Pilocarpine in the treatment of open angle glaucoma

Pilocarpine in the treatment of open angle glaucoma

1. 5/23/2017 1 Presented By;- Phr. Deepa kumari karn

2. PILOCARPINE IN THE TREATMENT OF OPEN ANGLE GLAUCOMA

3. Objective: Inform my audience about glaucoma and the use of pilocarpine in the treatment of glaucoma. 5/23/2017 3

4. CONTENT Major parts of eye Glaucoma Types of Glaucoma Open Angle Glaucoma Effect of Glaucoma Diagnosis Risk Factor Treatment Pilocarpine Therapeutic category 5/23/2017 4

5. Available dosage form Doses Missed Dose Proper use Mechanism of action Side effect Precaution References 5/23/2017 5

6. The Eye 5/23/2017 6

7. Major Parts of the Eye 5/23/2017 7

8. Glaucoma Group of eye disease characterized by increased intraocular pressure(>21 mmHg) This leads to atropy or damage of optic nerve and possibly leading to blindness Aqueous humor doesn’t flow through the trabecular meshwork properly Early detection and treatment are keys to preventing vision loss

9. Types of Glaucoma Glaucoma is seen in three principal clinical forms;- Open Angle Glaucoma(Chronic) Closed angle Glaucoma(Acute) Congenital Glaucoma 5/23/2017 9

10. Open Angle Glaucoma Trabecular meshwork becomes less effective at draining aqueous humor Tonometer indicates an intraocular pressure upto 45 to 50 mmHg Typically, open angle glaucoma has no symptoms in its early stages It is further divided into;- Primary open angle glaucoma Secondary open angle glaucoma 5/23/2017 10

11. Primary open angle glaucoma;- Its frequency increases greatly with age(over 50 years) People are usually not aware of the problem until the loss encroaches on their central visual area Secondary open angle glaucoma;- It can result from an eye (ocular) injury, even one that occurred many years ago 5/23/2017 11

12. 5/23/2017 12 Fig;- open and closed angle glaucoma

13. Effect of Glaucoma 5/23/2017 13

14. Diagnosis It may not cause any particular symptoms only way is to detect is by measuring intraocular pressure Some symptoms include;- Frequent need to change eye glass Mild headache, aching Impaired dark adaption may be present Reduce visual activity at night 5/23/2017 14

15. Risk Factor > age 55 Family history Having diabetes Elevated eye pressure Previous eye injury Thin cornea 5/23/2017 15

16. Treatment The goal of any treatment is to prevent loss of vision, as vision loss from glaucoma is irreversible Glaucoma can be treated with eye drops, pills, laser surgery, traditional surgery or combination of these methods Non operative treatment include the use of miotics ;- Pilocarpine Eserine Intravenous mannitol Parenteral acetazolamide 5/23/2017 16

17. Operative treatment include;- Paracentesis of cornea Iridectomy Cyclodialysis Anterior sclerotomy 5/23/2017 17

18. Pilocarpine ( pye-loe-KAR-peen) 5/23/2017 18 Origin of the Drug Obtain from leaves of Pilocarpus microphyllus South American Shrub Isolated in 1875

19. Therapeutic category;- Direct acting cholinergic agonist Muscarinic action Available dosage form;- Suspension Solution Gel/Jelly Insert 5/23/2017 19

20. Doses Dose of this medicine will be different for different patient and also depend on dosage form For Eye drop Adult and children ;- 1 drop,1-4 times a day For Eye gel/Jelly Adult and teenagers;- once a day at bed time Children;- use and dose is determined by doctor 5/23/2017 20

21. For Eye Insert;- Adult and children;-insert 1 ocular system every 7 days Infants;-determined by doctor Missed Dose Take it as soon as possible If it is almost time for next dose, skip the missed dose and go back to regular dosing schedule Do not double doses 5/23/2017 21

22. How to Use Eye Ointments and Gels Properly ? 5/23/2017 22

23. 5/23/2017 23

24. Mechanism of action The various process involved are;- Pilocarpine binds to muscarinic receptor(M3) Activates receptors binds G -protein Removal of GDP and addition of GTP to G-protein Dissociation of G-protein from muscarinic receptor Separation of G protein into alpha and beta-gamma subunit 5/23/2017 24

25. Alpha subunit interacts with Phospholipase C Phosphatidyl inositol biphosphate(PIP)complex Phospholipase enzyme break down PIP into inositol 1,4,5-triphosphate(IP3) and diacylglycerol IP3 interacts with ER membrane and release Calcium ion 5/23/2017 25

26. Calcium ion binds to calmodulin and form calcium ion/calmodulin complex This complex binds to Caldesmon which allow myocin-actin interaction to occurs As a result cillary muscle(pupil)contracts This stimulate the cillary muscle and cause opening of Trabecular meshwork Increased out flow of fluid and reduce the tension 5/23/2017 26

27. GTP GDP \ Muscarinic Receptor G- Protein subunits , ,  Phospholipase C Phosphatidyl inositol biphosphate (PIP) complex Inositol 1,4,5 - triphosphate (IP 3 ) + diacylglycerol Endoplasmic Reticulum Ca 2+ Calmodulin/ Ca 2 Reaction Sequence caldesmon Myosin-actin interaction (Muscle Contraction) 5/23/2017 27

28. Side Effects Symptoms of too much medicine being absorbed into the body ;- Increased sweating Muscle Tremors Nausea, vomiting, or diarrhea Watering of mouth 5/23/2017 28

29. More common ;- Change in vision Decrease in night vision Less common Eye irritation Headache Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. 5/23/2017 29

30. Precautions while using Pilocarpine For patients using the eye drop or gel form of pilocarpine: For a short time after using pilocarpine, vision may be blurred or there may be a change in near or far vision, especially at night. Make sure that vision is clear before driving, using machines, or doing anything else that could be dangerous if not able to see well. 5/23/2017 30

31. Patient using eye insert form of pilocarpine For several hour after insert the vision may be blurred, therefore insert it at bedtime If insert at any other time make sure that vision is clear before doing anything that is danger when not able to see 5/23/2017 31

32. REFERENCES Katzung BG (2007), Basic and Clinical Pharmacology (10 th Ed.), Mc Graw Hill Lange Medical Publication, Singapore, pp (93-106). Tripathi KD (2010), Essential of Medical Pharmacology (6 th Ed.), Jaypee Brothers Medical Publishers, New Delhi, pp (90-99). Davis FA (2001), Taber’s Cyclopedic Medical Dictionary (20 th Ed), FA Davis Company, Philadelphia, pp (883-885). URL;- http://www.medic8.com/healthguide/articles/glaucoma.html (Accessed on Jul 27, 2011) http://www.drugs.com/cons/pilocarpine.http (Accessed on Jul 28,2011) http://www.medicinet.com/script/main/art.asp?articlekey=44939 and page=1#how to use(Accessed on Jul 27 2011) 5/23/2017 32

33. THANKS A LOT FOR YOUR KIND ATTENTION!!!!!!!!!!!! 5/23/2017 33