Pharm - Glaucoma

Question 1

Carbachol

Answer 1

Activates ACh receptor
Increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork

Miosis and cylcospasm

Exhibits a strong nicotinic activity, may cause widespread autonomic disturbances if it gets into systemic circulation

Question 2

Pilocarpine

Answer 2

ACh receptor agonist
USED IN EMERGENCIES
Increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork

Miosis and cyclospasm

May cause paradoxical hypertension and tachycardia

Question 3

Physostigmine

Answer 3

AChE inhibitor
Increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork

crosses the BBB, can cause seizures and abnormal defecation

Question 4

Ecothiophate

Answer 4

AChE Inhbitor
Increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork

Can cause night blindness and frontal headache

Question 5

Timolol

Answer 5

non-selective beta blocker
Decreases aqueuous humor production by inhibiting ciliary process epithelium
Chronic open angle Glaucoma

Cold extremities, bradycardia, hypotension, fatigue are common with use of most beta blockers

bradycardia, confusion, blurred vision, dry eyes, hallucination, bronchospasm

Question 6

Carteolol

Answer 6

non-selective beta blocker
Decreases aqueuous humor production by inhibiting ciliary process epithelium
Chronic open angle Glaucoma

Cold extremities, bradycardia, hypotension, fatigue are common with use of most beta blockers

insomnia, bronchospasm

Question 7

Betaxolol

Answer 7

Selective beta 1 blocker
Decreases aqueuous humor production by inhibiting ciliary process epithelium
Chronic open angle Glaucoma

Cold extremities, bradycardia, hypotension, fatigue are common with use of most beta blockers

AV block, myocardial infarct

Beta blockers usually decrease the force and contraction and thus decrease the metabolic demand of the heart but betaxolol is paradoxal in that it can cause MI and AV Block

Question 8

latanoprost

Answer 8

Prostaglandin PGF2α analog, lowers intraocular pressure

Increase the uveoscleral outflow of the aqueous humor

Darkens color of the iris (browning)
Macular retinal edema

Question 9

bimatoprost

Answer 9

Prostaglandin PGF2α analog, lowers intraocular pressure

Increase the trabecular meshwork outflow of the aqueous humor

Darkens color of the iris (browning)
Macular retinal edema
Conjunctival hyperemia

Question 10

travoprost

Answer 10

Prostaglandin PGF2α analog, lowers intraocular pressure

Increase the trabecular meshwork outflow of the aqueous humor

Darkens color of the iris (browning)
Macular retinal edema
Conjunctival hyperemia

Question 11

Acetazolamide

Answer 11

Carbonic Anhydrase Inhibitors
Decrease aqueous humor production secondary to a decrease in HCO3- due to inhibition of carbonic anhydrase II in the eye.

Electrolyte imbalance
Metabolic acidosis
Urolithiasis

Agranulocytosis, aplastic anemia, thrombocytopenia (acetazolamide)

Question 12

Brinzolamide

Answer 12

Carbonic Anhydrase Inhibitors
Decrease aqueous humor production secondary to a decrease in HCO3- due to inhibition of carbonic anhydrase II in the eye.

Electrolyte imbalance
Metabolic acidosis
Urolithiasis

Question 13

Dorzolamide

Answer 13

Carbonic Anhydrase Inhibitors
Decrease aqueous humor production secondary to a decrease in HCO3- due to inhibition of carbonic anhydrase II in the eye.

Electrolyte imbalance
Metabolic acidosis
Urolithiasis

Immune hypersensitivity reactions
Burning sensation in the eye, visual discomfort

Question 14

Apraclonidine

Answer 14

Alpha-2 Selective Agonists
Decrease production (decrease cAMP) and increase outflow of aqueous humor → decrease ocular pressure
Lower ocular pressure associated with eye surgery. Given pre and post surgery

May include irregular heart rate, fatigue, dry mouth, red, itchy or swollen eyes

Depression, dizziness and chest pain may occur with apraclonidine

Question 15

Brimonidine

Answer 15

Alpha-2 Selective Agonists
Decrease production (decrease cAMP) and increase outflow of aqueous humor at uveoscleral outflow → decrease ocular pressure
Open angle glaucoma and ocular hypertension

May include irregular heart rate, fatigue, dry mouth, red, itchy or swollen eyes

Question 16

Alpha-2 selective agonist

Answer 16

Alpha 2 agonists, through the activation of a G protein-coupled receptor, inhibit the activity of adenylate cyclase. This reduces cAMP and hence aqueous humour production by the ciliary body.

Peripheral alpha 2 agonist activity results in vasoconstriction of blood vessels (as opposed to central alpha 2 agonist activity that decreases sympathetic tone, as can be seen by the medication clonidine). This vasoconstriction may explain the acute reduction in aqueous humor flow. The increased uveoscleral outflow from prolonged use may be explained by increased prostaglandin release due to alpha adrenergic stimulation. This may lead to relaxed ciliary muscle and increased uveoscleral outflow.[

Question 17

Dipivefrin

Answer 17

Non-Selective Adrenergic Agonists
Decrease aqueous humor production due to vasoconstriction and decrease blood flow to ciliary bodies (epinephrine)

Dipivefrin is a pro-drug, hydrolyzed to epinephrine within the eye

Burining sensation in the eye, follicular conjunctiva

Mydriasis, stinging, not be used in close-angle glaucoma

Question 18

Epinephrine

Answer 18

Non-Selective Adrenergic Agonists
Decrease aqueous humor production due to vasoconstriction and decrease blood flow to ciliary bodies (epinephrine)

Mydriasis, stinging, not be used in close-angle glaucoma

Question 19

Carbonic Anhhydrase Inhibitors

Answer 19

When used to treat glaucoma, CAIs inhibits production of HCO3-. In health, it is the production of HCO3- which draws Na+ into the eye; water follows by osmosis to form the aqueous humour. In glaucoma treatment, the goal is often to reduce the intraocular pressure and acetazolamide does this by reducing production of aqueous humour.