Lecture 11 - Other Adrenergic Agonists

Question 1

Describe Apraclonidine

Common name, receptor selectivity, MOA

Answer 1

• Iopidine
• selective a2 agonist
• MOA: inhibits adenylate cyclase, decrease cAMP, decrease aqueous production and increase uveoscleral outflow

Question 2

What are the uses of Apraclonidine?

Answer 2

• used with argon laser trabeculoplasty
• reduce IOP, treats Primary Open Angle Glaucoma
• ## Can dilate Horner’s (horner’s eye dilates)

Question 3

What are the adverse effects (allergic) of Apraclonide?

Ocular effects and SNS effects

Answer 3

• a1 stimulation
• mydriasis
• lid retraction
• conjunctival blanching
• systemic effects: dry mouth, fatigue, lethargy, headache, head cold symptoms

Question 4

Describe Brimonidine

Common name, receptor selectivity, MOA

Answer 4

• Alphagan P
• highly selective a2 receptor agonist
• Same MOA for antiglaucoma as Iopidine

Question 5

What are the side effects (allergic) of Brimonidine?

Ocular effects and SNS effects

Answer 5

• hyperemia, stinging, burning, blurred vision, FBS
• less allergic reactions that apraclonidine
• dry mouth, headache, fatigue, lethargy, drowsiness

Question 6

List three OTC sympathomimetics and their toxicities

“-zoline”

Answer 6

• Naphazoline
• Tetrahydrozoline
• Oxymetazoline
• Toxicity: narrow angle or abraided cornea can cause angle closure attack
• rebound hyperemia

Question 7

Describe Hydroxyamphetamine

Common name, MOA, onset and toxicities compared to Phenylephrine

Answer 7

• Paredrine
• Paremyd (combo with Tropicamide 0.25%)
• MOA: indirect acting, stimlulates NE release and blocks reuptake and inhibit MAO
• mydriatic, can diagnose post-ganglionic SNS denervation (Horner’s)
• similar onset and action to phenylephrine
• less likely to cause systemic toxicity

Question 8

What is the MOA and use of cocaine?

Answer 8

• blocks NE reuptake
• mydriasis, vasoconstriction and anesthesia
• Horner’s diagnosis dilation is absent in Horner’s eye (regardless of lesion)