terminology and guidelines for glaucoma ii - Kwaliteitskoepel
terminology and guidelines for glaucoma ii - Kwaliteitskoepel
terminology and guidelines for glaucoma ii - Kwaliteitskoepel
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3.3.2.2 - Category: ADRENERGIC ANTAGONISTS AND TOPICAL C.A.I. 74-75<br />
ß-Blockers & topical CAI<br />
Generics<br />
Timolol 0.5% <strong>and</strong> dorzolamide 2%<br />
Tradenames<br />
Cosopt<br />
Action<br />
Decreases intraocular pressure by reduction of the aqueous humor production. Peak effect in 2 hrs.<br />
Dosage <strong>and</strong> administration<br />
Starting dose is one drop in the affected eye twice a day. Dosing more than twice daily will not give any further<br />
pressure lowering effect.<br />
Additive effect with pilocarpine. Minimal extra effect with dipivefrine. No extra effect with adrenaline (epinephrine).<br />
Indications<br />
Elevations of intraocular pressure in patients where the IOP can be deleterious <strong>for</strong> the preservation of visual function.<br />
Major Contraindications<br />
Asthma, history of obstructive pulmonary disease, sinus bradycardia (< 60 beats/min), heart block, or cardiac failure,<br />
severe renal impairment (CrCl < 30 ml/min) or hyperchloremic acidosis, hypersensitivity to any component of<br />
the product. Relative contraindication in history of obstructive pulmonary disease.<br />
Major side effects<br />
Systemic:<br />
Bradycardia, arrhythmia, heart failure, syncope, bronchospasm, <strong>and</strong> airways obstruction.<br />
Peripheral edema, hypotension. Depression. Hypoglycemia may be masked in insulin dependent<br />
diabetes mellitus.<br />
Ocular (uncommon): Epithelial keratopathy, slight reduction in corneal sensitivity.<br />
Pregnancy <strong>and</strong> nursing mothers<br />
Only to be used if the potential benefit justifies the potential risk to the fetus or the infant.<br />
Drug interactions<br />
Caution should be used in the co-administration of beta-adrenergic blocking agents <strong>and</strong> oral or intravenous calcium<br />
antagonists, because of possible atrioventricular conduction disturbances, left ventricular failure, <strong>and</strong> hypotension.<br />
Digitalis <strong>and</strong> calcium antagonists: the concomitant use of beta-adrenergic blocking agents with digitalis <strong>and</strong> calcium<br />
antagonists may have additive effects in prolonging conduction time.<br />
Catecholamine-depleting drugs: because of possible additive effects <strong>and</strong> the production of hypotension <strong>and</strong>/or<br />
marked bradycardia.<br />
Wash-out<br />
The time needed to lose their activity completely is 2-4 weeks.<br />
Ch. 3 - 24 EGS