Glaucoma Drugs

Question 1

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

what percentage is associated with each

Answer 1

• produced by ciliary body

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

Question 2

aqueous humor production is controlled by the _____ nervous system

Answer 2

• autonomic

Question 3

which receptor stimulate production of aqueous humor

which inhibit it

Answer 3

• beta 1 and beta 2

- alpha 2

Question 4

glaucomas often caused by an increase in _____ pressure

Answer 4

• intraocular

Question 5

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

which one is typically reduced

Answer 5

• production
• outflow
• increases IOP
• aqueous humor outflow

Question 6

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

Answer 6

• cornea and iris
• reduced
• unchanged

Question 7

what happens in closed angle glaucoma

is it acute or chronic

Answer 7

• trabecular meshwork blocked by reduced angle

- acute emergency

Question 8

what happens in open angle glaucoma

it is acute or chronic

Answer 8

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

Question 9

glaucoma drugs either ________ or _______ or both

Answer 9

• decrease aqueous humor production

- increase outflow

Question 10

which drugs decrease aqueous humor production

Answer 10

• beta blockers
• carbonic anhydrase inhibitors
• alpha 2 agonists

Question 11

which drugs increase aqueous humor outflow

Answer 11

• alpha 2 agonists
• prostaglandin analogs
• m3 agonists

Question 12

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

Answer 12

• beta 2 - stimulates production

- alpha 2 - inhibits production

Question 13

which are the beta blocker glaucoma drugs

which receptors do they have an affinity for

Answer 13

• betaxolol (b1)
• carteolol (b1/2)
• timolol (b1/2)

Question 14

which are the alpha 2 agonist glaucoma drugs

which receptors do they have an affinity for

Answer 14

• brimonidine (a2)

- aproclonidine (a1/a2)

Question 15

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

Answer 15

• norepinephrine

Question 16

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

use in caution in patients with

Answer 16

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

Question 17

MOA of beta blockers in glaucoma

Answer 17

• direct competitive antagonists of NE at beta 2 receptor

Question 18

do not use beta blockers in patients with

Answer 18

• asthma/COPD (may inhibit bronchodilation)

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

Question 19

toxicity of alpha 2 agonists is

similar to which drug

Answer 19

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

Question 20

toxicity of aproclonidine (alpha 1 effect)

Answer 20

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

Question 21

aproclonidine is also useful in treating what condition

Answer 21

• ptosis

Question 22

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

Answer 22

• increase uveoscleral outflow

Question 23

carbonic anhydrase inhibitors are used for which glaucomas

Answer 23

• open and closed angle

Question 24

which drugs are carbonic anhydrase inhibitors

route of administration (oral/topical)

Answer 24

• acetazolamide (oral)

- brinzolamide (topical)

Question 25

MOA of carbonic anhydrase inhibitors in glaucoma

Answer 25

- inhibit movement of water and Na+ into eye | - reduce production of aqueous humor

Question 26

toxicities of topical carbonic anhydrase inhibitors

Answer 26

- ocular irritation | - transient myopia (near-sightedness)

Question 27

toxicities of oral carbonic anhydrase inhibitors

Answer 27

- paresthesia | - frequent urination, metabolic acidosis

Question 28

how can carbonic anhydrase inhibitors cause frequent urination

Answer 28

- also diuretics | - increase excretion of Na+ and water in PCT

Question 29

how can carbonic anhydrase inhibitors cause metabolic acidosis

Answer 29

- disrupt normal production of bicarbonate in kidney

Question 30

which drugs for glaucoma are prostaglandin analogs

Answer 30

- bimatoprost | - latanoprost

Question 31

MOA of prostaglandin analogs

Answer 31

- increase uveoscleral outflow | - mimic PGF2a (which promotes normal uveoscleral outflow)

Question 32

prostaglandin analog toxcities

Answer 32

- uveitis - cystoid macular edema - permanent discoloration of iris - increased eyelash length - reactivation of ocular herpes

Question 33

prostaglandin analogs are contraindicated in patients with

Answer 33

- herpetic keratitis

Question 34

which glaucoma drugs are M3 agonists

Answer 34

- carbachol | - pilocarpine

Question 35

which glaucoma drugs are acetylcholinesterase inhibitors

Answer 35

- echothiophate | - physostigmine

Question 36

MOA of M3 agonists in glaucoma

Answer 36

- contracts ciliary muscle - opens canal of Schlemm - increases aqueous humor outflow

Question 37

MOA of acetylcholinesterase inhibitors in glaucoma

Answer 37

- activate M3 agonist by inhibiting acetylcholinesterase | - increases synaptic concentration of Ach at the M3 receptor

Question 38

toxicities of M3 agonists and acetylcholinesterase inhibitors why

Answer 38

- myopia - loss of night vision - ciliary muscle regulates accommodation

Question 39

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

Answer 39

- not selective for M3 receptor - may cross agonize M2 receptor - decreased cardiac output (M2) - increased bronchochonstriction (M3) - increased acid secretion (M3)

Question 40

MOA of Netarusidil

Answer 40

- rho kinase inhibitor (rho kinase promotes cytoskeletal contraction and normally reduces permeability of trabecular meshwork) - increase trabecular outflow of aqueous humor

Question 41

_______ is the only drug that increases trabecular outflow

Answer 41

- netarsudil