drug management

Question 1

what are they symptoms of glaucoma

Answer 1

optic nerve damage, visual field loss, eventual blindness

Question 2

risk factors

Answer 2

high IOP >21, family history, race, systemic hypertension, cvd, migraine, previous ocular disease.

Question 3

what is the cause of glaucoma

Answer 3

impaired drainage of aqueous humour

Question 4

where are the sites of aqueous outflow

Answer 4

trabecular meshwork, sclera and ciliary body.

Question 5

what are the main Aims of antiglaucoma treatment

Answer 5

to reduce IOP to <16-20, preserves visual field, compatibility with other treatments and no topical or systemic se.

Question 6

how is prostaglandins involved in aq humour outflow

Answer 6

it decreased IOP

Question 7

which receptors do the prostaglandin analogues act via

Answer 7

FP receptors

Question 8

where are FP receptors present

Answer 8

ciliary body, muscle and sclera, trabecular meshwork

Question 9

3 examples of prostaglandin analogues

Answer 9

latanaprost, tafluprost, travoprost

Question 10

what is the moa of prostamide analogues

Answer 10

FP receptor agonist. increases uveoscleral and trabecular outflow

Question 11

how is IOP lowered

Answer 11

increase in uvoscleral outflow and reduced resistance by degradation of collagen and extracellular metric and decreases resistance of ciliary muscle and sclera

Question 12

side effects of prostaglandin and prostamide analogues

Answer 12

red eye, eyelash growth, sensitivity to light

Question 13

why can’t prostaglandin and prostamide analogues be used in pregnancy

Answer 13

effects on cell division

Question 14

how do beta blockers decrease aqueous humour production

Answer 14

blocks cAMP production which prevents ion transport in the ciliary epithelium preventing aqueous humour production due to lack of osmotic gradient.

Question 15

what are the disadvantaged of using beta blockers to decrease IOP

Answer 15

effects are seen on untreated eye too, systemic se are also observed

Question 16

what are the side effects of beta blockers

Answer 16

vasoconstriction, bronchoconstriction, masks hypoglycaemia

Question 17

how do carbonic anhydrase inhibitors lower IOP

Answer 17

carbonic anhydrase catalysis the formation of bicarbonate which is required for aq secretion.

Question 18

what formulation do carbonic anhydrase inhibitors come in

Answer 18

• systemic - serious se incl. gi problems, drowsiness and depression (enzyme also in the parts of the body) therefore only in when IOP is very highly elevated and for short term use only
• topical

Question 19

how would you decrease the side effects of CAIs

Answer 19

modify acetazolamide to allow corneal absorption ( lipid sol)

Question 20

combination treatments

Answer 20

CAIs+ beta blockers

CAIs+ prostaglandin analogues

Question 21

side effects of topical CAIs

Answer 21

blurred vision, burning, stinging

Question 22

what is the mechanism of adrenoceptor agonists

Answer 22

similar to beta blockers. decrease cAMP and mom transport and aq secretions ALSO
reduces blood flow and vasoconstriction.

Question 23

what is an example of an adrenoceptor agonist

Answer 23

brimonidine

Question 24

side effects of adrenoceptor agonists

Answer 24

stinging, burning, blurred vision, hypotension, fatigue, dry mouth

Question 25

what is the moa of a parasympathomimetics (pilocarpine)

Answer 25

contracts ciliary muscle, opens trebecular meshwork and increasing outflow decreasing IOP

Question 26

what precent decrease of IOP does prostaglandin analogues provide

Answer 26

35%

Question 27

what percent decrease in IOP do CAIs provide

Answer 27

20%

Question 28

what percent decrease in IOP do beta blockers provide

Answer 28

20-30%