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Clinical Neuro > neuropharmglaucoma > Flashcards

neuropharmglaucoma Flashcards

1
Q

Clinical Manifestations of open-angle glaucoma

A

gradual loss of peripheral vision (usually both eyes) tunnel vision in advanced stage

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2
Q

clinical manifestations of angle-closure glaucoma

A

eye pain, nausea and vomiting, sudden onset of visual disturbance, halos around lights, reddening of eyes

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3
Q

Which class of drugs can be considered a risk factor for glaucoma?

A

corticosteroid eye drops

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4
Q

What is the most common risk factor for glaucoma?

A

Increased intraocular pressure

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5
Q

Which two drugs are direct acting cholinergic agents?

A

pilocarpine, carbachol

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6
Q

How do direct acting cholinergic agents work to treat glaucoma?

A

Directly stimulate muscarinic receptors in the eye

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7
Q

Which two drugs are indirect acting cholinergic agents?

A

physostigmine, echothiophate

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8
Q

Cholinergic TX for open-angle glaucoma

A

contraction of ciliary muscles leading to increased flow through the intertrabecular spaces

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9
Q

Cholinergic TX for closed angle glaucoma

A

contraction of the sphincter muscles increasing the angle sclera and iris

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10
Q

Which cholinergic drug is used in emergencies?

A

pilocarpine (for open or closed angle)

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11
Q

Adverse effects of carbachol

A

miosis, cyclospasm, widespread autonomic disturbances if it gets into systemic circulation

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12
Q

adverse effects of pilocarpine

A

miosis, cyclospasm, hypertension, tachycardia

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13
Q

adverse effects of physostigmine

A

miosis, cyclospasm, crosses BBB (tertiary amine) and can cause seizures and abnormal defecation

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14
Q

adverse effects of ecothiophate

A

miosis, cyclospasm, night blindness, frontal headache

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15
Q

how does ecothiophate cause adverse effects?

A

binds to acetylcholinesterase, contracts ciliary muscle so much that lens becomes very thick, prevents pt from seeing well in the dark

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16
Q

Where do beta adrenergic blockers act?

A

ciliary epithelium

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17
Q

which 3 drugs are beta adrenergic blockers

A

betaxolol, carteolol, timolol

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18
Q

mechanism of action of beta blockers

A

interacts with ciliary epithelium to decrease production of aqueous humor, little or no effect on outflow

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19
Q

which beta blockers are non-selective

A

timolol and carteolol

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20
Q

which beta blocker is a beta-1 selective and has weak membrane stabilizing effects

A

betaxolol

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21
Q

Which beta blocker is less toxic?

A

betaxolol because it is selective

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22
Q

adverse effects of beta blockers

A

cold extremities, bradycardia, hypotension, fatigue

23
Q

adverse effects specific to timolol

A

bradycardia, confusion, blurred vision, dry eyes, hallucination, bronchospasm

24
Q

adverse effects specific to carteolol

A

insomnia, bronchospasm

25
Q

adverse effects of betaxolol

A

AV block, myocardial infarct

26
Q

which drugs are prostaglandin analogs

A

latanoprost, bimatoprost, travoprost

27
Q

mechanism of action of prostaglandin analogs

A

prostaglandin PGF2alpha analog, tightens ciliary projections and lowers intraocular pressure

28
Q

mechanism of action of latanoprost

A

increases uveoscleral outflow of aqueous humor

29
Q

mechanism of action of bimatoprost

A

increases outflow of aqueous humor through trabecular meshwork

30
Q

clinical uses of prostaglandin analogs

A

intraocular hypertension, open-angle glaucoma

31
Q

adverse effects of prostaglandin analogs

A

darkens color of iris, mecular retinal edema, conjunctival hyperemia (bimatoprost, travoprost)

32
Q

Which 3 carbonic anhydrase inhibitors are used to treat glaucoma

A

acetazolamide, brinzolamide, dorzolamide

33
Q

what is the mechanism of action of CA inhibitors

A

decrease aqueous humor production secondary to a decrease in bicarb due to inhibition of CAII in the eye

34
Q

do CA inhibitors affect the pupils or vision?

A

no

35
Q

clinical uses of CA inhibitors

A

intraocular hypertension, open-angle glaucoma

36
Q

adverse effects of CA inhibitors

A

electrolyte imbalance (esp. acetazolamide) metabolic acidosis, urolithiasis

37
Q

adverse effects of dorzolamide

A

immune hypersensitivity reactions, burning sensation in the eye

38
Q

adverse effects of acetazolamide

A

electrolyte imbalance, agranulocytosis (hallmark), aplastic anemia, thrombocytopenia

39
Q

what causes urolithiasis?

A

high pH of urine

40
Q

what occurs if bicarbonate is lost and chloride accumulates?

A

hyperchloremic metabolic acidosis

41
Q

Which 2 drugs are alpha-2 selective agonists

A

apraclonidine, brimonidine

42
Q

mechanism of action of alpha-2 selective agonists

A

decrease production and increase outflow of aqueous humor, decreasing ocular pressure

43
Q

MOA specific to brimonidine

A

(selective alpha 2) decrease aqueous humor production, increase uveoscleral outflow. Decrease cAMP

44
Q

clinical indications for alpha-2 selective agonists

A

lower ocular pressure associated with eye surgery, given pre and post surgery (apraclonidine). Open angle glaucoma and ocular hypertension (brimonidine)

45
Q

adverse effects of alpha-2 selective agonists

A

irregular heart rate, fatigue, dry mouth, red, itchy or swollen eyes

46
Q

adverse effects specific to apraclonidine

A

depression, dizziness, chest pain

47
Q

which drugs are non-selective adrenergic agonists

A

dipivefrin, epinephrine

48
Q

mechanism of action of non-selective adrenergic agonists

A

decrease aqueous humor production due to vasoconstriction and (decrease blood flow to ciliary bodies- epinephrine)

49
Q

which is a pro-drug, hydrolyzed to epinephrine within the eye

A

dipivefrin- epinephrine can’t cross the barrier of the eye

50
Q

how does vasoconstriction decrease aqueous humor production?

A

deprives ciliary epithelium of the nutrients it needs to produce aqueous humor

51
Q

clinical indications for brimonidine

A

ocular hypertension, open-angle glaucoma

52
Q

adverse effects of brimonidine

A

xerostomia, somnolence, syncope

53
Q

adverse effects of dipivefrin

A

burning sensation in eye, follicular conjunctiva

54
Q

adverse effects of epinephrine

A

mydriasis, stinging, not to be used in close-angle glaucoma

Clinical Neuro (4 decks)

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