Drugs commonly used in ophthalmology

Question 1

Glaucoma treatment drugs

Answer 1

Beta-blockers
Muscarinic stimulants
Alpha2-stimulants
Prostaglandin derivatives
Carbonic anhydrase inhibitors

Question 2

Glaucoma treatment drugs

Muscarinic stimulants

Answer 2

AKA parasympathetic stimulant
Pilocarpine
Topical
MOA: increase aqueous outflow via trabecular meshwork by ciliary mm contraction
S/E: miosis (reduced vision in presence of cataract + retinal examination impair), spasm of accommodation, brow ache, systemic sweating, bradycardia, GIT disturbance

Question 3

Glaucoma treatment drugs

Alpha2-stimulants

Answer 3

Brimonidine, apraclonidine
Topical
MOA: Reduce aqueous secretion by selective stimulation of alpha2- and adrenoreceptors in the iliary body
S/E: ocular allergy, mydriasis, eyelid retraction, dry mouth, hypotension, drowsiness, headache

Question 4

Glaucoma treatment drugs

Prostaglandin derivatives

Answer 4

Latanoprost (Xalatan), travaprost (Travatan), bimatoprost (Lumigan)
Topical
MOA: Increase aqueous outflow via uveoscleral route
S/E: iris darkneing, conjunctival hyperaemia, eyelash growth, bitter taste, asthma

Question 5

Glaucoma treatment drugs

Carbonic anhydrase inhibitors

Answer 5

Systemic (acetazolamide)
Topical (Dorzolamide, Brinzolamide)
MOA: Reduce aqueous secretion by the ciliary body
S/E: ocular irritation, ocular allergy, malaise, paraesthesia, U+E disturbance, aplastic anemia

Question 6

Glaucoma treatment drugs

Beta-blockers

Answer 6

Timolol, carteolol, betaxolol, levobunolol
Topical
MOA: Reduce aqueous secretion by inhibitory action on beta-adrenoreceptors in the ciliary body
S/E: ocular irritation, bronchospasm, bradycardia, exacerbation of HF, nightmares

Question 7

Lubricants

Answer 7

Carbomers, hypromellose, polyvinyl alcohol, liquid paraffin + sodium hyaluronate
Topical
MOA: exact mechanism depends on agent
S/E: preservative allergy/toxicity, blurred vision (esp w/ ointments)

Question 8

Mydriatics and cycloplegics

Antimuscarinics

Answer 8

Tropicamide, cyclopentolate, atropine
Topical
MOA: inhibit muscarinic receptors of parasympathetic nervous system to paralyse pupillary sphincter and ciliary mm
S/E: blurred vision (esp for near), glare, angle closure glaucoma, tachycardia, dry mouth, confusion, tremor

Question 9

Mydriatics and cycloplegics

Alpha-stimulant

Answer 9

Phenylephrine
Topical
MOA: Stimulates dilator mm of the pupil (no cycloplegic effect)
S/E: blurred vision, glare, angle glaucoma, conjunctival blanching, hypertension