neuropharmglaucoma

Question 1

Clinical Manifestations of open-angle glaucoma

Answer 1

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

Question 2

clinical manifestations of angle-closure glaucoma

Answer 2

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

Question 3

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

Answer 3

corticosteroid eye drops

Question 4

What is the most common risk factor for glaucoma?

Answer 4

Increased intraocular pressure

Question 5

Which two drugs are direct acting cholinergic agents?

Answer 5

pilocarpine, carbachol

Question 6

How do direct acting cholinergic agents work to treat glaucoma?

Answer 6

Directly stimulate muscarinic receptors in the eye

Question 7

Which two drugs are indirect acting cholinergic agents?

Answer 7

physostigmine, echothiophate

Question 8

Cholinergic TX for open-angle glaucoma

Answer 8

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

Question 9

Cholinergic TX for closed angle glaucoma

Answer 9

contraction of the sphincter muscles increasing the angle sclera and iris

Question 10

Which cholinergic drug is used in emergencies?

Answer 10

pilocarpine (for open or closed angle)

Question 11

Adverse effects of carbachol

Answer 11

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

Question 12

adverse effects of pilocarpine

Answer 12

miosis, cyclospasm, hypertension, tachycardia

Question 13

adverse effects of physostigmine

Answer 13

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

Question 14

adverse effects of ecothiophate

Answer 14

miosis, cyclospasm, night blindness, frontal headache

Question 15

how does ecothiophate cause adverse effects?

Answer 15

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

Question 16

Where do beta adrenergic blockers act?

Answer 16

ciliary epithelium

Question 17

which 3 drugs are beta adrenergic blockers

Answer 17

betaxolol, carteolol, timolol

Question 18

mechanism of action of beta blockers

Answer 18

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

Question 19

which beta blockers are non-selective

Answer 19

timolol and carteolol

Question 20

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

Answer 20

betaxolol

Question 21

Which beta blocker is less toxic?

Answer 21

betaxolol because it is selective

Question 22

adverse effects of beta blockers

Answer 22

cold extremities, bradycardia, hypotension, fatigue

Question 23

adverse effects specific to timolol

Answer 23

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

Question 24

adverse effects specific to carteolol

Answer 24

insomnia, bronchospasm

Question 25

adverse effects of betaxolol

Answer 25

AV block, myocardial infarct

Question 26

which drugs are prostaglandin analogs

Answer 26

latanoprost, bimatoprost, travoprost

Question 27

mechanism of action of prostaglandin analogs

Answer 27

prostaglandin PGF2alpha analog, tightens ciliary projections and lowers intraocular pressure

Question 28

mechanism of action of latanoprost

Answer 28

increases uveoscleral outflow of aqueous humor

Question 29

mechanism of action of bimatoprost

Answer 29

increases outflow of aqueous humor through trabecular meshwork

Question 30

clinical uses of prostaglandin analogs

Answer 30

intraocular hypertension, open-angle glaucoma

Question 31

adverse effects of prostaglandin analogs

Answer 31

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

Question 32

Which 3 carbonic anhydrase inhibitors are used to treat glaucoma

Answer 32

acetazolamide, brinzolamide, dorzolamide

Question 33

what is the mechanism of action of CA inhibitors

Answer 33

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

Question 34

do CA inhibitors affect the pupils or vision?

Answer 34

no

Question 35

clinical uses of CA inhibitors

Answer 35

intraocular hypertension, open-angle glaucoma

Question 36

adverse effects of CA inhibitors

Answer 36

electrolyte imbalance (esp. acetazolamide) metabolic acidosis, urolithiasis

Question 37

adverse effects of dorzolamide

Answer 37

immune hypersensitivity reactions, burning sensation in the eye

Question 38

adverse effects of acetazolamide

Answer 38

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

Question 39

what causes urolithiasis?

Answer 39

high pH of urine

Question 40

what occurs if bicarbonate is lost and chloride accumulates?

Answer 40

hyperchloremic metabolic acidosis

Question 41

Which 2 drugs are alpha-2 selective agonists

Answer 41

apraclonidine, brimonidine

Question 42

mechanism of action of alpha-2 selective agonists

Answer 42

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

Question 43

MOA specific to brimonidine

Answer 43

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

Question 44

clinical indications for alpha-2 selective agonists

Answer 44

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

Question 45

adverse effects of alpha-2 selective agonists

Answer 45

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

Question 46

adverse effects specific to apraclonidine

Answer 46

depression, dizziness, chest pain

Question 47

which drugs are non-selective adrenergic agonists

Answer 47

dipivefrin, epinephrine

Question 48

mechanism of action of non-selective adrenergic agonists

Answer 48

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

Question 49

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

Answer 49

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

Question 50

how does vasoconstriction decrease aqueous humor production?

Answer 50

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

Question 51

clinical indications for brimonidine

Answer 51

ocular hypertension, open-angle glaucoma

Question 52

adverse effects of brimonidine

Answer 52

xerostomia, somnolence, syncope

Question 53

adverse effects of dipivefrin

Answer 53

burning sensation in eye, follicular conjunctiva

Question 54

adverse effects of epinephrine

Answer 54

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