Glaucoma

Question 1

Decreases aqueous humor production via alpha2 agonism

Answer 1

Brimonidine

Question 2

Decreases aqueous humor synthesis via vasoconstriction

Answer 2

Epinephrine (alpha1 agonist); causes mydriasis though, so do not use in closed-angle glaucoma

Question 3

Decreases aqueous humor synthesis via beta2 antagonism

Answer 3

Timolol, betaxolol, carteolol

Question 4

Decreases aqueous humor synthesis via inhibition of carbonic anhydrase

Answer 4

Acetazolamide

Question 5

Increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork

Answer 5

1. Direct cholinomimetics – pilocarpine, carbachol

2. Indirect – physostigmine, echothiophate

Question 6

Which cholinomimetic would you use in an emergency case of glaucoma?

Answer 6

Pilocarpine – very effective at opening trabecular meshwork and allowing aqueous humor to drain via canal of Schlemm

Question 7

Side effects of cholinomimetics on the eye

Answer 7

Miosis and cyclospasm (contraction of ciliary muscle)

Question 8

Which prostaglandin analog can be used to increase outflow of aqueous humor?

Answer 8

Latanoprost (PGF2alpha)

Question 9

What is an interesting side effect associated with latanoprost use in the eye?

Answer 9

Darkens color of iris; causes browning of the iris