Introduction: Glaucoma is a group of optic neuropathies managed primarily by lowering intraocular pressure (IOP). This MCQ set addresses drugs used in glaucoma — beta blockers, prostaglandin analogs, carbonic anhydrase inhibitors, alpha-2 agonists, miotics, and osmotic agents — emphasizing mechanisms of action, pharmacokinetics, indications, adverse effects, contraindications, and drug interactions. Content is tailored for B.Pharm students studying pharmacology and clinical therapeutics, with focus on topical ocular therapy, systemic effects, combination regimens, and monitoring parameters. These questions aim to deepen understanding of rational drug selection, dosing considerations, and patient counseling in glaucoma care. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which class of glaucoma drugs primarily reduces aqueous humor production by inhibiting carbonic anhydrase in the ciliary body?
- Beta blockers
- Prostaglandin analogs
- Carbonic anhydrase inhibitors
- Alpha-2 adrenergic agonists
Correct Answer: Carbonic anhydrase inhibitors
Q2. Which topical agent is most associated with increasing uveoscleral outflow and causing iris pigmentation over time?
- Timolol
- Latanoprost
- Brimonidine
- Pilocarpine
Correct Answer: Latanoprost
Q3. Which mechanism best describes how beta-blocker eye drops lower IOP?
- Increase trabecular outflow
- Decrease aqueous humor production by blocking β-receptors
- Inhibit carbonic anhydrase to reduce bicarbonate formation
- Cause miosis to open the angle
Correct Answer: Decrease aqueous humor production by blocking β-receptors
Q4. Which glaucoma drug is a cholinergic agonist that increases trabecular outflow by contracting the ciliary muscle?
- Brinzolamide
- Acetazolamide
- Pilocarpine
- Latanoprost
Correct Answer: Pilocarpine
Q5. A patient with asthma should avoid which topical glaucoma medication due to potential bronchospasm?
- Prostaglandin analogs
- Topical beta blockers like timolol
- Topical carbonic anhydrase inhibitors like dorzolamide
- Alpha-2 agonists like brimonidine
Correct Answer: Topical beta blockers like timolol
Q6. Which systemic adverse effect is most commonly associated with oral carbonic anhydrase inhibitors such as acetazolamide?
- Hyperkalemia
- Metabolic acidosis
- Hypoglycemia
- Hypertension
Correct Answer: Metabolic acidosis
Q7. Which agent is commonly used as an emergency osmotic therapy to rapidly lower IOP in acute angle-closure glaucoma?
- Mannitol
- Dorzolamide
- Betaxolol
- Latanoprost
Correct Answer: Mannitol
Q8. Which prostaglandin analog is a prodrug activated in the cornea to increase uveoscleral outflow?
- Latanoprost
- Timolol
- Brimonidine
- Acetazolamide
Correct Answer: Latanoprost
Q9. Brimonidine lowers IOP primarily by which of the following actions?
- Increasing aqueous production
- Alpha-2 mediated decrease in aqueous production and increased uveoscleral outflow
- Inhibition of carbonic anhydrase
- Direct dilation of trabecular meshwork
Correct Answer: Alpha-2 mediated decrease in aqueous production and increased uveoscleral outflow
Q10. Combination eye drops containing a beta blocker and carbonic anhydrase inhibitor provide additive IOP reduction primarily because:
- Both increase trabecular outflow
- Both reduce aqueous production by different mechanisms
- One causes miosis, the other mydriasis
- They block prostaglandin synthesis
Correct Answer: Both reduce aqueous production by different mechanisms
Q11. Which topical glaucoma medication is most likely to cause eyelash growth and hypertrichosis as a side effect?
- Brimonidine
- Latanoprost
- Timolol
- Dorzolamide
Correct Answer: Latanoprost
Q12. Which property increases the ocular penetration of topical glaucoma drugs?
- High molecular weight and high ionization at physiological pH
- Low lipophilicity and large particle size
- Optimal lipophilicity and being unionized at tear pH
- Administration with systemic anticholinergics
Correct Answer: Optimal lipophilicity and being unionized at tear pH
Q13. Which of the following is a sulfonamide topical carbonic anhydrase inhibitor used for glaucoma?
- Brinzolamide
- Latanoprost
- Pilocarpine
- Timolol
Correct Answer: Brinzolamide
Q14. Which drug class is contraindicated in patients with narrow-angle glaucoma because it can cause mydriasis and precipitate angle closure?
- Muscarinic agonists
- Topical beta blockers
- Anticholinergic mydriatics (e.g., tropicamide)
- Prostaglandin analogs
Correct Answer: Anticholinergic mydriatics (e.g., tropicamide)
Q15. Which topical beta blocker is relatively selective for β1 receptors and may be preferred in patients with reactive airway disease?
- Timolol
- Betaxolol
- Levobunolol
- Carteolol
Correct Answer: Betaxolol
Q16. A patient on topical prostaglandin analogs is counseled about which cosmesis-related adverse effect?
- Periorbital fat atrophy and deepening of the upper eyelid sulcus
- Increased tear production causing epiphora
- Permanent corneal anesthesia
- Systemic hypertension
Correct Answer: Periorbital fat atrophy and deepening of the upper eyelid sulcus
Q17. Which of the following statements about timolol eye drops is true regarding systemic absorption?
- Systemic absorption is negligible and requires no precautions
- Punctal occlusion after instillation reduces systemic absorption
- Systemic absorption only occurs with oral administration
- Systemic effects are limited to ocular irritation
Correct Answer: Punctal occlusion after instillation reduces systemic absorption
Q18. Which drug is an α-2 adrenergic agonist used topically that can cause allergic follicular conjunctivitis as a local adverse effect?
- Brimonidine
- Acetazolamide
- Latanoprost
- Pilocarpine
Correct Answer: Brimonidine
Q19. Which agent works by directly increasing trabecular (conventional) outflow through contraction of the ciliary muscle and widening of trabecular spaces?
- Pilocarpine
- Latanoprost
- Brinzolamide
- Brimonidine
Correct Answer: Pilocarpine
Q20. Which medication is often avoided in elderly patients due to risk of systemic metabolic acidosis and renal stone formation when used orally?
- Topical timolol
- Oral acetazolamide
- Latanoprost eye drops
- Brimonidine eye drops
Correct Answer: Oral acetazolamide
Q21. In refractory glaucoma surgery, which class of drugs is commonly used preoperatively to lower IOP rapidly?
- Prostaglandin analogs only
- Osmotic agents like mannitol or hypertonic saline
- Topical beta blockers only
- Systemic NSAIDs
Correct Answer: Osmotic agents like mannitol or hypertonic saline
Q22. Which pharmacodynamic property explains why prostaglandin analogs are dosed once daily at night?
- Short duration of action and rapid washout
- Prolonged IOP-lowering effect and enhanced nocturnal efficacy
- Increased systemic side effects in daytime
- Instability in light leading to degradation
Correct Answer: Prolonged IOP-lowering effect and enhanced nocturnal efficacy
Q23. Which statement is true regarding fixed-dose combination (FDC) eye drops in glaucoma therapy?
- FDC always increase systemic adverse effects compared to separate drops
- FDCs improve adherence by reducing number of drops and may reduce exposure to preservatives
- FDCs are contraindicated in all patients with respiratory disease
- FDCs are less effective than individual agents given separately
Correct Answer: FDCs improve adherence by reducing number of drops and may reduce exposure to preservatives
Q24. Which lab monitoring is most relevant for a patient on chronic systemic acetazolamide therapy?
- Serum lipid profile
- Serum electrolytes and acid-base status
- Thyroid function tests
- Coagulation profile
Correct Answer: Serum electrolytes and acid-base status
Q25. Which glaucoma medication has partial β-adrenergic agonist activity and may cause less bradycardia than timolol?
- Carteolol
- Latanoprost
- Brimonidine
- Pilocarpine
Correct Answer: Carteolol
Q26. Which of the following is the primary therapeutic target for drugs treating open-angle glaucoma?
- Anterior chamber infection
- Reduction of intraocular pressure by altering aqueous humor dynamics
- Increase corneal thickness
- Raise systemic blood pressure
Correct Answer: Reduction of intraocular pressure by altering aqueous humor dynamics
Q27. Which topical agent is preferred in pregnancy due to relatively lower systemic absorption and safety profile?
- Topical timolol without precautions
- Use of prostaglandin analogs is always safe in pregnancy
- Lowest effective dose with punctal occlusion; consult specialist—no universally safe choice
- Oral acetazolamide is preferred
Correct Answer: Lowest effective dose with punctal occlusion; consult specialist—no universally safe choice
Q28. Which adverse effect is particularly associated with topical carbonic anhydrase inhibitors?
- Systemic bronchospasm
- Taste perversion (dysgeusia) and local stinging
- Marked eyelid hyperpigmentation
- Significant pupil dilation
Correct Answer: Taste perversion (dysgeusia) and local stinging
Q29. Which drug class lowers IOP primarily by remodeling extracellular matrix in the uveoscleral pathway?
- Prostaglandin analogs
- Carbonic anhydrase inhibitors
- Beta blockers
- Miotics
Correct Answer: Prostaglandin analogs
Q30. For patient counseling, which instruction reduces systemic absorption of topical glaucoma drops and associated side effects?
- Instill two drops rapidly without wiping excess
- Perform punctual occlusion or gentle nasolacrimal pressure for 1–2 minutes after instillation
- Lie down immediately after instillation
- Heat the bottle before use to increase absorption
Correct Answer: Perform punctual occlusion or gentle nasolacrimal pressure for 1–2 minutes after instillation
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
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