Introduction, Open angle glaucoma, Closed angle glaucoma, Wide angle glaucoma, Narrow angle glaucoma, IOP, Intra Ocular Pressure, IOT, Intra Ocular Tension, Laser iridotomy, Mechanism of action, Decreased aqueous production, increased aqueous out flow, increased trabecular outflow, Increased uveoscleral outflow, CA inhibitors, Carbonic Anhydrous, Carbonic Anhydrase (CA) Inhibitors, Acetazolamide, Brinzolamide, Dorzolamide, Alpha2 Selective Agonist, Apraclonidine, Brimonidine, Ocular Beta 2 Blockers
Hi hi students this is dr badrinath and today’s topic is a very important and compulsory question for regular examinations and the competitive exams also glaucoma a very important decision very interesting also right so drugs used in the glaucoma glaucoma is a disease of their eyeball that we know very well i is just like it looks like a cricket ball inside but
We cannot see complete eye directly okay right so what is this glaucoma model we will see so we are studying a subject of uh pharmacology one theory as per the syllabus of pharmacy council of india okay for pharmacy students and it is a common for mbbs all medical and paramedical courses yeah and this is a syllabus here we have already completed this one drugs
Used in my cci grave is is already completed and uploaded the video and here today drugs used in the glaucoma this is a we are the topic we are going to be complete right so what is this glaucoma see if you see the structure of the eye it looks like a round shape ah it looked like a round shape inside there was a aqueous humor very very important bit you see here
Aqueous humor see the pointer here where i am showing that aqueous humor is present inside the eyeball so this area consists of a liquid that liquid name is called as a aqueous humor okay so always there is a pressure on the inner walls of the eye see here pressure see here pressure is there that pressure okay so pressure just like a blood pressure here also
Pressure will be there exerted by the aqueous human on the inner layers or inner parts of the inner walls of the eyeball okay this is called as a iop intraocular intra means inside intraocular pressure what is the reason for this intraocular pressure is it is a this glaucoma is a complex eye disease why we are calling it as a very complex means because number
Of factors are involved multi factors are involved that’s why we are calling it as a complex eye disease because number of factors are involved it is a multifactorial disease it is a complex eye disease right okay so in the normal iop intraocular pressure is a 20 to 22 mm of hc it is a normal 21 also okay no problem or one plus or minus whatever it may be but
In glaucoma iop intraocular pressure in the glaucoma condition it is a greater than 22 mm of edges so we are measuring this is also very important just like a bp mm of hg we are using it so this is also called as a ocular hypertension generally we are using a blood pressure as a hypertension whenever it was excess then the 120 by 80 is normal whenever it crosses
We are calling it as a hypertension here also uh ocular hypertension ocular because inside the eye and here what happened when there was a pressure here see the red color how the it is becoming a red this this is a optic nerve we know very well so it becomes very red when there was a high pressure it is a dangerous situation that’s why you can see the red color
Here for initially blue initially but when the pressure is increased it turns to red here so that’s why i kept the red this optic nerve will be damaged so loss of field vision you can’t see that’s why it is a glaucoma is very dangerous disease also but however it is a simple if you give a treatment so whenever there was a high pressure inside the eyeball that
Is aqueous humor has to be go out for that purpose what they are doing is surgery uh laser iradiometry here exactly this is a point here so they will put the eye laser race so whenever there was a formation of hole proper drainage will be there this aqua swimmer which is present here it will be drainage properly it goes outside so inside the pressure will be less
But however we are studying our topic is drugs only direction are the surgery okay that’s why we will see only the drugs used in that see here this is a laser area material this is a side view exactly here the point where you have we have mentioned here there the doctors will make a punch with the help of a laser not they are not using any needles nothing only
Laser rise okay so also potentially they are using it yeah glaucoma is a two types that is an open angle and a closed angle very very important here if you see the open angle uh also called as a wide angle open angle wide angle see here there was an angle between the cornea and iris you see here it is a iris and this is a cornea there was a very big gap there
Was a open angle open angle very wide wide angle is there that’s why this is called a open angle or a wide angle whereas a closed angle are now see here the place carnia and iris see very less space see is he see here iris is almost touched with the cornea see the pointer here where i am showing that that’s why this is called exactly the point is a closed angle
Here there is a closed whereas here it was opened how much open is this see iris doesn’t touch the cornea here iris is almost touched with the cornea that is a problem here so that’s why this is called a open angle or wide angle that’s why this is also called as a this is a closed angle or narrow angle there was a very narrow or completely closed angle also
Okay and here also same problem both blockage of the drainage canal here also blockage of the drainage canals completely it will be blocked in both cases ah here what happened when there was a drainage blocked slow increase in the in iop slow increase but here sudden increase in the iop intraocular pressure the patient will feel tension eyeball will feel very
Tension and pain also you will feel the pain of the eye because of the sudden increase in the intraocular pressure but it is a less common this closed angle is less common it happens in the 10 percent of the people only more damage is noticed here inner walls more retina damage will be there that’s why it needs a sudden immediate requirement immediately they
Have to do a surgery okay our treatment whatever it may be here there is a less damage or no damage this is the most common open is the most common it is a 90 percent only it is open for all like that 90 percent you can be remember see the lengths of the thing and here what happen exactly you can see the ciliary body secretes the aqueous humor this will go like
This actually this will glow that’s why this is called a open angle and it enters into anterior chamber this chamber see here this chamber the chamber which is present in the space which is present between the cornea and iris is called as an anterior chamber and the chamber which is present between the lens and iris is called as a posterior chamber so this is
Posterior chamber this is an anterior chamber okay so what happens ciliary body whenever it was secreted the aqueous humor okay the aqueous humor will be entered here you will be entered and here the pressure also will be built up okay and drainage is blocked here also here also blocker and here also blocked okay and pressure will be increasing here also same
Here what happen it doesn’t enter because iris is almost touch with the lens see here the iris doesn’t touch the lens here here iris is touched the lens and also iris is touched with the carnia also so whatever the aqueous humor which is secreted here because of the closed contact here again it will be there only in the posterior chamber it doesn’t enter into
The anterior chamber very very important bit in closed angle aqueous humor doesn’t enter into the anterior chamber in the open angle only since it is open uh the aqueous femur enter into the anterior chamber but both are the is blocked this is exactly what happened in the glaucoma so easily we can remember what we have to these are the drugs used in the glaucoma
Screenshot i already summarized many things and here i have mentioned very clearly what you have to do is either you have to decrease the aqueous production number one aqueous humor production you have to decrease or increase the aqueous outflow so either you can be use this or you can be use this there you have two choices you can use the both also no problem
No problem one side you can decrease the aqueous humor another side you can increase the outflow so that pressure will be balanced here pressure will be reduced drastically and uh aqueous production where this aqueous production number one carbonic anhydrase enzyme so it is see here this is a ciliary body this shape this is called a ciliary body this ciliary body
Or ciliary epithelium it consists of ac here these are the star-like structures star just like a star carbonic anhydrase this is enzyme so carbonic hydras is an enzyme which is responsible for the secretion of the aqueous humor which is present on the ciliary body of the eye that point you have to keep in your mind so what we have to do we have to prevent this we
Have to kill this enzyme carbos anhydrous enzyme carbonic anhydrase engine you have to kill it so when you will kill it here production of aqueous femur will be reduced that is the main secretion of the thing i will show you what is a carbonic anhydrase enzyme yeah here you can see carbonic anhydrase enzyme inhibitors see this is a carbonic anhydrous enzyme why
We are calling as a carbonic anhydra is carbonic because it produces a bicarbonate ion that is a main thing so this bicarbonate ion is produced with a carbonic anhydrase it reacts with the hydrogen atom and it what happens here osmotic gradients it causes osmotic gradient and h2o will be inflow so aqueous humor will be produced because of this bicarbonate in the
Posterior chamber not anterior chamber in the posterior this is anterior okay like that posterior chamber water will be entered so aqueous humor will be entered now if you give a carbonic anhydrous inhibitor see negative this is negative this is negative this is negative this is also negative so all are negative only so no water will be entered like this see here
Water is no negative negative all are negative one so aqueous humor will be reduced see here the same points only i have mentioned here carbonic anhydrase is present in the ciliary epithelium it is responsible for the production of the bicarbonate ion this bicarbonate ion interacts with the hydrogen ion is the h2o this h2o enters into the posterior chamber and
Increases the aqueous humor so iop will be increased so what you have to do give a acetozolamide it is a one of the best example acetate carbon ca ca means uh you can charted accountancy you can be remember like that ca you have to inhibit the ca acetate brinjal amide zolamide all jewel so ca charted accountancy a to a b to b so that you can complete this portion
So all these will causes a decrease in the aqueous production e a to a agonist what you have to do alpha 2 receptor where here you can see here alpha tourism this is alpha one which is present on the blood vessels this is the alpha two receptor here you can see alpha two what you have to do you have to give a support alpha to agonists means supporters so if you
Give a support to alpha to selective agonist like a opera clonidine brimoclodin it reduces aqueous production that is a one type of mechanism and blockers see a to a agonist here reversal beta two blockers you have to see here beta2 this is alpha two both are sideways ion like that you can remember alpha two you have to give a support beta two you have to block
Timolon betaxalal here beta2 blockers stimula beta so decreases the aqueous production next is increase is the aqueous outflow there is a two type of outflow is there one is trabecular euvoscleral outflow what is this used clearly trabecular this is the trabecular you can see here the pointer here trabecular outflow green color so aqua’s humor which is secreted
By the ciliary body it enters into aqueous flow humor here and it will be drainage this is called a trabecular and if the aqueous femur will flow and here see that division is there it divides like this and yet it enters into the ciliary body and is clear up from the sclera it will be actually this is called a uvos clear up uvo’s clear outflow this is uvo’s
Clearal outflow this is the trabecular outflow now what you have to do these are the drugs which increases the u.s clearal outflow and these are the drugs which increases the trabecular both are increased only here oh because this is also outflow this is also outflow but channel is different channel is different this is a non-selective alpha agonist or they’re
Epinephrine okay deep urine and cholinomatic agonists are there like musculonic agonists pilocarpine very very important very very important pilocarpine muscarinic agonists okay and this is also cholinomatic this is also polynometric but here this is a direct acting it is an indirect acting because it increases the concentration of hostile colon by decreasing the
Cholinesterase enzyme whereas here acetylcholine is directly increasing that’s why this is called a direct okay this is a indirect as cholinesterase inhibitors pythostic meaning widely used you can okay latins approached these are the prostaglandin anal ago how these prostaglandin anal august will act okay here you can see the alpha one receptor okay these are
Blood vessels are there ciliary blood vessels are there ciliary body epithelium okay and prostaglandin is how it increases the uvo’s clitoral outflow see um outflow here very dense matter is that there is no proper drainage so we have to break down that’s why uvs clearall break down all the drugs whatever is there u.s clearance is a mechanical action of you so
Prostaglandin uvo’s clitoral outflow is increased what it crosses the cornea prostaglandins okay uh why prostaglandins means here i have mentioned already prostaglandin analagou keep in your mind uvo’s clearal outflow all prostaglandin analogous okay increases the uv’s clearal outflow how it increases yeah it crosses the cornea and it produces a prostaglandin acid
This prostaglandin accident acts on a fp receptor and he initiates the cell nucleus this cell nucleus what happen it increases one enzyme this means breakdown proteins will be breakdown proteins will be breakdown so matrix metallo proteinase proteomes it is an enzyme this enzyme will be secreted by the ciliary muscle okay because of the prostaglandin releases
The prostaglandin acid this acts on the fp receptor it stimulates the ciliary muscle so matrix protein is will be released so collagen like this collagens will be converted into collagen fragments see here how the gaps are came this is a complete collagen this is the collagen fragments so whenever the fragments will come outside the fluid will be go easily so
Increase your uv is clear on outflow this is a mechanism fraction very very very very important in all the examination prostaglandin prostaglandin acid that points you have to keep in your mind it breakdowns the collagen where this collagen is present means here all these parts will be breakdown uvo’s clearall okay by the prostaglandin okay right so we can end our session here
Transcribed from video
Drugs Used In Glaucoma By PHARMA TRICKS FOR EXAMS
