! Neuro Eye Pharm

Question 1

B blocking drugs

Answer 1

Betaxolol
Timolol
Metripranolol
Levobunonol
Carteolol

Question 2

A2 adrenergic agonists

Answer 2

Apraclondine

Brimonidine

Question 3

Prostagladin analogs

Answer 3

Latanoprost
Bimatoprost
Travoprost

Question 4

Carbonic anhydrase inhibitors

Answer 4

Topical-brinzolamide, dorzolamide

Systemic-acetazolamide, methazolamide

Question 5

Muscarinicagonists

Answer 5

Carbachol

Pilocarpine

Question 6

Inhibitors of cholinesterase

Answer 6

Demecarium

Echothiophate

Question 7

Iris circular muscle

Answer 7

Constricts pupil to cause miosis

Question 8

Iris radial muscle

Answer 8

Dilated pupil to cause mydriasis

Effect is due to activation of a1 adrenergic receptors

Question 9

Ciliary muscle

Answer 9

Causes accommodation of the eye to near vision
Opens up trabecular meshwork, improves outflow of aqueous humor into the canal of s helm, decreasing intraocular pressure

M3 receptors contract the muscle

Question 10

Ciliary epithelium

Answer 10

Produces (secretes) aqueous humor

B receptor activation increases humor production

Question 11

Ciliary body

Answer 11

Secretes aqueous humor

Question 12

How does aqueous humor flow

Answer 12

Into space in front of iris through trabecular meshwork and exits via canal of schlemm

Question 13

Blocking b adrenoreceptors associated with ciliary epithelium

Answer 13

Decreases secretion. Of aqueous humor

Question 14

Blood vessels

Answer 14

In sclera arealso under autonomic control and influence aqueous drainag

Question 15

B receptors and aqueous humor

Answer 15

Increase

Question 16

A2 receptors and aqueous humor

Answer 16

Decrease

Question 17

Carbonic anhydrase

Answer 17

Aqueous humor?

Question 18

Contraction of ciliary muscle and aqueous humor 9muscarinic)

Answer 18

Improved outflow

Question 19

Contraction of iris circulat muscle, (muscarinic)

Answer 19

Miosis an improved outflow

Question 20

____ improves uveoscleral, or unconventional outflow

Answer 20

Prostagladin F2a

Question 21

Contraction of iris radial muscle (a1), mydriasis

Answer 21

Decreased outflow (conventional outflow)

Question 22

Glaucoma

Answer 22

Group of ocular disorders that lead to an optic neuropathy associated with loss of visual sensitivity and field

Question 23

Whites or African Americans get glaucoma more

Answer 23

Blacks

Question 24

Open or closed angle glaucoma more common

Answer 24

Open

Question 25

When should a patient be treated for glaucoma

Answer 25

Increased IOP and optic disc changes and/or visual field defects

Question 26

Goal of glaucoma treatment

Answer 26

Reduce IOP by 30% want is less than 21 mmHg

Question 27

If two glaucoma meds are given. How far apart should administration be

Answer 27

Ten minutes

Question 28

Does initial response to therapy dictate long term

Answer 28

No

Question 29

If agents are to be changed

Answer 29

One day overlap

Question 30

First line agents open angle glaucoma

Answer 30

Prostagladin analogues B blockers-timolol Brimonidine

Question 31

Second line therapy open angle glaucoma

Answer 31

Pilocarpine Apraclonidine Topical carbonic anhydrase inhibitors

Question 32

Last line therapy open angle glaucoma

Answer 32

Carbachol Inhibitors of cholinesterase Oral carbonic anhydrase

Question 33

Why are B blockers used

Answer 33

Convince of dosing few side effects

Question 34

Why is timolol the preferred beta blockers

Answer 34

Lacks local anesthetic effects (propranolol local anesthetic properties0 Generically available Full antagonist As effective as pilocarpine

Question 35

MOAtimolol

Answer 35

Reducing the production of aqueous humor by the ciliary body by blocking B receptors

Question 36

Adverse local effects of beta blockers

Answer 36

``` Stinging Dry eyes Blurred vision Blepharitis, keratiti, conjunctivitis -could be due to other things in the formulation and not the B blockers ```

Question 37

Systemic adverse effects of b blockers

Answer 37

Can get systemic absorption Heart-negative inotropy effect, bradycardia Airway-bronchospasm Hyperlipidemia Exacerbation of hypoglycemia May interact with orally given verapamil-increase risk of cardiac depression and heart block Use with caution in patients with bradycardia, AV block heart failure, atherosclerosis, diabetes,

Question 38

Prostagladin analogues

Answer 38

Latanoprost Bimatoprost Travoprost

Question 39

Which prostagladin is most effective at lower IOP

Answer 39

Bimatoprost

Question 40

Prostagladin analogues for IOP

Answer 40

More effective than B blockers Given once daily at nighttime (1 drop) Systemic side effects are not significant

Question 41

Local side effects prostagladin analog

Answer 41

Corneal erosions Conjunctival hypermedia Iris hyperpigmentation(several months of therapy and is irreversible) Hypertrichosis, hyperpigmentation around eye lashes and eyelids are reversible upon discontinuation of therapy

Question 42

A2 agonists

Answer 42

Brimonidine-first line agent | Apraclonidine-frequent allergic reactions, development of tachyphylaxis

Question 43

MOA a2 agonists

Answer 43

Decrease the rate of aqueous humor production

Question 44

Adverse effects a2 agonists

Answer 44

Systemic-dizzy, Antigua, dry mouth, bradycardia, reduced blood pressure

Question 45

Locals adverse effect a2 agonists

Answer 45

Allergic reaction (eyelid edema, itching, hypermedia)

Question 46

How treat open angle glaucoma

Answer 46

1. B blocker 2. If intolerant to b blocker, use class alternative 3. If contraindications to b blockers, switch to brimonidine or prostagladin 4. If intolerance to prostagladin, use class alternative 5. If contraindications to all first class agents,use topical carbonic anhydrase inhibitors (2nd line) - if monotherapy fails, use a combo - if intolerance or inadequate response to the combination therapy, use laser or a surgical procedure

Question 47

Goal of treating closed angle glaucoma

Answer 47

Rapid reduction of IOP

Question 48

Acute treat closed angle

Answer 48

Use systemic osmotic diuretics in preparation for surgery (IV mannitol)

Question 49

Pilocarpine

Answer 49

Drug of choice for closed angle before surgery. It inducedmiosis

Question 50

Surgical or laser iridectomy for closed angle

Answer 50

Produce a hole in the iris facilitating the humor outflow

Question 51

What drugs are contraindicated in open angle

Answer 51

Glucocorticoids Fenoldopam Topical anti muscarinic drugs

Question 52

Drugs contraindicated in closed angle (angle closure may be triggered by any drug that causes mydriasis)

Answer 52

Antimuscarinic drugs (topical, systemic) Drugs with alpha adrenomimetics activity (topical) Tricyclic antidepressants and serotonin-NE reuptake inhibitors (because of their potent antimuscarinic action)