Unit 3-Ocular Pharmacology Flashcards by Akil Miah

Pilocarpine

Drug class

Direct Muscarinic agonist

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Pilocarpine

Mechanism

Pupillary constriction, increased aqueous outflow

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Pilocarpine

Uses

Treatment of glaucoma (both open angle and acute closed angle); cataract surgery

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Pilocarpine

Side effects

Decreased vision when patient has cataracts due to miosis and headache
Bronchospasm, salivation, nausea, vomiting,
diarrhea, abdominal pain, tenesmus, lacrimation, sweating
Used less frequently today due to side effects

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Echothiophate

Drug class

Indirect muscarinic agonist

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Echothiophate

Mechanism

Irreversibly binds cholinesterase

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Echothiophate

Uses

Treatment of glaucoma

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Echothiophate

Side effects

Bronchospasm, salivation, nausea, vomiting,
diarrhea, abdominal pain, tenesmus, lacrimation, sweating
Used less frequently today due to side effects

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Atropine

Drug class

Antimuscarinic

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Atropine

Mechanism

Pupillary dilatation; paralysis of ciliary body

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Atropine

Uses

Improve discomfort during active eye inflammation (uveitis)

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Atropine

Side effects

Ataxia, nystagmus, restlessness, mental confusion, hallucination, violent and aggressive behavior, insomnia, photophobia, urinary retention
Very long acting so not used unless severe inflammation

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Scopalamine

Drug class

Antimuscarinic

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Scopalamine

Mechanism

Pupillary dilatation; paralysis of ciliary body

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Tropicamide

Drug class

Antimuscarinic

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Tropicamide

Mechanism

Pupillary dilatation; paralysis of ciliary body

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Tropicamide

Uses

Most commonly used cycloplegia for eye exams

(due to short half life)

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Tropicamide

Side effects

Ataxia, nystagmus, restlessness, mental confusion, hallucination, violent and aggressive behavior, insomnia, photophobia, urinary
retention

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Edrophonium

Drug class

Nm agonist

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Edrophonium

Mechanism

Destroys acetylcholinesterase

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Edrophonium

Uses

Diagnoses Myasthenia Gravis

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Epinephrine

Drug class

Direct adrenergic agonist

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Epinephrine

Mechanism

Dilation of episcleral vessels –> increased aqueous outflow

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Epinephrine

Side effects

Extrasystoles, palpitation, hypertension, myocardial infarction, trembling, paleness, sweating

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Hydroxyamphetamine Drug class

Indirect adrenergic agonist

Hydroxyamphetamine Mechanism

Releases NE

Hydroxyamphetamine Uses

Separates 1st and 2nd from 3rd order neuron dysfunction in Horner's syndrome; positive dilation means 1st or 2nd order, an ominous sign

Cocaine Drug class

Indirect adrenergic agonist

Cocaine Mechanism

Prevent reuptake of NE

Cocaine Uses

Use initially to confirm diagnosis of Horner's Syndrome (pupil will not dilate)

Phenylephrine Drug class

Direct α1-agonist

Phenylephrine Uses

Dilate pupil for eye exam and cataract surgery

Phenylephrine Side effects

* Extrasystoles, palpitation, hypertension, myocardial infarction, trembling, paleness, sweating * Caution in elderly patients: at 10% can cause cardiac side effects

Brimondine tartrate Drug class

Direct α2-agonist

Brimondine tartrate Mechanism

Suppresses aqueous humor production through action of cAMP in non-pigmented ciliary epithelium

Brimondine tartrate Uses

Primary agent for treatment of glaucoma

Brimondine tartrate Side effects

May cause follicular conjunctivitis; use with MAOi can cause fatigue/drowsiness

Timolol Drug class

β-blocker

Timolol Mechanism

Reduce intraocular pressure by reducing aqueous production at the ciliary process

Timolol Uses

Second line treatment of glaucoma

Timolol Side effects

* Bradycardia, hypotension, syncope, palpitation, congestive heart failure, bronchospasm, mental confusion, depression, fatigue, lightheadedness, hallucinations, memory impairment, sexual dysfunction, hyperkalemia * Contraindicated in CHF, asthma; * bradycardia over time may produce tachyphylaxis

Levobunolol Drug class

β2-blocker

Levobunolol Mechanism

Reduce intraocular pressure by reducing aqueous production at the ciliary process

Levobunolol Uses

Second line treatment of glaucoma

Levobunolol Side effects

Bradycardia, hypotension, syncope, palpitation, congestive heart failure, bronchospasm, mental confusion, depression, fatigue, lightheadedness, hallucinations, memory impairment, sexual dysfunction, hyperkalemia

Betaxolol Drug class

β1-blocker

Betaxolol Mechanism

Reduce intraocular pressure by reducing aqueous production at the ciliary process

Betaxolol Uses

Second line treatment of glaucoma

Latanoprost Drug class

Prostaglandin analog

Latanoprost Mechanism

Increase uveoscleral outflow

Latanoprost Uses

Primary agent for treatment of glaucoma

Travoprost Drug class

Prostaglandin analog

Travoprost Mechanism

Increase uveoscleral outflow

Travoprost Uses

Increase uveoscleral outflow more effective in African Americans

Travoprost Side effects

Eyelash growth, change in iris color May cause cystoid macular edema in cataract surgery;

Bimatoprost Drug class

Prostaglandin analog

Bimatoprost Mechanism

Increase uveoscleral outflow

Bimatoprost Uses

Primary agent for treatment of glaucoma

Bimatoprost Side effects

Eyelash growth, change in iris color May cause cystoid macular edema in cataract surgery and activate herpes

Unoprostone isopryl Drug class

Prostaglandin analog

Unoprostone isopryl Mechanism

Increase uveoscleral outflow

Unoprostone isopryl Uses

Glaucoma | (Least effective)

Unoprostone isopryl Side effects

Eyelash growth, change in iris color

Nifedipine Drug class

Ca-channel blocker

Nifedipine Mechanism

Increases ocular perfusion at nervehead

Nifedipine Uses

Low-tension glaucoma | (not widely used)

Dorzolamide Drug class

Carbonic anhydrase inhibitor

Dorzolamide Mechanism

Reduce aqueous production via interfere with the active transport of Na through Na-K-ATPase pump

Dorzolamide Uses

Second line glaucoma therapy

Dorzolamide Side effects

Red eyes, lid allergies Contraindicated in sulfonamide allergies

Acetazolamide Drug class

Carbonic anhydrase inhibitor

Acetazolamide Mechanism

Reduce aqueous production via interfere with the active transport of Na through Na-K-ATPase pump

Acetazolamide Uses

Oral agent used for advanced glaucoma and with cataract surgery Used only if other topical therapy fails.

Acetazolamide Side effects

Paresthesia, fatigue, drowsiness, depression, diarrhea, metaboliv acidosis, electrolyte changes Anaphylaxis, blood dyscrasias

Brinzolamide Drug class

Carbonic anhydrase inhibitor

Brinzolamide Mechanism

Reduce aqueous production via interfere with the active transport of Na through Na-K-ATPase pump

Brinzolamide Uses

Second line glaucoma therapy

Brinzolamide Side effects

Red eyes, lid allergies