migrian medications

normal IOP

15-16 mmHg

abnormal IOP ; glaucoma risk

IOP >21mmHg

IOP that requires treatment

IOP >30mmHg

Beta-adrenergic blockers

Nonselective (beta1 & beta2) and cardioselective beta1

MOA: decrease IOP by decreasing aqueous humor production; usually open-angle tx
Timolol (Timoptic)

Beta-adrenergic
 blockers cmomplications

§stinging discomfort

§Occasional conjunctivitis, blurred vision, photophobia, dry eyes

§Systemic effects on heart and lungs 

§Contraindications/Precautions 

§Pregnancy Risk Category C

§Avoid beta2 blockers with chronic respiratory disease 

§Avoid with sinus bradycardia or AV heart block

how to adm beta adrenergic blockers:

Hold pressure on nasolacrimal duct 30-60 seconds immediately after instilling (minimize systemic circulatory absorption)

Alpha2 Adrenergic Agonists (Mydriatics)

MOA: sympathomimetics (alpha & beta) = pupil dilation; ↓ aqueous humor production while increasing outflow to ↓ IOP 

Brimonidine (Alphagan P)

Apraclonidine (Iopidine)

Propine (Dipivefrin)

Mannitol (Osmitrol)

MOA: ↓ IOP by making plasma hypertonic, thus drawing fluid from the anterior chamber of the eye 

*Treats the rapid progression of closed-angle glaucoma to prevent blindness 

Complications:

Headache, N/V, edema, fluid and electrolyte imbalance

Prophylactic Medications for migrains

Beta Blockers

Anticonvulsants

Tricyclic Antidepressants

Estrogens

First Line Treatment for migrain

ASA-like medications (acetaminophen and NSAIDs)

Serotonin Receptor Agonists (AKA triptans) 

Second Line Treatment for migrains

Ergot Alkaloids