Pharm: Ocular

Question 1

muscarinic antagonists

Answer 1

effect: cycloplegia and mydriasis
Tx: iritis, uveitis, eye exam
AE: increased intraocular pressure, stinging
systemic AE: xerostomia, tachycardia
CI: glaucoma, sulfite allergy

Question 2

muscarinic agonists

Answer 2

direct acting miotic
increase aqueous humor flow
Tx: glaucoma
AE: sting, tears, decreased night vision
CI: iritis, uveitis, inflammation of anterior chamber
caution: pts with cholinergic mediated medical conditions (CV failure, asthma, ulcer, GI spasm)

Question 3

AChE inhibitors

Answer 3

more potent and longer acting that direct miotics
AE more common
additive effects with: CARBAMATE and ORGANOPHOSPHATE toxicity
Tx: glaucoma
CI: CLOSE ANGLE GLAUCOMA

Question 4

sympathomimetics

Answer 4

produce mydriasis 
act on alpha receptors
outflow of aqueous humor
Tx: glaucoma, ocular HTN, decongestant 
caution: hyperthyroid, HTN, DM, asthma, arteriosclerosis

Question 5

PG analogs

Answer 5

FIRST LINE
-prost
prodrug activated by esterase
PGF2alpha analog: increase aqueous outflow via accessory uveoscleral outflow pathway
2 hours to onset
Tx: glaucoma
AE: blurry vision, stinging, itching, BROWN stain (iris, eyelid, eyelash); EYELASH growth

Question 6

beta-adrenergic antagonists

Answer 6

-olol
1. decrease aqueous humor production by decreased cAMP
2. decrease ocular blood flow and ultrafiltration producing humor
RAPID and SUSTAINED action
can be found in systemic circulation
Tx: glaucoma
AE: damage soft contact lenses, systemic effects

Question 7

carbonic anhydrase inhibitors

Answer 7

-zolamide
reduce bicarb secretion and fluid transport
Tx: glaucoma
AE: TASTE disturbance, stinging, blurry vision, lacrimation, dry eye
CI: SULFONAMIDE ALLERGY
can get BACTERIAL CONTAMINATION

Question 8

drugs for macular degeneration

Answer 8

intravitreal injection
VEGF interruption: decrease vascular growth
AE: arterial thromboembolic event

Question 9

atropine

Answer 9

muscarinic antagonist

Question 10

cyclopentolate

Answer 10

muscarinic antagonist

Question 11

homotropine

Answer 11

muscarinic antagonist

Question 12

scopolamine

Answer 12

muscarinic antagonist

Question 13

tropicamide

Answer 13

muscarinic antagonist

Question 14

carbachol

Answer 14

muscarinic agonist

Question 15

pilocarpine

Answer 15

muscarinic agonist

Question 16

acetylcholine HCl

Answer 16

muscarinic agonist

Question 17

echothiophate

Answer 17

AChE inhibitors

Question 18

dipivefrin

Answer 18

sympathomimetic
pro drug of epinephrine
alpha and beta agonist

Question 19

phenylephrine

Answer 19

sympathomimetic

Question 20

apraclonidine

Answer 20

sympathomimetic

Question 21

brimonidine

Answer 21

sympathomimetic

Question 22

naphazoline

Answer 22

sympathomimetic

Question 23

tetrahydrozoline

Answer 23

sympathomimetic

Question 24

latanoprost

Answer 24

PG analog

Question 25

travoprost

Answer 25

PG analog

Question 26

bimatoprost

Answer 26

PG analog | Tx: eyelash hypotrichosis

Question 27

timolol maleate

Answer 27

beta-adrenergic antagonist

Question 28

levobunolol

Answer 28

beta-adrenergic antagonist

Question 29

metipranolol

Answer 29

beta-adrenergic antagonist

Question 30

carteolol

Answer 30

beta-adrenergic antagonist

Question 31

dorzolamide

Answer 31

carbonic anhydrase inhibitor

Question 32

brinzolamide

Answer 32

carbonic anhydrase inhibitor

Question 33

aflibercept

Answer 33

VEGF decoy receptor | Tx: macular degeneration

Question 34

pegaptanib

Answer 34

VEGF antagonist | Tx: macular degeneration

Question 35

ranibizumab

Answer 35

VEGF mAb | Tx: macular degeneration

Question 36

bevacizumab

Answer 36

VEGF mAb | Tx: macular degeneration

Question 37

verteporfin

Answer 37

``` IV non-thermal laser activator free radical production damages vessels AE: visual disturbance, photosensitive, headache AVOID BRIGHT LIGHT Tx: macular degeneration ```

Question 38

ciliary body

Answer 38

1. accommodation | 2. aqueous humor secretion

Question 39

Receptor actions 1. M3 2. alpha 1 3. alpha 2 and beta 2 4. beta 2

Answer 39

1. miosis, accomodati, lacrimal secretion 2. mydriasis, lacrimal secretion 3. aqueous production 4. ciliary relaxation

Question 40

How can a drug cause unilateral mydriasis?

Answer 40

1. direct contamination | 2. nasolacrimal duct

Question 41

Gardener's Eye

Answer 41

unilateral dilated pupil and blurred vision due to Datura or Angel's Trumpets (contains scopolamine and atropine) cannot be reversed with pilocarpine

Question 42

MoA of opioid pinpoint pupils

Answer 42

act on Edinger-Westphal nucleus | block inhibitory neurons that allow pupil to dilate

Question 43

How can topical eye drugs become systemic

Answer 43

1. spill on cheeks: skin discoloration and vasoconstriction 2. lacrimal drainage and absorption in GI 3. ocular blood vessels

Question 44

Tx of close vs. open angle glaucoma

Answer 44

close: Sx iridectomy open: meds to decrease aqueous humor production or increase outflow

Question 45

Drugs to Tx glaucoma

Answer 45

1. AChE inhibitor | 2. miosis therapy

Question 46

considerations when choosing miotics vs. AChE inhibitor in glaucoma Tx

Answer 46

1. young patients intolerant, preferred in phakic, caution in patient with increased risk for retinal detachment 2. promote cataract formation in phakic patient