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Neuroscience II Exam III - Pharm and Clinical Medicine > Ocular Pharmacology > Flashcards

Ocular Pharmacology Flashcards

1
Q

Beta blocking drugs used in glaucoma

A 
Betaxolol
Timolol
Metipranolol
Levobunolol
Carteolol
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2
Q

Alpha2-adrenergic agonists used in glaucoma

A

Apraclonidine

Brimonodine

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3
Q

Prostaglandin analogs used in glaucoma

A

Latanoprost
Bimatoprost
Travoprost

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4
Q

Topical carbonic anhydrase inhibitors used in glaucoma

A

Brinzolamide

Dorzolamide

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5
Q

Systemic carbonic anhydrase inhibitors used in glaucoma

A

Acetazolamide

Methazolamide

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6
Q

Muscarinic agonists used in glaucoma

A

Carbachol

Pilocarpine

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7
Q

Cholinesterase inhibitors used in glaucoma

A

Demecarium

Echothiophate

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8
Q

In general, what classes of drugs are used to treat glaucoma?

A 
Beta-blockers
Alpha2-adrenergic agonists
Prostaglandin analogs
Carbonic anhydrase inhibitors (topical and systemic)
Muscarinic agonists
Cholinesterase inhibitors
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9
Q

The iris circular muscle constricts the pupil to cause miosis; its effect is due to the activation of ____ receptors

A

M3

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10
Q

The iris radial muscle dilates the pupil to cause mydriasis; its effect is due to the activation of _______ receptors

A

Alpha1-adrenergic

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11
Q

The ciliary muscle causes accommodation of the eye to near vision; it also opens the trabecular meshwork, improving the outflow of aqueous humor into the canal of schlemm, decreasing IOP; its action is due to the activation of ___ receptors

A

M3

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12
Q

The ciliary epithelium secretes the aqueous humor on activation of _____ receptors

A

Beta

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13
Q

What is the role of the sympathetic nervous system (i.e., what receptors) in production of aqueous humor?

A

Beta receptor activation —> increased production

Alpha-2 receptor activation —> decreased production

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14
Q

Role of ciliary muscle and iris circular muscle on aqueous humor outflow

A

Contraction of these muscles leads to improved outflow (under the control of M3 receptors)

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15
Q

_______ improves uveoscleral (or unconventional) outflow of aqueous humor

A

Prostaglandin F2a

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16
Q

What effect does contraction of the iris radial muscle have on aqueous humor outflow?

A

Contraction of iris radial muscle (alpha 1 receptor) —> mydriasis —> decreased outflow

17
Q

2 types of primary glaucoma

A

Open angle: chronic progressive disease with no apparent mechanical blockage for humor outflow [95% of cases; second leading cause of blindness]

Closed angle: acute intermittent partial or complete blockage of the outflow, may have to be treated as an emergency to avoid vision loss

18
Q

What are some anatomical predisposing factors to developing closed angle glaucoma?

A

Shallow anterior chamber
Narrow angle between cornea and iris
Tight contact between iris and lens

19
Q

What are the 2 types of classic primary closed angle glaucoma?

A

With pupillary block: tight contact between iris and lens, the flow of humor into anterior chamber is blocked, iris moves forward and blocks outflow

Without pupillary block: the ciliary processes are located in such a way that they push the iris forward and the iris blocks the outflow, especially during mydriasis

20
Q

T/F: increased IOP is a good diagnostic indicator for glaucoma

A

False, 20-30% with visual field loss have normal IOP

Optic disk exam and visual field evaluation is most conclusive method for diagnosis

21
Q

A ____ is an area of vision loss or decreased visual acuity surrounded by the field of normal vision

A

Scotoma

22
Q

First line agents for treatment of open angle glaucoma

A

Prostaglandin analogues
Beta-blockers (timolol)
Brimonidine

23
Q

Second line therapy for open angle glaucoma

A

Pilocarpine
Apraclonidine
Topical carbonic anhydrase inhibitors

24
Q

Last line therapy choices for open angle glaucoma

A

Carbachol
Cholinesterase inhibitors
Oral carbonic anhydrase inhibitors

25
Q

Beta-blockers are commonly used for open angle glaucoma due to convenience of dosing and relative lack of adverse effects. Why is timolol the favored agent?

A

Lacks local anesthetic effects
Available as a generic
Full antagonist
Shown to be as effective as pilocarpine

26
Q

MOA of timolol in open angle glaucoma

A

Reduces production of aqueous humor by the ciliary body by blocking beta-receptors

27
Q

Adverse effects of beta blockers used in glaucoma

A

Local: stinging, dry eyes, blurred vision, blepharitis (rarely keratitis and conjunctivitis) — often due to agents in formulation

Systemic: negative cardiac ionotropic effect, bradycardia, bronchospasm, hyperlipidemia, exacerbation of hypoglycemia in pts on insulin

28
Q

Beta blockers may interact with orally given ______, increasing the risk of cardiac depression and heart block

A

Verapamil

29
Q

In what patients should beta blockers be avoided/used with caution?

A

Patients with bradycardia, AV block, heart failure, atherosclerosis, diabetes, as well as receiving oral beta blocking therapy

30
Q

What are some of the prostaglandin analogues used in glaucoma, and which one is most effective in lowering IOP?

A

Latanoprost
Bimatoprost - most effective at lowering IOP
Travoprost

31
Q

T/F: prostaglandin analogues more efficiently reduce IOP than beta blockers

A

True

32
Q

Systemic side effects of prostaglandin analogues are not significant. What are some local side effects of these drugs?

A

Corneal erosions
Conjunctival hyperemia
Iris hyperpigmentation (irreversible)
Hypertrichosis and hyperpigmentation around eyelashes and eyelids (reversible)

33
Q

In terms of alpha2-agonists used to treat glaucoma, ______ is the first line agent of choice. ________ is associated with frequent allergic reactions including development of tachyphylaxis. Both are effective at decreasing the rate of aq.humor production

A

Brimonidine; apraclonidine

34
Q

Adverse effects associated with alpha2-agonists used for glaucoma

A

Systemic: dizziness, fatigue, dry mouth, bradycardia, reduced BP

Local: allergic reaction (eyelid edema, itching, hyperemia)

35
Q

What is the algorithm used for pharmacotherapy of open angle glaucoma?

A
  1. Start with a beta blocker
  2. If intolerance to specific beta-blocker, use class alternative
  3. If contraindications to beta-blockers, switch to alternative first line agent (prostaglandins or brimonidine)
  4. If intolerance to prostaglandin agent, switch to class alternative
  5. If contraindications to all first line agents, use topical CA inhibitors
  6. If monotherapy fails, use combo therapy
  7. If all else fails, use laser or surgical procedure
36
Q

Describe treatment of closed angle glaucoma in terms of treatment goals and drugs used

A

Goal is rapid reduction of IOP

Acute: use systemic osmotic diuretics in preparation for surgery [IV Mannitol]

Drug of choice before surgery = pilocarpine — induces miosis

Surgical or laser iridectomy — produce a hole in iris facilitating humor outflow

37
Q

Drugs contraindicated in open angle glaucoma

A

Glucocorticoids
Fenoldopam
Topical antimuscarinic drugs

38
Q

Drugs contraindicated in closed angle glaucoma

A

[angle closure may be triggered by any drug that causes mydriasis]

Antimuscarinic drugs
Drugs with alpha-adrenomimmetic activity
Tricyclic antidepressants and serotonin-NE reuptake inhibitors (because of their potent antimuscarinic activity)

Neuroscience II Exam III - Pharm and Clinical Medicine (10 decks)

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