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Ocular Pharmacology > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

glaucoma therapeutics acting via parasympathetic NS stimulate what receptors?

A

muscarinic receptors

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2
Q

glaucoma therapeutics acting via sympathetic NS stimulate which receptors?

A

alpha 1, 2 or inhibit beta 2

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3
Q

why are sympathomimetics not used orally for IOP reduction?

A

they are rapidly metabolized by first pass effect in liver and intestine - do not readily cross the BBB

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4
Q

which sympathomimetics mildly decrease aqueous production?

A

aproclonidine

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5
Q

which sympathomimetic is most effective at decreasing aqueous production?

A

Brimonidine

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6
Q

what are the most common side effects to aproclonidine?

A

xeroma (dry mouth) and dry nose

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7
Q

do beta blockers (sympatholytics) or sympathomimetics affect IOP at night?

A

no - sympathetic tone is considered inactive during sleep

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8
Q

which drug is the gold standard for reduction of IOP?

A

Timolol (decreases 25% in IOP)

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9
Q

which drug stabilizes membrane excitability and is used to treat cardiac arrhythmias?

A

metipranolol

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10
Q

which is the “safest” beta-blocker for asthma and has putatuve neuro-protection potential?

A

Betaxolol (betaoptic) = targets beta1 only

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11
Q

precautions should be taken with the use of beta blockers in which types of patients?

A

hyperthyroidism, myasthenia gravis, ACG, anesthesia, aphakia and diabetes

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12
Q

what type of agonists stimulate ciliary body longitudinal smooth muscle ACh muscarinic receptors directly or indirectly?

A

parasympathomimetic cholinergic agonists

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13
Q

which CAI drug is the best ocular penetrating agent?

A

methazolamide because it is the least ionic

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14
Q

which PG analog would you use if you wanted to avoid BAK toxicity?

A

Zioptan (Tafluprost)

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15
Q

which PG analog causes orbital fat degredation?

A

Bimatroprost (it inhibits adipocyte differentiation and survival)

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16
Q

what is the mechanism of action for hyperosmotic agents?

A

transfer fluid from eye to circulation to quickly drop IOP in ACG attacks

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17
Q

which receptor type will you not want a glaucoma drug to be selective for?

A

nicotinic - there are none in the eye involved in IOP

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18
Q

do alpha2 agonists work better in the day or night?

A

day while awake - sympathetic system is down while you sleep

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19
Q

which alpha2 agonist is used in long-term treatment? which is only post-op?

A

brimonidine (alphagan-P) for long term and apraclonidine (short term)

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20
Q

which beta blocker causes the least amount of corneal anesthesia?

A

Timolol

21
Q

which parasympathometic is the only one to be more selective towards muscarinic receptors?

A

pilocarpine

22
Q

pilocarpine is indicated for what conditions?

A

OAG and angle closure glaucoma

23
Q

why is pilocarpine better suited for old people?

A

presbyopic - drug physically stimulates ciliary body and move it, may cause a ciliary spasm in younger people

24
Q

describe how carbonic anhydrase inhibitors work?

A

reversible non-competitive inhibitor of ciliary body CA - decreases bicarbonate ions

25
Q

what are the two topical CAIs and what can they treat besides OAG?

A

Brinzolamide (susp) and Dorzolamide (soln) - both can treat HTN

26
Q

what oral CAI is best at penetrating the eye and why?

A

methazolamide - least ionic and has a long duration

27
Q

why might CAIs cause transient myopia?

A

causes swelling in ciliary body which displaces lens/iris

28
Q

prostaglandin analogs mimic which prostaglandin?

A

PGF2a

29
Q

which PG is preservative free?

A

zioptan (tafluprost)

30
Q

what makes PG analogs the 1st line of therapy for OAG?

A

used once per day at bedtime

31
Q

most PG analogs stimulate the FP receptor on ciliary muscle except one - which one and how?

A

Brimatoprost (lumigan) - at trabecular meshwork it increases uveoscleral outflow

32
Q

which 3 types of glaucoma therapeutics inhibit aqueous production?

A

alpha-adrenergics, beta-blockers, and CAIs

33
Q

which 2 types of glaucoma therapeutics increase TM outflow?

A

alpha-adrenergics and miotics

34
Q

which 2 types of glaucoma therapeutics increase uveoscleral outflow?

A

alpha-adrenergics and prostaglandins

35
Q

what are 2 selective sympathomimetic agents? and what are they selective for?

A

apraclonidine (+a2>1) and brimonidine (+a2»1)

36
Q

what type of preservative does Brimonidine have?

A

Purite ‘disappearing’ preservative - light inactivated

37
Q

what side effect is the reason selective sympathomimetics are only used for short term?

A

tachyphylaxis (rapidly developing resistance) = most common in alpha2 agoninsts

38
Q

what are the 5 beta-blockers (sympatholytics)?

A

metipranolol, timolol, betaxolol, levobunolol, carteolol

39
Q

which category of glaucoma therapeutics can cause corneal anesthesia?

A

beta blockers

40
Q

what is the only parasympathomimetic agent still used and is selective for muscarinic receptors?

A

pilocarpine

41
Q

which glaucoma therapeutic category are sulfonamides?

A

carbonic anhydrase inhibitors

42
Q

what are the 2 topical CAIs?

A

Brinzalamide and Dorzolamide

43
Q

what are the 5 CAI’s?

A

acetazolamide, brinzalamide, methazolamide, dichlorphenamide, dorzolamide

44
Q

what are the 4 topical prostaglandin analogs?

A

latanoprost, travoprost, bimatoprost, tafluprost

45
Q

what are 4 hyperosmotic agents?

A

mannitoal and urea (IV), glycerin (oral) and isosorbide (oral)

46
Q

what type of receptor does the iris sphincter have?

A

muscarinic

47
Q

what type of receptor does the iris dilator have?

A

alpha

48
Q

what type of receptor does the ciliary body have?

A

muscarinic

Ocular Pharmacology (10 decks)

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