acetazolamide in glaucoma

7/29/2019 Acetazolamide in Glaucoma

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A Case Of Glaucoma treatedwith Acetazolamide


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LAYOUT

Diagnosis

Features

Pathophysiology

Management

Glaucoma

Case History

Investigation


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PATIENTS PROFILE

Name: XYZ

Age:25 Years

Sex: Female

Residence: Rawalpindi

Occupation: Housewife

Date Of History Taking: 17 January

,2011


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hopi

History Of

Presenting

Illness


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HOPI

Past historyAsthmaDM negative

HTN

No H/O any medical or surgicalintervention

Personal history

Family history

Drug history

Socioeconomic historymiddle class


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xam nat on


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GENERAL PHYSICAL EXAMINATIO BP 140/90 mmhg

Pulse 84 beats/min

Temp 1o1 F

Resp. Rate 18/min

pallor

jaundice negative

Clubbing

JVP


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DIAGNOSIS

A diagnosis of Uncomplicated UTI was made


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TREATMENT

Septran (Co-Trimoxazole)


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UTI

Definition:

.

IOP


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TYPES OF GLAUCOMA


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Risk factors for open angle glaucoma

Level of intraocular

pressure

Increasing age

African-Caribbeanorigin

Family history

Thin corneas


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NORMAL FLOW OF AQUEOUS

HUMOUR

Ciliaryprocess

Postchamber

pupil

AntchamberTrabecularmeshwork


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PATHOPHYSIOLOGY


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CONSEQUENCES

Increased IOP

Decreased B.S topupil and dec.responsiveness

Optic nerve damagein later stages

Iris becomesedematous andshows patches of

necrosis


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MANAGEMENT

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DRUG OF CHOICE ACETAZOLAMIDE


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Structure and Chemistry

Sulfonamide derivative

synthetic origin.

ACETAZOLAMIDE


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PHARMACOKINETICS

Route of administration: Oral

Absorption: Well Absorbed

Bioavailability: 100%

Distribution: High Conc. In CA Rich tissues

Metabolism: not metabolized

Half life: 6-9 Hours

Excretion: S2 Segment, PCT(Secretion)


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SITE OF ACTION

Acetazolamide


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PHARMACODYNAMICS

PCT (Membranebound & Cytoplasmic)

EYE(Ciliary Body)

BRAIN(Choroidepithelium)

Site ofaction

CarbonicAnhydrase in

MECHANISMOF DRUG

ACTION


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MECHANISM OF ACTION

Acts as an inhibitor ofCarbonic Anhydrase

Plays a key role in

NAHCO3 Reabsorption

& Acid secretion


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PHARMACOLOGICAL

ACTIONS


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EFFECTS ON KIDNEY

HCO3 Diuresis

NaHCO3 Excreted

Metabolic Acidosis

Excess Na+ Reabsorbed;K+ Secreted

K+ Wasting

Urine BloodHCO3

CA In PCT

Na+ In CCT


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EFFECTS ON EYE

Inhibition of HCO3Secretion into

aqueous humour

AcetazolamideAdministration

DecreasedI.O.P

For TreatmentOf Glaucoma

BloodHCO3

CA In Ciliary Epithelium

Aqueous humour


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Protection against High Altitude Sickness

Promotes Hyperventilation

EFFECTS ON CSF

BloodHCO3

Blood

CA In Choroid plexus

Acidosis of CNS

Acetazolamide administered

Decreased HCO3 Secretion into CSF


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For Open

angleglaucoma

For Urinary

Akalanization

For

MetabolicAlkalosis

CLINICAL INDICATIONS


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CLINICAL INDICATIONS(CONTD.)

Weakness

Dizziness

Insomnia

Headache

Nausea

Acute

Mountain

Sickness

FATE

HAPE

HACE Death

Mild Lasts afew

days


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OTHER USES

Epilepsy Adjuvant

Hypokalemic Periodic Paralysis

Severe Hyperparathyroidism


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FORMULATIONS AVAILABLE

125 mg tablets

250 mg tablets

500 mg sustained release capsules

Intravenous injection 500 mg/5 cc

No topical formulation of

acetazolamide is available (mainlybecause of it having a limited aqueous solubilityand poor corneal permeation)


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THERAPEUTIC DOSAGE

Glaucoma

250 to 1000 mg by mouth daily

unable to take oral medicine, 500 mg IV or IM

High-altitude sickness

500 to 1000 mg daily

Metabolic alkalaemia

2.5 to 5 mg per kg body-weight IV

Abnormal retention of fluid 250-375 mg once daily in the morning


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ADVERSE EFFECTS

HyperchloremicMetabolic Acidosis

Due To ChronicIn Body HCO3

Effect Not Self-Limiting

Renal K+ Wasting

Na+ In CCT

Partially Reabsorbed

Lumen ve Potential In CCT

K+ Secretion


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RenalStones

Hypercalciuria

Phosphaturia

Excretion ofsolublizingfactors e.g.

Citrate

Effects Of Acetazolamide

ADVERSE EFFECTS(Contd.)


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OTHER TOXICITIES

Drowsiness

Paraesthesias

Cross-Allergenicity withSulfonamide Derivatives

CNS Toxicity


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HYPERSENSITIVITY REACTIONS

Fever

Rash

Bone Marrow

Suppression

Interstitial Nephritis


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CONTR-INDICATIONS

ACZ Alk.Urine

NH4+Excretion

HepaticEncephalopathy

HyperNH4+emia

In pts. Of Cirrhosis

In pts. Of Hyperchloremic Acidosis/COPD

ACZCauses

WorseningOf

Metabolic/Respiratory

Acidosis

DRUG DRUG INTERACTIONS


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DRUG-DRUG INTERACTIONS

folic acid antagonists, oral hypoglycemic

agents and oral anticoagulants

Effects

Salicylates

risk of Acetazolamides side effects

Primidone, salicylates (e.g., aspirin),

lithium, or methenamine

their effectiveness may be byAcetazolamide


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JazakAllah and Thank you!


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Any Questions???

acetazolamide in glaucoma

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