3 4 cholinergic pharmacology younus h johan 2016
TRANSCRIPT
Important drugs used in glaucoma
Dr. Younus H Johan Dr. Younus H Johan Department of pharmacology & toxicology College of pharmacy University of al-anbar2016
VISUAL FIELD LOSS
OPTIC NERVE
DAMAGE
GLAUCOMA
INCREASE
IOP
Normal
Open-angle glaucoma
Drainage
Cholinergics
Production
Cholinergics
Closed-angle glaucoma
Mydriatics (contra.)
Adhesion glaucoma
DarknessMydriatics
Drugs or class Nature of action and important remarks
Cholinergic agentsMuscarinic agonists (pilocarpine)Anticholinesterases [physostigmine,
Improved drainage of aqueous humour (contracting the longitudinal muscle of the ciliary body leading to opening the trabecular meshwork around Schlemm’s canal (drainage channels), immediate drop s [physostigmine,
DFP (isoflurophate)]
channels), immediate drop (IOP). •acute glaucoma •chronic open-angle glaucoma.
M.AK.Lafi : Essentials of Medical Pharmacology 2009
Drugs or class Nature of action and important remarks
-blockersTimololBetaxololCartelolMetipranolol
Decrease production of AH -to reduced IOP. No effect on focusing for near vision or pupil size;(used in Metipranolol (used in chronic open-angle glaucoma, narrow and acute glaucoma.
M.AK.Lafi : Essentials of Medical Pharmacology 2009
Drugs or class
Nature of action and important remarks
α-agonistsNon-selectiveAdrenaline
α2-selectivePraclonidine
Enhances AH outflow (drainage, -receptors) by increasing PG production that enhance uveoscleral drainage
decreases production of AH by vasoconstriction of the ciliary body blood Praclonidine
Brimonidinevasoconstriction of the ciliary body blood vessels leading to reduced IOP. Topical 2% adrenaline solution used in chronic open-angle glaucoma.
C/I •closed-angle •acute glaucomas
M.AK.Lafi : Essentials of Medical Pharmacology 2009
Drugs or class Nature of action and important remarks
Prostaglandins(PGF2α derivatives:latanoprost, unoprostone)
Increase outflow by acting at the FP receptor -stimulates collagenase and metalloproteinase to degrade the extracellular matrix between ciliary muscle bundles, which in turn leads to the reduction of hydraulic resistance to uveoscleral flowSESE•irreversible brown pigmentation of the iris and eyelashes,
•Eyelash : lengthening, thickening•drying of the eyes, and conjunctivitis.
M.AK.Lafi : Essentials of Medical Pharmacology 2009
Drugs or class Nature of action and important remarks
Diuretics
Carbonic anhydrase inhibitorsAcetazolamide
Decreases production of AH by blocking carbonic anhydrase in the ciliary body leading to reduced IOP. •chronic glaucoma •acute closed-angle glaucoma.•acute closed-angle glaucoma.
Osmotic agentsMannitol
Reduces IOP in acute closed-angle glaucoma.
M.AK.Lafi : Essentials of Medical Pharmacology 2009
Summary of selected mydriatic and cycloplegicsmydriatic and cycloplegics
Mydriasismiosis Mydriasismiosis
Drug Duration Use
Tropicamide 3-6 hr Fundus examination
Homatropine 1-3 days Cycloplegic for refraction* in children
Atropine 7-10 days For refraction as above; also iridocyclitis**(+ phenylephrine)
They may precipitate acute glaucoma in the elderly and predisposed patients
M.AK.Lafi : Essentials of Medical Pharmacology 2009
Thank YouThank You
Anticholinergic drugs
Dr. Younus H Johan Department of pharmacology & toxicology College of pharmacy University of al-anbar
Effects• Decreased secretion• Mydriasis • Cycloplegia (decreased accommodation )• Hyperthermia• Tachycardia
Antichloinergic prototype:
Atropine
• Sedation• Urinary retention and constipation• Behavioural excitation and
hallucinations
Selected therapeutic uses and important remarks*
Antimuscarinicagents
• to produce mydriasis & cycloplegia prior to refraction (7 days)
• spastic disorders of GI and lower urinary tracts• organophosphate poisoning
Atropine( click )
• organophosphate poisoning• premedication prior to surgery, to suppress
respiratory secretion in children
M.AK.Lafi : Essentials of Medical Pharmacology 2009
Selected therapeutic uses and important remarks*
Antimuscarinicagents
• to produce mydriasis & cycloplegia prior to refraction (7 days)
• spastic disorders of GI and lower urinary tracts• organophosphate poisoning• premedication prior to surgery, to suppress
respiratory secretion in children
Atropine( click )
• Cycloplegic for refraction in children (24 hr)Homatropine
• Fundus examination (3 hr)Tropicamide
M.AK.Lafi : Essentials of Medical Pharmacology 2009
Selected therapeutic uses and important remarks*
Antimuscarinicagents
• In obstetrics with morphine to produce amnesia and sedation
Scopolamine(hyoscine) and sedation
• Motion sickness(hyoscine)
• Asthma (inhalation)Ipratropium
M.AK.Lafi : Essentials of Medical Pharmacology 2009
Selected therapeutic uses and important remarks*
Antimuscarinicagents
• With chlordiazepoxide (Librax®) in GI disorders like • peptic ulcer, • nervous dyspepsia,• irritable bowel syndrome, • spastic colitis, • mild ulcerative colitis
Clidinium
With trifluoperazine (Stelabid®) in • peptic ulcer, • visceral spasm
Isopropamide
• Peptic ulcer (inhibits acid secretion), Pirenzepine • Peptic ulcer (inhibits acid secretion), • poorly enters the CNS, thus, no or little CNS side-effects
Pirenzepine
• Peptic ulcer, • irritable bowel syndrome, & • urinary disorders of storage (urinary frequency,
incontinence, nocturnal enuresis
Propantheline
• Urinary disorders of storage (as above)Emepronium(Cetiprin®)
M.AK.Lafi : Essentials of Medical Pharmacology 2009
Selected therapeutic uses and important remarks*
Antimuscarinicagents
• Peptic ulcer (inhibits acid secretion), • poorly enters the CNS, thus, no or little CNS side-effects
Pirenzepine
• Peptic ulcer, • irritable bowel syndrome, &
Propantheline• irritable bowel syndrome, & • urinary disorders of storage (urinary frequency,
incontinence, nocturnal enuresis
• Urinary disorders of storage (as above)Emepronium(Cetiprin®)
M.AK.Lafi : Essentials of Medical Pharmacology 2009
CNS AgentsBenzotropine
(Centrally acting antimuscarinic antagonists)• Drug induced dystonias• Parkinson’s disease
BenzotropineProcyclidineBenzhexol-HClOrphenadrine
Adverse-effects commonly observed with cholinergic antagonists:
blurred vision, mydriasis, tachycardia, constipation, urinary retention, and confusion.
M.AK.Lafi : Essentials of Medical Pharmacology 2009
Moderately severe to severe hypertensionGanglionic blockersMecamylamineMecamylamine
Short-term treatment of hypertension (emergency lowering of blood pressure, when other agents cannot be used)
Trimethaphan
M.AK.Lafi : Essentials of Medical Pharmacology 2009
See appropriate section in the chapter on CNS pharmacology (later on)
Neuromuscular blockersNondepolarising(competitive agents)(competitive agents)Depolarising agents
M.AK.Lafi : Essentials of Medical Pharmacology 2009