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Ocular Pharmacology Flashcards

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  1. Which class of drugs is specifically contraindicated with topical pilocarpine due to risk of cholinergic toxicity?

    Answer: Systemic cholinesterase inhibitors (e.g., echothiophate iodide)

    Echothiophate (an irreversible cholinesterase inhibitor) combined with pilocarpine produces additive muscarinic stimulation; echothiophate also prolongs succinylcholine-induced apnea in surgery.

  2. Brimonidine (alpha-2 agonist) lowers IOP through which dual mechanism?

    Answer: Decreasing aqueous production AND increasing uveoscleral outflow

    Brimonidine stimulates alpha-2 adrenergic receptors to both decrease aqueous production (reduced cAMP) and increase uveoscleral outflow, achieving a 20–25% IOP reduction.

  3. Topical corticosteroids used for ocular inflammation can cause which serious ocular complication with prolonged use?

    Answer: Posterior subcapsular cataracts and elevated IOP (steroid-induced glaucoma)

    Long-term topical steroid use induces posterior subcapsular cataracts and increases IOP in susceptible 'steroid responders' by reducing trabecular outflow facility.

  4. Which mydriatic agent is preferred for fundus examination in pediatric patients due to its shorter duration?

    Answer: Tropicamide 0.5–1%

    Tropicamide has a short duration (4–8 hours) making it practical for routine dilation, while atropine's 7–14 day effect is reserved for cycloplegic refraction when needed.

  5. Systemic side effects of topical phenylephrine 10% include:

    Answer: Hypertension and tachycardia due to systemic absorption

    Phenylephrine 10% can be absorbed systemically via nasolacrimal drainage, stimulating alpha-1 receptors to cause hypertension, sometimes severe, especially in elderly patients.

  6. Topical antihistamine-mast cell stabilizer combinations (e.g., olopatadine) are first-line treatment for:

    Answer: Allergic conjunctivitis

    Dual-acting antihistamine/mast cell stabilizers like olopatadine block H1 receptors and prevent mast cell degranulation, providing rapid and sustained relief from allergic conjunctivitis symptoms.