Glaucoma Drops

Question 1

Pilocarpine

• Decrease in IOP
• How many drops when pt has acute angle closure and exception
• Adverse effects
• Caution
• Contra

Answer 1

15-25% decrease

• 3 drops over 30 minutes UNLESS pressure is over 50.
• Browache, accomodatite spasm, misosis, shallowing of AC.
• Caution in people over 40, high myopia, history of uveitis.
• Pts with any glaucoma types other than OAG.

Question 2

Ester and amide based prostaglandins

Answer 2

Ester based- Latanaprost, travaprost, tafluprost. Quickly hydrolyzed to active forms, don’t need as high of conc.

Amide based- Bimatoprost. Less hydrolyzed, need a higher concentration.

Question 3

MOA of Latanoprostene Bunod

Answer 3

Releases NO that relaxes TM along with increasing uveal outflow.
Decreases IOP by 7.5-9mmHg

Question 4

Dense prostaglandin receptors are located where

Answer 4

Ciliary muscle and iris sphincter

Question 5

How do prostaglandins affect eye lashes

Answer 5

Hypertrichosis (eyelash change) and trichomegaly (increase in lash number) also increases pigment.
May change iris stromal pigmentation.

Question 6

Latisse concentration

Answer 6

Bimatoprost 0.03%
No contraindications
Same SE as other prostaglandins
dose: Brush on eyelash base qd with applicator.

Question 7

Rescula side effects, IOP decrease, and dose

Answer 7

3-4 mmHg drop
1 drop BID OU
Bruning, hyperemia

Question 8

IOP decrease in Rhopressa and Rocklatan

Answer 8

Rhopressa is 25-30 %

Rocklatan is 34 %

Question 9

Rocklatan includes

Answer 9

Rhopressa and latanoprost.

Question 10

ROCK inhibitors
Onset of action
SE

Answer 10

30 minutes

Hyperemia from vasodilation

Question 11

Dose of BB

Answer 11

1 drop qam or BID. Effective in blunting AM rise. RX OU and see back in 1 month.

Question 12

How do topical and oral BB interact

Answer 12

Pt already taking oral BB? Topical will have a decreased effect

Question 13

BB Ocular side effects

Answer 13

Hyperemia
Stinging
Hypoasthesia
Allergic rxn

Question 14

What drop can be used off label to tx myokymia

Answer 14

BB stabilizes membrane stage 4

Question 15

BB contra and caution

Answer 15

Contra- Heart or respiratory conditions
Caution- depression, diabetics.

**Always measure baseline pulse and BP before Rx.

Question 16

Percentage of B2 and B1 receptors in the CB

Answer 16

75-90% B2

10-25% B1

Question 17

Apraclonidine/Iopidine 
Contra 
Side effects 
Onset
How does it effect Horners

Answer 17

Contra- allergic to clonidine, taking MAOIs
Side effects- FDA cat C, mydriasis, blanching.
Onset- 1 hour, 3 is max effect. Good to use for emergency closed angle in office.

A2>1

Horners- Reversal of anisocoria (will dilate horners pupil) and improve ptosis.

Question 18

Adrenergic agonist IOP decrease

Answer 18

25% (same as BB, CAI topical is less, CAI oral is more)

Question 19

Brimonidine/Alphagan P

• Preservative
• Contra
• caution
• Side effects
• Fun facts
• percentage dose

Answer 19

Purite preservative 
Contra under 2 
Caution MAOI, tricyclics and CVD. 
Side effects: Miosis, blanching. 
A2>>>>A1
Neuroprotective mechanism 
0.1% to 0.15% for Alphagan, 0.15% to 0.2% for brimonidine generic

Question 20

Ocular and systemic side effects of adrenergic agonists

Answer 20

Ocular- 
Iopidine causes mydriasis, alphagan P causes miosis.
Stinging
Blanching
Allergic rxn 

Systemic-
Dry mouth, nasal congestion
Bradycardia and fatigue

Question 21

Category C

Answer 21

Apraclonidine/Iopidine
Topical CAIs
Oral CAIs
caution in prostaglandin

Question 22

Why is brinzolamide better than dorzolamide

Answer 22

Brinzolamide- BID, fewer side effects bc higher affinity to CAII. Suspension so stings less.

Dorzolamide- TID, more side effects bc not as high affinity, stings more.

Question 23

Topical CAI
side effects
Contra
caution

Answer 23

Burning, blur, SPK, tearing, allergic reactions to sulfa, metallic taste, irreversible K edema in pts with endothelial compromise.

Contra in sulfa allergies or pts taking oral CAI

Caution in pregnancy (cat C), endothelial damage or renal.

Question 24

Oral CAI

• use
• side effects
• contra
• caution

Answer 24

• Use: Short term emergency control of IOP
• Side effects: transient myopia, metallic taste, tinnitus, tingling, GI, blood clot.
• Contra in sulfa allergies, sickle cell, cirrhosis, chronic angle closure
• Caution: Pregnancy and children

Question 25

Cosopt
Combigan
Simbrinza

Answer 25

Cosopt- dorzolamide and timolol
Combigan- Brimonidine and timolol
Simbrinza- Brinzolamide and Brimonidine

Question 26

CAI MOA

Answer 26

Inhibitis CA II, which decreases bicarbonate, which decreases aqueous secretion.