Cholinergic glaucoma with

These drugp are contraindicated in patients with known hypersensitivity to die drugs, asthma, peptic ulcer disease, coronary artery disease, and hyperthyroidism. Bethanecol is contraindicated in those with mechanical obstruction of die gastrointestinal or genitourinary tracts. Fhtients with secondary glaucoma, iritis, corneal abrasion, or any acute inflammatory disease of the eye should not use die ophtiialmic cholinergic preparations. 

GLAUCOMA When a cholinergic drug is used to treat glaucoma, die nurse checks the eye and die area around die eye daily for evidence of redness, inflammation, and excessive secretions, particularly if die ocular system is used. If secretions are present around die eye, the nurse removes them with a cotton ball or gauze soaked in normal saline or other cleansing solution recommended by die primary health care provider. 

Contraindications Glaucoma, obstructive uropathy, obstructive disease of Gl-anti-cholinergic tract, paralytic ileus, intestinal atony of the elderly or debilitated patient, unstable cardiovascular status in acute hemorrhage, severe ulcerative colitis especially if complicated by toxic megacolon, myasthenia gravis, hiatal hernia associated with reflux esophagitis, hypersensitivity to any component of f he formulaf ion, acuf e infermiffenf porphyria. 

A 70-year-old woman treated with topical timolol for glaucoma developed a papular eruption on the arms and back, consistent with prurigo. All tests were within the reference ranges. There was no improvement after 1 month of topical corticosteroids. The eruption cleared completely within 1 month of timolol withdrawal. Betaxolol eye-drops were introduced and the eruption recurred within 1 week. When beta-blocker therapy was replaced by synthetic cholinergic eye-drops (drug unspecified) the eruption cleared completely without any recurrence a year later. 

For the treatment of glaucoma there are substances available with different modes of action. Two short-acting cholinergics which are used are pilocarpine, which is a first-hand remedy, and physostigmine. 

CiiHi NjOa, Mr 208.26, oily liquid or crystals, mp. 34 °C (as hydrochloride 193-205 °C, nitrate I74°C), bp. 260°C (0.7 kPa), [a] > +106° (HjO), soluble in water, ethanol, chloroform forms well crystallizing salts with acids. P. is the main alkaloid of the South American jaborandi tree (Pilocarpus jaborandi). It is isolated from the leaves. P. is also easily accessible by synthesis and is used as its salts in medicine as a cholinergic parasympathicomimetic, miotic (for glaucoma) agent and as an atropine antagonist it is also used in veterinary medicine for colics and constipation. Detection by means of Helch s reaction. Pilocarpus species contain further imidazole alkaloids (see table). 

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