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Drugs used in Glaucoma Flashcards

1
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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2
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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3
Q

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

A

Ciliary muscle

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4
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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5
Q

What produces aqueous humor?

A

Ciliary epithelium

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6
Q

What receptor activation increases humor production from ciliary epithelium?

A

Beta adrenergic

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7
Q

What receptor activation decreases humor production?

A

alpha2 adrenergic

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8
Q

Beta and alpha2 receptors activate what system?

A

sympathetic

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9
Q

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

A

carbonic anhydrase

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10
Q

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

A

carbonic anhydrase

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11
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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12
Q

What does Prostaglandin F2a do?

A

improves uveoscleral or unconventional outflow of aqueous humor to regulate IOP

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13
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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14
Q

What is open angle glaucoma?

A

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

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15
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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16
Q

What is secondary glaucoma?

A

Glaucoma caused by other diseases, trauma surgery, or drugs

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17
Q

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

A
  1. Beta blocking drugs
  2. A2 adrenergic agonists
  3. Carbonic anhydrase inhibitors
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18
Q

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

A
  1. Prostaglanic analogs
  2. A2 adrenergic agonists
  3. direct cholinergic agonists
  4. inhibitors of cholinesterase
19
Q

What is Betaxolol MOA?

A

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

20
Q

What is timolol MOA?

A

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

21
Q

What is metipranolol Moa?

A

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

22
Q

What is Levobunolol MOA?

A

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

23
Q

What is Carteolol MOA?

A

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

24
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

25
What drugs can have negative inotropic effects, Bradycardia, bronchospasm, hyperlipidemia, exacerbate hypoglycemia, increase risk of cardiac depression and heart block , ocular irritation dry eyes?
Beta blocker
26
Brimonidine MOA?
a2 agonist - decrease rate of aqueous humor production - increased uveoscleral outflow (esp. brimonidine) by relaxing the ciliary M.
27
Apraclonidine MOA?
a2 agonist decrease rate of aqueous humor production - increased uveoscleral outflow (esp. brimonidine) by relaxing the ciliary M.
28
What a2 agonist can develop tachyphylaxis and allergic rxns?
Apraclonidine
29
What are adverse effects of a2 agonists brimonidine and apraclonidine?
Headache fatigue dry mouth allergic rxns (eyelid edema, itching, hyperemia
30
Topical: Brinzolamide and Dorzolamide Systemic: Acetazolamide, Methazolamide have what MOA?
- Carbonic anhydrase inhibitors | - decrease osmotic pressure of aqueous humor
31
What drugs have systemic adverse effects of - nausea, diarrhea, loss of appetite, altered taste - weightloss - paresthesias - renal stones - decreased libido
systemic anhydrase inhibitors: acetazolamide and methazolamide local carbonic anhydrase inhibitors( Brinzolamide and Dorzolamide) can cause irritation and redness
32
What is MOA of prostaglandin analogs?
reduce IOP by increasing uveoscleral and, lesser extent, outflow of aqueous humor
33
What is Latanoprost?
prostaglandin analog
34
what is bimatoprost?
prostaglandin analog - most effective in lowering IOP
35
what is travoprost?
prostaglandin analog
36
Are prostaglandin analogs or beta blockers better to reduce IOP?
Prostaglandin analogs more efficiently reduce IOP
37
Corneal erosions, conjunctival hyperemia, iris hyperpigmentation, hypertrichosis, and hyperpigmentation around the eyelashes and eyelids are local side effects of what?
Prostaglandin analogs (latanoprost, bimatoprost, travoprost)
38
What is the MOA of pilocarpine, carbachol and echothiophate?
cholinergic agonists, activated M 3 receptor directly or indirectly --> M3 receptor activation increases conventional humor outflow Direct: Carbachol and pilocarpine Indirect: echothiphate
39
``` What drug class can cause -headaches -miosis -eyelid twitching -myopia -cataracts iris- lens adhesions ```
Cholinergic agonists : pilocarpine, carbachol, echothiophate
40
How is open angle glaucoma treated?
1. beta blocker or prostaglandin agent | 2. if contraindicated, use brimonidine or topical anhydrase inhibitors
41
How is closed angle glaucoma treated for rapid reduction of IOP?
surgery prep: oral glycerin and IV mannitol pilocarpine before surgery induces miosis
42
What agents reduce humor production in closed angle glaucoma?
- beta blockers - a2 agonists - carbonic anhydrase inhibitors
43
What promotes increase of IOP in open angle glaucoma?
- glucocorticoids (topical, systemic, inhaled) | - topical muscarinic drugs
44
What can trigger angle closure in patients with closed angle glaucoma?
drugs with alpha 1 adrenomimetic activity antimuscarinc drugs (including tricyclic antidepressants ** can be triggered by any drug that causes mydriasis

NMSP (14 decks)

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