Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Pilocarpine

(Isopto Carpine)

Direct – Acting parasympathomimetic

(Ophthalmic agent)

Directly stimulates PSNS receptors

Causes miosis (constriction), which leads to reduction of IOP from increased outflow of aqueous humor

Chronic open angle

Chronic angle-closure glaucoma

Can be given 1x/week

SE: Hypotension, bradycardia, HA, visual blurring

*Don’t drive at night

Dipivefrin

(Propine)

Sympathomimetic

(Ophthalmic agent)

Stimulates adrenergic receptors

Causes mydriasis (dilation)

Increase in aqueous humor outflow, decreases IOP

Penetrates into anterior chamber

Chronic open angle glaucoma

SE: Burning, eye pain & lacrimation

Tachycardia, hypertension

Contra: Not for narrow-angle glaucoma

Don’t mix w/ cardiac glycosides, thyroid hormones, or tricyclic antidepressants

Timolol

(Timoptic)

Beta – adrenergic blocker

(Ophthalmic agent)

Reduces aqueous humor formation, which reduces IOP

Open angle glaucoma

Ocular hypertension

1x/day dosing

SE: burning, discomfort, blurred vision, photophobia

Systemic: bradycardia, bronchospasm

Not for: bronchial asthma, cardiac failure

Contra: Beta blockers

*Don’t want systemic absorption, so apply pressure for 1 min.

Acetazolamide

(Diamox)

Carbonic anhydrase inhibitor

(ophthalmic agent)

Inhibits enzyme- results in reduced aqueous humor formation = reduced IOP

~ increased renal excretion of water, bicarb, K+

Chronic open- angle glaucoma

Acute angle- closure preop.

Edema from heart failure

Can be taken orally = systemic effects

*Drink 2L fluid/day

*Eat increased K+, low Na

SE: drowsiness, confusion, tinnitus, anorexia, hypokalemia, increased digitalis toxicity, photosensitivity, seizures

*Cross allergy w/ sulfonamides

Mannitol

(Osmitrol)

Osmotic diuretic

(Ophthalmic agent)

Produce an osmotic gradient, which forces water from aqueous & vitreous humors into the bloodstream, causing reduction in IOP

Acute angle closure

Lowering IOP before surgery

*Only by IV

SE: Tachycardia, angina, confusion, dehydration, urinary retention, edema, fever, chills, dry mouth

Contra: Increases lithium excretion

Toxicity: hypovolemia, cardiac dysrhythmias, hyperosmolar nonketotic coma

*Sudden volume shift is bad for cardiac, renal or hepatic diseases

Latanoprost

(Xalatan)

Prostaglandin Agonist

(Ophthalmic agent)

Increases outflow of aqueous fluid

* No effect on the production of aqueous humor

Open angle glaucoma

Ocular hypertension

May turn eyes brown permanently

SE: foreign body sensation, stinging, dotted appearance of cornea, blurred vision