1. DSA Drugs used in Glaucoma

Question 1

The following are what kind of drugs used in glaucoma?
Betaxolol
Timolol
Metipranolol
Levobunolol
Carteolol

Answer 1

B-blocking drugs

Question 2

The following are what kind of drugs used in glaucoma?
Apraclonidine
Brimonidine

Answer 2

a2 adrenergic agonists

Question 3

The following are what kind of drugs used in glaucoma?
Latanoprost
Bimatoprost
Travoprost

Answer 3

Prostaglandin Analogs

Question 4

The following are what kind of drugs used in glaucoma?
Topical : Brinzolamide/Dorzolamide
Systemic: Acetazolamide/Methazolamide

Answer 4

Carbonic Anhydrase Inhibitors

Question 5

The following are what kind of drugs used in glaucoma?
Carbachol
Pilocarpine

Answer 5

Muscarinic Agonists

Question 6

The following are what kind of drugs used in glaucoma?
Demecarium
Echothiophate

Answer 6

Inhibitors of cholinesterase

Question 7

Iris circular muscle constricts pupil to cause miosis, d/t activation of M3 receptors. Iris radial msucle dilates pupil to cause myadriasis, due to activation of a1 adrenergic receptors. Ciliary M. causes accomodation of the eye to near vision- opens trabecular meshwork, inc outflow aqueous humor into canal of schlemm, dec. intraocular pressure- M3 receptors contract muscle. Ciliary epithelium produces/secretes aqueous humor, Badrenergic activation increases and what decreases aqueous humor production?

Answer 7

A2 adrenergic receptor activation

Question 8

Regulation of IOP (intraocular pressure) is via production of aqueous humor via B/A2 activation… what functions to transport sodium and bicarbonate ions from ciliary body to the aqueous humor and increases osmotic pressure of aqueous humor to enhance transport of water to humor and increase volume?

Answer 8

Carbonic Anhydrase

Question 9

Outflow of aqueous humor is controlled via muscarinic receptors- contraction of ciliary m improves outflow (conventional) and contraction of iris circular muscle (miosis) improves outflow as well. Contraction of iris radial m via SNS -a1 (myadriasis) decreases conventional outflow… What improves uveoscleral or unconventional outflow?

Answer 9

Prostaglandin F2a

Question 10

Glaucoma is a group of ocular disorders that lead to an optic neuropathy associated with loss of visual sensitivity and field… WHAT is thought to play an important role in the pathogenesis of glaucoma?

Answer 10

Increased intraocular pressure*

Question 11

There are two type of glaucoma; primary and secondary. Primary is genetic/congenital/without apparent factor, with two kinds- open angle glaucoma (95%) which is a chronic progressive dz with no mechanical blockage for the humor outflow, and what other type which accounts for 5% and is acute, intermittent partial or complete blockage of the outflow - may be treated as emergency to avoid vision loss?

Answer 11

Closed angle glaucoma

other type is Secondary such as secondary to other diseases/trauma/surgery/drug induced

Question 12

Current treatment for open angle glaucoma is directed at reduction of IOP… Second line therapy is pilocarpine, apraclonidine and topical carbonic anhydrase inhibitors, last line is carbachol, inhibs of cholinesterase and oral carbonic anhydrase inhibitors and what are the 3 “first line treatments”?

Answer 12

1. Prostaglandin analogues
2. B Blockers- Timolol is favored
3. Brimonidine (a2 adrenergic)

Question 13

Beta blockers are used because there is convenience of dosing and relative lack of adverse effects. Timolol is favored it lacks loacl anesthetic effects, is generic, full antagonist, effective as pilocarpine. What is the MOA?

Answer 13

reducing production of aqueous humor by the ciliary body by blocking B receptors

Question 14

B blocker SE are usually local and tolerable and include stinging, dry eyes, blurred vision, blepharitis. Systemic effects include negative inotropic/bradycardia, bronchospasm, hyperlipidemia, hypoglycemia, use w caution in pts with bradycard, AV block, heart failure, and taking oral Bblocking therapy, B-blockers may interact with what drug, which increases the risk of cardiac depression and heart block?

Answer 14

Verapamil (ca channel blocker and HTN med)

Question 15

Prostaglandins (bimatoprost - most effective), more efficient than B blockers, given once at night, no systemic SE, local SE include corneal erosions, conjunctival hyperemia, iris hyperpigmentation and hypertrichosis (pigment around eye lashes/lids), what is the MOA?

Answer 15

reduce IOP by increasing the uveoscleral and to a lesser extent trabecular outflow of aqueous humor

Question 16

a2 agonist such as brimonidine (first line) and apraclonidine (freq. allergic reactions- devel tachyphylaxis). Brimonidine reduces IOP as well as Timolol, with a MOA of decreasing the rate of aqueous humor production… Systemic SE include dizziness, fatigue, dry mouth, bradycardia and reduced BP, local SE include? (1)

Answer 16

Allergic Reaction (eyelid edema/itching/hyperemia)

Question 17

Tx for open angle glaucoma: start w B blocker, if contraindication to Bblockers switch to prostaglandins or brimonidine, if contraindications to all first line- use topical carbonic anhydrase inhibitors (2nd line), if monotherapy doesnt work then use combination, if inadequate response then?

Answer 17

Laser and surgical procedure

Question 18

Tx of closed angle glaucoma is RAPID reduction of IOP- use systemic hyperosmotic diuretics in prep for surgery such as oral glycerin or IV mannitol. B blockers/ a2 agonists and carbonic anhydrase inhibitors are used to reduce humor production.. what is the drug of choice before surgery to induce miosis?

Answer 18

Pilocarpine

Question 19

Surgical or laser iridectomy is the treatment for closed angle glaucoma and it produces a hold in the iris facilitating the humor outflow…

Answer 19

MEOW

Question 20

Glucocorticoids and topical antimuscarinic drugs increase IOP for open angle glaucoma. Closed angle glaucoma may be triggered by any drug that causes WHAT? such as antimuscarinics and a1 agonists

Answer 20

Mydriasis