Transcript Analgesia and Asthma

NAPLEX
Analgesics
PG 132
Treatment Algorithm for Pain
Patient in pain
Rating Scale 0-10
Mild Pain (0-3)
NSAID, aspirin,
APAP
Moderate Pain (4-6)
Weak opioid:
codeine,
hydrocodone
Severe Pain (7-10)
Strong opioid:
morphine,
oxycodone,
hydromorphone
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
Non Opioid Analgesics
Drug
Dose
Interval
Renal Adjustment
Hepatic Adjustment
Acetaminophen
500-1000 mg
4-6 hours
GFR: >50 ml/min q4h,
10-50 ml/min q6h,
<10 ml/min q8h
1/2 life is increased,
Can be given safely
Max: 4 g
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
Non Opioid Analgesics con’t
Drug
Dose
Interval
Renal Adjustment
Hepatic Adjustment
Ibuprofen
200-800 mg
4-6 hours
Use with caution
Contraindicated in
renal failure
No dose alterations,
Kinetics minimally
effected
Max: 3.2 g/day
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
Propionic Acids
oxaprozin
naproxen
ibuprofen
ketoprofen
fenoprofen
flurbiprofen
Naphthylalkanone
Carboxylic Acids
Nonacetylated
Salicylates
Oxicams
salsalate
diflunisal
choline
piroxicam
meloxicam
nabumetone
Fenamates
meclofenamate
mefenamic acid
GI Sparing Agents
diclofenac/misoprostol
Salicylates
ASA
Acetic Acids
sulindac
etodolac
indomethacin
tolmetin
diclofenac
ketorolac
Weak Opioid Analgesics
Drug
Dose
Interval
Codeine
15-60 mg
Max: 120 mg
4-6 hours
Oxycodone w/
-acetaminophen
-aspirin
5 mg
Max: 4 g*
Hydrocodone w/
-ibuprofen
(7.5/200)
-acetaminophen
(5/500)
-aspirin
(5/500)
1-2 tabs
Max: 5 tabs
4-6 hours
1-2 tabs
Max: 4 g*
1-2 tabs
Max: 4 g*
4-6 hours
Tramadol
50-100 mg
Max: 400mg
2 tabs
Max: 8 tabs
4-6 hours
-acetaminophen
(37.5/325)
4-6 hours
Renal Adjustment
Hepatic Adjustment
CrCl:
10-50 ml/min=75% of dose,
<10 ml/min=50% of dose
A dosage adjustment decrease
Be conservative, drug levels
increase by 50%
1/3 to 1/2 of usual dose,
Elimination 1/2 life increase by
2.3 hours
Use cautiously in mild to
moderate renal failure, avoid
in severe renal failure
Avoid
CrCl < 30 ml/min increase
dosing interval to q12h with a
max of 200 mg per day
Cirrhosis 50 mg q12h
4-6 hours
4-6 hours
Avoid
Weak Opioid Analgesics con’t
Drug
Propoxyphene
-acetaminophen
-aspirin
Dose
1-2 tabs
Max: 4 g*
1-2 tabs
Interval
Renal Adjustment
Hepatic Adjustment
Avoid
4 hours
Don’t give in severe renal
failure, use cautiously in mild
and moderate renal failure
4 hours
Strong Opioid Analgesics
Drug
Dose
Interval
Renal Adjustment
Hepatic
Adjustment
Meperidine
- Binds opiate
receptors
50 - 150 mg
3-4 hours
GFR
>50 ml/min No adjustment
10-50 ml/min 75% of dose
<10 ml/min 50% of dose
Decrease dose,
1/2 life is
increased
Titrate to
response
2-6 hours
GFR
>50 ml/min No adjustment
10-50 ml/min 75% of dose
<10 ml/min 50% of dose
1/2 life prolonged
increase interval
by 1.5 to 2 times
Morphine (gold standard)
-immediate release
-IV, IM, SQ,
continuous infusion
-epidural
-intrathecal
Metabolite
accumulation
(normeperidine)
Anxiety, agitation,
tremor &/or seizures
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
-rectal
10-20 mg
No repeat
dose
4 hours
(morphine-6-glucuronide)
accumulates in renal
failure
Strong Opioid Analgesics con’t
Drug
Hydromorphone
-PO, IM, IV, SQ
-rectal
Oxycodone
- percocet (APAP)
- percodan (ASA)
Methadone
-PO, IM, SQ
-IV
Dose
Interval
Renal Adjustment
Hepatic Adjustment
Decrease dose
1-4 mg
3 mg
4-6 hours
6-8 hours
5 mg
May titrate to
response – no
maximum dose
6 hours –
2.5-10 mg
Max:1000 mg
0.1mg/kg
3-8 hours
4 hrs x 3
doses then
6-12 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
GFR
>50ml/min
q6h
10-50 ml/min q8h
<10 ml/min q12h
No Change in dose mild to
moderate disease,
Avoid in severe liver
disease
CrCl
<10 ml/min 50-75% dose
Strong Opioid Analgesics con’t
Drug
Fentanyl
-transdermal
-transmucosal
-Parenteral
Dose
Initial 25 mcg/hr
Initial 200 mcg
Interval
Renal Adjustment
Hepatic Adjustment
72 hours
30 min
CrCl
10-50 ml/min 75% of dose
<10 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.
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
4 acute
1 chronic
x
10 acute?
2-4 chronic
2 acute
1 chronic
0.1-0.2
x
1
300
75
Levorphanol
Fentanyl
Oxymorphone
Meperidine
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
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 25–50%
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
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
Acetaminophen—analgesic, antipyretic
NSAIDs - analgesic, antipyretic, anti-inflammatory (See Table pg. 133)
• Mechanism of action
• Common adverse effects: GI toxicity, hypersensitivity, renal effects
PG 133
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
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
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
Drugs for Migraine
Prophylactic Therapy
- Given to patients with >2-3 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
Pathophysiology
Complications
Source: www.arava.com
Rheumatoid Arthritis
Corticosteroids – early, acute, not long-term
- also NSAIDs / COX-2 Inhibitors
Disease Modifying Antirheumatic Drugs (DMARDs) – liver, heme
Auranofin (Ridaura)
Gold
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
PG 134
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 (Tlymphocytes 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
Joint Distribution: RA Compared to OA
Rheumatoid Arthritis
Osteoarthritis
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
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
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
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
Trigeminal neuralgia is treated by the
use of:
a. aspirin
b. carbamazepine
c. dipyridamole
d. methylprednisolone
e. thiamine
Trigeminal neuralgia is treated by the
use of:
a. aspirin
b. carbamazepine
c. dipyridamole
d. methylprednisolone
e. thiamine
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
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
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
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
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
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)
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
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
NAPLEX
Drugs for the Treatment
of Asthma
PG 142
Classification
Symptoms
Step 1
Mild
Intermittent
¨ Symptoms ≤ 2 times a week
¨ Asymptomatic and normal
PEF between exacerbations
¨ Exacerbations brief (from a
few hours to a few days);
intensity may vary
Step 2
Mild
Persistent
¨ Symptoms > 2 times a week
but < 1 time a day
¨ Exacerbations may affect
activity
Step 3
Moderate
Persistent
¨ Daily symptoms
¨ Daily use of inhaled shortacting beta-2 agonist
¨ Exacerbations affect activity
¨ Exacerbations ≥ 2 times a
week; may last day
Step 4
Severe
Persistent
¨ Continual Symptoms
¨ Limited Physical Activity
¨ Frequent Exacerbations
Nighttime
Symptoms
≤ 2 times a month
> 2 times a month
Lung Function
¨ FEV1/PEF ≥ 80%
predicated
¨ PEF variability < 20%
¨ FEV1/PEF ≥ 80%
predicated
¨ PEF variability < 2030%
> 1 time a week
¨ FEV1/PEF > 60 - <
80% predicated
¨ PEF variability > 30%
Frequent
¨ FEV1/PEF ≤ 60%
predicated
¨ PEF variability > 30%
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
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
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
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);
PG 142
monitor hepatic function, think DIs---potent inhibitor

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 betaagonists.
New NIH guidelines will improve asthma treatment.
You'll see renewed emphasis on controlling
symptoms...patient education...and avoiding allergens.

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
PG 142
Tiotropium (Spiriva)----long acting, dry powder capsule for inhalation
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
Side effects of oral corticosteroids
include all of the following except:
a. hyperglycemia
b. nervousness
c. fluid retention
d. HPA axis suppression
e. thrombocytopenia
Side effects of oral corticosteroids
include all of the following except:
a. hyperglycemia
b. nervousness
c. fluid retention
d. HPA axis suppression
e. thrombocytopenia
Patients exhibiting Cushing syndrome
should avoid products containing:
a. corticosteriods
b. iodine
c. sulfas
d. penicillins
e. salicylates
Patients exhibiting Cushing syndrome
should avoid products containing:
a. corticosteriods
b. iodine
c. sulfas
d. penicillins
e. salicylates
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
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
All of the following drugs are available as
aerosol units EXCEPT:
a. Spiriva
b. Azmacort
c. Rhinocort
d. Beconase
e. Combivent
All of the following drugs are available as
aerosol units EXCEPT:
a. Spiriva
b. Azmacort
c. Rhinocort
d. Beconase
e. Combivent
NAPLEX
Drugs Used to Treat
Glaucoma
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
An instrument used to measure intraocular
pressure is a(n):
a. gonioscope
b. otoscope
c. ophthalmoscope
d. tonometer
e. barometer
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)
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
Drugs for Glaucoma Treatment
mydriasis
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)
PG 136
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
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
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
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
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
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
Glaucoma Case Study
Page 138
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
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
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
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
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
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
Special caution must be used when
timolol is used in patients with:
a. sulfonamide allergy
b. asthma
c. cancer
d. hypertension
e. NSAID hypersensitivity
Special caution must be used when
timolol is used in patients with:
a. sulfonamide allergy
b. asthma
c. cancer
d. hypertension
e. NSAID hypersensitivity