B41 - ophthalmology

Question 1

2 types and examples of topical beta blockers used in glaucoma

Answer 1

Non-selective beta blocker e.g., Timolol

Selective beta-1 receptor blocker e.g., Betaxolol

Question 2

b blocker MOA glaucoma

Answer 2

Act on beta 2 receptors on ciliary body to decrease aqueous production

Question 3

Drugs indicated for open angle glaucoma

Answer 3

timolol, betaxolol

Question 4

drug indicated for closed angle glaucoma

Answer 4

timolol

Question 5

what are topical b blockers used in combination with for glaucoma usually

Answer 5

carbonic anhydrase

inhibitor

Question 6

Common side effects of b blockers

Answer 6

Bradycardia
Heart block
Bronchospasm (less with selective beta – 1 antagonists) 
Hypotension
Localised stinging

Question 7

important/cautions SE b blockers

Answer 7

Exacerbation of COPD

Asthma

Question 8

b blockers CI

Answer 8

Bradycardia, heart block, uncontrolled heart failure

Asthma or COPD

Question 9

b blockers interactions

Answer 9

Risk of systemic absorption which can lead to;
Hypotension with anti-hypertensives e.g. ACEi, ARBs, calcium channel blockers
Bradycardia with anti-arrhythmic drugs

Question 10

Brimonidine MOA

Answer 10

α2 adrenergic agonist

Acts on decreasing synthesis of aqueous humour and increasing drainage through uveoscleral outflow

Question 11

Brimonidine indications

Answer 11

Open angle glaucoma

Ocular hypertension

Question 12

Brimonidine SE (9)

Answer 12

Localised burning
Conjunctival whiteness
Redness of eyelids
Dry mouth
Dizziness
Ocular disturbances
Upper respiratory symptoms
Blurred vision
Allergic conjunctivitis

Question 13

Brimonidine cautions (3)

Answer 13

Depression
Cardiovascular disease
Cerebral insufficiency

Question 14

Brimonidine interactions (2)

Answer 14

Tricyclic antidepressants;
Decrease effectiveness of brimonidine
Monoamine oxidase inhibitors;
Increased risk of headache, high blood pressure, fever

Question 15

Acetazolamide MOA

Answer 15

Inhibitor of carbonic anhydrase

Inactivates carbonic anhydrase, an enzyme found in red blood cells and catalyses this reaction to lower blood pH

Question 16

Acetazolamide indications

Answer 16

Open angle glaucoma

Short term treatment for acute angle closure glaucoma

Question 17

Acetazolamide SE

Answer 17

Important Side effects:
Electrolyte changes - hyponatraemia - hypokalaemia
Stevens-Johnson syndrome (rare)

Common Side effects:
Numbness 
Ringing in the ears
Ataxia
Depression
Dizziness
Fatigue
Flushing
Headache 
Nausea 
Parasthesia
Taste disturbance 
Loss of appetite

Question 18

Acetazolamide cautions

Answer 18

Renal impairment
Liver impairment
Allergies to sulphonamides
Adrenal insufficiency
Breast feeding mothers

Question 19

Acetazolamide interactions

Answer 19

Topiramate (metabolic acidosis)

Question 20

Acetazolamide route of administration

Answer 20

IV, tablet

Question 21

Brinzolamide and Dorzolamide route of administration

Answer 21

topical eye drops

Question 22

Brinzolamide and Dorzolamide SE

Answer 22

Important Side effects
Fast or irregular heart beat

Common Side effects
Blurred vision
Itching
Pain and watering of eyes
Headache
Bitter or sour taste
Corneal erosion
Corneal oedema
Conjunctivitis

Cautions
Renal tubular abnormality

Question 23

4 examples prostaglandin analogues

Answer 23

Latanoprost , Travoprost, Bimatoprost, Tafluprost

Question 24

Prostaglandin analogues MOA glaucoma

Answer 24

enhances uveoscleral aqueous outflow and lowers the intraocular pressure

Question 25

Prostaglandin analogues

Answer 25

open angle glaucoma

Question 26

Prostaglandin analogues SE (4)

Answer 26

Blurred vision
Burning/stinging itching
Brown pigmentation of iris (heretochromia)
lengthening and thickening of eyelashes

Question 27

Prostaglandin Analogues cautions and interactions

Answer 27

Cautions
Compromised respiratory function

Interactions
NSAIDs (Can reduce/increase the effectiveness)
Multiple prostaglandins (may cause paradoxical increase in intraocular pressure)

Question 28

Pilocarpine MOA

Answer 28

Acts on the muscarinic receptor (M3), found on the iris muscle, causing the muscle to contract, causing pupil constriction (miosis).
It also causes the ciliary muscle to contract, opening the trabecular meshwork. This increases the trabecular outflow and decreases intraocular pressure

Question 29

Pilocarpine indications

Answer 29

Chronic open angle glaucoma

Primary angle-closure glaucoma

Question 30

Pilocarpine SE

Answer 30

rare with topical administeation:
Excessive salivation, 
Sweating 
Bronchial mucus secretion 
Bronchospasm 
Bradycardia 
Vasodilation 
Diarrhoea

Question 31

Pilocarpine cautions and interactions

Answer 31

Cautions
Asthma
Cardiac or renal disease
Iritis

Interactions
Rare with topical eye drops

Question 32

2 examples of topical corticosteroids used in opthalmology

Answer 32

Dexamethosone, Prednisolone

Question 33

Indications for corticosteroid eye drops (4)

Answer 33

Allergic eye disease
Anterior Uveitis
Post-operative intraocular surgery
Keratitis

Question 34

Important SE of corticosteroids in opthalmology (4)

Answer 34

Cataracts
Glaucoma
Central Serous Chorio-Retinopathy (CSCR)
Systemic effects of steroids e.g. Cushing Syndrome

Question 35

Corticosteroids CI and interactions

Answer 35

Contraindications
Active ocular infection e.g. herpes simplex
Suspected periocular infections
Uncontrolled advanced glaucoma

Interactions
Anticoagulant or antiplatelet drugs (increased risk of haemorrhagic events)

Question 36

2 examples of topical antihistamines used in opthalmology

Answer 36

Antazoline

Levocarbastine

Question 37

Antazoline/Levocarbastine SE

Answer 37

Important / Serious side effects
Drowsiness (older generation H1 antagonists)

Common Side effects
Dry mouth
Nausea
Lightheadedness
Drowsiness
Headaches
Agitation
Dry mouth