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NMSP Exam 1 > Drugs for Glaucoma > Flashcards

Drugs for Glaucoma Flashcards

1
Q

What does the iris circular muscle do in the eye? What activates it?

A
  • Constricts pupil to cause miosis

- Effect is due to activation of M3 receptors –> GPCR coupled to Gq

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2
Q

What does the iris radial muscle do in the eye? What activates it?

A
  • Dilates pupil to cause mydriasis

- Effect is due to activation of alpha1 adrenergic receptors –> GPCR coupled to Gq

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3
Q

What does the ciliary muscle do in the eye?

A
  • Causes accommodation of the eye to near vision
  • Opens up trabecular meshwork, improves outflow of aqueous humor into the canal of Shlemm, decreasing intraocular pressure
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4
Q

What makes the ciliary muscle work?

A
  • M3 receptors
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5
Q

What does the ciliary epithelium do in the eye?

A
  • Produces (secretes) aqueous humor
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6
Q

What allows the ciliary epithelium to make aqueous humor?

A
  • Beta adrenergic receptor activation increases humor production
  • Alpha2 adrenergic activation decreases humor production
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7
Q

What is a part of the regulation of intraocular pressure?

A
  • Production of aqueous humor

- Outflow of aqueous humor

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8
Q

What plays a role in the production of aqueous humor?

A
  • Sympathetic nervous system –> Beta and alpha2 receptor activation
  • Carbonic anhydrase
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9
Q

How does carbonic anhydrase help with the production of aqueous humor?

A
  • Functions to transports sodium and bicarbonate ions from the ciliary body to the aqueous humor
  • Increase in osmotic pressure of the aqueous humor enhances transport of water to the humor to increase its volume
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10
Q

What plays a role in the outflow of aqueous humor?

A
  • Muscarinic receptors
  • Prostaglandin F2alpha improves uveoscleral or unconventional outflow
  • Sympathetic nervous system –> contraction of iris radial muscle or relaxation of ciliary muscle
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11
Q

What are the types of primary glaucoma?

A
  • Open angle glaucoma

- Closed angle glaucoma

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12
Q

What is open angle glaucoma?

A
  • Chronic progressive disease with no apparent mechanical blockage for the humor outflow
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13
Q

What is closed angle glaucoma?

A
  • Acute intermittent partial or complete blockage of the outflow, may have to be treated as an emergency to avoid vision loss
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14
Q

What could be some causes of secondary glaucoma?

A
  • Secondary to other diseases
  • Trauma
  • Surgery
  • Drug-induced
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15
Q

What drug classes help reduce aqueous humor production?

A
  • Beta blockers
  • Alpha2 adrenergic agonists
  • Carbonic anhydrase inhibitors –> both topical and systemic
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16
Q

What drug classes help increase aqueous humor outflow?

A
  • Prostaglandin analogs
  • Alpha2 adrenergic agonists
  • Direct cholinergic agonists
  • Inhibitors of cholinesterase (indirect acting cholinergic agonists)
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17
Q

What is the MOA of beta blocker in glaucoma?

A
  • Reducing the production of aqueous humor by the ciliary body via blocking beta receptors
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18
Q

Why is use of beta blockers common in glaucoma?

A
  • Convenience of dosing

- Relative lack of local adverse effects?

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19
Q

What beta blocker is favored? Why?

A
  • Timolol
  • Lacks local anesthetic effects (propranolol and some others possess local anesthetic activity)
  • Available as generic
  • Full antagonist
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20
Q

What are some systemic adverse effects of beta blockers?

A
  • Negative inotropic effect and bradycardia
  • Bronchospasm
  • Hyperlipidemia
  • Exacerbation of hypoglycemia
  • May interact with CCBs causing an increased risk of cardiac depression and heart block
21
Q

What patients should use of beta blockers be cautioned?

A
  • Patients with bradycardia, AV block, or heart failure

- Those with diabetes or receiving oral beta blocking therapy

22
Q

What are some local adverse effects of beta blockers?

A
  • Ocular irritation

- Dry eyes

23
Q

What are some alpha2 agonists used in glaucoma?

A
  • Brimonidine

- Apraclonidine

24
Q

What is the MOA of alpha2 agonists in glaucoma?

A
  • Decrease rate of the aqueous humor production

- Increase uveoscleral outflow by relaxing ciliary muscle

25
Q

What are some systemic adverse effects of alpha2 agonists?

A
  • Headache
  • Fatigue
  • Dry mouth
26
Q

What are some local adverse effects of alpha2 agonists?

A
  • Allergic reactions –> eyelid edema, itching, hyperemia)
27
Q

What are the topical carbonic anhydrase inhibitors used in glaucoma?

A
  • Brinzolamide

- Dorzolamide

28
Q

What are some systemic carbonic anhydrase inhibitors used in glaucoma?

A
  • Acetazolamide

- Methazolamide

29
Q

What is the MOA of carbonic anhydrase inhibitors in glaucoma?

A
  • Decrease osmotic pressure of the aqueous humor
30
Q

What are some systemic adverse effects of carbonic anhydrase inhibitors?

A
  • N/D, loss of appetite, altered taste
  • Weight loss
  • Paresthesias
  • Renal stones
  • Decreased libido
31
Q

What are some local adverse effects of carbonic anhydrase inhibitors?

A
  • Ocular irritation and redness
32
Q

What are some prostaglandin analogs used in glaucoma?

A
  • Latanoprost
  • Bimatoprost
  • Travoprost
33
Q

What is the MOA of prostaglandin analogs in glaucoma?

A
  • Reduce IOP by increased the uveoscleral and, to a lesser extent, conventional outflow of aqueous humor
34
Q

What is prostaglandins analog use common?

A
  • Given once daily at nighttime

- More efficiently reduce IOP than B-blockers

35
Q

What are some local adverse effects of prostaglandin analogs?

A
  • Corneal erosions
  • Conjunctival hyperemia
  • Iris hyperpigmentation
  • Hypertrichosis –> hyperpigmentation around eyelashes and eyelids (reversible after discontinuation)
36
Q

What are some direct acting cholinergic agonists?

A
  • Pilocarpine

- Carbachol

37
Q

What are some indirect acting cholinergic agonists?

A
  • Echothiophate
38
Q

What is the MOA of cholinergic agonists in glaucoma?

A
  • Activate M3 receptor either directly or indirectly which increases conventional humor outflow
39
Q

What are some local adverse effects of cholinergic agonists?

A
  • Headaches and periorbital pain
  • Miosis
  • Eyelid twitching
  • Myopia
  • Cataracts
  • Iris-lens adhesions
40
Q

What is done in the treatment of open angle glaucoma?

A
  • Start on B-blocker or prostaglandin agent –> if there is intolerance to a specific agent, use a class alternative
  • If those don’t work then switch to brimonidine or topical carbonic anhydrase inhibitors
41
Q

What is done if there is intolerance to combination therapy in open angle glaucoma?

A
  • Laser or surgical procedure
42
Q

What are some anatomic predispositions that cause closed angle glaucoma?

A
  • Shallow anterior chamber
  • Narrow angle between cornea and iris
  • Tight contact between iris and the lens
43
Q

What is closed angle glaucoma with pupillary block?

A
  • Tight contact between iris and the lens causing the flow of humor into anterior chamber to be blocked
  • Iris moves forward and blocks the outflow
44
Q

What is closed angle glaucoma without pupillary block?

A
  • The ciliary processes are located in such a way that they push iris forward and iris blocks the outflow, especially during mydriasis
45
Q

What are the goals of treating closed angle glaucoma?

A
  • Rapid reduction of IOP –> surgical or laser iridectomy
46
Q

What is done before surgery in closed angle glaucoma to reduction IOP rapidly?

A
  • Systemic osmotic diuretics are given –> oral glycerin and IV mannitol
  • Pilocarpine given before surgery to induce miosis
  • B-blockers, alpha2 agonists, or carbonic anhydrase inhibitors given
47
Q

What is a surgical or laser iridectomy?

A
  • Produce a hole in the iris facilitating the humor outflow
48
Q

What are some drugs that promote elevation of IOP in open angle glaucoma?

A
  • Glucocorticoids

- Topical antimuscarinic drugs

49
Q

What are some drugs that promote elevation of IOP in closed angle glaucoma?

A
  • Drugs with alpha1 adrenomimetic activity

- Antimuscarinic drugs (including TCA and SNRIs)

NMSP Exam 1 (12 decks)

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