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neuro pharm > Drugs used in Glaucoma > Flashcards

Drugs used in Glaucoma Flashcards

1
Q

Iris ciscular muscle function and receptor

A

constricts pupil to cause miosis

M3 receptors

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2
Q

Iris radial muscle function and receptor

A

Dilates pupil to cause mydriasis

a1 adrenergic receptor

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3
Q

Ciliary muscle function and receptor

A

Accommodation of the eye to near vision

M3 receptors

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4
Q

What produces/secretes aqueous humor?

A

ciliary epithelium

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5
Q

What is the role of B adrenergic receptor activation in humor production

A

increases humor production

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6
Q

What is the role of a2 adrenergic receptor activation in humor production?

A

decreases humor production

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7
Q

What is the role of carbonic anhydrase in the regulation of intraocular pressure (IOP)

A

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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8
Q

What is the role of muscarinic receptors in regulation of IOP?

A

conventional outflow

Contraction of ciliary muscle –> improved outflow
Contraction of iris circular muscle, miosis- improved outflow

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9
Q

What is the rols of the sympathetic nervous system in regulation of IOP

A

Contraction of iris radial muscle (a1), mydriasis - decreased outflow (conventional outflow)

Relaxation of the ciliary muscle (presynaptic a2) - increased uveoscleral outflow

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10
Q

What is the difference between open angle and closed angle glaucoma?

A

open angle is a chronic progressive disease with no blockage for humor outflow

Closed angle is intermittent partial of complete blockage that may have to be treated as an emergency to prevent vision loss

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11
Q

What are the drug categories that reduce aqueous humor production

A

B-blockers
a2 adrenergic agonists
Carbonic anhydrase inhibitors

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12
Q

Which B-blocker is favored in treatment?

Why?

A

Timolol

Lacks local anesthetic effects
available as genetic
full antagonist

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13
Q

What are the B-blockers used in the reduction of humor

A 
betaxolol
timolol
metipranolol
levobunolol
carteolol
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14
Q

What are the a2 agonists used in reduction of humor

A

Brimonidine (first line)

Apraclonidine

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15
Q

What are the topical carbonic anhydrase inhibitors used in reduction of humor

A

Brinzolamide

Dorzolamide

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16
Q

What are the systemic carbonic anhydrase inhibitors used in reduction of humor

A

Acetazolamide

Methazolamide

17
Q

What are the drug categories that increase the aqueous humor outflow?

A

Prostaglandin analogs
a2 adrenergic agonists
Direct cholinergic agonists
Cholinesterase inhibitors (indirect cholinergic agonists)

18
Q

What are the prostaglandin analogs that increase outflow

A

latanoprost
bimatoprost - most effective at lowering IOP
travoprost

19
Q

What is the MOA of the prostaglandin analogs

A

reduce IOP byy increaseing the uveoscleral and, to a lesser extent, conventional outflow of aqueous humor

20
Q

What are some notable side effects of the prostaglandin analogs?

A

iris hyperpigmentation

reversible hypertrichosis and hyperpigmentation around the eye lashes and eyelids

21
Q

What are the direct acting cholinergic agonists

A

pilocarpine

carbachol

22
Q

What is the indirect acting cholinergic agonist (cholinesterase inhibitor)

A

echothiophate

23
Q

How do you treat open angle glaucoma?

IF there are contraindications?

If intolerance or inadequate response to combination therapy?

A

1) start with a B-blocker or a prostaglandin agent
2) switch to brimonidine or topical carbonic anhydrase inhibitors
3) laser or surgical procedure

24
Q

What is a technique used in the treatment of open angle glaucoma?

A

Nasolacrimal duct occlusion technique

Apply pressure for about 3 mins over the nasolacrimal sac after eye drops are applied

25
Q

What is the goal in the treatment of closed angle glaucoma

A

rapid reduction of IOP

26
Q

What is used in preparation for CA glaucoma surgery

What induces miosis before surgery

A

1) systemic osmotic diuretics: oral glycerin and IV Mannitol

2) pilocarpine1

27
Q

WHat drugs promott elevation in patients with open angle glaucoma?

A

glucocoricoids

topical antimuscarinic drugs

28
Q

What drugs promote angle closure in closed angle glaucoma

A

drugs that cause mydriasis

drugs with a1 adrenomimetic activity
antimuscarinic drugs

neuro pharm (5 decks)

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