eye treatment

Question 1

effect of muscarinic antagonists?

which two drugs?

Answer 1

loss of accomodation(cycloplegia) and adaptation (mydriasis)

scopalamine and atropine

Question 2

what do scopalamine and atropine treat?

Answer 2

iris/uveal tract inflammatory conditions and eye examination

Question 3

what are the 4 ADEs of muscarinic antagonists (scopalamine and atropine)? (PBS)

two contraindications?

Answer 3

increased intraocular presssure, transient stings, burns

c/I in glaucoma w/sulfite preservative allergy

Question 4

if drainage of aqueus humor impaired, pressure w/in eye may increase and compress retina and damage the optic nerve –> ?

Answer 4

glaucoma

Question 5

what is the normal pressure range in glaucoma?

Answer 5

10-21 mmHg

Question 6

which glaucoma tx inthe following way:

decrease aqueous humor production and/or increase aqueous humor outflow

Answer 6

open angle glaucoma

Question 7

which glaucoma tx in following way:

surgical iridectiomy; short term medical management to decrease IOP and clear cornea prior to surgery

Answer 7

closed angle

Question 8

which drugs are first line for glaucoma tx(2)?

Answer 8

prostaglandins (PGF2alpha analogs) - _latanoprost + bimatoprost _

Question 9

which 3 drug classes used to treat glaucoma?

Answer 9

1st line: prostaglandin analogs (PGF2): bimatoprost and latanoprost

beta-receptor antagonists (timolol and carteolol)

carbonic anhydrase(isoenzyme II) inhibitors (dorzolamide)

Question 10

MOA of prostaglandin analogs latonoprost and bimatoprost?

Answer 10

mech unclear: thought to faciliate aqueous outflow via accesory uveoscleral outflow pathway

NOTE: isopropyl ester pro-drugs undergo in situ hydrolysis after penetrating cornea

Question 11

the 3 ADEs of bimatoprost and latonoprost (BIV)+ the ONE major chronic one

Answer 11

ADE: blurred vision, burning/stinging, itching

CHRONICALLY: slow+ permanent brown pigmentation of iris, eyelid skin, and eyelashes; also increases their growth, including length, thickness

Question 12

which comsetic condition are bimatoprost and latanoprost used to tx?

Answer 12

hyoptrichosis (marketed as Latisse)

Question 13

75-90% of ciliary body epithelium and BV receptors are ______

Answer 13

beta-2

Question 14

how do the beta-blockers timolol and carteolol function in the tx of glaucoma?

Answer 14

1. decrease aqueos humor prodution by decreased cAMP-PKA stimulation
2. decrease ocular blood flow and ultrafiltration producing humor

Question 15

are b-blockers detected in systemic circulation following topical use?

Answer 15

yes

Question 16

what can co-formulated preservatives(benzalkonium chloride) damage?

Answer 16

soft contact lenses

Question 17

what type of beta blockers used to inhibit production of aqueous humor?

Answer 17

beta-2 antagonists

Question 18

how do carbonic anyhyrase inhibtiros reduce intraocular pressure?

Answer 18

by reducing bicarbonate secretion and fluid transport

Question 19

what are the two signifcant ADEs of carbonic anyhyrdase inhibitors?

Answer 19

1. taste disturbance(dysgeusia = bitter taste) from inhibition of carbonic anyhydrase in the oral cavity
2. SULFMONAMIDES –> ALLERGIC RXN.

Question 20

blurred, vision, lacrimation, photophobia, and xeropthalmia as well as allergic rxns such as: agranulocytosis, aplastic anemia, fulminant hepatic necrosis, SJEN, and TEN, and allergic ocular manifestations such as: bacterial keratitis and are all ADEs of

Answer 20

carbonic anhydrase inhibitors = DORZOLAMIDE

Question 21

what are direct acting miotics that increase aquus humor flow?

Answer 21

muscarinic agonists and cholinesterase inhibitors

Question 22

which two muscarinic agonists used for tx of OPEN angle glaucoma but C/I in closed angle?

Answer 22

carbachol and pilocarpine

Question 23

which 3 conditions are muscarinic agonists and cholinesterase inhibitors C/I in? b/c constriction undesirable

Answer 23

iritis, uveitis, and inflammatory condition of anterior chamber

Question 24

what are the three ADEs of muscranic agonists(pilocarpine and carbachol) and cholinesterase inhibitors?(STN)

Answer 24

transient stinging, tearing, decreased night vision

Question 25

cholinesterase inhibitors are MORE potent, longer-acting than direct-acting miotics + ADE MC. they have additive effects with carbamate + organophosphate toxicity. Which condition are they C/I b/c they Increase IOP?

what is the ONE drug from thisclass?

Answer 25

CLOSED-angle glaucoma.

Echothiophate

Question 26

which 4 drugs considered sympathomimetics and used in the tx of glaucoma?(P TAB)

Answer 26

P-phenylephrine

T-tetrahyrozoline

A- apraclonidine

B- brimonidine

Question 27

what is the receptor for phenylephrine? indication (3 MVD)

Answer 27

alpha

inidcation: Mydriasis, vasconstriction, decongestion

Question 28

receptor for apraclonidine? what is the one indication for this drug?

Answer 28

apraclonidine - alpha2 for ocular HTN

Question 29

Brimonidine receptor and indication(2 GO)

Answer 29

brimonidine - alpha 2 and glaucoma and ocular HTN

Question 30

tetrahyrozoline receptor and indication

Answer 30

alpha and decongestation

Question 31

what is the common MOA for all sympathomimetis and their ocular ADE(3) ?

Answer 31

MOA: decrease IOP by increasing outflow of aqueous humor from the eye.

Systemic effects rare but include: used w/caution in HTN, hyperthyroidisim, Diabetes, arteriosclersosi and ASTHMA

3 ADEs: photosensitivity, conjuctival hyperemia, and hypersensitivity

Question 32

sympathamomimetic drugs used for a # of clinical conditions in addition to glaucoma such as: (2)

Answer 32

glaucoma

produce mydriasis

decongestants

Question 33

what causes the ADE of bitter taste of carbonic anahydrase inhibitor dorzolamide

Answer 33

inhibition of carbonic anyhydrase in oral cavity