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A Case Of Glaucoma treatedwith Acetazolamide
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LAYOUT
Diagnosis
Features
Pathophysiology
Management
Glaucoma
Case History
Investigation
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PATIENTS PROFILE
Name: XYZ
Age:25 Years
Sex: Female
Residence: Rawalpindi
Occupation: Housewife
Date Of History Taking: 17 January
,2011
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hopi
History Of
Presenting
Illness
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HOPI
Past historyAsthmaDM negative
HTN
No H/O any medical or surgicalintervention
Personal history
Family history
Drug history
Socioeconomic historymiddle class
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xam nat on
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GENERAL PHYSICAL EXAMINATIO BP 140/90 mmhg
Pulse 84 beats/min
Temp 1o1 F
Resp. Rate 18/min
pallor
jaundice negative
Clubbing
JVP
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DIAGNOSIS
A diagnosis of Uncomplicated UTI was made
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TREATMENT
Septran (Co-Trimoxazole)
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UTI
Definition:
.
IOP
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TYPES OF GLAUCOMA
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Risk factors for open angle glaucoma
Level of intraocular
pressure
Increasing age
African-Caribbeanorigin
Family history
Thin corneas
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NORMAL FLOW OF AQUEOUS
HUMOUR
Ciliaryprocess
Postchamber
pupil
AntchamberTrabecularmeshwork
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PATHOPHYSIOLOGY
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CONSEQUENCES
Increased IOP
Decreased B.S topupil and dec.responsiveness
Optic nerve damagein later stages
Iris becomesedematous andshows patches of
necrosis
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MANAGEMENT
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sem sed magna suscipit egestas.
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DRUG OF CHOICE ACETAZOLAMIDE
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Structure and Chemistry
Sulfonamide derivative
synthetic origin.
ACETAZOLAMIDE
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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)
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SITE OF ACTION
Acetazolamide
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PHARMACODYNAMICS
PCT (Membranebound & Cytoplasmic)
EYE(Ciliary Body)
BRAIN(Choroidepithelium)
Site ofaction
CarbonicAnhydrase in
MECHANISMOF DRUG
ACTION
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MECHANISM OF ACTION
Acts as an inhibitor ofCarbonic Anhydrase
Plays a key role in
NAHCO3 Reabsorption
& Acid secretion
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PHARMACOLOGICAL
ACTIONS
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EFFECTS ON KIDNEY
HCO3 Diuresis
NaHCO3 Excreted
Metabolic Acidosis
Excess Na+ Reabsorbed;K+ Secreted
K+ Wasting
Urine BloodHCO3
CA In PCT
Na+ In CCT
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EFFECTS ON EYE
Inhibition of HCO3Secretion into
aqueous humour
AcetazolamideAdministration
DecreasedI.O.P
For TreatmentOf Glaucoma
BloodHCO3
CA In Ciliary Epithelium
Aqueous humour
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Protection against High Altitude Sickness
Promotes Hyperventilation
EFFECTS ON CSF
BloodHCO3
Blood
CA In Choroid plexus
Acidosis of CNS
Acetazolamide administered
Decreased HCO3 Secretion into CSF
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For Open
angleglaucoma
For Urinary
Akalanization
For
MetabolicAlkalosis
CLINICAL INDICATIONS
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CLINICAL INDICATIONS(CONTD.)
Weakness
Dizziness
Insomnia
Headache
Nausea
Acute
Mountain
Sickness
FATE
HAPE
HACE Death
Mild Lasts afew
days
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OTHER USES
Epilepsy Adjuvant
Hypokalemic Periodic Paralysis
Severe Hyperparathyroidism
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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 (mainlybecause of it having a limited aqueous solubilityand poor corneal permeation)
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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
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ADVERSE EFFECTS
HyperchloremicMetabolic Acidosis
Due To ChronicIn Body HCO3
Effect Not Self-Limiting
Renal K+ Wasting
Na+ In CCT
Partially Reabsorbed
Lumen ve Potential In CCT
K+ Secretion
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RenalStones
Hypercalciuria
Phosphaturia
Excretion ofsolublizingfactors e.g.
Citrate
Effects Of Acetazolamide
ADVERSE EFFECTS(Contd.)
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OTHER TOXICITIES
Drowsiness
Paraesthesias
Cross-Allergenicity withSulfonamide Derivatives
CNS Toxicity
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HYPERSENSITIVITY REACTIONS
Fever
Rash
Bone Marrow
Suppression
Interstitial Nephritis
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CONTR-INDICATIONS
ACZ Alk.Urine
NH4+Excretion
HepaticEncephalopathy
HyperNH4+emia
In pts. Of Cirrhosis
In pts. Of Hyperchloremic Acidosis/COPD
ACZCauses
WorseningOf
Metabolic/Respiratory
Acidosis
DRUG DRUG INTERACTIONS
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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 byAcetazolamide
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JazakAllah and Thank you!
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Any Questions???
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