Learning unit: Antiglaucoma drugs and mydriatics


Impact of the learning unit

The aim is to provide students with a basic overview of antiglaucoma and mydriatic agents used in
ophthalmology. During the course, students will learn about the mechanisms of action of the most
common antiglaucoma agents, their therapeutic application and side effects. Special attention will
be paid to the pharmaceutical forms of ophthalmic medicinal products and the most frequent
combinations of antiglaucoma drugs used in ophthalmology. Antiglaucoma drugs prevent damage to the
optic nerve by reducing intraocular pressure. Acute glaucoma attack requires urgent treatment.
Mydriatics are used in ophthalmology for both diagnosis and therapy of ocular diseases, e.g. for
prevention of synechiae in eye surgery. Anticholinergic drugs induce cycloplegia along with
mydriasis.


Important terms

antiglaucoma drugs reducing production of aqueous humour

                carbonic anhydrase inhibitors

                               brinzolamide (local administration)

dorzolamide (local administration)

acetazolamide (systemic - orally)

                beta adrenergic receptor blockers

                               timolol (non-selective without ISA)

                               betaxolol (beta 1 selective without ISA)

                               carteolol (non-selective with ISA)


                selective and non-selective sympathomimetics

                               alpha 2 adrenergic agonists

brimonidine

                               adrenaline (IPP eye drops, therapy of neovascular glaucoma)


antiglaucoma drugs increasing uveoscleral outflow

                direct parasympathomimetics (miotics)

                               pilocarpine

                               carbachol (miosis during ocular surgery)

indirect parasympathomimetics (miotics)

                               physostigmine

                                               miosis before intraocular surgery

                                               (earlier also therapy of open-angle glaucoma)

                alpha 2 selective sympathomimetics

                               brimonidine


                prostaglandin F2 alpha analogues

                               latanoprost

travoprost


hyperosmotic antiglaucoma drugs

                mannitol (i.v. in eye surgery)

                glycerol (p.o.)

      not used in chronic therapy of glaucoma


mydriatics

anticholinergics (mydriatic and cycloplegic effects)

                      therapeutic mydriatic drugs (long term, prevention of synechiae)

                                      atropine

                                               hyoscine (scopolamine) (IPP)

                      diagnostic mydriatics (short term, examination of the fundus)

                                      tropicamide

                                               cyclopentolate

                                               homatropine (IPP)



                sympathomimetics

tetryzoline

phenylephrine



Learning outcomes

Student knows basic pharmacological profile (mechanism of action, adverse effects, drug
administration routes, other indications) of the particular groups of drugs used in the treatment
of glaucoma.


Student knows basic pharmacological profile (mechanism of action, adverse effects, drug
administration routes, other indications) of mydriatic agents.


Student explains the term cycloplegic agent.




Recommended study materials

Rang & Dale's Pharmacology E - Book, Humphrey Rang 8th edition, 2016, chapter 8 (pp. 101–112);
chapter 13 (pp. 155–176); chapter 14 (pp. 177–196).


Study materials of the course aVLFA0721p, VLFA0721c, aVLFA0822p and aVLFA0822c.


Chapter 17.4 “Anti-glaucoma and miotic drugs“ and 17.5 „Mydriatics and cyclophlegics“ in the
textbook  “Pharmacology for students  of bachelor’s programmes at LF MU“ (pp. 266-269), in IS
aVLFA0822c.


Exam questions

General pharmacology: 7. Drug administration routes

Special pharmacology: 68. Antiglaucoma drugs and cycloplegics

Detail: 1. adrenaline/noradrenaline, 3. ephedrine/pseudoephedrine, 4.           phenylephrine, 5.
oxymetazoline, 10. timolol, 11. atropine, 14. pilocarpine, 16. physostigmine