PILOCARPINE IN THE TREATMENT OF OPEN ANGLE GLAUCOMA

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Presented By-
Phr. Deepa kumari karn
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PILOCARPINE IN THE TREATMENT OF OPEN ANGLE
GLAUCOMA
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• Objective
• Inform my audience about glaucoma and the use
  of pilocarpine in the treatment of glaucoma.

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CONTENT

• Major parts of eye
• Glaucoma
• Types of Glaucoma
• Open Angle Glaucoma
• Effect of Glaucoma
• Diagnosis
• Risk Factor
• Treatment
• Pilocarpine
• Therapeutic category

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• Available dosage form
• Doses
• Missed Dose
• Proper use
• Mechanism of action
• Side effect
• Precaution
• References

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The Eye
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• Major Parts of the Eye

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Glaucoma

• Group of eye disease characterized by increased
  intraocular pressure(gt21 mmHg)
• This leads to atropy or damage of optic nerve and
  possibly leading to blindness
• Aqueous humor doesnt flow through the trabecular
  meshwork properly
• Early detection and treatment are keys to
  preventing vision loss

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Types of Glaucoma

• Glaucoma is seen in three principal clinical
  forms-
• Open Angle Glaucoma(Chronic)
• Closed angle Glaucoma(Acute)
• Congenital Glaucoma

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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

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• 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

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Fig- open and closed angle glaucoma
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Effect of Glaucoma
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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

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Risk Factor

1. gt age 55
2. Family history
3. Having diabetes
4. Elevated eye pressure
5. Previous eye injury
6. Thin cornea

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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

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• Operative treatment include-
• Paracentesis of cornea
• Iridectomy
• Cyclodialysis
• Anterior sclerotomy

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Pilocarpine(pye-loe-KAR-peen)
Origin of the Drug

• Obtain from leaves of Pilocarpus microphyllus
• South American Shrub
• Isolated in 1875

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• Therapeutic category-
• Direct acting cholinergic agonist
• Muscarinic action
• Available dosage form-
• Suspension
• Solution
• Gel/Jelly
• Insert

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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

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• 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

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How to Use Eye Ointments and Gels Properly?
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(No Transcript)
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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

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• 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

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• 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

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Reaction Sequence
Phospholipase C Phosphatidyl inositol
biphosphate (PIP) complex
G- Protein subunits ?, ?, ?
GDP\
Inositol 1,4,5 - triphosphate (IP3)
diacylglycerol
Myosin-actin interaction (Muscle Contraction)
GTP
Muscarinic Receptor
caldesmon
Ca2
Calmodulin/ Ca2
Endoplasmic Reticulum
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Side Effects

• Symptoms of too much medicine being absorbed into
  the body -
• Increased sweating
• Muscle Tremors
• Nausea, vomiting, or diarrhea
• Watering of mouth

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• 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.

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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.

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• 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

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REFERENCES

• Katzung BG (2007), Basic and Clinical
  Pharmacology (10th Ed.), Mc Graw Hill Lange
  Medical Publication, Singapore, pp (93-106).
• Tripathi KD (2010), Essential of Medical
  Pharmacology (6th Ed.), Jaypee Brothers Medical
  Publishers, New Delhi, pp (90-99).
• Davis FA (2001), Tabers Cyclopedic Medical
  Dictionary (20thEd), FA Davis Company,
  Philadelphia, pp (883-885).
• URL-
• http//www.medic8.com/healthguide/articles/glaucom
  a.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?artic
  lekey44939 and page1how to use(Accessed on Jul
  27 2011)

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• THANKS A LOT FOR YOUR KIND ATTENTION!!!!!!!!!!!!