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  1. By which route would the β-blocker, the prostaglandin analogue and muscarinic agonist be administered in the treatment of TH’s glaucoma? Why? 

Manias & Bullock argue that, the beta blocker, the prostaglandin analogue and muscarinic agonist would be best administered through the non-conventional route. These collections of drugs decrease intraocular compression by adding drainage of aqueous indulge using the uveoscleral trail: non-conventional route. These drugs are suitable to apply as one night time submission and are of rate widely recommended as first-line treatment and glaucoma management. This route is more proficient and is related with less side effects, and adverse effects (Manias & Bullock, 2007).

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  1. Explain how each of the drug groups used to treat her glaucoma relieve the high intraocular pressure. Cover the pharmacological mechanisms.

Glaucoma is a gradually progressive eye disorder that causes mutilation to the optic nerve. Therefore, becomes the leading source of blindness amid African-Americans as well as older individuals in the United States. Since, there are no initial symptoms of this disease; around half the population suffering from glaucoma live with it without their knowledge. Beta blockers collection of compounds assists to decrease intraocular pressure through minimizing creation of aqueous humor inside the eye. It changes cardiac activity through reducing the measure of blood propelled out from the heart, which may decrease beat rate or/and sluggish hearts reaction rate within the exercise. This group helps minimize intraocular pressure through both minimizing creation of aqueous humor in the eye and upraising drainage of liquid fluid via the uveoscleral pathway. Prostaglandin analogues decrease intraocular pressure by raising drainage of the aqueous humor via the uveoscleral path. Muscarinic agonist set of compound assists decreases intraocular pressure through reducing the creation of aqueous humor into the eye and upgrading the drainage of the liquid fluid via the uveosleral trail. It has also been displayed, in experimental mammals’ replicas of glaucoma, to acquire neuroprotective operative (Manias & Bullock, 2007).

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  1. Explain how the anatomy of the eye facilitates systemic absorption of topical preparations.

Bullock, S., &Manias contends that, Drug action site or the site of absorption is quickly cleaned by the protective mechanism that the eye has such as reflex and basal tearing, nasolachrymal drainage and blinking. This shows the importance of frequent instillation, therefore, covering dangerous side effects. Intensifying ocular bioavailability leaves behind a stimulating task on the topical systems formulators. The attempts of this challenge have been the decreasing factor of drainage percentage by adding the glueyness of liquid formulations. The capability of a polymer to advance ocular bioavailability of medicine by observing the ocular superficial and strapping the medicine to its extra favorable stuff than the polymer viscosity potential. A drug must pass basement membranes or several cells before reaching its site of action. Membrane barriers are made of many of cells; this implies the cornea. The cornea is the basic path for drug insertion in the eye; conjunctiva and sclera are also uncommonly important. Medicine penetration via conjunctiva epithelium is faster   in comparison with through cornea epithelium. This is brought by the difference in systematic absorption.  

  1. How can systemic absorption of these drugs be minimized?

According to Blondeau et al., in their critique, when a drug has a higher affinity stratum corneum, diffusion will reduce. This is because increasing permeability decreases diffusion rate. Fitting to absorption numerous ocularly put on medication provide growth to systematic side-effect.  The trouble of general medicine absorption ought to be seized in manipulating dosage forms and drug so that specific effect of the drug on the eyesight is optimized. In this assessment, we run through resent know-how concerning general absorption of ocularly used topical drugs. Exceptional emphasis is given to the schemes that can be applied to decrease general absorption and improve the specific effects of medicine. These may include, minimizing volume and mounting gluiness of eye drops, drug abuse control release from store, prodrug derivatization, and extra of vasoconstrictive representatives. Systematic immersion of ocular directed drug might lead to cardiovascular and respiratory side effects. As a result of these effects, it is vital to reduce the systemic application of the dosage (Blondeau, et al, 2007). 

    5. What are the common local adverse reactions associated with topical administration of eye drops?

According to Bullock, S., &Manias, administration of drugs in the body by any path that is used has a reaction in the body. The reactions are either affirmative or negative varying on the body. Just like other body organs, the eye is also a part of the affected organs in the body by drug administration. Some of the effects on the eye include headache; some drugs when applied to the eye may lead to a condition where one feels pain that is felt on the neck region or head referred to as headache. This is brought about by many factors based on the medical condition. Sometimes, headache comes hand in hand with dizziness, vomiting, and nausea. Burning and stinging are also major reactions that occur during administration of eye drops. This is the process where the patient feels pain and itching in the eyes. Eyelid inflammation or eyelid irritation is also commonly reported. This occurs when the eyelids of the patient itch and some swellings can appear, as well. Tearing, conjunctival injection, corneal erosion, ocular itching and blurred vision are also commonly observed. These are just some of the most common adverse effects associated with drug administration in the form of eye drops.


    6. Given PB’s pre-existing health problems, are there likely to be any precautions associated with her prescribed glaucoma therapy? 

In the article, Markov Model Bimatoprost Pharmacology Analysis Christensen, et al argue that, before the start of treatment, the eye specialist should know about any other drug taken by the patient or any historic health problem. In some cases, glaucoma drops usually interfere with how other drugs work. However, most patients are capable of taking medication without any medical complications. Some glaucoma drugs may cause side effects such as headaches; drops may cause stinging, redness in the eyes and burning. Research shows that hypertension increases the risk of obtaining glaucoma. However, hypertension treatment research shows that topical prescription reduces those who are in the hazard of obtaining glaucoma. Age is also a key determiner in the increase of this disease and prescription of its therapy. Therefore, because of the patient’s age and other ongoing prescriptions, precautions should be taken. It is advisable to observe frequent date schedules with the eye specialist to be checked on the effects of the medications. All the drugs should be taken as directed by the doctor. In this case, therefore, PB has been suffering from hypertension, and asthma, the medical practitioner should take into considerations, the risk associated with these already existing medical complications. It is also recommended for the medical practitioner, to consider the age of PB since, at old age, patients are likely to suffer more adverse effects than the young (Christensen, et al, 2005).  

    7. Are there any potential drug interactions between her existing therapy and her glaucoma therapy worth noting?

According to Blondeau et al, the results of the eye treatment can intermingle with other medications taken orally, such as calcium-channel blockers, oral better-blockers, and antiarrhythmic medicine quinidine. Patients with diabetes who usually take hypoglycemic insulin medications should know that beta-blocker has side effects that may cover the signs of hypoglycemia, low blood sugar.

    8. What changes to eye structures are associated with prostaglandin analogue therapy? Are these changes harmful to the eye?

According to Bullock et al., prostaglandin analogs are the most used eye medications commonly available. They are endured well by patients and are needed only a dose per day. Some of themost noted changes associated with prostaglandin analogs are: blurred vision, burning, eye redness, stinging, itching, eyelid skin, and eye color. The effects of this treatment are typically not permanent, thus the side effects will eventually disappear. Anti-allergies can also be applied for some cases. Therefore, the changes are not harmful. Although, the changes are not permanent, they cause discomfort to the patients. This makes the treatment unfavorable to some patients, who may have existing eye problems, although, it is the most used. In the case study, in question, the patient is an aged lady; therefore, she is likely to be suffering from eye problems; therefore, the changes in the eye structure will cause a lot of discomfort (Bullock, et al., 2007).      

     9. What advice would you give her regarding the adverse effects she might expect whenusing the β-blocker and the muscarinic agonist?  Christensen argues that, adverse medicine reactions related with application of beta blockers are bronchospasm, nausea, dyspnea, diarrhea, heart failure, dizziness, hypotension, heart block, hair loss, fatigue, abnormal vision, cold extremities, sexual dysfunction, exacerbation of Raynaud’s syndrome, hallucinations, alteration of glucose and lipid metabolism, insomnia, erectile dysfunction, bradycardia, and nightmares. Muscarinic agonist is also usually linked with orthostatic hypotension. As a result of deep entrance across the blood brain hindrance beta blockers like metoprolol and propranolol cause sleep discomforts like vivid dreams, insomnia, and nightmares. Therefore, the patient should be aware that some or even all of these side effects may occur to her as a result of using the beta blockers and the muscarinic agonist. With this awareness, it will be easier for her to handle them, and in case of any extremes, the patient should seek medical attention from her doctor.

   10. Indicate whether the following drug groups are miotics, mydriatic, or have no effect on pupil size when administered topically to the eye:

According to Blondeau et al, miotic drugs are elements that trigger the pupil of the eye to constrict while mydriatic, on the other hand, brings about pupil dilation. Miotic ingredients typically lead to minimization of darkening of the vision, night vision acuity, redness and irritation, while mydriatic drugs produce headaches, feeling to bright lights, and hinder the ability of the eye to see for a period after usage.

  1. Sympathomimetics are mydriatic drugs; therefore, can lead to pupil dilation. Drugs under this group lead to eye dilation.
  2. Corticosteroid is a miotic medicine; it triggers the pupil of the eye to constrict.
  3. Muscarinic agonist is also a miotic drug that initiates the pupil of the eye to constrict.
  4. Carbonic anhydrase inhibitors are ameotic medicine, as well. It promotes the pupil of the eye to contract.  
  5. Antimuscarinics are mydriatic medicines, which bring about the pupil of the eye to increase.    

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