Board Certified Ophthalmologist Glaucoma Diagnosis and Management 3 — Questions and Answers
Question 1: Latanoprost lowers IOP primarily by:
- Decreasing aqueous production
- Increasing uveoscleral outflow (Correct answer)
- Increasing trabecular outflow via ciliary muscle contraction
- Reducing episcleral venous pressure
Correct answer: Increasing uveoscleral outflow
Prostaglandin F2α analogs remodel ciliary muscle extracellular matrix to increase uveoscleral outflow.
Question 2: Which adverse effect is particularly characteristic of netarsudil?
- Iris heterochromia
- Cornea verticillata (Correct answer)
- Bradycardia
- Metabolic acidosis
Correct answer: Cornea verticillata
The Rho kinase inhibitor netarsudil commonly causes hyperemia and whorl-like corneal deposits (verticillata).
Question 3: Brimonidine should be avoided in infants and young children chiefly because of:
- Severe allergic conjunctivitis
- CNS depression and apnea (Correct answer)
- Bronchospasm
- Stevens-Johnson syndrome
Correct answer: CNS depression and apnea
Brimonidine crosses the immature blood-brain barrier and can cause somnolence, hypotension, and apnea in infants.
Question 4: Which glaucoma medication is contraindicated in a patient with moderate persistent asthma?
- Dorzolamide
- Latanoprost
- Timolol (Correct answer)
- Brimonidine
Correct answer: Timolol
Nonselective beta-blockers like timolol can precipitate bronchospasm.
Question 5: A patient on oral acetazolamide is most likely to develop which laboratory abnormality?
- Hyperkalemia
- Metabolic alkalosis
- Hypokalemia with metabolic acidosis (Correct answer)
- Hypercalcemia
Correct answer: Hypokalemia with metabolic acidosis
Systemic carbonic anhydrase inhibitors cause bicarbonate wasting and potassium loss, leading to hypokalemic metabolic acidosis.
Question 6: Latanoprostene bunod has a dual mechanism because it additionally:
- Inhibits carbonic anhydrase
- Donates nitric oxide to increase trabecular outflow (Correct answer)
- Blocks beta-1 receptors
- Stimulates alpha-2 receptors
Correct answer: Donates nitric oxide to increase trabecular outflow
Its butanediol mononitrate moiety releases nitric oxide, relaxing the trabecular meshwork to increase conventional outflow.
Question 7: Which drug class both reduces aqueous production and increases uveoscleral outflow?
- Alpha-2 adrenergic agonists (Correct answer)
- Beta-blockers
- Miotics
- Carbonic anhydrase inhibitors
Correct answer: Alpha-2 adrenergic agonists
Alpha-2 agonists such as brimonidine decrease aqueous production and increase uveoscleral outflow.
