all right so carbonic anhydrase inhibitors or cai's uh mechanism of action so first of all carbonic anhydrase this is an enzyme that is found in the kidneys the eyes um other parts of the body basically just makes hydrogen ions available for sodium and water exchange so it's going to allow sodium and water to be reabsorbed back into the blood um and that's just the typical role of carbonic anhydrase so what a cai or carbonic anhydrase inhibitor does its mechanism of action is it inhibits carbonic anhydrase activity at multiple sites so if it's inhibiting it then we're going to have decreased hydrogen availability for sodium and hydrogen exchange and what this results in is water and sodium excretion so you'll also see that we use this particular drug for aqueous humor production and i already flipped to the slide um so when we're looking at someone who has glaucoma okay so looking at this eye we have the normal eye okay to the left here and then to the right here we have the patient with glaucoma so what's happening with glaucoma is we have this buildup of aqueous humor fluid right and because we have this build of a fluid then we have all this extra pressure in the eye and this extra pressure in the eye can actually damage or cause damage to the optic nerve and then when that occurs we're going to have permanent damage that can occur to our vision okay or the patient with glaucoma's vision all right so going back to our outline so somebody on a cai we can give this um a carbonic anhydrase inhibitor just to help decrease that aqueous humor production so we don't have so much pressure in the eye okay that's that would affect that optic nerve okay so therapeutic effects decreases circulating sodium bicarbonate um so alter acid-base balance decreases aqueous humor production that's an important one to remember and by doing so we decrease intraocular pressure and then renal sodium we have water excretion um and primarily this happens in the proximal tubules so what i really want you to remember about this particular class the biggest take take backs here are the indications and part of the mechanism of action especially when we're looking at um the patient with glaucoma okay so important to remember altitude sickness okay we can give this particular medication for altitude sickness the mechanism is kind of unclear um we're not really sure why um why it works for that but it does help a patient with altitude sickness a patient with metabolic alkalosis right this is when their body is too alkaline so that's the opposite of acidic okay so altitude sickness metabolic alkalosis and then glaucoma so those are the three i want you to really remember for this particular class okay and we talked about why for the glaucoma so this would be someone who has increased intraocular pressure and then edema resistant to other treatments but the biggest ones is the altitude sickness metabolic alkalosis and the glaucoma uh precautions it is a diuretic we are pulling fluid right so we want to look make sure that we're looking out for electrolyte and fluid volume disturbances and then contraindication severe renal or hepatic dysfunction pre-existing electrolyte imbalance especially hyponatremia and hypokalemia because we're going to pull off sodium and potassium side effects acidosis sure that can occur um so and also hypokalemia and then drowsiness and paresthesias parathesis is when they have just like numbness and tingling um in their finger so when i say acidosis what happens is we have a decreased circulating sodium bicarb right so sodium bicarb is our acid-base buffer so if we decrease sodium bicarb then our patient is at risk for becoming acidotic right um so that's just just to be aware of it's not the side and adverse effects you don't really see these too often again the biggest take back thus far for this particular class are the indications that i mentioned okay nursing actions we're going to assess blood pressure eyes and nose building creatinine potassium mag sodium and acid-base balance so you've seen all of that um except for the acid-base balance might be a little more new um because we would give this particular medication for someone who is in metabolic alkalosis remember so example of drug in class so the only one you have to remember is the acetazolamide all right so now we are under e for extras you