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Which of the following medications would be most appropriate for a patient with asthma and glaucoma?
Which of the following medications would be most appropriate for a patient with asthma and glaucoma?
A patient presents with a history of sulfa allergy. Which of the following medications would you avoid prescribing?
A patient presents with a history of sulfa allergy. Which of the following medications would you avoid prescribing?
Which of the following medications is most likely to cause increased pigmentation of the iris?
Which of the following medications is most likely to cause increased pigmentation of the iris?
A patient complains of dry mouth, headache, and ocular hyperemia after starting a new eye medication. Which medication is most likely the culprit?
A patient complains of dry mouth, headache, and ocular hyperemia after starting a new eye medication. Which medication is most likely the culprit?
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Which of the following medications is most likely to cause miosis and ciliary muscle contraction?
Which of the following medications is most likely to cause miosis and ciliary muscle contraction?
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Which of the following medications is most likely to cause bronchospasm?
Which of the following medications is most likely to cause bronchospasm?
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A patient presents with glaucoma and a history of heart failure. Which of the following medications would you use with caution?
A patient presents with glaucoma and a history of heart failure. Which of the following medications would you use with caution?
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Which of the following medications is most likely to delay optic nerve degeneration and protect retinal neurons from death?
Which of the following medications is most likely to delay optic nerve degeneration and protect retinal neurons from death?
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What should be done to increase the absorption of eye drops after administration?
What should be done to increase the absorption of eye drops after administration?
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Which option is a specific caution related to elderly patients taking β blockers?
Which option is a specific caution related to elderly patients taking β blockers?
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Which condition is a significant risk when medications contain benzalkonium as a preservative?
Which condition is a significant risk when medications contain benzalkonium as a preservative?
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What monitoring is recommended for patients using β blockers initially?
What monitoring is recommended for patients using β blockers initially?
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Which of the following could potentially occur from using cholinesterase inhibitors in certain patients?
Which of the following could potentially occur from using cholinesterase inhibitors in certain patients?
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What is the primary purpose of topical cyclosporine ophthalmic emulsion?
What is the primary purpose of topical cyclosporine ophthalmic emulsion?
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Which class of medications is commonly associated with causing dry eye due to their side effects?
Which class of medications is commonly associated with causing dry eye due to their side effects?
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What is a significant risk factor for the exacerbation of dry eye symptoms?
What is a significant risk factor for the exacerbation of dry eye symptoms?
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In which situation are steroids typically avoided in dry eye treatment?
In which situation are steroids typically avoided in dry eye treatment?
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Which of the following is NOT a recommended management strategy for individuals with dry eyes?
Which of the following is NOT a recommended management strategy for individuals with dry eyes?
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Which systemic medication is most likely to contribute to dry eye by causing aqueous tear deficiency?
Which systemic medication is most likely to contribute to dry eye by causing aqueous tear deficiency?
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What adverse effect is common to the use of ocular decongestants?
What adverse effect is common to the use of ocular decongestants?
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Which of the following conditions is most commonly associated with dry eye in older adults?
Which of the following conditions is most commonly associated with dry eye in older adults?
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Which treatment for bacterial conjunctivitis is typically not used for the duration of 7–14 days?
Which treatment for bacterial conjunctivitis is typically not used for the duration of 7–14 days?
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What is a crucial patient education point for those diagnosed with bacterial conjunctivitis?
What is a crucial patient education point for those diagnosed with bacterial conjunctivitis?
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In high-risk patients, which condition is indicated as a contraindication for ocular decongestants?
In high-risk patients, which condition is indicated as a contraindication for ocular decongestants?
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Which medication from the Macrolides class is used for bacterial conjunctivitis?
Which medication from the Macrolides class is used for bacterial conjunctivitis?
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What is a recommended practice to minimize adverse effects from eye treatments?
What is a recommended practice to minimize adverse effects from eye treatments?
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What symptom would most likely indicate a need for cautious assessment, as it could signify an underlying issue rather than allergies?
What symptom would most likely indicate a need for cautious assessment, as it could signify an underlying issue rather than allergies?
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What is not a method for symptom relief in allergic eye conditions?
What is not a method for symptom relief in allergic eye conditions?
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Which ocular treatment is reserved for short-term therapy to avoid rebound congestion?
Which ocular treatment is reserved for short-term therapy to avoid rebound congestion?
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What is the primary mechanical cause of angle closure glaucoma?
What is the primary mechanical cause of angle closure glaucoma?
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What is the recommended initial treatment approach for acute angle closure glaucoma?
What is the recommended initial treatment approach for acute angle closure glaucoma?
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Which of the following treatments for allergic conjunctivitis provides immediate symptomatic relief?
Which of the following treatments for allergic conjunctivitis provides immediate symptomatic relief?
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What is the therapeutic goal of managing allergic conjunctivitis?
What is the therapeutic goal of managing allergic conjunctivitis?
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What is the mechanism of action of ocular decongestants in treating allergic conjunctivitis?
What is the mechanism of action of ocular decongestants in treating allergic conjunctivitis?
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What is a key prescribing consideration when using glucocorticoids for allergic conjunctivitis?
What is a key prescribing consideration when using glucocorticoids for allergic conjunctivitis?
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Which of the following is a treatment option for angle closure glaucoma?
Which of the following is a treatment option for angle closure glaucoma?
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Which symptom is NOT associated with allergic conjunctivitis?
Which symptom is NOT associated with allergic conjunctivitis?
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What is the primary goal of treatment for Primary Open-Angle Glaucoma (POAG)?
What is the primary goal of treatment for Primary Open-Angle Glaucoma (POAG)?
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Which age-related factor increases the risk for developing POAG?
Which age-related factor increases the risk for developing POAG?
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Which class of drugs is considered first-line treatment for POAG?
Which class of drugs is considered first-line treatment for POAG?
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Which of the following is a common adverse effect of nonselective beta blockers used in glaucoma treatment?
Which of the following is a common adverse effect of nonselective beta blockers used in glaucoma treatment?
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What treatment is indicated for a patient with severe disease and risk factors for disease progression in POAG?
What treatment is indicated for a patient with severe disease and risk factors for disease progression in POAG?
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What is the mechanism of action of beta blockers in the treatment of POAG?
What is the mechanism of action of beta blockers in the treatment of POAG?
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Which systemic condition is associated with a higher risk of developing POAG?
Which systemic condition is associated with a higher risk of developing POAG?
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Which of the following is a second-line agent for treating POAG?
Which of the following is a second-line agent for treating POAG?
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What common adverse effect might a patient experience with carbonic anhydrase inhibitors?
What common adverse effect might a patient experience with carbonic anhydrase inhibitors?
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What is the target IOP reduction goal for initial treatment in POAG?
What is the target IOP reduction goal for initial treatment in POAG?
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What is the mechanism of action (MOA) of Timolol and Betaxolol?
What is the mechanism of action (MOA) of Timolol and Betaxolol?
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What Beta blocker is the only ophthalmic B blocker that is B1 selective?
What Beta blocker is the only ophthalmic B blocker that is B1 selective?
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What is the mechanism of action of Prostaglandin Analogues?
What is the mechanism of action of Prostaglandin Analogues?
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What class of drug is Pilocarpine?
What class of drug is Pilocarpine?
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What is the mechanism of action (MOA) of Pilocarpine?
What is the mechanism of action (MOA) of Pilocarpine?
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What class of drug is Dorzolamide?
What class of drug is Dorzolamide?
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What ophthalmic drug has a bitter aftertaste, blurred vision, and causes burning/stinging?
What ophthalmic drug has a bitter aftertaste, blurred vision, and causes burning/stinging?
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What is the site of action of B-adrenoceptor blockers, carbonic anhydrase inhibitors, A2 adrenoceptor agonists and epinephrine?
What is the site of action of B-adrenoceptor blockers, carbonic anhydrase inhibitors, A2 adrenoceptor agonists and epinephrine?
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What is the site of action of prostaglandins?
What is the site of action of prostaglandins?
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What preservative requires waiting 15 minutes before inserting contact lenses?
What preservative requires waiting 15 minutes before inserting contact lenses?
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What class of medication can cause orthostatic hypotension?
What class of medication can cause orthostatic hypotension?
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What is the mechanism of action of Cromolyn and Lodoxamide?
What is the mechanism of action of Cromolyn and Lodoxamide?
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Match the following classes of antibiotics used in the management of bacterial conjunctivitis with their corresponding examples:
Match the following classes of antibiotics used in the management of bacterial conjunctivitis with their corresponding examples:
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What is the mechanism of action (MOA) of Topical Cyclosporine Ophthalmic Emulsion?
What is the mechanism of action (MOA) of Topical Cyclosporine Ophthalmic Emulsion?
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Study Notes
Pharmacotherapy II: Ophthalmic Diseases
- Course offered by the Augsburg PA Program in 2025
- Instructor: Miranda LaCroix, MSPAS, PA-C
Objectives
- Describe the physiology and treatments for primary open-angle and angle-closure glaucoma
- Identify first and second-line agents for open-angle glaucoma
- Select the best medication for a patient scenario considering lifespan effects
- Summarize prescribing considerations and patient education for glaucoma
- Explain the physiology of allergic conjunctivitis, dry eye, and bacterial conjunctivitis
- Summarize prescribing considerations and patient education for allergic and bacterial conjunctivitis
- Identify at least two drugs for each class of commonly prescribed topical ophthalmic antibacterial agents for bacterial conjuntivitis or eye trauma
Glaucoma
- Group of eye disorders causing progressive optic nerve damage
- Primarily due to increased intraocular pressure (IOP)
- Second leading cause of blindness behind cataracts
Progression of Vision Loss in Glaucoma
- Visual loss initially progresses in the peripheral visual field
- As the disease advances, loss occurs in the central visual field
Normal Anterior Eye
- Diagram illustrating the flow of aqueous humor within the eye. Includes the cornea, lens, iris, trabecular meshwork, Schlemm's canal, and ciliary body.
- Labelled diagram of components like vitreous humor, optic nerve, retina etc. (Refer to images in the notes for visual representation)
Primary Open Angle Glaucoma (POAG)
- Progressive optic nerve damage with visual impairment.
- Visual loss starts in the peripheral visual field and progresses to the center.
Acute Angle-Closure Glaucoma
- Sudden rise in IOP due to iris displacement, blocking aqueous humor outflow
- Immediate, noticeable vision loss is a key symptom.
Open vs. Closed Angle Glaucoma
- Open angle: gradual blockage of drainage canals
- Closed angle: sudden blockage of drainage canals with rapid increase in IOP.
POAG Risk Factors
- Elevated IOP: Increased intraocular pressure is a significant risk factor
- Ethnicity: African or Hispanic descent
- Family History: Glaucoma in family history
- Age: Older age is a risk factor
- Cornea Thickness: Thinner central corneal thickness
- Myopia: Nearsightedness (myopia)
- Diabetes: Type 2 diabetes
POAG Treatment Goals
- Control IOP: Managing intraocular pressure
- Stabilize optic nerve and retinal fibers
- Prevent further vision loss
- Minimize adverse effects of therapy
Target IOP in POAG Treatment
- Determined by patient's baseline IOP and visual field loss.
- The initial target is at least 25% lower than baseline
- Greater reductions (30-50%) might be required for patients with severe disease, risk factors, or normal tension glaucoma
POAG Treatment: First and Second Line
- First Line (Topical): Beta-blockers, Prostaglandin analogs, Alpha2-adrenergic agonists
- Second Line: Carbonic anhydrase inhibitors, Cholinergics, Rho Kinase inhibitors
Glaucoma Medication Classes, Mechanisms, and Adverse Effects
- (Refer to Table on page 11 for specific information)*
- Different classes, mechanisms, and adverse effects for these medications.
Drugs Used in Glaucoma Treatment (Refer to Table, page 14)
- Specific medications within each class, their receptor specificity, formulations, and usual dosages
Prostaglandin Analogues
- Mechanism: Lower IOP by facilitating aqueous humor outflow.
- Common adverse effects include increased brown pigmentation of the iris and eyelids as well as eyelashes increases in length, thickness and color.
- Other common adverse effects include visual changes, ocular irritation, and swelling. (Refer to page 15 for a complete list)
a2-Adrenergic Agonists
- Mechanism: Lower IOP by reducing aqueous humor production
- Common adverse effects include dry mouth, ocular hyperemia, local burning/stinging, blurry vision.
- Other possible adverse effects include head ache and fatigue.
Cholinergics
- Mechanism: Increase aqueous humor outflow. Common adverse effects include miosis (constricted pupils), retinal detachment., local irritation, and eye pain.
- Other adverse effects include rare systemic effects (bradycardia, bronchospasm, etc.).
Carbonic Anhydrase Inhibitors
- Mechanism: Decrease aqueous humor production
- Common adverse effects include bitter aftertaste, blurred vision, burning sensation and stinging.
- Other systemic effects include malaise, anorexia, fatigue, and paraesthesias
Glaucoma Patient Education
- Adherence to medication schedule is critical
- Seek immediate medical attention for severe eye pain, headache.
- Use sunglasses during photophobia
- Avoid touching the eye dropper to the eye to prevent infection
Patient-Centered Care Across the Lifespan (Refer to page 21 for details)
- Special considerations in children, elderly, etc. due to differing pharmacokinetics.
Key Prescribing Considerations
- Establish baseline measurements, including IOP, fundoscopic exams, visual field testing, and other necessary assessments.
- Monitor intraocular pressure routinely Medication safety and avoidance of contraindications in specific patient populations
- Consideration for other health conditions that may affect treatment or medication response.
Angle Closure Glaucoma
- Less common than open-angle glaucoma
- Mechanical issues in the outflow of aqueous humor; increase in intraocular pressure causes vision loss in hours or days
- Requires prompt treatment and possible surgery
Acute Conjunctivitis: Bacterial, Viral, and Allergic
- Bacterial: Redness with sticky discharge. Usually due to bacterial infection; easily spread. (Refer to pages 24-25 for details)
- Viral: Red, itchy eyes, watery discharge; contagious. Often termed "pink eye." (Refer to pages 24-25 for details)
- Allergic: Red, itchy eyes; inflammation results from exposure to airborne allergens; not contagious. (Refer to pages 26-27 for details)
Bacterial Conjunctivitis Management
- Various topical ophthalmic antibiotics, including fluoroquinolones, aminoglycosides, macrolides, tetracyclines, and polymyxin B/trimethoprim are common treatments. (Refer to page 32 for a list of specific drugs.
Key Prescribing Considerations & Patient Education for Conjunctivitis (Refer to page 33 for details)
- Instructions on hygiene
- Proper handling of eye drops or other medications
- Avoidance of sharing personal items or contaminated surfaces
Dry Eye: Systemic and Treatment Considerations
- Systemic medications: Considerations for diuretics, anticholinergics.
- Treatment: Ophthalmic demulcents, ocular decongestants, topical cyclosporine, steroids
Dry Eye Management
- Ophthalmic Demulcents: Artificial tears replacing natural tears.
- Ocular Decongestants: Symptomatic relief, but not a cure
- Topical Cyclosporine: Suppresses the immune system to reduce inflammation
Key Prescribing Considerations and Patient Education for Dry Eye (Refer to page 36)
- Hydration and environmental conditions.
- Avoiding allergens and irritants that worsen symptoms
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