Ocular Flashcards
What are the 4 cholinergic muscarinic agonists?
ACh, Carbachol, methacholine, pilocarpine
What is the effect and therapeutic use of the drugs ACh, Carbachol, methacholine and pilocarpine?
pupillary constriction –> increased aqueous outflow (useful in glaucoma and cataract surgery)
What are the side effects of Carbachol? What 3 other drugs have the same SEs?
Bronchospasm, salivation, nausea, vomiting,
diarrhea, abdominal pain, tenesmus, lacrimation, sweating
What are the 5 antimuscarinic drugs used in ocular care?
Atropine, Scopolamine, Homatropine, Cyclopentolate, Tropicamide
What is the effect and use of antimuscarinic drugs in ocular treatment?
pupillary dilation & cycloplegia (paralysis of ciliary body) –> used for eye exams and uveitis (improve comfort during inflamm)
What are the side effects of the drug Cyclopentolate? What other drugs have the same SEs?
Ataxia, nystagmus, restlessness, mental confusion, hallucination, violent and aggressive behavior, insomnia, photophobia, urinary
retention
Name 1 nonspecific alpha-adrenergic agonist. What is its effect and use?
Apraclonidine- Amino derivative of clonidine; does not cross blood-brain barrier –> minimal effect on systemic blood pressure
What class of drug is Clonidine? What is its mechanism of effect?
Direct α2-agonist- Lowers intraocular pressure through central nervous system effects (can cross BBB)
What class of drug is Brimondine tartrate (Alphagan)? What is its therapeutic effect?
Direct α2-agonist- suppresses aqueous humor production (used in glaucoma)
What are the epinephrine compounds and what is their effect and use in ocular treatment
L-epinephrine and Dipivalyl epinephrine- increase aqueous outflow by dilating the episcleral vessels (glaucoma)
What class of drug is Dapiprazole? What is its action and use?
α-antagonist- Blocks alpha-adrenergic receptors in smooth dilator muscle of iris to reverse action of Tropicamide and phenylephrine
*not available in US
What is the mechanism of effect of Beta-blockers in ocular treatment?
reduces aqueous humor production at ciliary process (Glaucoma)
What are 5 beta-blockers used in the treatment of Glaucoma?
Timolol, Betaxolol, Carteolol, Levobunolol, Metipranolol
What are the side effects of Carteolol and the other drugs in its class?
Bradycardia, hypotension, syncope, palpitation, congestive heart failure, bronchospasm, mental confusion, depression,
fatigue, lightheadedness, hallucinations, memory impairment, sexual dysfunction, hyperkalemia
What are 3 carbonic anhydrase inhibitors given orally in the treatment of Glaucoma?
Acetazolamide, ethoxzolamide, methazolamide
What class of drug is Acetazolamide? What is its effect?
Carbonic anhydrase inhibitor- Reduce aqueous production via interference with the active transport of Na through Na-K-ATPase pump
Are orally given carbonic anhydrase inhibitors a good treatment for Glaucoma?
extremely effective but have many side effects and only used if other topical therapy fails
What class of drug are Dorzolamide hydrochloride and Brinzolamide? Side effects?
topical carbonic anhydrase inhibitors- side effects are red eyes & lid allergies but much less systemic effects than oral agents
What is the mechanism of action of carbonic anhydrase inhibitors?
Reduce aqueous production via interference with the active transport of Na through Na-K-ATPase pump
What class of drugs is the main therapy to treat Glaucoma? What is their action?
prostaglandins (topical)- Increase uveoscleral outflow
What are the 4 prostaglandin analogs used to treat glaucoma?
latanoprost, bimatroprost, travoprost & unoprostone isopryl
What are the side effects of bimatroprost and other drugs in its class?
Eyelash growth, change in iris color
What class of drug is latanoprost? What are some contraindications?
Prostaglandin analog- Contraindicated in cystoid macular edema and herpes
What are the 4 first line medications for the treatment of glaucoma?
TImolol (beta-blocker); latanaprost (PG); brimondine (alpha agonist); dorzolamide hydrochloride (carbonic anhydrase inhibitor)
What is the class, effect and use of Nifedipine?
Calcium channel blocker which increases ocular perfusion at the nerve head used in glaucoma
What are the 4 osmotic drug agents? Which ones are given IV and which orally? Danger?
glycerol, sorbitol (orally); mannitol, urea (IV)
-increase serum osmolarity and can only be used for a short, monitored time due to heart failure risks
