Miotics - direct acting include-

Acetyl choline, Carbachol, Pilocarpine

Refer - Acetylcholine

NSAIDs -topical - althouh studies with acetyl choline chloride or carbachol revealed interference and there is no known pharmacological basis for an interaction, there have been reports that both these drugs have been ineffective when used in patients with topical NSAIDs agents

Miotics - direct acting include-

Acetyl choline, Carbachol, Pilocarpine

Refer - Acetylcholine

Acetyl cholne chloride Miosis - to induce misosis during surgery

Acetyl choline - Opthalmic- corneal edema ,. clouding, decompensation

Systemic - bradycardia, hypotension, flushing, breathing difficulties, seating Carbachol-

Opthalmic - transcient stinging and burning, corneal clouding, persistent bullous keratopathy, post operative iritis following cataract extration with intraocular use, retinal detachment, transcient ciliary and conjuntival injection, ciliary spasm with resultant temorary decrease of visual acuity

Systemic - headache, salivation, GI cramps, vomiting, duarrhea, asthma, syncope, cardiac arrhyhtmias, flushing, sweating, epigastric distress, tightness in bladder, hpotension, frequent urge to urinate

Pilocarpine- Opthalmic- transcient stinging and burning, tearing, ciliary spasm ,conjuntival vascular congestion, temporal, peri- or supra -orbital headache, superficial keratitis, induced myopia ( espicially in younger individuals who have started admin.) blurred vision, poor dark adaptation, reduced poor acuity in poor illumination in older individuals, with lens opacity

Systemic- hypetension, tachcardia, bronchiolar spasm, pulmonary edema, salivation, sweating, nausea, vomitng diarrhea ( rare )

Hypersensity to any of the components of the formulation, where constriction is undesirable ( eg acute iritis, acute or anterior uveitis, some form of secondary glaucoma )

Warning

Corneal abaration- use carbachil with caution in the presence of corneal abaration to avoid excessive penetration

Pregnancy

Safety for use during pregnancy not been establlished, use only when clearly needed.

Lactation

Excecise caution when administering to a nursing woman

Children-

Safety and efficacy for use in children have not been established

Precautions-

Systemic reactions- caution is adviced in patients with acute cardiac failure, bronchial asthma, peptic ulcer, hyperthyroidism, GI spasm, urinary tract obstruction, Parkinsons disease, recent MI hypertension or hypotension

Retinal detachment- has been caused by miotics in susceptible individuals with pre-exiting retinal disease or in those who are predisposed to retinal tears,

Fundus examination is advised for all patients prior to initiation of therapy Miosis - usually causes difficulty in dark adaptation,

Advice patients to use caution while night driving or performing tasks in poor light.

Angle- closure- Miotics can occassionally precipitate angle closure by increasing resistence to aqueous flow from posterior to anterior chamber

Miosis - to induce misosis during surgery

Dosage: Instil the solution into the anterior chamber before or after securing one or more sutures. The pupil is rapidly constricted and the peripheral iris is drawn away from the angle of the anterior chamber if there are no mechanical hinderances. Any anatomical hinderance to miosis may require surgery to permit desired effect of the drug.

Miotics - direct acting include-

Acetyl choline, Carbachol, Pilocarpine

Refer - Acetylcholine

1. May sting upon instillation, espicially first few drops

2. May cause headache, browache, and decreased night vision. Use caution while night driving or peforming hazardous tasks in poorlight.

3.To avoid contamination, do not touch tip of container to any surface. Replace cap after using. Keep bottle tightly closed when not in use, Discard solution after expiration

Pregnancy

Safety for use during pregnancy not been establlished, use only when clearly needed.

Lactation

Excecise caution when administering to a nursing woman

Children-

Safety and efficacy for use in children have not been established