Ocular Drugs

Question 1

Pilocarpine

Answer 1

• Direct muscarinic agonist: pupillary constriction, increased aqueous outflow
• Glaucoma (open and acute closed angle), cataract surgery
• Side effects: decreased vision due to miosis and headache (in cataract pts), bronchospasm, SLUDGE

Question 2

Echothiophate

Answer 2

• Indirect muscarinic agonist: irreversibly binds cholinesterase
• Glaucoma
• Side effects: bronchospasm, SLUDGE

Question 3

Atropine

Answer 3

• Antimuscarinic: pupillary dilation, paralysis of ciliary body
• Uveitis
• Side effects: ataxia, nystagmus, restlessness, mental confusion, hallucination, violent and aggressive behavior, insomnia, photophobia, urinary retention

Question 4

Scopolamine

Answer 4

-Antimuscarinic: pupillary dilation, paralysis or ciliary body
-Uveitis
-Side effects:Ataxia, nystagmus, restlessness, mental confusion, hallucination, violent and aggressive behavior, insomnia, photophobia, urinary
retention

Question 5

Tropicamide

Answer 5

-Antimuscarinic: pupillary dilation, paralysis of ciliary body
-Cycloplegia for eye exams
-Side effects:Ataxia, nystagmus, restlessness, mental confusion, hallucination, violent and aggressive behavior, insomnia, photophobia, urinary
retention

Question 6

Edrophonium

Answer 6

• Nm agonist: destroys Acetylcholinesterase

- Myasthenia gravis dx

Question 7

Epinephrine

Answer 7

• Direct adrenergic agonist: dilation of episcleral vessels–> increased aqueous outflow
• Side effects: extrasystoles, palpitation, hypertension, myocardial infarction, trembling, paleness, sweating

Question 8

Hydroxyamphetamine

Answer 8

• Indirect adrenergic agonist: release NE
• Separates 1st and 2nd from 3rd order neuron dysfunction in Horner’s syndrome; positive dilation means 1st or 2nd order, an ominous sign

Question 9

Cocaine

Answer 9

• Indirect actin adrenergic agonist: prevent reuptake of NE

- Use initially to confirm diagnosis of Horner’s syndrome

Question 10

Phenylephrine

Answer 10

• Direct alpha1-agonist
• Dilate pupil for eye exam and cataract surgery
• Side effects: Extrasystoles, palpitation, hypertension, myocardial infarction, trembling, paleness, sweating
• Cardiac side effects in elderly

Question 11

Brimondine tartrate

Answer 11

• Direct alpha2 agonist: suppresses aqueous humor production through action of cAMP in non-pigmented ciliary epithelium
• Primary agent for glaucoma
• May cause follicular conjunctivitis

Question 12

Timolol

Answer 12

-B blocker: reduce intraocular pressure by reducing aqueous production at the ciliary process
-Second line treatment for glaucoma
-Side effects: Bradycardia, hypotension, syncope, palpitation, congestive heart failure, bronchospasm, mental confusion, depression,
fatigue, lightheadedness, hallucinations, memory impairment, sexual dysfunction, hyperkalemia
-Contraindicated in CHF, asthma

Question 13

Levobunolol

Answer 13

-B2 blocker: reduce intraocular pressure by reducing aqueous production at the ciliary process
-Second line treatment of glaucoma
-Side effects: Bradycardia, hypotension, syncope, palpitation, congestive heart failure, bronchospasm, mental confusion, depression,
fatigue, lightheadedness, hallucinations, memory impairment, sexual dysfunction, hyperkalemia

Question 14

Betaxolol

Answer 14

• B1 blocker: reduce intraocular pressure by reducing aqueous production at the ciliary process
• Second line treatment of glaucoma

Question 15

Latanoprast

Answer 15

• Prostaglandin analog: increase uveoscleral outflow
• Primary agent for treatment of glaucoma
• Side effects: eyelash growth, change in iris color, intraocular inflammation
• May cause cystoid macular edema in cataract surgery and activate herpes

Question 16

Travoprost

Answer 16

• Prostaglandin analog: increase uveoscleral outflow
• Primary agent for treatment of glaucoma
• Side effects: eyelash growth, change in iris color
• May cause cystoid macular edema in cataract surgery; more effective in African Americans

Question 17

Bimatoprost

Answer 17

• Prostaglandin analog: increase uveoscleral outflow
• Primary agent for glaucoma
• Side effects: eyelash growth, change in iris color
• May cause cystoid macular edema in cataract surgery and activate herpes

Question 18

Unoprostone

Answer 18

• Prostaglandin analog: increase uveoscleral outflow
• Glaucoma
• Side effects: Eyelash growth, change in iris color

Question 19

Nifedipine

Answer 19

• Ca channel blocker: increases ocular perfusion at nervehead
• Low-tension glaucoma
• Not widely used

Question 20

Dorzolamide HCl

Answer 20

• Carbonic anhydrase inhibitor: reduce aqueous production via interfering with the active transport of Na through Na-K ATPase pump
• Second line glaucoma
• Side effects: red eyes, lid allergies
• Contraindicated in sulfonamide allergies

Question 21

Acetazolamide

Answer 21

• Carbonic anhydrase inhibitor: reduce aqueous production via interfering with the active transport of Na through Na-L ATPase pump
• Oral agent for advance glaucoma and cataract surgery
• Side effects: Paresthesia, fatigue, drowsiness, depression, diarrhea, metabolic acidosis, electrolyte changes, anaphylaxis, blood dyscrasias

Question 22

Brinzolamide

Answer 22

• Carbonic anhydrase inhibitor: reduce aqueous production through interfering with active transport of Na through NA-K ATPase pump
• Second line glaucoma therapy
• Side effects: red eyes, lid allergies