3 - Glaucoma Drugs

Question 1

MOAs

-cholinergic agonists

Answer 1

Incr corneoscleral outflow

Pilocarpine

Question 2

MOAs

-alpha-adrenergic agonists

Answer 2

Decr production of AH
Incr uveoscleral outflow

Apraclonidine, Brimonidine

Question 3

MOAs

-beta-adrenergic antagonists

Answer 3

Decr AH production

-olols

Question 4

MOAs

-carbonic anhydrase inhibitors

Answer 4

Decr AH production

-olamides

Question 5

MOAs

-prostaglandins

Answer 5

Incr uveoscleral outflow

-prosts

Question 6

CAIs

• what is carbonic anhydrase
• importance of bicarb
• drug base

Answer 6

Enzyme that acts on CB epithelium to catalyze joining of CO2 + water -> bicarb

Incr AH production by incr Cl- and Na+ influx into posterior chamber

Sulfa-based (allergies!)

Question 7

Brinzolamide

• type of drug
• use
• SE

Answer 7

Topical CAI

In combination with timolol for glaucoma (combigan)

Bad taste, sting

Question 8

Dorzolamide

• type of drug
• use
• SE

Answer 8

Topical CAI

In combination with timolol for glaucoma (cosopt)

Bad taste, sting

Question 9

Acetazolamide

• type of drug
• use
• SE
• contraindications

Answer 9

Oral CAI

Commonly given with liquid during acute angle closure attacks
Last resort to tx POAG (SEs)

Common: metallic taste, tingling hands/feet, metabolic acidosis
Most serious: thrombocytopenia, agranulocytosis, aplastic anemia, sickle cell crisis (bone marrow suppression + aplastic anema = fatal)
Other: malaise, fatigue, weight loss, anorexia, impotence, depression, diarrhea, myopic shifts

Contra: severe COPD, pregnancy, sulfa allergy
Caution: liver/renal disease

Question 10

Methazolamide

• type of drug
• use
• SE
• contraindications

Answer 10

Oral CAI

Last resort to tx POAG (SEs)

Common: metallic taste, tingling hands/feet, metabolic acidosis
Most serious: thrombocytopenia, agranulocytosis, aplastic anemia, sickle cell crisis (bone marrow suppression + aplastic anemia = fatal)
Other: malaise, fatigue, weight loss, anorexia, impotence, depression, diarrhea, myopic shifts

Contra: severe COPD, pregnancy, sulfa allergy
Caution: liver/renal disease

Question 11

Prostaglandin analogs

• MOA
• use
• dosing
• SE
• contraindications

Answer 11

1) act on FP receptors (PGF2a) on ciliary muscle -> reduction of neighboring collagen via metaloproteinases -> decr uveoscleral resistance
2) act on skin receptors -> activate phospholipase C -> alter hair follicles

First-line POAG
-avg 27-35% IOP lowering

Bedtime: better diurnal control, daytime peak effect (12-24h after)

Iris heterochromia (permanent, avoid in monocular glauc), incr pigmentation and growth of eyelashes, skin darkening around eyes
Conj hyperemia can occur (worst with lumigan, least with xalatan)
Pruritis (esp lumigan)

Pts at risk for CME, cases of active inflammation, pts with previous HSK episode(s)