A Case Of Glaucoma treated with Acetazolamide

LAYOUT
Case History Investigation Diagnosis Glaucoma Pathophysiology

Features
Management

PATIENTS PROFILE
Name: XYZ Age:25 Years Sex: Female Residence: Rawalpindi Occupation: Housewife Date Of History Taking: 17 January ,2011

hopi

History Of Presenting Illness

HOPI
Past history
Asthma DM negative HTN No H/O any medical or surgical intervention

Personal history Family history Drug history Socioeconomic history

middle class

Examination

GENERAL PHYSICAL EXAMINATION

BP Pulse Temp Resp. Rate pallor jaundice Clubbing JVP 140/90 mmhg 84 beats/min 1o1 F 18/min

negative

DIAGNOSIS
A diagnosis of Uncomplicated UTI was made

TREATMENT
Septran (Co-Trimoxazole)

UTI
Definition: .
IOP

TYPES OF GLAUCOMA

Risk factors for open angle glaucoma

Level of intraocular pressure Increasing age African-Caribbean origin Family history Thin corneas

NORMAL FLOW OF AQUEOUS HUMOUR

Ciliary process Post chamber
pupil

Trabecular meshwork

Ant chamber

PATHOPHYSIOLOGY

CONSEQUENCES

Increased IOP

Decreased B.S to pupil and dec. responsiveness

Optic nerve damage in later stages

Iris becomes edematous and shows patches of necrosis

MANAGEMENT
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DRUG OF CHOICE ACETAZOLAMIDE

ACETAZOLAMIDE
Structure and Chemistry
Sulfonamide derivative synthetic origin.

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)

SITE OF ACTION

Acetazolamide

PHARMACODYNAMICS
Site of action
Carbonic Anhydrase in

MECHANISM OF DRUG ACTION

PCT (Membrane
bound & Cytoplasmic)

EYE(Ciliary Body) BRAIN (Choroid

epithelium)

MECHANISM OF ACTION

Acts as an inhibitor of

Carbonic Anhydrase

Plays a key role in NAHCO3 Reabsorption & Acid secretion

PHARMACOLOGICAL ACTIONS

EFFECTS ON KIDNEY
HCO3

Urine
CA In PCT

Blood

HCO3 Diuresis NaHCO3 Excreted

Metabolic Acidosis
Na+ In CCT Excess Na+ Reabsorbed; K+ Secreted

K+ Wasting

EFFECTS ON EYE
HCO3

Blood
CA In Ciliary Epithelium

Aqueous humour

Acetazolamide Administration

Inhibition of HCO3 Secretion into aqueous humour

Decreased I.O.P

For Treatment Of Glaucoma

EFFECTS ON CSF
HCO3

Blood
CA In Choroid plexus

Blood
Acetazolamide administered
Decreased HCO3 Secretion into CSF Acidosis of CNS Promotes Hyperventilation

Protection against High Altitude Sickness

CLINICAL INDICATIONS

For Open angle glaucoma

For Urinary Akalanization

For Metabolic Alkalosis

CLINICAL INDICATIONS(CONTD.)
Weakness

Dizziness

HAPE HACE FATE

Death

Acute Mountain Sickness

Insomnia

Mild
Headache

Lasts a few days

Nausea

OTHER USES

Epilepsy Adjuvant

Hypokalemic Periodic Paralysis

Severe Hyperparathyroidism

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 (mainly
because of it having a limited aqueous solubility and poor corneal permeation)

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

ADVERSE EFFECTS
Renal K+ Wasting

Hyperchloremic Metabolic Acidosis Na+ In CCT Due To Chronic In Body HCO3

Partially Reabsorbed

Effect Not SelfLimiting

Lumen ve Potential In CCT

K+ Secretion

ADVERSE EFFECTS(Contd.)

Effects Of Acetazolamide

Phosphaturia Excretion of solublizing factors e.g. Citrate

Hypercalciuria

Renal Stones

OTHER TOXICITIES
Drowsiness

CNS Toxicity

Paraesthesias

Cross-Allergenicity with Sulfonamide Derivatives

HYPERSENSITIVITY REACTIONS
Fever

Rash Bone Marrow Suppression Interstitial Nephritis

CONTR-INDICATIONS
In pts. Of Cirrhosis
ACZ

Alk. Urine

NH4+ Excretion

Hepatic Encephalo pathy

Hyper NH4+ emia

In pts. Of Hyperchloremic Acidosis/COPD

ACZ Causes Worsening Of Metabolic/ Respiratory Acidosis

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 by Acetazolamide

JazakAllah and Thank you!

Any Questions???
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