
<ul>
  <li>Many therapies utilise the pharmacology of the autonomic nervous system</li>
  <li>Carbonic anhydrase: numerous subtypes throughout ocular tissues</li>
  <ul>
    <li>Carbonic anhydrase isoenzyme II works in the non-pigmented ciliary epithelium</li>
    <li>
      Formation of aqueous relies on bicarbonate which is produced by carbonic anhydrase catalysing
      the hydration of carbon dioxide to bicarbonate
    </li>
    <li>Note: carbonic anhydrase has a high turnover</li>
  </ul>
  <li>
    Carbonic anhydrase inhibitors like acetazolamide <span className="font-semibold">reduce aqueous production</span>
  </li>
  <ul>
    <li>
      Part of the sulfonamide class of diuretics, related to sulphonylureas (eg. gliclazide) and
      sulfonamide antibiotics (eg. sulfamethoxazole)
    </li>
  </ul>
</ul>
<HotTopic>
  <p>
    A severe allergy to sulphonylureas is a contraindication to use of carbonic anhydrase inhibitors
  </p>
</HotTopic>
<ul>
  <li>Side effects</li>
  <ul>
    <li>Ocular: tearing, allergic blepharoconjunctivitis, transient myopia</li>
    <li>Potassium depletion</li>
    <li>Dermatitis</li>
    <li>Renal calculi</li>
    <li>Metabolic acidosis</li>
    <li>Peripheral paraesthesia</li>
    <li>Thrombocytopenia&nbsp;</li>
    <li>Agranulocytosis and aplastic anaemia</li>
    <li>Can precipitate sickling in those with sickle cell anaemia</li>
    <li>Hepatic encephalopathy</li>
    <li>Steven-Johnson syndrome</li>
    <li>Teratogenicity is documented in mouse models</li>
  </ul>
</ul>
<ul>
  <li>
    Prostaglandin analogues (eg. latanoprost): <span className="font-semibold">prostaglandin F2-alpha analogues</span> and
    prostanoid FP receptor agonists which reduce IOP by <span className="font-semibold">increasing aqueous outflow</span>{' '}
    via the uveoscleral route.
  </li>
  <ul>
    <li>Prodrugs that are activated by corneal esterases</li>
    <li>
      Bimatoprost is a synthetic prostamide analogue and increases both uveoscleral and conventional
      outflow
    </li>
  </ul>
</ul>
<HotTopic>
  <p>Avoid prostaglandin analogues in uveitis. They can precipitate an episode or CMO
    (contraindicated after complicated cataract surgery)</p>
</HotTopic>
<p>Pregnancy</p>
<ul>
  <li>
    Prostaglandin analogues, carbonic anhydrase inhibitors and beta-blockers have all been found to
    have teratogenic effects
  </li>
  <li>
    Brimonidine and other alpha-2 agonists are the safest in pregnancy. However they should be
    avoided while breastfeeding
  </li>
</ul>
<div className="bg-blue-200 px-4 rounded-md shadow-lg dark:text-gray-700">
  <table>
    <tbody>
      <tr>
        <td>
          <span className="font-semibold">Glaucoma medication side effects</span>
        </td>
      </tr>
      <tr>
        <td>Bimatoprost</td>
        <td>
          Increased iris and periocular skin pigmentation<br />Iris pigment epithelial cysts<br />Hypertrichosis
          of eyelashes<br />Periorbital fat atrophyPrecipitate uveitis<br />Cystoid macular oedema<br />Conjunctival
          hyperaemia<br />Reactivation of herpetic disease
        </td>
      </tr>
      <tr>
        <td>Timolol</td>
        <td>
          Allergic blepharoconjunctivits<br />Punctate keratitisBradycardia (may interact with other
          cardiac agents)<br />Depression<br />Bronchospasm (contraindicated in asthma/COPD)&nbsp;
        </td>
      </tr>
      <tr>
        <td>Pilocarpine</td>
        <td>Increased vascular permeability</td>
      </tr>
      <tr>
        <td>Dipivefrin (epinephrine)</td>
        <td>Conjunctival injectionCMO (especially in aphakics)</td>
      </tr>
    </tbody>
  </table>
</div>


Pharmacology

Intraocular Pressure Control

Intro

FRCOphth Part 1 Study Notes

Orbit and ocular adnexae

Orbit

Extraocular Muscles

Orbital Blood Vessels

Paranasal Sinuses

Lacrimal Glands

Tear Film

Eyelids

Blinking

Anterior segment - ocular surface

Conjunctiva

Conjunctivitis

Sclera

Cornea

Corneal Structure And Development

Corneal Physiology

AC to Lens

Angle

Ciliary Body

Aqueous Humour Dynamics

Iris

Pupil

Lens

Posterior segment

Choroid

Vitreous

Retinal Macrostructure

Neurosensory Retina

Retinal Pigment Epithelium

Neuroanatomy

Venous Sinuses

Cerebral Ventricles

Cerebral Blood Supply

Supranuclear Gaze Pathways

Head And Neck Autonomic Nervous Supply

Head And Neck Glands

Osteology

Nerves

Muscles And Pharyngeal Arches

Extraocular Nerves

Sensory Nerves

Physiology

Physics Of Blood Flow

Neuronal Control Of Blood Vessels

Oxygen-Haemoglobin Dissociation Curve

Cytochrome p450

Pituitary Gland

Thyroid Hormone Production

Insulin

Glucagon

Parathyroid Hormone

Corticosteroids

Catecholamines

Cardiac Cycle

Renal Physiology

Fluid Balance

Acid-Base Balance

Muscle Physiology

Sensory Fibres

Cutaneous Receptors

Endocytosis

Glycosaminoglycans

Condensed Ocular Biochemistry

Eye Movements

Accomodation

Vision

Visual Cycle And Phototransuction

Visual Pathway

Visual Acuity

Colour Vision

Binocular Vision

Pathology

Collagen

Tissue Damage

Inflammation

Disease Entities

Wound Healing

Thrombosis / Atherosclerosis

Cell Growth

Neoplasia

Histopathology

Nystagmus

Free Radicals And Antioxidants

Immunology

Ocular Immunology

Microbiology

Viral Infections

Bacterial Infections

Fungal Infections

Protozoa

Nematodes

Antimicrobials

Genetics

Chromosomes

Mitosis

Meiosis

Genes

Polypeptide Synthesis

Histones

MicroRNA

Hardy-Weinberg Equilibrium

Mutations

Chromosome Defects

Autosomal Inheritance

X-Linked Inheritance

Mitochondrial Inheritance

Multifactorial Inheritance