Why adrenaline is contraindicated in glaucoma? These agents stimulate both alpha-1 and alpha-2 adrenergic receptors, thus topical administration can induce transient mydriasis, either with or without the use of concomitant miotic agents.
What are the contraindications for the use of epinephrine?
There are no absolute contraindications against using epinephrine. Some relative contraindications include hypersensitivity to sympathomimetic drugs, closed-angle glaucoma, anesthesia with halothane. Another unique contraindication to be aware of is catecholaminergic polymorphic ventricular tachycardia.[5]
Can intraoperative sympathetic drugs increase the risk of acute angle closure glaucoma?
This serves as a cautionary tale as the effects, both positive or negative of intraoperative sympathomimetic drugs can be compounded by psychological stress, thus heightening the risk for acute angle closure glaucoma. Symptoms of acute angle closure glaucoma can easily be misinterpreted or overlooked in a recently anaesthetized patient.
Can ephedrine cause glaucoma attacks?
Ephedrine can result in acute angle-closure glaucoma attacks in patients with preexisting narrow angles. Some cold medications contain ephedrine for managing congestion. There are certain drugs that can cause angle closure in some people, often in both eyes. This is because patients are likely to experience an allergic reaction to the sulfa drug.
Are there any medications that should be avoided when treating glaucoma?
These treatments are no longer used and should now be avoided when treating glaucoma: Dibenamine: This adrenergic antagonist had to be administered intravenously (IV) and caused orthostatic hypotension and even death in some cases. Topical epinephrine: This medication had both systemic and topical side effects.
How does epinephrine affect glaucoma?
Epinephrine, administered topically in the management of open-angle glaucoma, effectively lowers intraocular pressure, but it has side-effects which may be both local and systemic.
Is adrenaline contraindicated in glaucoma?
Epinephrine is contraindicated for angle-closure glaucoma and should be used with caution in patients with narrow angles. Although there is a potential for serious systemic side effects, most of the recognized side effects are not serious and are reversible with drug discontinuation.
Is ephedrine contraindicated in glaucoma?
Ephidrine-Containing Drugs Ephedrine can result in acute angle-closure glaucoma attacks in patients with preexisting narrow angles.
Which of the following drug is contraindicated in angle closure glaucoma?
Sulfa-based drugs (acetazolamide, hydrochlorothiazide, cotrimoxazole, and topiramate) can cause acute angle closure glaucoma by ciliary body edema with anterior rotation of the iris-lens diaphragm. Iridotomy is not effective.
What are the contraindications of epinephrine?
There are no absolute contraindications against using epinephrine. Some relative contraindications include hypersensitivity to sympathomimetic drugs, closed-angle glaucoma, anesthesia with halothane. Another unique contraindication to be aware of is catecholaminergic polymorphic ventricular tachycardia.
Who should not use epinephrine?
Epinephrine is contraindicated in patients with known hypersensitivity to sympathomimetic amines, in patients with angle closure glaucoma, and patients in shock (nonanaphylactic).
Why are antihistamines contraindicated in glaucoma?
Medications and Glaucoma: Over the counter medicines such as decongestants and antihistamines can dilate the pupil and lead to dangerously elevated eye pressure.
When is ephedrine contraindicated?
Ephedrine is contraindicated in patients with closed-angle glaucoma. Use ephedrine with caution in patients with hypertension, cardiac disease (including coronary artery disease, angina pectoris, and patients receiving cardiac glycosides), cardiac arrhythmias, or unstable vasomotor system.
What medications should be avoided with narrow-angle glaucoma?
Closed-Angle Glaucoma: Medicines to AvoidAntihistamines and decongestants.Asthma medicines.Motion sickness medicines.Some medicines used to treat depression (tricyclic antidepressants).
What is the drug of choice for closed angle glaucoma?
Pilocarpine eye drops are used in the treatment of angle closure glaucoma for its miotic effect. It also helps in reducing the intraocular pressure by enhancing the aqueuous outflow.
What is the first line treatment for angle closure glaucoma?
Laser peripheral iridotomy [Fig. 4] is the current standard approach to initial treatment of AC. It alleviates pupillary block, which is a common underlying mechanism of AC [Box 3].
Which treatment is used to treat closed angle glaucoma?
Peripheral Iridotomy. This is a laser treatment that creates tiny drainage holes in your iris. It is used to treat both acute and chronic closed-angle glaucoma.
What medications should be avoided with glaucoma?
Closed-Angle Glaucoma: Medicines to AvoidAntihistamines and decongestants.Asthma medicines.Motion sickness medicines.Some medicines used to treat depression (tricyclic antidepressants).
What should I avoid if I have glaucoma?
High trans fats have been proven to cause damage to the optic nerve. Time to cut out fried foods, baked goods and any product with an ingredient list that includes hydrogenated or partially hydrogenated oils. Saturated foods that include red meat, beef, lard, shortening and oils can also worsen glaucoma.
Which category of drugs is contraindicated in clients with glaucoma?
Medication classes addressed in this review that may increase the risk of angle closure glaucoma include anticholinergics, adrenergic agonists, certain classes of antidepressants, sulfonamides, and topiramate.
What medications should be avoided by patients with open-angle glaucoma?
If you have open-angle glaucoma, oral steroids can increase your eye pressure to dangerous levels. They should only be taken in short courses or avoided altogether. These medications are often used to reduce inflammation for allergies, asthma, joint and muscle conditions, and autoimmune diseases.
Which level of management of epinephrine therapy yields the best patient outcomes with the fewest adverse?
Interprofessional management of epinephrine therapy will yield the best patient outcomes with the fewest adverse effects. [Level 5]
What are the effects of epinephrine?
Epinephrine is a hormone that produces widespread effects. Certain effects need monitoring. Tachycardia and hypertension are expected effects when giving epinephrine intravenously, so it is important to titrate the drug carefully while monitoring hemodynamics. Epinephrine is also used with anesthetic agents to provide analgesia. In locations where extravasation of epinephrine has occurred, prevention and treatment of ischemia-induced necrosis are necessary. The infiltrated area should receive treatment with a 10 mL to 15 mL saline solution containing 5 mL to 10 mg of phentolamine, an alpha-adrenergic blocking agent. A study showed how hospitalized patients in the ICU with finger ischemia were associated with the use of vasopressors, including epinephrine. [7]
How much epinephrine is effective for mydriasis?
Epinephrine is effective at a dilution of between 1 to 100,000 and 1 to 400,000 for mydriasis induction and maintenance in pediatric intraocular surgeries.
What is epinephrine used for?
Epinephrine is one of the most commonly used agents in various settings as it functions as medication and hormone. It is currently FDA-approved for various situations, including emergency treatment of type 1 hypersensitivity reactions, including anaphylaxis, induction, and maintenance of mydriasis during intraocular surgeries and hypotension due to septic shock.[1] Off-label uses of epinephrine include, but are not limited to, ventricular fibrillation, pulseless ventricular tachycardia, asystole, pulseless electrical activity (PEA), croup, and severe asthma exacerbations unresponsive to standard treatment. [2][3]In the operating room (OR) setting, epinephrine is also used as a local anesthetic block. Produced by the adrenal medulla, epinephrine plays a vital role in the body’s acute stress response by stimulating the sympathetic nervous system. [4]
How long does epinephrine stay in your system?
When administered parenterally, epinephrine has a rapid onset but a short duration of action. When given intravenously, it has a half-life of fewer than 5 minutes. Metabolism is primarily in the liver, along with various other locations such as the kidneys, skeletal muscle, and mesenteric organs. It is degraded into an inactive metabolite named vanillylmandelic acid by MAO and COMT and excreted into the urine. However, a small amount of the drug is excreted unchanged as well.
Where is epinephrine injected?
For the treatment of anaphylaxis, epinephrine is preferably injected intramuscularly into the anterolateral aspect of the thigh due to rapid absorption. Subcutaneous injection is also an option. For advanced cardiovascular life support (ACLS), patients can receive epinephrine intravenously or intraosseous if needed. Another route of administration is through an endotracheal tube often used in neonatal resuscitation.
Is epinephrine FDA approved?
Epinephrine is one of the most commonly used agents in various settings as it functions as medication and hormone. It is currently FDA-approved for various situations, including emergency treatment of type 1 hypersensitivity reactions, including anaphylaxis, induction, and maintenance of mydriasis during intraocular surgeries and hypotension due to septic shock. It also has several off-label uses. This activity will highlight the mechanism of action, adverse event profile, pharmacology, monitoring, and relevant interactions of epinephrine, pertinent for members of the interprofessional team in treating patients with conditions where this agent is indicated.
Ophthalmic epinephrine (applies to epinephrine ophthalmic) cardiovascular
Major Potential Hazard, Moderate plausibility. Applicable conditions: Cerebrovascular Insufficiency, Hyperthyroidism, Cardiovascular Disease, Corneal Abrasion
Ophthalmic epinephrine (applies to epinephrine ophthalmic) narrow angles
Major Potential Hazard, High plausibility. Applicable conditions: Glaucoma (Narrow Angle)
Ophthalmic epinephrine (applies to epinephrine ophthalmic) BPH
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Benign Prostatic Hyperplasia
Topical sympathomimetics (applies to epinephrine ophthalmic) diabetes
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus
Why do you need to stay away from medication for glaucoma?
These medications are often used to reduce inflammation for allergies, asthma, joint and muscle conditions, and autoimmune diseases . With angle-closure, or closed-angle, glaucoma, it is important to stay away from medications that can dilate (widen) your pupil. These include:
What are the side effects of glaucoma medication?
These are typical glaucoma medications and their potential side effects: Beta blockers: low pulse and blood pressure, shortness of breath, and fatigue. Prostaglandin analogs: growth of the eyelashes and darkening of eyelid skin, changing eye color, redness and/or stinging in the eye, droopy eyelids and sunken eyes, and itchiness.
What are the best medications for glaucoma?
Medications for glaucoma have come a long way. These treatments are no longer used and should now be avoided when treating glaucoma: 1 Dibenamine: This adrenergic antagonist had to be administered intravenously (IV) and caused orthostatic hypotension and even death in some cases. 2 Topical epinephrine: This medication had both systemic and topical side effects. It was discontinued in 80 percent of patients due to risks outweighing the potential benefits. 3 Dipivefrin: This adrenergic agonist was applied topically and caused significant allergic reactions. It was discontinued in the U.S. as a result. 4 Beta-adrenergic antagonists: These were used up until the medication timolol became available. These medications caused reduced tear production, corneal anesthesia, and tachyphylaxis.
What is the preservative in glaucoma eye drops?
Many glaucoma eye drops contain the preservative benzalkonium chloride, which can cause a host of eye problems, including:
Why is it important to discuss glaucoma with your doctor?
When taking glaucoma medications, it is important to discuss anything else you take with your doctor to avoid any potential interactions that can cause complications. You will need to take medications exactly as directed to reduce the odds for problems.
What is the treatment for glaucoma?
Current treatments generally include medications, usually as eye drops, although a combination of oral and topical medications can be beneficial as well as laser treatments.
What is the most common form of glaucoma?
The most common form of glaucoma is open-angle glaucoma. Another less common form is angle-closure glaucoma. If you have open-angle glaucoma , oral steroids can increase your eye pressure ...
What is angle closure glaucoma?
What is Angle-Closure Glaucoma? Angle-closure glaucoma, the second most common type, is a largely inherited disorder caused by a too-narrow angle in the passageway where aqueous fluid would normally drain. This type of glaucoma may occur in two ways:
What is the effect of anticholinergic drugs on narrow angles?
Medications that have anticholinergic properties can adversely affect patients with narrow angles. Anticholenergic means that these drugs block the action of acetylcholine, a chemical messenger that transmits signals from one nerve cell to another nerve cell, muscle cell, or gland cell, for example.
What are anticholinergic drugs?
Medications that have anticholinergic properties are used to treat the following medical conditions: Asthma and COPD (chronic obstructive pulmonary disease) medications include drugs such as Atrovent (ipratroprium bromide) or Spiriva (tiotropium bromide), and may be associated with angle-closure glaucoma attacks.
What causes a rise in IOP?
Many factors, including age, structural defects, damage to the trabecular meshwork and/or other drainage systems in the eye, aqueous humor overproduction, or blockages may be responsible for a rise in IOP. Treatment for open-angle glaucoma includes medication, laser surgery, and incisional surgery..
What percentage of glaucoma cases are open?
Primary open-angle glaucoma is the most common type and accounts for 70-90 percent of all cases. Often there are no noticeable symptoms at early stages, and high intraocular pressure (IOP) is the most significant risk factor or indication that you are developing glaucoma.
How does glaucoma affect the optic nerve?
This type of glaucoma may occur in two ways: The chronic type progresses slowly and, like open-angle glaucoma, can result in optic nerve damage. There are no symptoms until there is an apparent loss off peripheral vision. Treatment includes medication and laser therapy.
How long does it take to get blind from glaucoma?
Without treatment, blindness can result in one or two days. Most medications that could adversely affect glaucoma, or increase the chance of developing glaucoma, have the potential to narrow the drainage angle of your eye, called the trabecular meshwork. This would prevent eye fluid from exiting properly resulting in high eye pressure.
Which antipsychotics are used to treat angle closure glaucoma?
Antipsychotics including trifluoperazine, perphenazine and fluphenazine have also been reported to induce acute angle closure glaucoma, but have weaker anticholinergic effects than tricyclic antidepressants on ocular smooth muscle.2,6
What is acute angle closure glaucoma?
Acute angle closure glaucoma is an ophthalmic emergency and can lead to blindness if left untreated. Several types of drugs have the potential to precipitate acute angle closure glaucoma. These include adrenergic, cholinergic and anticholinergic, antidepressants, anticoagulants and sulfa-based agents. This article provides a basic overview of the risk factors and pathophysiologic mechanisms involved in angle closure glaucoma and focuses on drug-induced angle closure glaucoma for the non-ophthalmologist. A PubMed search limited to the English language was conducted to find relevant literature for the purpose of this article. Most attacks occur in subjects unaware that they are at risk due to innately narrow iridocorneal angles. Clinicians should always review medications in patients presenting with symptoms of acute angle closure glaucoma. The aim of this article is to bring this ophthalmic condition to the attention of clinicians, particularly those outside the field of ophthalmology who commonly prescribe these medications or see these patients prior to referring to ophthalmologists.
Why is acetazolamide used for cataract surgery?
Acetazolamide is routinely used in ophthalmic and neurologic practice to reduce intraocular and intracranial pressure. Incidentally, oral acetazolamide is commonly administered for one day following cataract surgery to prevent excessive intraocular pressure increases. A few case reports have described acute bilateral angle-closure glaucoma and choroidal effusion associated with acetazolamide administration following cataract surgery.33–35Therefore, clinicians should consider this important adverse effect of acetazolamide in patients who develop acute angle-closure glaucoma after cataract surgery.
Which antidepressants cause angle closure?
Tricyclic antidepressants e.g., clomipramine, imipramine, amitryptyline and selective serotonin reuptake inhibitors (SSRI) e.g., venlafaxine, citalopram, escitalopram, fluoxetine and paroxetine have been reported to precipitate acute angle closure glaucoma. The underlying mechanism is pupillary block caused by pupil dilatation, which is attributed to the significant anticholinergic and serotonergic side effects of these antidepressants.20–23The role of serotonin in human ocular physiology however has yet to be determined. Clinicians should consider referring patients at increased risk of acute angle closure glaucoma for an ophthalmic assessment prior to prescribing SSRIs.
Does salbutamol cause angle closure?
In fact, there was even one case where it was hypothesized that absorption of a nasal decongestant through the nasal mucosa used for a week triggered bilateral acute angle closure glaucoma in a patient.11,12Adrenergic agents such as salbutamol are commonly found in nebulizers and inhalers used in the management of asthma, flu remedies or rectal suppositories. Salbutamol is a beta-2-adrenergic receptor agonist that stimulates beta-2-adrenergic receptors in the ciliary body to promote aqueous humour secretion. Angle closure is exacerbated by pupil dilatation caused by the parasympathetic inhibitory effect of ipratropium , often combined with salbutamol in nebulizers or inhalers. However, it should be noted that salbutamol does not induce angle closure when used alone. Therefore, caution should be exercised when prescribing or administering these medications together, many of which can be obtained over-the-counter.
Can apha-adrenergic agonists cause glaucoma?
Alpha-adrenergic agonists can precipitate acute angle closure glaucoma by pupillary block due to pupil dilatation in individuals with innately narrow iridocorneal angles. Phenylephrine (alpha-adrenergic agonist) eye drops are often administered by opticians and ophthalmologists to dilate the pupil for fundus examination, a prime example of iatrogenicity. The estimated incidence of acute angle closure glaucoma following diagnostic pupil dilatation has been reported to be 0.03 percent.9
Does topiramate cause glaucoma?
Topiramate is commonly used for migraines and weight loss. Although some literature describe topiramate- induced as type B reactions i. e., idiosyncratic reactions, quite a number of reports have actually described cases of bilateral a cute angle closure glaucoma induced by to piramate in patients with narrow angles.27–29The main mechanism of angle closure precipitated by topiramate is choroidal effusion. Ultrasound images have shown that a contributing factor is topiramate-induced ciliary oedema causing relaxation of the zonules, which in turn increases the lens thickness. The resulting effect is anterolateral rotation of the ciliary body, forward displacement of the lens-iris diaphragm and consequent shallowing of the anterior chamber.30More than 100 previously published cases of topiramate-induced angle closure described bilateral non-pupillary block acute angle closure glaucoma (only three cases of unilateral involvement) after taking the first doses of the medication. The attacks typically occurred between days 1 and 49 and resolved after discontinuing the causative agent.2It is important to emphasize that topiramate induces mostly bilateral attack of angle closure glaucoma that occurs simultaneously in both eyes. The element of bilaterality is a clear sign that the acute attack is drug-induced.
