Ophthalmological Pharmacotherapy Lecture PDF

Question 1

Aqueous humor production and travel

Answer 1

• Occurs in the ciliary body and secreted into the posterior chamber of the eye (behind the iris)
• then travels around the iris into the anterior chamber where it is drained (drains via trabechular canal of shlemm

Question 2

Angle closure glaucoma can cause the iris to be….

Answer 2

….pushed up against the cornea as pressure builds in the eye

Question 3

Unconventional outflow pathway

Answer 3

Aqueous humor drainage via uveoscleral outflow to remove from anterior and posterior chamber in a way other than the trabecular meshwork

Question 4

90% of glaucoma cases are what type?

Answer 4

Primary open angle

Question 5

Risk factors of primary open angle glaucoma (4)

Answer 5

• African American heritage
• advancing age
• diabetes
• hypertension

Question 6

Trabechulectomy

Answer 6

Most common procedure to reduce intraocular pressure that reates shunts to allow aqueous humor to exit anterior chamber, scarring may cause shunt to close

Question 7

Angle closure glaucoma

Answer 7

Displacement of iris covers trabecular meshwork preventing aqueous humor from the anterior chamber exiting, development is suddenly painful and causes irreversible vision loss within 1 to 2 days

Question 8

1st line treatment for glaucoma and 2nd line treatment

Answer 8

• Prostaglandin analogs

- B blockers

Question 9

B blockers for glaucoma #1 used example, mech of action, function, ADR’s (4)

Answer 9

• Timolol
• Decrease production of aqueous humor thru unknown mechanism
• lower IOP 20-25% once or twice daily dosing, much less effective at night, equal efficient as pilocarpine to treat acute angle closure glaucoma
• Local stinging, conjunctivitis, bradycardia, bronchospasm

Question 10

Prostaglandin analogs function

Answer 10

Topical usually lower IOP by 25-30% and are mainstay of glaucoma treatment

Question 11

Latanoprost (Xalatan) drug class, mech of action, and ADR’s (3)

Answer 11

• Prostaglandin analog
• Enhances aqueous humor outflow via a dropper
• Heightened brown pigmentation of iris most noticeable in patients with green brown iris (irreversible), stinging, conjunctiva

Question 12

Bimatoprost (Lumigan) function

Answer 12

Similar to latanoprost in function and marketed to increase eyelash length, darkness, and thickness

Question 13

Pilocarpine drug class, mech of action, function, ADR’s (5)

Answer 13

• direct acting muscarinic agonist (parosympathomimetic agent)
• stimulates cholinergic receptors in eyes producing miosis and contraction of ciliary muscle to focus lens on near vision
• Used to treat open angle glaucoma by reducing tension generated by ciliary muscle and close angle glaucoma by allowing for contraction of iris sphincter to pull it away from the pores of the trabecular mesh work
• Contraction of lens causing difficulty seeing distance, bradycardia, urinary urgency, diarrhea, hypersalivation

Question 14

How to reverse pilocarpine effects?

Answer 14

Atropine

Question 15

Long acting cholinesterase inhibitors function and one drug example

Answer 15

• Inhibit breakdown of Ach allowing accumulation at muscarinic receptors producing same ocular effects as parasympathomimetic drugs such as pilocarpine
• echothiophate iodide (phosopholine iodide)

Question 16

Systemic carbonic anhydrase inhibitors function, ADR’s (4), examples (3)

Answer 16

• PO agents that lower IOP by decreasing production of aqueous humor in patients who do not respond to first line agents and B blockers
• Malaise, anorexia, parasthesias, acidosis
• Acetazolamide (diamox), dichlorphenamide, methazolamide

Question 17

Which is preferred in ocular treatment? Topical or systemic carbonic anhydrase inhibitors?

Answer 17

Topical

Question 18

Topical carbonic anhydrase inhibitor examples (2) and ADR’s (2)

Answer 18

• Dorzolamide (trusopt) and brinzolamide (azopt)

- Ocular stinging, bitter taste, NO acidosis,

Question 19

a2 agonist function in IOP and 1 example

Answer 19

• Lower aqueous humor production like B blockers and increase uveoscleral outflow used for short term therapy of open angle glaucoma and supplemental, as well as preoperative medications
• Brimonidine (alphagan)

Question 20

Osmotic agents function, 4 examples, ADR’s (4)

Answer 20

• Used for rapid and significant reduction in IOP
• mannitol, urea, glycerin, isosorbide
• Systemic hyperosmolarity and electrolyte abnormality causing thirst, confusion, diuresis, rebound IOP

Question 21

Netarsudil (rhopressa) mech of action, function and ADR’s (1)

Answer 21

• New agent that inhibits norepi transporter reducing resistance in trabechular network outflow pathway by modifying cytoskeleton, decreasing aqueous humor production and increasing outflow
• Used in refractive when 1st line agents are not successful in treating glaucoma
• Corneal verticella (corneal deposits forming a golden brown whorl pattern on inferior cornea that is reversible)

Question 22

Cycloplegic

Answer 22

Drugs that cause paralysis of ciliary muscle

Question 23

Cycloplegics and mydriatics function

Answer 23

Used to facilitate ophthalmic exams and surgeries by facilitating observation of eyes interior and preventing lens undergoing changes during assessment either by being anticholinergic or adrenergic agents (adrenergic just produce mydriasis)

Question 24

2 mainstays of treatment for anterior uveitis

Answer 24

• Glucocorticoid to reduce inflammation

- anticholinergic

Question 25

Risks of cycloplegics and mydriatics

Answer 25

Can induce closure of filtration angle in individuals who have narrow angle to begin with causing acute angle closure glaucoma

Question 26

Age related macular degeneration mech of action and 2 types

Answer 26

- Painless progressive disease that blurs central vision limiting perception of fine detail where symptoms result from injury to macula, leading cause of blindness in older americans - either dry (atrophic) which is more common and are characterized by presence of drusen (yellow deposits under retina where # and size of them relate directly to lack of vision quality) or wet (neovascular) which is more severe and progresses faster caused by new subretinal blood vessels often fragile and leaky and quickly causes permanent damages

Question 27

Age related eye study (AREDS)

Answer 27

Study that demonstrated that high doses of antioxidant and zinc can reduce development of advanced ARMD

Question 28

Management of wet (neovascular) ARMD (2)

Answer 28

- Laser therapy - photodynamic therapy (high affinity drug for neovascular tissue and then infrared laser shined to activate drug to seal vessel, 5 days after must avoid light to avoid activation that could cause severe skin burn)

Question 29

Angiogenisis inhibitors mech of action, administration, ADR's (3)

Answer 29

- Inhibit new vessel growth in patients with neovascular ARMD by antagonizing vascular endothelial growth factor - administered by direct injection into affected eye - Endophthalmitis (inflammation inside eye caused by infection), blurred vision, cataracts

Question 30

Ranibizumab, bevacizumab, pegaptinab, and aflibercept function

Answer 30

Approved for treatment of neovascular ARMD

Question 31

Demulcents function

Answer 31

Artificial tears, isotonic solutions used as subs for natural tears to treat dry eye syndromes, provide relief of discomfort caused by irritants, lubrication of artificial eyes

Question 32

Topical cyclosporine (restasis) function

Answer 32

Treatment of dry eyes thru unknown mechanism that can take up to 3 months for full effect with minimal to no systmeic or topical toxicity reported

Question 33

Lifitegrast (Xiidra) function

Answer 33

LFA-1 antagonist that prevents inflammatory factors from T cells being active on the ocular surface treating dry eyes

Question 34

Topical antibiotics are often used...

Answer 34

....post operatively to prevent infection after ocular surgeries such as cataract surgery

Question 35

Patients should not wear contact lenses while they have...

Answer 35

...eye infection or while treating infection with topical agent

Question 36

Allergic conjunctivitis treatment and 2 examples

Answer 36

Antihistamines most often 2nd gen non sedating agents such as zyrtec (ceterizine) or fexofenadine (allegra)

Question 37

Topical glucocorticoids function and 2 examples

Answer 37

- Highly effective at treating allergic conjunctivitis but have serious ADR's such as cataracts, infections, or elevation of IOP so reserved for short term therapy, prolong infection due to immunosuppressant function so contraindicated in any infection - loteprednol, fluoromethalone

Question 38

Topical NSAIDS function and example

Answer 38

- Antiinflammatory activities inhibit prostaglandin production, play role in miiotic response by constricting iris sphincter independent of cholinergic mechanisms - diclofenac (voltaren)

Question 39

Components to consider in ophthalmic products (5) and why does it matter?

Answer 39

- sterility - buffer btwn 6-8 acceptable for eye - tonicity - vehicle - viscosity increasing agents -Patients might have hypersensitivity rxn to any of the components used in ophthalmic products which may necessitate discontinuing agent and switching to another product that does not contain irritating agent