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Neuro Pharm Quiz > Glaucoma Drugs > Flashcards

Glaucoma Drugs Flashcards

1
Q
  • aqueous humor is produced by the ______ and drains via ______ and ______ outflow

what percentage is associated with each

A
  • produced by ciliary body

- drains via trabecular (90%) and uveoscleral (10%) outflow

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2
Q

aqueous humor production is controlled by the _____ nervous system

A
  • autonomic
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3
Q

which receptor stimulate production of aqueous humor

which inhibit it

A
  • beta 1 and beta 2

- alpha 2

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4
Q

glaucomas often caused by an increase in _____ pressure

A
  • intraocular
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5
Q

the imbalance between aqueous humor ____ and ______ increases ____ which leads to glaucoma

which one is typically reduced

A
  • production
  • outflow
  • increases IOP
  • aqueous humor outflow
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6
Q

most glaucomas are defined as either open angle or closed angle based on their effect on the angle between the ____ and _____

  • in closed angle glaucoma, the angle is _____
  • in open angle glaucoma, the angle is
A
  • cornea and iris
  • reduced
  • unchanged
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7
Q

what happens in closed angle glaucoma

is it acute or chronic

A
  • trabecular meshwork blocked by reduced angle

- acute emergency

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8
Q

what happens in open angle glaucoma

it is acute or chronic

A
  • trabecular meshwork or canal of Schlemm blocked for another reason
  • chronic
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9
Q

glaucoma drugs either ________ or _______ or both

A
  • decrease aqueous humor production

- increase outflow

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10
Q

which drugs decrease aqueous humor production

A
  • beta blockers
  • carbonic anhydrase inhibitors
  • alpha 2 agonists
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11
Q

which drugs increase aqueous humor outflow

A
  • alpha 2 agonists
  • prostaglandin analogs
  • m3 agonists
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12
Q

activation of __ receptors on ciliary bodies stimulates aqueous humor production while activation of ___ receptors on ciliary bodies inhibits it

A
  • beta 2 - stimulates production

- alpha 2 - inhibits production

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13
Q

which are the beta blocker glaucoma drugs

which receptors do they have an affinity for

A
  • betaxolol (b1)
  • carteolol (b1/2)
  • timolol (b1/2)
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14
Q

which are the alpha 2 agonist glaucoma drugs

which receptors do they have an affinity for

A
  • brimonidine (a2)

- aproclonidine (a1/a2)

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15
Q

_____ released from a presynaptic neuron stimulates beta 2 receptors on the cell of the ciliary body and promotes aqueous humor production

A
  • norepinephrine
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16
Q

MOA of alpha 2 agonists in decreasing aqueous humor production in glaucoma

use in caution in patients with

A
  • bind alpha 2 receptors
  • inhibit release of NE from presynaptic neuron
  • other antihypertensive drugs
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17
Q

MOA of beta blockers in glaucoma

A
  • direct competitive antagonists of NE at beta 2 receptor
18
Q

do not use beta blockers in patients with

A
  • asthma/COPD (may inhibit bronchodilation)

- bradycardia/HF/arrhythmias (may reduce cardiac output or interfere with normal sinus rhythm)

19
Q

toxicity of alpha 2 agonists is

similar to which drug

A
  • blepharitis (inflammation of eyelid)
  • dizziness, fatigue, somnolence
  • clonidine
20
Q

toxicity of aproclonidine (alpha 1 effect)

A
  • mydriasis (alpha 1 controls dilator muscle)
  • conjunctival blanching (vascular smooth muscle contraction)
  • eyelid retraction (Muller’s muscle contraction
21
Q

aproclonidine is also useful in treating what condition

A
  • ptosis
22
Q

MOA of alpha 2 agonists in increasing aqueous humor outflow in glaucoma

A
  • increase uveoscleral outflow
23
Q

carbonic anhydrase inhibitors are used for which glaucomas

A
  • open and closed angle
24
Q

which drugs are carbonic anhydrase inhibitors

route of administration (oral/topical)

A
  • acetazolamide (oral)

- brinzolamide (topical)

25
Q

MOA of carbonic anhydrase inhibitors in glaucoma

A
  • inhibit movement of water and Na+ into eye

- reduce production of aqueous humor

26
Q

toxicities of topical carbonic anhydrase inhibitors

A
  • ocular irritation

- transient myopia (near-sightedness)

27
Q

toxicities of oral carbonic anhydrase inhibitors

A
  • paresthesia

- frequent urination, metabolic acidosis

28
Q

how can carbonic anhydrase inhibitors cause frequent urination

A
  • also diuretics

- increase excretion of Na+ and water in PCT

29
Q

how can carbonic anhydrase inhibitors cause metabolic acidosis

A
  • disrupt normal production of bicarbonate in kidney
30
Q

which drugs for glaucoma are prostaglandin analogs

A
  • bimatoprost

- latanoprost

31
Q

MOA of prostaglandin analogs

A
  • increase uveoscleral outflow

- mimic PGF2a (which promotes normal uveoscleral outflow)

32
Q

prostaglandin analog toxcities

A
  • uveitis
  • cystoid macular edema
  • permanent discoloration of iris
  • increased eyelash length
  • reactivation of ocular herpes
33
Q

prostaglandin analogs are contraindicated in patients with

A
  • herpetic keratitis
34
Q

which glaucoma drugs are M3 agonists

A
  • carbachol

- pilocarpine

35
Q

which glaucoma drugs are acetylcholinesterase inhibitors

A
  • echothiophate

- physostigmine

36
Q

MOA of M3 agonists in glaucoma

A
  • contracts ciliary muscle
  • opens canal of Schlemm
  • increases aqueous humor outflow
37
Q

MOA of acetylcholinesterase inhibitors in glaucoma

A
  • activate M3 agonist by inhibiting acetylcholinesterase

- increases synaptic concentration of Ach at the M3 receptor

38
Q

toxicities of M3 agonists and acetylcholinesterase inhibitors

why

A
  • myopia
  • loss of night vision
  • ciliary muscle regulates accommodation
39
Q

why can M3 agonists/Ach inhibitors cause pro-cholinergic effects

some toxicities

A
  • not selective for M3 receptor
  • may cross agonize M2 receptor
  • decreased cardiac output (M2)
  • increased bronchochonstriction (M3)
  • increased acid secretion (M3)
40
Q

MOA of Netarusidil

A
  • rho kinase inhibitor (rho kinase promotes cytoskeletal contraction and normally reduces permeability of trabecular meshwork)
  • increase trabecular outflow of aqueous humor
41
Q

_______ is the only drug that increases trabecular outflow

A
  • netarsudil

Neuro Pharm Quiz (5 decks)

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