Drugs used in Glaucoma Flashcards by Sarah Mahonski | Brainscape

Q

What muscle constricts the pupil to cause miosis through activation of M3 receptors (GPCR coupled to Gq protein)

A

Iris circular muscle

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Q

What muscle dilates the pupil to cause mydriasis through activation of alpha1 adrenergic receptors (GPCR coupled to Gq protein) ?

A

Iris radial muscle

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Q

What Muscle causes accommodation of the eye to near vision through M3 receptor mediated contraction?

A

Ciliary muscle

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Q

What muscle opens trabecular meshwork, improves aqueous humor outflow in the canal of scheme and decreased IOP?

A

Ciliary m.

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Q

What produces aqueous humor?

A

Ciliary epithelium

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Q

What receptor activation increases humor production from ciliary epithelium?

A

Beta adrenergic

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Q

What receptor activation decreases humor production?

A

alpha2 adrenergic

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Q

Beta and alpha2 receptors activate what system?

A

sympathetic

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Q

What transports sodium and bicarbonate ions from the ciliary body to aqueous humor?

A

carbonic anhydrase

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Q

What increases transport of H2O to increase volume of aqueous humor?

A

carbonic anhydrase

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Q

What is the role of muscarinic receptors in aqueous humor outflow?

A

contract ciliary M to improve outflow

- contract iris of circular muscle to cause miosis and improve outflow of aqueous humor to regulate IOP

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Q

What does Prostaglandin F2a do?

A

improves uveoscleral or unconventional outflow of aqueous humor to regulate IOP

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Q

What is the role of sympathetics in aqueous humor outflow?

A

Contract iris radial muscle (a1 receptor) causing mydriasis decreased outflow

-relax ciliary m via presynaptic a2 receptors to increase uveoscleral outflow

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Q

What is open angle glaucoma?

A

primary glaucoma that is chronic progressive disease with no apparent mechanical humor blockage

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Q

What is closed angle glaucoma?

A

primary glaucoma that is acute intermittent partial or completee blockage of outflow

may have to be treated as an emergency to avoid vision loss

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Q

What is secondary glaucoma?

A

Glaucoma caused by other diseases, trauma surgery, or drugs

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Q

What drug classes reduce aqueous humor production to treat open angle glaucoma?

A

Beta blocking drugs
A2 adrenergic agonists
Carbonic anhydrase inhibitors

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Q

What drugs increase aqueous humor outflow to treat open angle glaucoma?

A

Prostaglanic analogs
A2 adrenergic agonists
direct cholinergic agonists
inhibitors of cholinesterase

Q

What is Betaxolol MOA?

A

reduces the production of aqueous humor by the ciliary body through blocking Beta receptors

Q

What is timolol MOA?

A

reduces the production of aqueous humor by the ciliary body through blocking Beta receptors

Q

What is metipranolol Moa?

A

reduces the production of aqueous humor by the ciliary body through blocking Beta receptors

Q

What is Levobunolol MOA?

A

reduces the production of aqueous humor by the ciliary body through blocking Beta receptors

Q

What is Carteolol MOA?

A

reduces the production of aqueous humor by the ciliary body through blocking Beta receptors

Q

What beta blocker lacks local anesthetic effects, is available as generic, and a full antagonist?

A

Timolol–> is favored for these reasons as opposed to propranolol which possesses local anestethic effects and is not suitable for use in glaucoma

Q

What drugs can have negative inotropic effects, Bradycardia, bronchospasm, hyperlipidemia, exacerbate hypoglycemia, increase risk of cardiac depression and heart block , ocular irritation dry eyes?

A

Beta blocker

Q

Brimonidine MOA?

A

a2 agonist

decrease rate of aqueous humor production
increased uveoscleral outflow (esp. brimonidine) by relaxing the ciliary M.

Q

Apraclonidine MOA?

A

a2 agonist
decrease rate of aqueous humor production
- increased uveoscleral outflow (esp. brimonidine) by relaxing the ciliary M.

Q

What a2 agonist can develop tachyphylaxis and allergic rxns?

A

Apraclonidine

Q

What are adverse effects of a2 agonists brimonidine and apraclonidine?

A

Headache
fatigue
dry mouth
allergic rxns (eyelid edema, itching, hyperemia

Q

Topical: Brinzolamide and Dorzolamide
Systemic: Acetazolamide, Methazolamide

have what MOA?

A

Carbonic anhydrase inhibitors

- decrease osmotic pressure of aqueous humor

Q

What drugs have systemic adverse effects of

nausea, diarrhea, loss of appetite, altered taste
weightloss
paresthesias
renal stones
decreased libido

A

systemic anhydrase inhibitors: acetazolamide and methazolamide

local carbonic anhydrase inhibitors( Brinzolamide and Dorzolamide) can cause irritation and redness

Q

What is MOA of prostaglandin analogs?

A

reduce IOP by increasing uveoscleral and, lesser extent, outflow of aqueous humor

Q

What is Latanoprost?

A

prostaglandin analog

Q

what is bimatoprost?

A

prostaglandin analog - most effective in lowering IOP

Q

what is travoprost?

A

prostaglandin analog

Q

Are prostaglandin analogs or beta blockers better to reduce IOP?

A

Prostaglandin analogs more efficiently reduce IOP

Q

Corneal erosions, conjunctival hyperemia, iris hyperpigmentation, hypertrichosis, and hyperpigmentation around the eyelashes and eyelids are local side effects of what?

A

Prostaglandin analogs (latanoprost, bimatoprost, travoprost)

Q

What is the MOA of pilocarpine, carbachol and echothiophate?

A

cholinergic agonists, activated M 3 receptor directly or indirectly –> M3 receptor activation increases conventional humor outflow
Direct: Carbachol and pilocarpine

Indirect: echothiphate

Q

What drug class can cause
-headaches
-miosis
-eyelid twitching 
-myopia
-cataracts
iris- lens adhesions

A

Cholinergic agonists : pilocarpine, carbachol, echothiophate

Q

How is open angle glaucoma treated?

A

beta blocker or prostaglandin agent

2. if contraindicated, use brimonidine or topical anhydrase inhibitors

Q

How is closed angle glaucoma treated for rapid reduction of IOP?

A

surgery prep: oral glycerin and IV mannitol

pilocarpine before surgery induces miosis

Q

What agents reduce humor production in closed angle glaucoma?

A

beta blockers
a2 agonists
carbonic anhydrase inhibitors

Q

What promotes increase of IOP in open angle glaucoma?

A

glucocorticoids (topical, systemic, inhaled)

- topical muscarinic drugs

Q

What can trigger angle closure in patients with closed angle glaucoma?

A

drugs with alpha 1 adrenomimetic activity

antimuscarinc drugs (including tricyclic antidepressants

** can be triggered by any drug that causes mydriasis