Glaucoma Drugs Flashcards
what are two outflows of aqueous humor?
trabecular and uveoscleral
which of trabecular or uveosacral does majority of aqueous humor flow out of?
trabecular is 90%
what produces the aqueous humor?
ciliary body
what stimulates aqueous humor production?
B1/B2 receptors
what inhibits aqueous humor production?
a2 receptors
name the two types of glaucomas
open angle and closed angle
describe how an open angle glaucoma occurs
trabecular meshwork or canal of schlemm is blocked
describe how a closed angle glaucoma occurs
trabecular network obstructed by a reduced angle
which of closed or open glaucoma is acute?
closed angle is acute
name the two glaucoma drugs that both inhibit aqueous production and increase flow
apraclonidine and brimonidine
what is class of apraclonidine and brimonidine?
a2 agonist
what are two classes of drugs that reduce production of aqueous humor?
b blocker and alpha agonsit
what are the two alpha 2 agonist for glaucoma?
brimonidine and apraclonidine
what are the two b blockers for glaucoma?
betaxolol
timolol
what are two tox of beta blockers in glaucoma?
reduced cardiac output and bronchospasm
what is a random tox of alpha agonists for glaucoma?
blepharitis
what is blepharitis?
inflamm of eyelids
what is main toxicity of alpha agonist, brimonidine and apraclonidine?
dizziness fatigue and somnolence
who should you be careful giving alpha agonist drugs to?
patinets on anti HTNs already
what is eye toxicity with apraclonidine?
mydriasis and conjunctival blanching
what is a special use for apraclonidine?
treatment of eyelid dropp bc it can stimulate superior tarsal muscl e
name the two carbonic anhydrase inhibitors
acetazolamide
brinzolamide
what is MoA of acetazolamide and brinzolamide?
CA inhibitors leda to no aqueous humor production
how do carbonic anhydrase inhibitors limit aqueous humor production?
limit movement of Na and H2o into eye
name two SEs of CA inhibitor
occular irritation and transient myopia
which CA inhibitor is oral?
acetazolamide
which CA inhibitor is topical?
brinzolamide
what is extra SE with acetazolamide since it is oral?
parasthesias
what can CA inhibitors cause with kidneys?
frequent urination and met acidosis
what is molecule that stimulates flow out of uveoscleral tract?
PGF2a
what are drugs named that mimic PGFa2?
latanoprost and bimatoprost
what is MoA of latanoprost and bimatoprost ?
they mimic PGFa2 to help increase uveoscleral outflow
what are eye toxicities of latanoprost and bimatoprost ?
uveitis
cystoid macular edema
discolored iris
increased eye lash length
what is contraindication for latanoprost and bimatoprost ? why?
herpetic keratosis because it reactivated ocular herpes infection
what is parasympathetic drug class for glaucoma
direct and indirect M3 agonists
what are the direct M3 agonists in glaucoma?
carbachol and pilocarpine
how does carbachol and pilocarpine treat glaucoma?
contract the ciliary muscle which lead to opening of canal of schlem and allows aqueous to flow out
what are the indirect M3 inhibitors used for glacucoma?
echothiphate and physostigmine
what is MoA of echothiophate and physiostigmine?
AcH esterase inhibitor so increases AcH and allows for more ciliary contraction and canal of schlemm to be open more and allow flow of equeous out
what are two toxicities of direct and indirect M3 agonists with the eye?
Miosis and loss of night vision
name three general side effects with M3 agonists
decreased CO
increased bronchoconstriction
increased gastric acid
what is the target of Netarusidil?
Rho kinase
what is normal action of Rho kinase?
make trabecular meshwork less permeable
explain MoA of netarusidil?
blocks rho kinase that normally makes meshworknon permeable, so now meshwork is permeable and aqueous can flow out
