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DEENT > Glaucoma PCOL > Flashcards

Glaucoma PCOL Flashcards

1
Q

Based on the picture of the ciliary body what effect will be seen when blocking the B1 receptor?

A. Increased Aqueous humor production

B. Decreased Aqueous humor production

C. Increased Accomidation

D. Decreased accomidation

A

B

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2
Q

Which of the following statments bout Aqueous humor is true? (Select All)

A. Nourishes the lens and cornea

B. Lubricates lens and cornea

C. Has no effect on IOP

D. Produced from the ciliary processes on the ciliary body

E. Production is decreased by stimulating B1 receptors

F. Production is increased by stimulating A2 receptors

A

A, B, D

E is not correct since stimulating B1 receptors increases aqueous humor production

F is not correct since stimulating A2 receptors will decrease aqueous humor production

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3
Q

Which of these statements is true regarding how aqueous humor leaves the eye? (Select All)

A. Can leave the eye via the trabecular meshwork and suprachorodial space (Uveoscleral outflow)

B. Primarily leaves the eye through the trabecular meshwork (Conventional outflow)

C. Primarily leaves the eye through the suprachorodial space (uveoscleral outflow)

D. Altered outflow of aqueous humor will have no effect one IOP

E. Increased outflow of aqueous humor will decrease IOP

A

A, B, E

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4
Q

All of the following are B1 selective Beta Blockers EXCEPT:

A. Timolol (Timoptic/ XE)

B. Carteolol (Ocupres)

C. Metipranolol (Optipranolol)

D. Betaxolol (Betoptic S)

E. Levobunolol (Betagan)

A

D

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5
Q

Which of the following effects will be seen when using Beta Blockers? (Select All)

A. Decreased aqueous humor production

B. Will decrease accomidation of the eye

C. Work equally well in ALL colored eyes

D. Will only work well in certain colored eyes

E. Have no effect on accomidation

A

A, C, E

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6
Q

What types of systemic side effects can you possibly see with topical timolol (timoptic)? Try explaining each to yourself.

A. Hypotension

B. Bradycardia

C. Heart failure

D. All of the above

A

D.

Hypotension- Timolol is a selective B1 antagonist. Blocking B1 at the heart will decrease the force of contraction and lower blood pressure.

Bradycardia- There are B1 receptors in the heart on the SA node as well as the muscle of the heart. Blocking the B1 receptors on the SA node will lower sympathetic activity and decrease heart rate.

Heart failure- Patients with weak heart contractions and low heart rate can suddenly experience more obvious signs of heart failure with the use of timolol in the eye. This will depend on the extent of the patients heart failure, risk factors of heart failure and if the patient is already taking a prescribed beta blocker (or Calcium channel blocker such as diazepam).

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7
Q

What are the local side effects that are seen with usuing ocular betablockers such as timolol?

A. Stinging and burning

B. Decreased corneal sensitivity

C. Diplopia (double vision) and decreased night vision

D. Blurry vision

E. Conjunctivial hyperemia (red eye) and ptosis (drooping eyelid)

F. All of the above

A

F

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8
Q

Mydriatic medications mimic the ____ and cause ____ of the pupils.

A. PNS, Dilation

B. SNS, Constriction

C. PNS, Constriction

D. SNS, Dilation

A

D

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9
Q

Which of these drugs is an example of an A2 selective agonist? (Select All)

A. Apraclonidine (Iopidine)

B. Epinephrine (Epifrin)

C. Dipivefrin (Propine)

D. Brimonidine (Alphagan P)

A

A, D

However, Apraclonidine (Iopidine) is not used anymore since it is a derivative of clonidine and can affect blood pressure

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10
Q

Which of the following drugs will block BOTH Alpha and Beta receptors in the eye? (Select All)

A. Apraclonidine (Iopidine)

B. Brimonidine (Alphagan)

C. Epinephrine (Epifrin)

D. Dipivefrin (Propine)

A

C, D

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11
Q

What pharmacologic effects will you see when using Brimonidine (Alphagan P)? (Select All)

A. Increased accomidation

B. Decreased Accomidation

C. Increased aqueous humor production

D. Decreased aqueous humor production

E. Increased Uveoscleral outflow

A

D, E

There are Alpha 2 receptors on the uveulosclera and stimulating them with an alpha 2 agonist such as brimonidine will cause them to relax and allow more aqueous humor to drain from the eye

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12
Q

Where are Alpha 1 receptors located in the eye? (Select all)

A. Ciliary blood vessels

B. Cornea

C. Radial muscle in Iris

D. Surface of ciliary body

A

A, C

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13
Q

T/ F Stimulating Alpha 1 receptors on the radial muscle of the Iris will cause the muscle to constrict and widen the pupil (mydriasis)

A

T

When the radial muscle constricts it dilates the pupil. Imagine a curtain that is circular in shape and when you pull on the string it pulls up the bottom of the curtain into a tight circle

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14
Q

What receptors in the eye will be affected when giving an ocular medication such as Dipivefrin (Propine) or Epinephrine (Epifrin)?

A. Stimulation of the A2 receptor, causing decreased aqueous humor production and increased Uveoscleral outflow.

B. Stimulation of the B1 receptor causing an increase in aqueous humor production

C. Stimulation of the A1 receptors of the ciliary blood vessels, decreasing bloodflow to the ciliary body

D. Mydriasis

E. Overall net effect of decreased IOP

F. All of the above

A

F

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15
Q

Which of the following statements is true regarding the use of Dipivefrin (Propine) and Epinephrine (Epifrin)? (select all)

A. Stimulates the B2 receptor on the ciliary muscle (relaxation) and increasing aqueous humor outflow.

B. Stimulates the A1 receptors of the radial msucle which will cause pupil dilation (Mydriasis)

C. Stimulates the A2 receptors of the ciliary body and cause increased aqueous humor production

D. Stimulates the B1 Receptors of the ciliary body and cause decreased aqueous humor production

E. Stimulates the A1 receptors of the ciliary blood vessels, decreasing Aqueous humor production

A

A, B, E

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16
Q

Which of these medications are muscarinic agonists? (select all)

A. Carbachol (Miostat, Isopto)

B. Dipivefrin (Propine)

C. Pilocarpine (Carpine, Pilocar, Piloptic)

D. Brimonidine (Alphagan P)

E. Echothiophate (Phospholidine Iodine)

A

A, C, E

17
Q

Miotic medications bind to ___ receptors in the eyes and cause ___ of the pupils.

A. Muscarinic, dilation

B. Adrenergic, narrowing

C. Muscarinic, narrowing

E. Muscarinic, dilation

A

C

18
Q

T/F Miotic medications are also known as parasympathomimetics because they promote actions similar to the PNS

A

T

19
Q

Which of the following statments is true about Parasympathomimetics? (select all)

A. They are known as production drugs (decrease aqueous production)

B. They are known as outflow drugs (increase outflow of aqueous humor)

C. Located on both the sphincter muscle of the eye and trabecular meshwork

D. Causes contraction of the sphincter muscle and trabecular meshwork in order to increase outflow

D. Equally effective in eyes of any color

A

B, C, D

They are less effective in dark colored eyes and more effective in light colored eyes.

20
Q

Which of these parasympathomimetic medications is direct-acting? (Select All)

A. Pilocarpine (Pilocar)

B. Carbachol (Miostat)

C. Echothiophate

D. Physostigmine

A

A, B

Direct acting medications will DIRECTLY stimulate the M3 receptors in the eye and cause the constriction of the sphincter muscles and trabecular meshwork.

21
Q

How do Indirect-acting parasympathomimetics such as Physostigmine and Echothiophate cause stimulation of the M3 receptors of the eye?

A. Directly binding to the M3 receptors

B. Directly inhibiting the AChE enzyme and decreasing the amount of ACh available to bind to M3 receptors

C. Directly inhibiting the AChE enzyme and increasing the amount of ACh available to bind to M3 receptors

D. Directly stimulating the AChE enzye and increasing the amount of ACh available to bind to M3 receptors

A

C

AChE (acetylcholinesterase) is an enzyme that removes ACh from the blood by degrading its structure. If you inhibit this enzyme then more ACh will be remain intact and able to stimulate the M3 receptors of the eye.

22
Q

All of the following medications are carbonic anhydrase inhibitors EXCEPT:

A. Acetazolamide (Diamox sequels)

B. Methazolamide (Nepatazane)

C. Dorzolamide (Trusopt)

D. Brinzolamide (Azopt)

E. Brimonidine (Alphagan P)

A

E

23
Q

What is the mechanism of action of Carbonic Anhydrase Inhibitors?

A. Directly bind to Muscarinic receptors and cause miosis

B. Inhibit carbonic anhydrase in order to increase aqueous humor production

C. Inhibit carbonic anhydrase in order to decrese aqueous humor production

A
24
Q

Which of the following statements is true regarding carbonic anhydrase inhibitors? (Select All)

A. Prevent conversion of CO2 and Water to Carbonic Acid (HCO3)

B. Decrease the amount of carbonic acid (HCO3) produced in order to increase aqueous humor production.

C. Decrease active transport of Na+ and (HCO3), decreasing the formation of aqueous humor

D. Known as production drugs

E. Have miotic effects

A

A, C, D

25
Q

All of the following medications are prostaglanding agonists EXCEPT:

A. Bimatoprost (Lumigan, Latisse)

B. Latanoprost (Xalatan)

C. Travaprost (Travatan)

D. Tafluprost (Zioptan)

E. Echothiophate

A

E

26
Q

What is the Mechanism of action of Prostaglandin agonists?

A. Bind to PGF2a receptors in ciliary muscles and Uveosclera in order to increase aqueous humor outflow.

B. Binds to PGF2a Recetpros in ciliary muscles in order to decrease production of aqueous humor

C. Can bind to adrenergic receptors (Alpha and Beta) in order to affect outflow and aqueous humor production

D. Binds to PGF2a receptors in ciliary muscles and cause mydriasis, increasing aqueous humor outflow.

A

A

27
Q

Which of the following statements are true regarding Prostaglandin agonists?

A. They are known as both outflow and production drugs

B. They affect the outflow of aqueous humor only and are thus known as outflow drugs

C. Does not affect aqueous humor production

D. Are equally effective in all-colored eyes

E. Are more effective in hazel/brown eyes than blue/green eyes

A

B, C, E

28
Q

T/F Prostaglandin agonists are considered as first-line agents in the treatment of glaucoma

A

T

29
Q

What were the unique effects of Prostaglandin agonists?

A. Increase brown pigmentation of iris and eyelids and some black discoloration

B. Causes hypertrichosis (increased growth) of eyelashes and other areas

C. Can take up to 3-5 weeks to show an effect

D. Have few systemic side effects

E. All of the above

A

E

30
Q
A

DEENT (3 decks)

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