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Title: Analgesics


1
Analgesics
NAPLEX
PG 132
2
(No Transcript)
3
Treatment Algorithm for Pain
4
Treating Specific Types of Cancer Pain
  • Bone pain
  • NSAIDs, bisphosphonates, corticosteroids, opiates
  • Visceral pain
  • NSAIDs, opiates
  • Neuropathic pain
  • TCAs, gabapentin, carbamazepine, corticosteroids
  • Muscle spasms
  • Benzodiazepines, baclofen

5
Non Opioid Analgesics
Drug Dose Interval Renal Adjustment Hepatic Adjustment
Acetaminophen 500-1000 mg Max 4 g 4-6 hours GFR gt50 ml/min q4h, 10-50 ml/min q6h, lt10 ml/min q8h 1/2 life is increased, Can be given safely
Aspirin 500- 1000 mg Max 4 g 4-6 hours Avoid Avoid
Celecoxib 100-200 mg Max 800 mg 12 hours Avoid Decrease dose by 50
Rofecoxib (off market) 12.5 mg-25 mg Max 50 mg Daily Avoid Avoid
Valdecoxib (off market) 10-20 mg Max 40 mg Daily Avoid Avoid
PG 134
6
Non Opioid Analgesics cont
Drug Dose Interval Renal Adjustment Hepatic Adjustment
Ibuprofen 200-800 mg Max 3.2 g/day 4-6 hours Use with caution Contraindicated in renal failure No dose alterations, Kinetics minimally effected
Naproxen 550 mg initial, 250 subsequent Max 1.5g/day 6-8 hours Use with caution Reduce dose 50
Indomethacin 25 mg Max 200mg/day 8-12 hours Use with caution Avoid
Ketoralac 30 mg or 60 mg IM Max 5 days of combine treatment (IM PO) 6 hours Avoid Avoid
7
NSAID's
Propionic Acids
Carboxylic Acids
oxaprozin naproxen ibuprofen ketoprofen fenoprofen
flurbiprofen
Nonacetylated Salicylates
Salicylates
ASA
salsalate diflunisal choline
Oxicams
piroxicam meloxicam
Acetic Acids
Naphthylalkanone
sulindac etodolac indomethacin tolmetin diclofenac
ketorolac
nabumetone
Fenamates
GI Sparing Agents
meclofenamate mefenamic acid
diclofenac/misoprostol
8
Weak Opioid Analgesics
Drug Dose Interval Renal Adjustment Hepatic Adjustment
Codeine 15-60 mg Max 120 mg 4-6 hours CrCl 10-50 ml/min75 of dose, lt10 ml/min50 of dose A dosage adjustment decrease
Oxycodone w/ -acetaminophen -aspirin 5 mg Max 4 g 4-6 hours Be conservative, drug levels increase by 50 1/3 to 1/2 of usual dose, Elimination 1/2 life increase by 2.3 hours
Hydrocodone w/ -ibuprofen (7.5/200) -acetaminophen (5/500) -aspirin (5/500) 1-2 tabs Max 5 tabs 1-2 tabs Max 4 g 1-2 tabs Max 4 g 4-6 hours 4-6 hours 4-6 hours Use cautiously in mild to moderate renal failure, avoid in severe renal failure Avoid
Tramadol -acetaminophen (37.5/325) 50-100 mg Max 400mg 2 tabs Max 8 tabs 4-6 hours 4-6 hours CrCl lt 30 ml/min increase dosing interval to q12h with a max of 200 mg per day Cirrhosis 50 mg q12h Avoid
9
Weak Opioid Analgesics cont
Drug Dose Interval Renal Adjustment Hepatic Adjustment
Propoxyphene -acetaminophen -aspirin 1-2 tabs Max 4 g 1-2 tabs 4 hours 4 hours Dont give in severe renal failure, use cautiously in mild and moderate renal failure Avoid
10
Strong Opioid Analgesics
Drug Dose Interval Renal Adjustment Hepatic Adjustment
Meperidine - Binds opiate receptors 50 - 150 mg Metabolite accumulation (normeperidine) Anxiety, agitation, tremor /or seizures 3-4 hours GFR gt50 ml/min No adjustment 10-50 ml/min 75 of dose lt10 ml/min 50 of dose Decrease dose, 1/2 life is increased
Morphine (gold standard) -immediate release -IV, IM, SQ, continuous infusion -epidural -intrathecal -rectal 10-30 mg 2.5-20 mg 0.8 to 10 mg/hr Max 80 mg/hr 5mg bolus, redose 1 hr 1 to 2 mg Max 10 mg/24 hr 0.2 to 1 mg 10-20 mg Titrate to response 2-6 hours No repeat dose 4 hours GFR gt50 ml/min No adjustment 10-50 ml/min 75 of dose lt10 ml/min 50 of dose (morphine-6-glucuronide) accumulates in renal failure 1/2 life prolonged increase interval by 1.5 to 2 times
11
Strong Opioid Analgesics cont
Drug Dose Interval Renal Adjustment Hepatic Adjustment
Hydromorphone -PO, IM, IV, SQ -rectal 1-4 mg 3 mg 4-6 hours 6-8 hours Decrease dose
Oxycodone - percocet (APAP) - percodan (ASA) 5 mg May titrate to response no maximum dose 6 hours Be conservative, drug levels increase by 50 1/3 to 1/2 of usual dose, Elimination 1/2 life increase by 2.3 hours
Methadone -PO, IM, SQ -IV 2.5-10 mg Max1000 mg 0.1mg/kg 3-8 hours 4 hrs x 3 doses then 6-12 hours GFR gt50ml/min q6h 10-50 ml/min q8h lt10 ml/min q12h CrCl lt10 ml/min 50-75 dose No Change in dose mild to moderate disease, Avoid in severe liver disease
12
Strong Opioid Analgesics cont
Drug Dose Interval Renal Adjustment Hepatic Adjustment
Fentanyl -transdermal -transmucosal Parenteral Initial 25 mcg/hr Initial 200 mcg 72 hours 30 min CrCl 10-50 ml/min 75 of dose lt10 ml/min 50 of dose Unaffected by cirrhosis, effected by hepatic blood flow

Remind patients that heat can increase fentanyl
absorption. Warn against extended exposure of the
patch to heating pads, hot tubs, sunbathing, high
fever, etc.
13
Opioid Equianalgesic Dosing
Drug Oral (mg) Parenteral (mg)
Morphine 30 10
Hydromorphone 7.5 1.5
Oxycodone 20-30 10-15
Methadone 10-20 acute? 2-4 chronic 10 acute? 2-4 chronic
Levorphanol 4 acute 1 chronic 2 acute 1 chronic
Fentanyl x 0.1-0.2
Oxymorphone x 1
Meperidine 300 75
14
  • Morphine Analogs---table 2-28, pg.132
  • General properties
  • CNS depression
  • Respiratory depression
  • Reduce propulsive activity of the gut
  • Urinary retention
  • Toxicity causes pinpoint pupils
  • No maximum dose

15
  • Meperidine Analogs---See Table 2-28, pg.132
  • General properties
  • Good analgesic (parenteral)
  • Less CNS depression or constipation than opiates
  • Spasmolytic action - may be useful for pain
    related to uterus, GI, bronchi, etc.
  • Combination with hydroxyzine or promethazine
    permits 2550 dosage reduction
  • Principal drugs
  • Meperidine (Demerol)---accumulates in renal
    disease, metabolite can cause siezures
  • Diphenoxylate atropine (Lomotil) C-V
  • - antidiarrhea - subtherapeutic dose of
    atropine to prevent abuse

16
  • Central Analgesics
  • Tramadol (Ultram) oral
  • - binds to u-opiate receptors in the CNS -
    inhibits reuptake of NE 5HT in ascending pain
    pathway - CYP 450 2D6 - renal adjusted
  • Clonidine (Duraclon) - epidural, PO or patch for
    HTN
  • For neuropathic pain-----See other sections

PG 133
17
  • Drugs for Migraine
  • Headache Types
  • - Tension, Cluster, Migraine
  • - Migraine is unilateral, pulsating,
    throbbing, with or w/o aura,
  • nausea, photophobia, sonophobia
  • Treatments Prophylactic and Abortive
  • Abortive
  • Aspirin - analgesic, antipyretic,
    anti-inflammatory, anti-platelet
  • Acetaminophenanalgesic, antipyretic
  • NSAIDs - analgesic, antipyretic,
    anti-inflammatory (See Table pg. 133)
  • Mechanism of action
  • Common adverse effects GI toxicity,
    hypersensitivity, renal effects

PG 133
18
  • Contraindications to the use of Imitrex
    include
  • which of the following
  • I. uncontrolled HTN
  • II. use of and MAOI within the past 2 weeks
  • III. ischemic heart disease
  • a. I only
  • b. III only
  • c. I and II only
  • d. II and III only
  • e. I, II, and III

19
  • Contraindications to the use of Imitrex
    include
  • which of the following
  • I. uncontrolled HTN
  • II. use of and MAOI within the past 2 weeks
  • III. ischemic heart disease
  • a. I only
  • b. III only
  • c. I and II only
  • d. II and III only
  • e. I, II, and III

20
  • Drugs for Migraine
  • Abortive - (cont.)
  • Dihydroergotamine (Migranal) - nasal spray dose
    may be repeated after 15 min MOA blocks alpha
    adrenergic causing vasoconstrition
  • 5-HT1D Receptor Agonists - avoid in patients with
    cardiovascular disease
  • Almotriptan (Axert)
  • Eletriptan (Relpax) tablets newest agent on
    the market another me-too
  • Frovatriptan (Frova) tablets longest half
    life among agents
  • Naratriptan (Amerge) - tablets
  • Rizatriptan (Maxalt) - tablets also Maxalt MLT
    (oral disintegrating tab)
  • Sumatriptan (Imitrex) - injection, tablet,
    nasal spray
  • Zolmitriptan (Zomig) - tablets also Zomig ZMT
    (oral disintegrating tab)

PG 132
21
  • Drugs for Migraine
  • Prophylactic Therapy
  • - Given to patients with gt2-3 HA/month, severe
    HA, ineffective
  • treatment
  • Drugs of Choice
  • - propranolol (Inderal) use if patient also
    has HTN
  • - amitriptyline (Elavil) concomitant
    depression
  • - valproate (Depakote) - concomitant seizures
  • Other agents
  • - verapamil, topiramate

PG 133
22
(No Transcript)
23
Pathophysiology
24
Complications
Source www.arava.com
25
Rheumatoid Arthritis
  • Corticosteroids early, acute, not long-term
  • - also NSAIDs / COX-2 Inhibitors
  • Disease Modifying Antirheumatic Drugs (DMARDs)
    liver, heme
  • Auranofin (Ridaura)
  • Aurothioglucose (Solganol)
  • Azathioprine (Imuran)
  • Cyclophosphamide (Cytoxan)
  • Cyclosporine (Neoral, Sandimmune)
  • Gold sodium thiomalate (Myochrysine)
  • Hydroxychloroquine (Plaquenil) retinal
    toxicity Q 6 months
  • Methotrexate (Rheumatrex)
  • Leflunomide (Arava)---Preg Cat X, long
    half-life, hepatotoxic
  • Penicillamine (Cuprimine, Depen)
  • Sulfasalazine (Azulfindine) orange-yellow
    urine

Gold
PG 134
26
  • Biologic Response Modifiers
  • Etanercept (Enbrel) avoid with live vaccine
    (soluble receptor TNF inhibitor)
  • Anakinra (Kineret) monitor for pulmonary
    problems (IL-1 receptor antagonist)
  • Infliximab (Remicade) monitor for infection
    (monoclonal antibody for TNF)
  • Adalimumab (Humira) monitor for infection
    (monoclonal antibody for TNF receptor)
  • Abatacept (Orencia) monitor for
    infection (Inhibits T-Cell (T-lymphocytes
    activation by binding to CD80 and CD86 on antigen
    presenting cells)
  • Osteoarthritis (OA)
  • - acetaminophen NSAIDs
  • - surgery knee/hip replacement
  • - glucosamine/chondrotin NIH study (GAIT)

PG 134
27
Joint Distribution RA Compared to OA
Rheumatoid Arthritis
Osteoarthritis
28
  • SLE (systemic lupus erythematosus) occurs more
    frequently in
  • a. male African Americans
  • b. Asians
  • c. post-menopausal women
  • d. people of Mediterranean origin
  • e. young women

29
  • SLE (systemic lupus erythematosus) occurs more
    frequently in
  • a. male African Americans
  • b. Asians
  • c. post-menopausal women
  • d. people of Mediterranean origin
  • e. young women

30
  • Patients who are life time smokers have the
    greatest risk of leg pain associated with?
  • a. hypokalemia
  • b. rhabdomylosis
  • c. intermittent claudication
  • d. dopamine deficiency
  • e. myocardial infarction

31
  • Patients who are life time smokers have the
    greatest risk of leg pain associated with?
  • a. hypokalemia (cramps)
  • b. rhabdomylosis (statins)
  • c. intermittent claudication (PVD)
  • d. dopamine deficiency (RLS)
  • e. myocardial infarction

32
  • Trigeminal neuralgia is treated by the use of
  • a. aspirin
  • b. carbamazepine
  • c. dipyridamole
  • d. methylprednisolone
  • e. thiamine

33
  • Trigeminal neuralgia is treated by the use of
  • a. aspirin
  • b. carbamazepine
  • c. dipyridamole
  • d. methylprednisolone
  • e. thiamine

34
  • When dispensing a prescription for Robitussin AC,
    the pharmacist should attach label(s) indicating
  • I. May cause drowsiness
  • II. Shake well before using
  • III. Finish all of this medication
  • a. I only
  • b. III only
  • c. I and II only
  • d. II and III only
  • e. I, II, and III

35
  • When dispensing a prescription for Robitussin AC,
    the pharmacist should attach label(s) indicating
  • I. May cause drowsiness
  • II. Shake well before using
  • III. Finish all of this medication
  • a. I only
  • b. III only
  • c. I and II only
  • d. II and III only
  • e. I, II, and III

36
  • Which of the following is/are appropriate
    warning(s) for the use of Duragesic transdermal
    system patches?
  • I. Do not cut patches before applying
  • II. Not intended for use in children under the
    age of 12
  • III. Replace patch every day unless pain is
    under control
  • a. I only
  • b. III only
  • c. I and II only
  • d. II and III only
  • e. I, II, and III

37
  • Which of the following is/are appropriate
    warning(s) for the use of Duragesic transdermal
    system patches?
  • I. Do not cut patches before applying
  • II. Not intended for use in children under the
    age of 12
  • III. Replace patch every day unless pain is
    under control
  • a. I only
  • b. III only
  • c. I and II only
  • d. II and III only
  • e. I, II, and III

38
  • The upper daily dosing regimen for naproxen is
    NOT more than
  • a. 0.5 g
  • b. 1 g
  • c. 1.5 g
  • d. 2.5 g
  • e. 4 g

39
  • The upper daily dosing regimen for naproxen is
    NOT more than
  • a. 0.5 g
  • b. 1 g (mefenamic)
  • c. 1.5 g (naproxen)
  • d. 2.5 g
  • e. 4 g (acetaminophen)
  • Ibuprofen (3.2g) Indomethacin (200mg)

40
  • Which of the following ingredients is are present
    in Percodan but not in Percocet
  • I. Aspirin
  • II. Acetaminophen
  • III. Oxycodone
  • a. I only
  • b. III only
  • c. I and II only
  • d. II and III only
  • e. I, II, and III

41
  • Which of the following ingredients is are present
    in Percodan but not in Percocet
  • I. Aspirin
  • II. Acetaminophen
  • III. Oxycodone
  • a. I only
  • b. III only
  • c. I and II only
  • d. II and III only
  • e. I, II, and III

42
Drugs for the Treatment of Asthma
NAPLEX
PG 142
43
(No Transcript)
44
(No Transcript)
45
Classification
46
Drugs for the Treatment of Asthma
phosphodiesterase Adenyl cyclase cyclic AMP
(bronchodilation) elimination Sympathomimetics
Increase formation of cyclic AMP Nonselective
Ephedrine Epinephrine (Adrenalin,
Medihaler-Epi, Bronkaid, Primatene, etc.)
Ethylnorepinephrine (Bronkephrine)
PG 142
47
  • Drugs for the Treatment of Asthma
  • Selective Short-Acting Beta-2 Agonists. Provide
    quick relief may cause tachycardia, tremor, etc.
  • Albuterol (Proventil, Ventolin, Airet, Volmax)
    0.5hr peak, 4

    hours
    duration
  • Albuterol - oral sustained-release product
  • Pirbuterol (Maxair) Autoinhaler longer
    duration 6 hrs (tertiary butyl


    group)
  • Levalbuterol (Xopenex) active isomer of
    albuterol, neb., less cardiac


    side effects
  • Metaproterenol (Alupent, Metaprel) delayed
    onset (1 hour)

    prolonged effect (4 hour)
  • Terbutaline (Brethine, Bricanyl) delayed
    onset 1 hour prolonged duration (6hr)
    no-inhalation in U.S. (management of pretermed
    labor)
  • isoproterenol (Isuprel, Medihaler-Iso)
    beta-1 beta-2 activity

PG 143
48
Drugs for the Treatment of Asthma (cont.)
Long-Acting Beta-2 Agonists. For long-term
symptom control frequently used with
inhalational corticosteroids may cause
tachycardia, tremor, etc. for prophylaxis
only. Formoterol (Foradil) DPI -
capsule Salmeterol (Serevent) DPI
Diskus NOT SUITABLE AS A RESCUE
INHALER!!!!!!!!!!!!!!
PG 142
49
  • Drugs for the Treatment of Asthma
  • Xanthines
  • Phosphodiesterase inhibitors generally for
    prophylaxis adverse effects similar to caffeine
  • Theophylline (Slo-Phyllin, Theolair,
    Theo-Dur)----Think drug interactions, serum
    levels 10-20, arryhthimogenic at high levels
  • Dyphylline (Lufyllin).theophylline derivative
  • Aminophylline (Somophyllin-CRT).anhydrous
    contains 86
  • - 300mg theo (PO) 380mg Amino (IV)
  • theophylline, dihydrate 79
  • Oxtriphylline (Choledyl).contains 64
    theophylline
  • Leukotriene receptor drugs
  • For prophylaxis may reduce need for beta-2
    agonist
  • Zafirlukast (Accolate).leukotriene receptor
    antagonist
  • Montelukast Sodium (Singulair).leukotriene
    receptor antagonist
  • Zileuton (Zyflo).inhibits leukotriene
    formation (5-lipoxygenase inhibitor)
  • monitor hepatic function, think
    DIs---potent inhibitor

PG 142
50
  • Zyflo CR will be given BID instead of QID.   
     But patients will still need liver function
    tests every month for the first 3 months...then
    every 2 to 3 months for the rest of the first
    year. 2007
  • Omalizumab. Save the monoclonal antibody, Xolair,
    for patients with severe asthma and
    allergies...who are not responding adequately to
    high-dose inhaled steroids and long-acting
    beta-agonists.
  • New NIH guidelines will improve asthma
    treatment.     You'll see renewed emphasis on
    controlling symptoms...patient education...and
    avoiding allergens.

51
  • Drugs for the Treatment of Asthma
  • Corticosteroids
  • Inhalational reduce inflammation and bronchial
    reactivity may cause oral candidiasis, cough,
    and other steroid effects (with prolonged use).
    Prophylaxis only.
  • Beclomethasone dipropionate (Beclovent,
    Vanceril)
  • Triamcinolone acetonide (Azmacort)
  • Flunisolide (Aerobid)
  • Fluticasone propionate (Flovent)
  • Mometasone (Asmanex Twisthaler)
  • Budesonide (Pulmicort) (Pulmicort Respules
    only neb ICS)
  • Anticholinergics
  • Ipratropium bromide (Atrovent) bronchodilator.
    Reduces secretions alternative to beta-2
    agonists anticholinergic adverse effects
  • - combivent albuterol and ipratropium
  • Tiotropium (Spiriva)----long acting, dry powder
    capsule for inhalation

PG 142
52
  • Drugs for the Treatment of Asthma
  • Mast cell stabilizers
  • Anti-inflammatory very safe for prophylaxis
    only
  • Cromolyn sodium (Intal, Nasalcrom)
  • Nedocromil sodium (Tilade)
  • Combination products
  • Ipratropium bromide/albuterol sulfate (Combivent)
  • Salmeterol xinafoate/fluticasone propionate
    (Advair Diskus)
  • Symbicort contains the corticosteroid budesonide
    (Pulmicort)...plus the long-acting beta-agonist
    formoterol (Foradil). - 2007 - 2 puffs BID

PG 143
53
  • Side effects of oral corticosteroids include
    all of the following except
  • a. hyperglycemia
  • b. nervousness
  • c. fluid retention
  • d. HPA axis suppression
  • e. thrombocytopenia

54
  • Side effects of oral corticosteroids include
    all of the following except
  • a. hyperglycemia
  • b. nervousness
  • c. fluid retention
  • d. HPA axis suppression
  • e. thrombocytopenia

55
  • Patients exhibiting Cushing syndrome should avoid
    products containing
  • a. corticosteriods
  • b. iodine
  • c. sulfas
  • d. penicillins
  • e. salicylates

56
  • Patients exhibiting Cushing syndrome should avoid
    products containing
  • a. corticosteriods
  • b. iodine
  • c. sulfas
  • d. penicillins
  • e. salicylates

57
  • Which of the following drugs is/are
    administered by dry powder inhalation?
  • I. Ipratropium (atrovent of combivent)
  • II. Pirbuterol (MaxAir Turboinhaler)
  • III. Salmeterol (Diskus)
  • a. I only
  • b. III only
  • c. I and II only
  • d. II and III only
  • e. I, II, and III

58
  • Which of the following drug(s) is/are
    administered by dry powder inhalation?
  • I. Ipratropium (atrovent of combivent)
  • II. Pirbuterol (MaxAir Turboinhaler)
  • III. Salmeterol (Diskus)
  • a. I only
  • b. III only
  • c. I and II only
  • d. II and III only
  • e. I, II, and III

59
  • All of the following drugs are available as
    aerosol units EXCEPT
  • a. Spiriva
  • b. Azmacort
  • c. Rhinocort
  • d. Beconase
  • e. Combivent

60
  • All of the following drugs are available as
    aerosol units EXCEPT
  • a. Spiriva
  • b. Azmacort
  • c. Rhinocort
  • d. Beconase
  • e. Combivent

61
Drugs Used to Treat Glaucoma
NAPLEX
62
Causes of Glaucoma Wide or open angle most
common, malfunction of trabecular meshwork
Narrow angle or closed angle obstruction of the
outflow of aqueous humor through the trabecular
meshwork.
PG 136
63
  • An instrument used to measure intraocular
    pressure is a(n)
  • a. gonioscope
  • b. otoscope
  • c. ophthalmoscope
  • d. tonometer
  • e. barometer

64
  • An instrument used to measure intraocular
    pressure is a(n)
  • a. gonioscope (lens to study angle of eye)
  • b. otoscope (instrument to examine the drum
    membrane of the ear)
  • c. ophthalmoscope (device to study interior of
    eye)
  • d. tonometer (device to measure intraocular
    pressure)
  • e. barometer (device to measure the atmospheric
    pressure)

65
  • Drugs for Glaucoma Treatment
  • Goal of Therapy reduced intraocular pressure
    (IOP)
  • - measured by a tonometer (10-20mmhg)
  • - decrease rate of aqueous humor production
  • - increase rate of outflow (drainage) of aqueous
  • humor
  • Sympathomimetics increase outflow and decrease
    production of aqueous humor
  • - epinephrine (Epifrin, Glaucon) discard if
    color change occurs
  • - dipiverfrin (Propine) epinephrine prodrug
    less side effects
  • - apraclonidine (Iopidine) alpha-2 agonist
    watch for ocular allergy
  • - brimonidine (Alphagan) - alpha-2 agonist, more
    selective

PG 136
66
  • Drugs for Glaucoma Treatment
  • Miotics (direct acting)have direct cholinergic
    action causing miosis increases outflow, may
    cause eye pain, burning, blurred vision less
    with gel and Ocusert formulations
  • - acetylcholine (Miochol)
  • - carbachol (Isoptocarbachol)
  • - Pilocarpine (Isoptocarpine, Pilocar, Pilostat,
    Pilopine HS, Ocusert Pilo)
  • Miotics (cholinesterase inhibitors)increase
    cholinergic action by inhibiting cholinesterase
    similar adverse effects as direct-acting miotics
  • - physostigmine (Eserine) may cause cataracts
  • - Demecarium (Humersol)
  • - Echothiophate (phospholine iodide)

mydriasis
PG 136
67
  • Drugs for Glaucoma Treatment
  • Beta-adrenergic blocking agents reduce
    production of aqueous humor watch for possible
    breathing difficulty, bradycardia, hypotension,
    and CNS depression
  • - betaxolol (Betopic, Betoptic S) beta 1
    selective
  • - levobetaxolol (Betaxon) beta 1 selective
  • - carteolol (Ocupress), levobunolol (Betagan,
    AKBeta)
  • - metipranolol (Optipranolol),
  • - timolol (Timoptic, Timoptic XE) B1 B2
  • Prostaglandin analogs increase outflow of
    aqueous humor may darken iris color and cause
    thickened lashes
  • - latanoprost (Xalatan)
  • - bimatoprost (Lumigan)
  • - travoprost (Travatan)
  • - Unoprostone (Rescula) Not available in U.S.

PG 136
68
  • Drugs for Glaucoma Treatment
  • Carbonic anhydrase inhibitors suppress
    production of aqueous humor watch for urinary
    frequency and nephrolithiasis
  • - dichlorphenarnide (Daranide)
  • - acetazolamide (Diamox)----oral capsules, IV
    Also used for mountain sickness
  • - methazolamide (Neptazane)
  • - dorzolamide (Trusopt)
  • - brinzolamide (Azopt)
  • Osmotic diuretics----given orally or IV
  • - glycerin (Osmoglyn) , mannitol (Osmitrol)
  • - urea (Ureaphil), isosorbide (Isomotic)

PG 136
69
  • Timoptic dosage forms include
  • I. capsule
  • II. tablet
  • III. ophthlamic solution
  • a. I only
  • b. III only
  • c. I and II only
  • d. II and III only
  • e. I, II, and III

70
  • Timoptic dosage forms include
  • I. capsule
  • II. tablet
  • III. ophthlamic solution
  • a. I only
  • b. III only
  • c. I and II only
  • d. II and III only
  • e. I, II, and III

71
  • Dosage forms for timolol maleate include
  • I. gel
  • II. tablet
  • III. ophthlamic solution
  • a. I only
  • b. III only
  • c. I and II only
  • d. II and III only
  • e. I, II, and III

72
  • Dosage forms for timolol maleate include
  • I. gel
  • II. tablet
  • III. ophthlamic solution
  • a. I only
  • b. III only
  • c. I and II only
  • d. II and III only
  • e. I, II, and III

73
Glaucoma Case Study
  • Page 138

74
  • Pilocarpine can be classified as a(n)
  • a. anticholinergic agent
  • b. carbonic anhydrase inhibitor
  • c. beta-adrenergic blocking agent
  • d. cholinergic agent
  • e. sympathomimetic agent

75
  • Pilocarpine can be classified as a(n)
  • a. anticholinergic agent
  • b. carbonic anhydrase inhibitor
  • c. beta-adrenergic blocking agent
  • d. cholinergic agent
  • e. sympathomimetic agent

76
  • An Ocusert Pilo-20 system
  • a. is administered orally once daily
  • b. releases 20 mg of pilocarpine each day
  • c. must be replaced each month
  • d. releases 20 µg of pilocarpine each hour
  • e. must be soaked in normal saline just prior to
    use

77
  • An Ocusert Pilo-20 system
  • a. is administered orally once daily
  • b. releases 20 mg of pilocarpine each day
  • c. must be replaced each month
  • d. releases 20 µg of pilocarpine each hour
  • e. must be soaked in normal saline just prior to
    use

78
  • A normal intraocular pressure reading would be
  • a. 10-20 mm Hg
  • b. 20-30 mm Hg
  • c. 30-40 mm Hg
  • d. 40-50 mm Hg
  • e. 50-60 mm Hg

79
  • A normal intraocular pressure reading would be
  • a. 10-20 mm Hg
  • b. 20-30 mm Hg
  • c. 30-40 mm Hg
  • d. 40-50 mm Hg
  • e. 50-60 mm Hg

80
  • Special caution must be used when timolol is used
    in patients with
  • a. sulfonamide allergy
  • b. asthma
  • c. cancer
  • d. hypertension
  • e. NSAID hypersensitivity

81
  • Special caution must be used when timolol is used
    in patients with
  • a. sulfonamide allergy
  • b. asthma
  • c. cancer
  • d. hypertension
  • e. NSAID hypersensitivity
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