Open Angle Glaucoma Treatment

Question 1

First line agents

Answer 1

Prostaglandin analogues

B-blockers (timolol preferred)

Brimonidine

Question 2

Second line therapy

Answer 2

Pilocarpine

Apraclonidine

Topical carbonic anhydrase inhibitors

Question 3

Last line of therapy

Answer 3

Carbachol

Inhibitors of cholinesterase

Oral carbonic anhydrase inhibitors

Question 4

Why Timolol favored?

Answer 4

Lacks local anesthetic effect unlike propranolol.

Available as generic, full antagonist

Question 5

Prostaglandin analogs

Answer 5

Latanoprost

Bimatoprost- most effective in lowering BP

Travoprost

Question 6

Why give prostaglandin analogs first?

Answer 6

More effectively reduce IOP than B-blocker

Systemic side effects not significant

Question 7

Alpha2-Agonists

Answer 7

Brimodine- first line

Apraclonidine- frequent allergic rxns occur

Decrease rate aqueous humor production

Question 8

Algorithm for pharmacotherapy of open angle glaucoma

Answer 8

B-blocker

Intolerance, use alternative 1st line

Contraindication to B-blocker, alternative 1st line

Contraindication to 1st line->topical carbonic anhydrase inhibitors

Mono therapy fails-> use combo

Intolerance to all-> laser/surgical procedure

Question 9

Contraindications

Answer 9

Corticosteroids

Fenoldopam

Topical antimuscarinic drugs

Succinylcholine

Question 10

Inhibitors of cholinesterase

Answer 10

Demecarium

Echothiophate

Question 11

Muscarinic Agonists

Answer 11

Carbachol

Pilocarpine