Ocular

Question 1

What are the 4 cholinergic muscarinic agonists?

Answer 1

ACh, Carbachol, methacholine, pilocarpine

Question 2

What is the effect and therapeutic use of the drugs ACh, Carbachol, methacholine and pilocarpine?

Answer 2

pupillary constriction –> increased aqueous outflow (useful in glaucoma and cataract surgery)

Question 3

What are the side effects of Carbachol? What 3 other drugs have the same SEs?

Answer 3

Bronchospasm, salivation, nausea, vomiting,

diarrhea, abdominal pain, tenesmus, lacrimation, sweating

Question 4

What are the 5 antimuscarinic drugs used in ocular care?

Answer 4

Atropine, Scopolamine, Homatropine, Cyclopentolate, Tropicamide

Question 5

What is the effect and use of antimuscarinic drugs in ocular treatment?

Answer 5

pupillary dilation & cycloplegia (paralysis of ciliary body) –> used for eye exams and uveitis (improve comfort during inflamm)

Question 6

What are the side effects of the drug Cyclopentolate? What other drugs have the same SEs?

Answer 6

Ataxia, nystagmus, restlessness, mental confusion, hallucination, violent and aggressive behavior, insomnia, photophobia, urinary
retention

Question 7

Name 1 nonspecific alpha-adrenergic agonist. What is its effect and use?

Answer 7

Apraclonidine- Amino derivative of clonidine; does not cross blood-brain barrier –> minimal effect on systemic blood pressure

Question 8

What class of drug is Clonidine? What is its mechanism of effect?

Answer 8

Direct α2-agonist- Lowers intraocular pressure through central nervous system effects (can cross BBB)

Question 9

What class of drug is Brimondine tartrate (Alphagan)? What is its therapeutic effect?

Answer 9

Direct α2-agonist- suppresses aqueous humor production (used in glaucoma)

Question 10

What are the epinephrine compounds and what is their effect and use in ocular treatment

Answer 10

L-epinephrine and Dipivalyl epinephrine- increase aqueous outflow by dilating the episcleral vessels (glaucoma)

Question 11

What class of drug is Dapiprazole? What is its action and use?

Answer 11

α-antagonist- Blocks alpha-adrenergic receptors in smooth dilator muscle of iris to reverse action of Tropicamide and phenylephrine
*not available in US

Question 12

What is the mechanism of effect of Beta-blockers in ocular treatment?

Answer 12

reduces aqueous humor production at ciliary process (Glaucoma)

Question 13

What are 5 beta-blockers used in the treatment of Glaucoma?

Answer 13

Timolol, Betaxolol, Carteolol, Levobunolol, Metipranolol

Question 14

What are the side effects of Carteolol and the other drugs in its class?

Answer 14

Bradycardia, hypotension, syncope, palpitation, congestive heart failure, bronchospasm, mental confusion, depression,
fatigue, lightheadedness, hallucinations, memory impairment, sexual dysfunction, hyperkalemia

Question 15

What are 3 carbonic anhydrase inhibitors given orally in the treatment of Glaucoma?

Answer 15

Acetazolamide, ethoxzolamide, methazolamide

Question 16

What class of drug is Acetazolamide? What is its effect?

Answer 16

Carbonic anhydrase inhibitor- Reduce aqueous production via interference with the active transport of Na through Na-K-ATPase pump

Question 17

Are orally given carbonic anhydrase inhibitors a good treatment for Glaucoma?

Answer 17

extremely effective but have many side effects and only used if other topical therapy fails

Question 18

What class of drug are Dorzolamide hydrochloride and Brinzolamide? Side effects?

Answer 18

topical carbonic anhydrase inhibitors- side effects are red eyes & lid allergies but much less systemic effects than oral agents

Question 19

What is the mechanism of action of carbonic anhydrase inhibitors?

Answer 19

Reduce aqueous production via interference with the active transport of Na through Na-K-ATPase pump

Question 20

What class of drugs is the main therapy to treat Glaucoma? What is their action?

Answer 20

prostaglandins (topical)- Increase uveoscleral outflow

Question 21

What are the 4 prostaglandin analogs used to treat glaucoma?

Answer 21

latanoprost, bimatroprost, travoprost & unoprostone isopryl

Question 22

What are the side effects of bimatroprost and other drugs in its class?

Answer 22

Eyelash growth, change in iris color

Question 23

What class of drug is latanoprost? What are some contraindications?

Answer 23

Prostaglandin analog- Contraindicated in cystoid macular edema and herpes

Question 24

What are the 4 first line medications for the treatment of glaucoma?

Answer 24

TImolol (beta-blocker); latanaprost (PG); brimondine (alpha agonist); dorzolamide hydrochloride (carbonic anhydrase inhibitor)

Question 25

What is the class, effect and use of Nifedipine?

Answer 25

Calcium channel blocker which increases ocular perfusion at the nerve head used in glaucoma

Question 26

What are the 4 osmotic drug agents? Which ones are given IV and which orally? Danger?

Answer 26

glycerol, sorbitol (orally); mannitol, urea (IV)

-increase serum osmolarity and can only be used for a short, monitored time due to heart failure risks