↑(1)HDL,↓(-)TG

Cholesterol absorption-↓(1)LDL, ↑(1)HDL,↓(1)TG

Beta- Blockers

Beta 1-

Betaxolol

Metoprolol

Non-selective B

Propranolol

Timolol

Alpha-Beta-Blocker

Labetalol-

For severe HTN, ↓ BP

SE: Bronchospasm, Hypotenstion HA

Centrally Acting Blockers

a-methyldopa and Clonidine- Direct alpha adrenergic agonist

↓Symp tone, from medulla

Lowers bp

decrease vascular resistance

↓ C.O

Peripherally Acting Blockers

Calcium Channel Blocker

Ditiazem,Verapamil,Nifefipine

Vaso Dilator, ↓HR, ↑C.O

Angiotensin II Receptor Antag

Losartan

Valsartan

Block vasocontriction and aldosterone secretion

↓BP, ↑ C.O

S:E Cough, Hyperkalemia

ACE Inhibitors

Vasodilators

Thiazideduretics

Loop Diuretics

Furosemide, Ethacrynic acid, Bumetanide

inhibits Na,Cl reabsorp

↑H2O,Na,Cl,K excretion

More Rapid 7 effective than thiazides

SE: Hypovolemia, death, ototoxicity, hypokalemia

Potassium-sparing Diuretics

Ganglionic blockers

Trimethaphan

Produces controlled hypotension

treatment of hypertensive crises and pulmonary edema due to hypertension

Renin inhibitors

Aliskiren

works by decreasing substances in the body that narrow blood vessels and raise blood pressure

Bile acid sequestrants

HMG-CoA RI (Statins)

Fibric Acid Derivatives

Cholesterol Absorption Blocker

Ezetimibe- inhibits absorption

Orlistat- inhibitor of lipase

Niacin

Get rid of LDL, VLDL, total cholesterol

Increases plasma HDL