Lecture 11 - Medical management of Glaucoma 2

Question 1

What initial beta blocker lowered IOP but caused corneal anesthesia?

Answer 1

Propranol

Question 2

Practolo was developed, in the wake of Propranol, even though it didn’t cause corneal anesthesia, what was a major sideffect it created?

Answer 2

Occulomucuataneous syndrome

Question 3

What type of beta adrenoreceptor causes dilation of bronchi and blood vessels?

Answer 3

Beta 2

Question 4

OBB’s are what type of beta drug, agonist or antagonist?

Answer 4

Antagonist

Question 5

What is the mechanism of action of a OBB?

Answer 5

Exact mechanism not known but it will reduce aqueous formation

Question 6

What type of stimulation of the Ciliary process interfere with?

Answer 6

Tonic stimulation

Note: This is speculative

Question 7

What type of Glaucoma(s) are OBB’s used for?

Answer 7

OAG, Secondary glaucoma, ACG and Ocular HTN

Question 8

What type of Betaxolol is not contraindicated for 1. Pulmonary disease

2. Bronchial Asthma
3. Severe COPD?

Answer 8

Selective OBB’s

Question 9

True or False. Taking OBB’s twice a day will have a larger impact than once a day?

Answer 9

True

Note: Exception to this rule are:
Isatalol qam
Timoptic XE or GFS (gels) qd
Betagan qd

Question 10

What is the commonly used non-selective OBB?

Answer 10

Timolol 0.5%

Question 11

What is the maximal effect regarding Timolol instillation?

Answer 11

12 hours but IOP lowering will stick around for 24 hours

Note: Onset is 30 minutes

Question 12

When is the best time to to instill Timolol to get the best result?

Answer 12

In the AM

Question 13

True or False. In all pts, short term escape of timolol will occur?

Answer 13

False. Not all pts but the efficacy of Timolol will decrease over a period of time, due to constant antagonism

Question 14

What does Long term drift mean?

Answer 14

Control of IOP is not as good as once, as it use to be. Takes about months to year to occur.

Question 15

What is washout period?

Answer 15

IOP lowering effects may persist for 2 weeks.
Aqueous flow upto 6 weeks

Note: Clinically a 4 week wash out period is acceptable

Question 16

What are the benefits of using gels and disadvantage of using gels?

Answer 16

Advantage: Improve bioavailability, decrease systemic absorption, and once a day drop

Disadvantage: Blurry vision in the morning, has a preservative

Question 17

What is the major difference between Istalol vs. Timoptic XE?

Answer 17

Istalol = BAK

Timpotic XE = Benzododdecinium

Question 18

What does Betaxolol suspension have that the solution does not have?

Answer 18

resin coated beads

Note: Betaxolol is not available in the USA

Question 19

True or False. You can use a selective BB with pts who have pulmonary disease?

Answer 19

True.

Note: Betxolol can used for this process and is less effective compared to Timolol

Question 20

What are three benefits of betaxolol properties?

Answer 20

1. May possess calcium channel blocker properties
2. Thus may have neuroprotectic effect*
3. Highly lipid soluble, binds well with plasma proteins

Question 21

What are three ocular sideeffects of propranolol?

Answer 21

Discomfort, Burning and stinging

Question 22

What OBB is associated with granulomarous uveitis?

Answer 22

Metipranolol

Question 23

What are 4 local sideffects regarding BAK usage?

Answer 23

1. Decreased tear production
2. Decreased goblet cell density
3. Dry eye symptoms
4. Ocular cicatrical pemphigoid.

Question 24

Which method do OBB’s enter the systemic system?

Answer 24

Nasolacrimal system

Question 25

True or False. One of the major CNS adverse effects is the decrease in libido in men.

Answer 25

True but its also true in women aswell

Question 26

What do OBB's do to cardiovascular effects?

Answer 26

Reduce blood pressure | Bradycardia

Question 27

What receptor is blocked that causes pulmonary effects?

Answer 27

Beta 2 receptor

Question 28

True or False. OBB's affect hypoglycemia?

Answer 28

True

Question 29

Why is clonidine not used in IOP lowering?

Answer 29

Causes sedation, systemic hypotension and narrow therapeutic index

Question 30

Apraclonidine would be a great IOP recducer but why is it not used?

Answer 30

Very hydrophillic, therefore does not penetrate eyes and BBB Note: Use Post-laser surgery

Question 31

Why should you avoid using Brominidine post laser IOP?

Answer 31

It acts as a prophylactic??? Note: Brominidine is contraindicated with pts on MAOI's

Question 32

What does Combigan consist of two drugs?

Answer 32

Brimonidine and Timolol

Question 33

What does neuroprotection mean?

Answer 33

Prevent destructive cellular events and enhance survivial of cells after damage Note: No glaucoma drug is neuroprotective

Question 34

What are the 4 criteria to be considered neuroprotective in glaucoma?

Answer 34

1) the agent must have a target in the retina; Yes they are present 2) it must be neuroprotective in animal models; 3) it must reach neuroprotective concentrations in the posterior segment after clinical dosing; 4) it must be shown to be neuroprotective in controlled clinical trials.

Question 35

Which older drug is used for ACG with pupillary block?

Answer 35

Pilocarpine - works on anterior tendons of ciliary muscles and other CB structures and Contraction of ciliary muscle, which causes unfolding or meshwork and widening of schlemm's canal

Question 36

How is pilocarpine absorbed?

Answer 36

By the cornea Note: Side effects are Stinging and Burning. You will notice intense miosis and constant accommodation as well

Question 37

What is the pharmacological antagonist for pilocarpine?

Answer 37

Atropine

Question 38

What family do CAI's belong too?

Answer 38

Sulfonamide Hence if someone has a sulfa allergy you don't give CAI's then.

Question 39

What do CAI's actually inhibit?

Answer 39

Reduction of Bicarbonate ions in posterior chamber

Question 40

What will occur if you give CAI's and cannot tolerate the increase in serum ammonia?

Answer 40

Hepatic insufficiency

Question 41

What drug is known to cause Hirsutism, hairy-ness in women, as a side effect?

Answer 41

CAI's

Question 42

What are the two topical CAI's available to us?

Answer 42

Dorzolamide and Brinzolamide