ophthalmic drugs: anti-glaucoma Flashcards Preview

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Flashcards in ophthalmic drugs: anti-glaucoma Deck (70):
1

list the 5 categories of drugs used to treat glaucoma

- Prostaglandin agonists
- Beta receptor antagonists
- Alpha 2 receptor agonists
- Carbonic anhydrase inhibitors
- Cholinergic agonists

all target different processes

2

which 2 ways can you bring IOP down

- by inhibiting aqueous production
or
- by enhancing aqueous drainage

3

what are the 2 drainage pathways

- conventional pathway via the trabecular meshwork and canal of schlemm
or
- uveoscleral pathway - 30%

4

where is the production of aqueous from

the ciliary body

5

what do patients with early to moderate glaucoma damage still retain

good central visual function

6

what is the aim for therapy used on glaucoma patients

to maintain ‘target IOP’ ie IOP that is expected to prevent further glaucomatous damage

7

what are most patient with OAG initially treated with and what is the other option

topical medication (start with single eyedrop, then adding other drops or using multiple therapies)
other option is Laser trabeculoplasty

8

what is the name of a incisional surgical treatment for glaucoma and when is it considered

trabeculectomy may be considered in advanced glaucoma or high IOP

9

how much is IOP lowered by with glaucoma drugs and how much of aqueous does this correspond to

IOP lowered by 20-35%
corresponds to approx. 5 - 7mmHg

10

what is the normal episcleral venous pressure

8-10mmHg

11

what is the normal aqueous formation rate

2-3uL/min

12

what is the normal outflow facility of aqueous

0.2-0.3uL/min/mmHg

13

what is the mechanism of action with the topical anti-glaucoma drugs: CAI’s, α receptor agonists, and βreceptor antagonist

Reduce aqueous production

14

what is the mechanism of action with the topical anti-glaucoma drugs: cholinergics, bimatoprost

Increase outflow through the trabecular meshwork (the conventional method)

15

what is the mechanism of action with the topical anti-glaucoma drugs: PG agonists, brimonidine

Increase uveoscleral flow

16

what is the mechanism of action with the systemic anti-glaucoma drug: Carbonic anhydrase inhibitors and β receptor antagonists

Reduce aqueous production

tablets: Diamox or Dorzolamide

17

what is the mechanism of action with the systemic anti-glaucoma drug: mannitol, glycerol

Osmotic agents i.e. they pull water out of the vitreous

18

when are the systemic anti-glaucoma drugs used

- as a last option for people who are on maximum eye drops and their pressure is still too high
- used to treat acute angle closure attack when IOP really high and want to bring it down rapidly in A&E

19

list the 5 categories of anti-glaucoma drugs from highest to lowest efficacy

- Prostaglandin agonists
- Beta antagonists
- Alpha 2 agonists
- Cholinergic agonists
- Carbonic anhydrase inhibitors

20

which drug is the first choice for IOP reduction in OAG and newly diagnosed patients with glaucoma

Prostaglandin agonists

21

by which mechanism do Prostaglandin agonists work to reduce IOP

Increase uveoscleral outflow, reducing IOP by 25-33%

22

after how long from administration do Prostaglandin agonists reduce IOP and when is its peak effect

within 2-4 hours of administration
with peak effect 8-12 hours

23

how often should Prostaglandin agonists be administered

One drop preferably in the evening
which is an advantage as only one drop per day

24

what other drug is Prostaglandin agonists available with as a fixed combination

Timolol (beta antagonist)

25

list the 3 main Prostaglandin agonist drugs

- Latanoprost (Xalatan)
- Travoprost (Travatan)
- Tafluprost (Saflutan)

26

what is the trade name for the Prostaglandin agonist - Latanoprost

Xalatan

27

list 7 side effects of prostaglandin agonists

- Hyperaemia
- Eyelash growth (hypertrichosis)
- Iris darkening
- Darkening of periocular skin
- Reactivation of HSK
- Cystoid macular oedema in aphakes/pseudophakes
- Avoid in pregnancy as prostaglandins can induce labour

28

how do beta receptor agonists work in order to reduce IOP

Block β receptors (sympathetic) in ciliary epithelium, reducing aqueous humour formation

29

what are the 2 types of beta blockers available to treat glaucoma

- Selective beta blockers (ß1)
and
- non-selective (ß1 and ß2) available

30

what can happen with beta receptor agonists drugs over time

tachyphylaxis (reduced effectiveness over time)

31

list the 4 non-selective beta receptor agonists drugs available

- Timolol (Timoptol, Nyogel)
- Levobunolol (Betagan)
- Metipranolol
- Carteolol (Teoptic)

32

name the selective beta receptor agonists drug available

Betaxolol (Betoptic)

33

what is meant by selective beta receptor agonists

drugs that only work on receptors that are in the eye and not on beta receptors in the lungs
however these type of drugs don't work very effectively

34

what can non-selective beta receptor agonists be contraindicated in

those with airways disease

35

what does blocking β2 receptors cause

impair respiratory function by causing constriction of the bronchioles resulting in:
- shortness of breath
- wheezing
- bronchospasm

36

what 2 things may blocking β1 receptors cause

- bradycardia
- hypotension
= increased falls in elderly

37

what mechanisms does Alpha-2 receptor agonists use to reduce IOP

- Decrease aqueous production
and
- Increase aqueous outflow

38

how does Alpha-2 receptor agonists decrease aqueous production

- because they're sympathomimetic drugs, therefore they mimic the action of the sympathetic nervous system

- it inhibits aqueous production via alpha receptors by stimulating them

39

what disadvantage does Alpha-2 receptor agonists have

it displays tachyphylaxis
the drug works initially, but its effectiveness reduces overtime

40

name 2 Alpha-2 receptor agonists

- Apraclonidine hydrochloride (Iopidine)
- Brimonidine tartrate (Alphagan)

41

list the 7 side effects of Alpha-2 receptor agonist drugs

- Follicular conjunctivitis
- Allergy
- Dry mouth
- Headache
- Fatigue
- Dizziness
- Drowsiness

42

how does Carbonic anhydrase inhibitors reduce IOP

Decrease aqueous production by inhibiting enzyme involved in aqueous secretion

43

which types of formulations is Carbonic anhydrase inhibitors available in

topical and systemic

44

which formulation of Carbonic anhydrase inhibitors is used in treatment of acute angle closures

oral formulation

45

what is the topical form of Carbonic anhydrase inhibitors called

Dorzolamide

46

what is the systemic form of Carbonic anhydrase inhibitors called

Diamox/Acetazolamide tablets

47

which enzyme is involved in aqueous production and how does it work

carbonic anhydrase
it produces bicarbonate ions ( which may exert its effect on aqueous production by influencing Cl- movement as well as by transmembrane transport) which are transported across the ciliary epithelium, setting up a osmotic gradient one which aqueous production depends on

48

what happens when Carbonic anhydrase inhibitors block the carbonic anhydrase enzyme (that produces aqueous)

it inhibits the bicarbonate production, therefore lowers aqueous production

49

name the three Carbonic anhydrase inhibitor drugs available

- Brinzolamide (Azopt)
- Dorzolomide (Trusopt)
- Oral acetazolamide (Diamox)

50

what are the 2 topical versions of Carbonic anhydrase inhibitor drugs

- Brinzolamide (Azopt)
- Dorzolomide (Trusopt)

51

list the 5 side effects of topical Carbonic anhydrase inhibitor drugs

- Metallic taste (at back of throat, from the eye drops)
- Rashes
- Polyuria
- Irritation
- Blurred vision

52

list the 8 side effects of oral Carbonic anhydrase inhibitor drugs e.g. Diamox and Acetozolamide

- Allergy
- Hypokalemia
- Polyuria
- Acidosis
- Depression
- Paresthesia
- Kidney stones
- Blood dyscrasia

53

what type of drug are Cholinergic agonists

Parasympathomimetics (causes pupil constriction)

54

what is the pharmacological action/how do Cholinergic agonists reduce IOP

by increasing aqueous outflow by opening the trabecular meshwork

55

what is the mechanism of Cholinergic agonist drugs

they act as miotics and constrict the pupil, in doing so they potentially stretch the trabecular meshwork allowing for increased aqueous outflow

56

name 2 Cholinergic agonist drugs

- Pilocarpine – 0.1- 6%
- Pilogel

57

list 5 side effects of Cholinergic agonist drugs

- Miosis
- Myopia
- Symblepharon
- Post synechiae
- Retinal detachment (theoretical risk - very rare)

58

list the 5 categories of anti glaucoma drugs from the most to least safest i.e. least side effects to most side effects

- Prostaglandin agonists
- Cholinergic agonists
- Carbonic anhydrase inhibitors
- Alpha adrenergics
- Beta antagonists

59

what are none of the anti glaucoma eye drops licensed for

use in children and pregnant women

60

what are all combination drugs combined with and why are drugs combined

- all combined with a topical beta blocker Timolol 0.5%
- combined and patients are more compliant than using 2 separate drugs

61

list the 6 available combined anti glaucoma drugs

- Xalacom
- Duotrav
- Ganfort
- Combigan
- Cosopt
- Azarga

62

which 2 drugs make up Xalacom

Timolol + Latanoprost

63

which 2 drugs make up Duotrav

Timolol + Travoprost

64

which 2 drugs make up Ganfort

Timolol + Bimaptoprost

65

which 2 drugs make up Combigan

Timolol + Brimonidine

66

which 2 drugs make up Cosopt

Timolol + Dorzolamide

67

which 2 drugs make up Azarga

Timolol + Brinzolamide

68

what guidelines need to be followed for new prescriptions of anti glaucoma drugs

- Start only one drug regardless of presenting IOP in COAG (to look at the effectiveness of that drug)

- Show the patients how to put the drops in

- Check IOP again within 3 months (to see if the drug is working)

69

what is used to check peak flow when a px is on beta antagonists and what does it measure

- peak flow meter
- a device that measures lung functions, it measures the lung volume to diagnose lung problems and is measured before prescribing beta blockers

70

what needs to be done is more than 2 drops of anti glaucoma drugs are required

surgery or laser