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Glaucoma medication.

This feature considers the mechanism of action of glaucoma drops and possible ocular and systemic side effects.

Optometrists

01 Which of the following statements regarding IOP lowering drops for this patient is false?

a) Miotics and prostaglandin analogues can make the iritis worse

b) Carbonic anhydrase inhibitors are contraindicated in the presence of corneal decompensation

c) The type of drop shown can be used even if the patient has cardiovascular or respiratory issues

d) Alpha adrenergic agonists are contraindicated in patients taking tricyclic antidepressant medications

02 Which of the following statements regarding timolol is false?

a) It lowers the IOP by reducing aqueous formation

b) Ganfort is a combination of bimatoprost and timolol

c) It is available in 0.25% and 0.50% concentrations

d) It only blocks beta adrenergic receptor [beta]1 and not [beta]2

03 Which of the following is not a potential systemic side effect of timolol?

a) Hypotension

b) Increased libido

c) Shortness of breath

d) Depression

Therapeutic optometrists

04 Which of the following statements is false?

a) The type of drug shown is effective at reducing IOP but may potentially result in more systemic side effects than other IOP lowering drops

b) Miotics can induce myopia and headaches in younger patients

c) Alpha adrenergic agonists and carbonic anhydrase inhibitors may not be effective at reducing IOP sufficiently

d) Beta blockers can potentially affect the physical activity of the patient

05 How is the IOP predominantly lowered by the drug shown?

a) Reduced aqueous production

b) Enhanced aqueous outflow due to ciliary muscle contraction

c) Increased uveoscleral outflow

d) Reduced uveoscleral outflow

06 Which of the following is not a potential ocular side effect of prostaglandin analogues?

a) Hypotrichosis

b) Increased iris pigmentation

c) Increased risk of cystoid macular oedema in pseudophakes and patients with a history of uveitis

d) Conjunctival hyperaemia

07 How is the IOP predominantly lowered by the drug shown?

a) Increased trabecular meshwork outflow

b) Increased uveoscleral outflow

c) Reduced aqueous production

d) Increased aqueous production

08 Which other IOP lowering agent is combined with the drug shown to form Cosopt?

a) Brimonidine

b) Timolol

c) Brinzolamide

d) Bimatoprost

09 Which of the following is a potential side effect of the drug shown?

a) Bitter metallic taste in mouth

b) Conjunctival hyperaemia

c) Irreversible corneal oedema in patients with a compromised endothelium

d) All of these options

10 What is the name of the drug shown when combined with timolol?

a) Duotrav

b) Ganfort

c) Xalacom

d) Combigan

11 Which of the following statements regarding the drug shown is false?

a) Reduces aqueous production to lower IOP

b) Increases aqueous outflow through uveoscleral pathway

c) It is an [alpha]2 receptor agonist

d) 1% solution is used to prevent IOP spikes following anterior segment laser surgery

12 Which of the following statements regarding Brimonidine is false?

a) Corneal irritation/foreign body sensation is a potential side effect

b) Dry mouth is a potential side effect

c) It can cross the blood brain barrier to potentially cause hypotension and lethargy especially in elderly people

d) It is indicated for use in patients taking monoamine oxidase inhibitors

Exam questions

Under the enhanced CET rules of the GOC, MCQs for this exam appear online at www.optometry.co.uk. Please complete online by midnight on 16 November 2018. You will be unable to submit exams after this date.

Course code: C-60087 Deadline: 16 November 2018

Learning objectives

* Understand the different topical treatment options for glaucoma (Group 6.1.11)

* Be aware of the adverse effects of different glaucoma drugs (Group 1.1.4)

About the authors

* Prashant Shah is an optometrist with postgraduate diplomas in ophthalmology and in clinical optometry and currently works in routine practice.

* Yashita Shah is an optometrist working in independent practice. She holds a postgraduate diploma in ophthalmology.

Caption: Image A

A 50-year-old woman with left iritis, intraocular pressure (IOP) of 30mmHg and mild corneal oedema attends. She is taking amitriptyline for shingles pain.

Caption: Image B

A 30-year-old man attends with pigment dispersion syndrome and IOPs of 35mmHg in each eye. He runs marathons on a regular basis.

Caption: Image C

A 60-year-old woman with bradycardia is using the drops shown three times daily. She also takes thyroxine.

Caption: Image D

An 80-year-old asthmatic man is using the drops shown. He has longstanding Fuchs'dystrophy and has also had bilateral cataract extraction.
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Title Annotation:VRICS
Author:Shah, Prashant; Shah, Yashita
Publication:Optometry Today
Date:Oct 1, 2018
Words:732
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