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• " Am. J. Ophthalmoi 102:606-611 (1986). Most (80%) of a
p "-.
topically administered eyedrop volume drains through the
nasolacrimal duct becoming systemically absorbed° Approxi-
mately 40% to 70% of a dose of systemic beta adrenergic
blockers (propranolol) administered orally undergoes a first-
pass hepatic metabolism before reachln_ the systemic circu-
lation. A beta-adrenergic antagonist administered in eyedrop
form does not undergo such first-pass metabolism, and may
behave like an intravenous drug dose. Shell, J_W._
Pharmacokinetics of topically applied opthalmic drugs, Surv.
Ophthaimol. 26:207-218 (1982).
17. Serious adverse respiratory events from topical
beta blockers (FDA defined) consists of respiratory arrest,
l
_. respiratory failure, respiratory distress, dyspnea, broncho-
spasm, asthma, wheezing, bronchitis, apnea, pulmonary edema,
diminished pulmonary functions and exacerbation of preexisting
respiratory disease. For purposes of analysis, reports of
asthma, shortness of breath, wheezing_ and bronchospasm were
classified as bronchcspasm=related events. Serious adverse
cardiovascular events were defined as follows: cardiac arrest,
myocardial infarctions engines chest pain, arrhythmia_
bridycardia_ tach_cardia, palpitations, heart failu:e_
..... cardiospasm/ cerebrovascular accidents syncopes unspecified
cardiovascular disorders, and exacerbation of preexisting
cardiovascular disease. Reports of hypes:tension, dizziness,
headache, andohypotension not resulting in syncope were not
considered to be serious. |
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