Pilocarpine, Pilocarpine Hydrochloride, Pilocarpine Nitrate
Kelas obat: Agen Antineoplastik
Panganggone Pilocarpine, Pilocarpine Hydrochloride, Pilocarpine Nitrate
Glaukoma sudut terbuka
Penurunan tekanan intraokular (IOP) ing pasien kanthi glaukoma sudut terbuka primer (kronis prasaja, noncongestif).
Bisa digunakake bebarengan karo miotik liyane , agen simpatomimetik, agen pamblokiran β-adrenergik, inhibitor karbonik anhidrase, utawa agen hiperosmotik.
Angle-closure Glaukoma
Pengurangan TIO ing perawatan darurat glaukoma sudut-tutup akut (kongestif) sadurunge operasi. Amarga bisa nyegah operasi sing sukses, aja digunakake kanggo wektu sing suwe sadurunge perawatan bedhah.
Lack of response bisa disebabake paralisis sphincter iris dening IOP sing dhuwur banget; administrasi sistemik acetazolamide utawa solusi hiperosmotik (contone, gliserin utawa mannitol) bisa uga dibutuhake.
Bedah Okular
Ngurangi TIO lan nglindhungi lensa kanthi nyebabake miosis sadurunge goniotomi utawa iridektomi, kalebu iridektomi laser.
Bisa digunakake kanggo ngontrol glaukoma sing tetep sawise operasi.
Pemeriksaan Oftalmologis
Produksi miosis kanggo nglawan efek midriatik saka agen simpatomimetik (contone, phenylephrine) sawise pemeriksaan oftalmoskopik ing pasien glaukoma.
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Carane nggunakake Pilocarpine, Pilocarpine Hydrochloride, Pilocarpine Nitrate
Administrasi
Administrasi Oftalmik
Singkirake kontaminasi solusi utawa wadhah gel.
Solusi ophthalmic luwih disenengi nalika pangurangan akut ing IOP lan/utawa efek miotik sing kuat perlu (contone, sadurunge operasi, sawise pemeriksaan ophthalmologic).
Pengukuran tonometrik dianjurake sadurunge lan sajrone terapi.
Solusi OphthalmicOlesake topikal menyang kantung konjungtiva mata sing kena pengaruh kaya sing diarahake dening dokter, biasane kaping 3-4 saben dina; administrasi luwih kerep bisa uga perlu ing sawetara patients. Ora kanggo injeksi.
Sawise instilasi topikal, tekanan driji ing kantung lakrimal suwene 1-2 menit kanggo nyilikake saluran menyang irung lan tenggorokan lan nyuda resiko penyerapan lan reaksi sistemik. Copot solusi sing berlebihan ing sakubenge mripat nganggo tisu lan mbilas obat apa wae ing tangan langsung.
Gel OphthalmicOlesake kanthi topikal menyang kantung konjungtiva ngisor mripat sing kena pengaruh sapisan dina sadurunge turu.
Ukur IOP sakdurunge dosis sabanjure sawise wiwitan terapi kanggo mesthekake kontrol IOP sing nyukupi sajrone interval dosis 24 jam.
Yen digunakake bebarengan karo solusi ophthalmic, intake solusi dhisik lan aplikasi gel ≥5 menit mengko .
Dosis
Kasedhiya minangka pilocarpine hydrochloride; dosis sing dituduhake ing syarat-syarat uyah.
Setel konsentrasi lan frekuensi instilasi solusi miturut kabutuhan lan respon pasien, kaya sing ditemtokake dening maca tonometrik.
Ing pasien karo irides sing akeh pigmen, konsentrasi larutan sing luwih dhuwur bisa uga dibutuhake.
Setel dosis gel ophthalmic adhedhasar maca tonometric periodik.
Dewasa
Open-Angle Glaucoma Ophthalmic1-2 tetes larutan 1-4% ing mripat (s) saben 4-12 jam. Konsentrasi larutan >4% mung sok-sok luwih efektif tinimbang konsentrasi sing luwih murah.
Gunakake pita 1,3 cm (0,5 inci) saka gel 4% menyang kantong konjungtiva ngisor sapisan dina sadurunge turu.
Glaukoma Sudut Penutupan Akut Ophthalmic1 tetes larutan 2% ing mripat sing kena pengaruh saben 5-10 menit kanggo 3-6 dosis, banjur 1 tetes saben 1-3 jam nganti tekanan dikontrol. Kanggo nyegah serangan bilateral, 1 tetes larutan 1-2% ing mripat sing ora kena pengaruh saben 6-8 jam.
Bedah Okular Iridektomi Ophthalmic1 tetes larutan 2% kaping 4 sadurunge iridektomi wis wis digunakake.
Congenital Glaukoma (Goniotomi) Ophthalmic1 tetes larutan 2% saben 6 jam sadurunge operasi wis digunakake.
Bisa nggunakake solusi 2% kanggo ngisi gonioskopi lensa sadurunge goniotomi, utawa bisa menehi 1 tetes larutan 2% saben 6 jam ditambah kaping 3 ing 30 menit sadurunge goniotomi, kanthi utawa tanpa administrasi acetazolamide bebarengan.
Pemeriksaan Ophthalmologic Ophthalmic1 tetes saka solusi 1% ing mripat sing kena pengaruh.
Pènget
Kontraindikasi
Pènget/PanandhapReaksi Sensitivitas
Hipersensitivitas
Konjungtivitis alergi, dermatitis, utawa keratitis kacarita sok-sok karo miotik; reaksi kasebut biasane dikurangi kanthi ngganti menyang miotik liyane. Ing sawetara kasus, reaksi alergi bisa disebabake dening pengawet ing preparat.
Pancegahan Umum
Efek OkularDetasemen retina jarang dilapurake; Gunakake kanthi ati-ati banget, yen kabeh, ing pasien sing duwe riwayat utawa risiko detasemen retina, utamane sing isih enom utawa aphakic. Priksa periphery retina kanthi ati-ati paling sethithik saben taun kanggo ndeteksi detasemen sing bakal teka.
Gunakake kanthi ati-ati ing pasien abrasi kornea supaya ora penetrasi sing berlebihan lan keracunan sistemik.
Kamungkinan spasme akomodasi lan penglihatan sing kurang. ing cahya sing surem, utamane ing pasien geriatrik lan pasien kanthi opacities lensa. (Deleng Saran kanggo Pasien.)
Hipertrofi konjungtiva folikel bisa kedadeyan kanthi terapi sing luwih dawa.
Kamungkinan paningkatan IOP sementara sanajan sudut mbukak. Ing sawetara pasien glaukoma sudut-tutup sing nampa miotik, IOP bisa uga tambah lan serangan akut bisa diendhani.
Kamungkinan opasitas kornea.
Pemeriksaan slit-lamp reguler dianjurake; mungkasi terapi, paling ora kanggo sementara, yen kista iris, iritis, sinekia, utawa kekeruhan lensa dumadi.
Populasi Spesifik
KandhutanKategori C.
LaktasiOra dingerteni manawa pilocarpine disebarake menyang susu. Gunakake kanthi ati-ati.
Panggunaan PediatrikKeslametan lan khasiat ora ditetepake.
Panggunaan GeriatrikKetajaman visual suda ing cahya surem sing kerep dialami ing pasien geriatrik.
Efek Umum sing Sabar
Iritasi okular (kobong utawa rasa ora nyaman), lacrimation, nyeri sirah temporal utawa periorbital, spasme ciliary utawa akomodatif, penglihatan kabur utawa miopia, kongesti pembuluh darah konjungtiva, keratitis superfisial, penglihatan sing kurang. ing cahya surem.
Apa obatan liyane bakal mengaruhi Pilocarpine, Pilocarpine Hydrochloride, Pilocarpine Nitrate
Obat Spesifik
Obat
Interaksi
Komentar
Agen hipotensi okular
Efek penurun IOP aditif
Digunakake kanggo Kauntungan terapeutik
Miotik antikolinesterase
Inhibisi kompetitif efek miotik lan bisa uga efek ngedhunake IOP
Administrasi bebarengan umume ora dianjurake
Sawetara dokter nyaranake administrasi pilocarpine nalika wiwitan terapi antikolinesterase long-acting diikuti dening taper bertahap saka pilocarpine supaya antagonisme antarane obat kasebut ngidini efek lengkap saka antikolinesterase bisa dipikolehi kanthi bertahap
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