This MCQ set focuses on glaucoma pharmacotherapy and treatment strategies tailored for M.Pharm students in the Pharmacotherapeutics I (MPP 102T) course. It covers mechanisms of action, clinical uses, adverse effects, contraindications, drug interactions, and recent therapeutic advances including prostaglandin analogs, beta‑blockers, carbonic anhydrase inhibitors, alpha‑2 agonists, rho‑kinase inhibitors, miotics, and systemic agents. Questions emphasize reasoning about aqueous humour dynamics, IOP reduction strategies, emergency management of acute angle‑closure glaucoma, preservative toxicity, fixed combinations, and perioperative considerations. Use these 20 MCQs with answers to test knowledge, reinforce drug selection principles, and prepare for examinations or clinical decision‑making in glaucoma management. Detailed explanations are not provided here, so review core texts and guidelines to deepen understanding.
Q1. Which of the following best describes the primary mechanism of action of prostaglandin analogs (e.g., latanoprost) in lowering intraocular pressure?
- Decrease aqueous humor production by the ciliary epithelium
- Increase trabecular meshwork outflow through cytoskeletal modulation
- Increase uveoscleral outflow by remodeling extracellular matrix
- Inhibit carbonic anhydrase in the ciliary processes
Correct Answer: Increase uveoscleral outflow by remodeling extracellular matrix
Q2. Which systemic adverse effect is most likely to occur after instillation of topical timolol in a susceptible patient?
- Bronchospasm
- Iris pigmentation
- Eyelash hypertrichosis
Correct Answer: Bronchospasm
Q3. What is the principal pharmacodynamic effect of systemic carbonic anhydrase inhibitors (e.g., acetazolamide) relevant to glaucoma therapy?
- Increase uveoscleral outflow
- Reduce aqueous humor formation by inhibiting carbonic anhydrase in the ciliary epithelium
- Constrict the pupil to open the trabecular meshwork
- Lower episcleral venous pressure
Correct Answer: Reduce aqueous humor formation by inhibiting carbonic anhydrase in the ciliary epithelium
Q4. Which adverse metabolic disturbance is commonly associated with chronic systemic use of acetazolamide?
- Metabolic acidosis
- Respiratory alkalosis
- Hyperkalemia
- Hypercalcemia
Correct Answer: Metabolic acidosis
Q5. Brimonidine (an alpha‑2 agonist) lowers IOP primarily by which mechanism?
- Stimulating aqueous humor production via beta receptors
- Decreasing aqueous humor production and increasing uveoscleral outflow
- Blocking trabecular meshwork pores to increase outflow
- Acting as a muscarinic antagonist to dilate the pupil
Correct Answer: Decreasing aqueous humor production and increasing uveoscleral outflow
Q6. Rho‑kinase inhibitors (e.g., netarsudil) reduce intraocular pressure mainly by:
- Decreasing aqueous production via ciliary body necrosis
- Increasing trabecular meshwork outflow and lowering episcleral venous pressure
- Enhancing uveoscleral outflow through prostaglandin pathways
- Blocking carbonic anhydrase in the corneal endothelium
Correct Answer: Increasing trabecular meshwork outflow and lowering episcleral venous pressure
Q7. Pilocarpine reduces IOP by which of the following actions?
- Relaxing the ciliary muscle to increase uveoscleral outflow
- Contracting the ciliary muscle and widening trabecular meshwork spaces to enhance outflow
- Inhibiting carbonic anhydrase in the ciliary body
- Blocking alpha receptors to reduce aqueous production
Correct Answer: Contracting the ciliary muscle and widening trabecular meshwork spaces to enhance outflow
Q8. Chronic use of which topical glaucoma agent is most characteristically associated with iris pigmentation and eyelash growth?
- Latanoprost
- Timolol
- Brimonidine
- Acetazolamide
Correct Answer: Latanoprost
Q9. Which topical glaucoma medication is contraindicated or used with extreme caution in patients with reactive airway disease?
- Timolol
- Betaxolol
- Latanoprost
- Dorzolamide
Correct Answer: Timolol
Q10. Long‑term systemic administration of carbonic anhydrase inhibitors can predispose to which renal complication?
- Nephrolithiasis (renal calculi)
- Acute tubular necrosis
- Proteinuria
- Hypocalciuria
Correct Answer: Nephrolithiasis (renal calculi)
Q11. Which class of topical agents is generally considered first‑line therapy for primary open‑angle glaucoma due to efficacy and once‑daily dosing?
- Prostaglandin analogs (e.g., latanoprost)
- Topical carbonic anhydrase inhibitors (e.g., dorzolamide)
- Topical alpha agonists (e.g., brimonidine)
- Topical miotics (e.g., pilocarpine)
Correct Answer: Prostaglandin analogs (e.g., latanoprost)
Q12. In the emergency management of acute angle‑closure glaucoma, which intervention produces the most rapid reduction in intraocular pressure?
- Oral acetazolamide
- Intravenous mannitol
- Topical latanoprost
- Topical beta‑blocker alone
Correct Answer: Intravenous mannitol
Q13. What is a principal advantage of fixed‑combination topical glaucoma preparations?
- Increased number of daily drops to enhance absorption
- Improved patient adherence and reduced exposure to preservatives
- Guaranteed reduction of systemic side effects
- Elimination of the need for periodic monitoring
Correct Answer: Improved patient adherence and reduced exposure to preservatives
Q14. Which preservative used in many ophthalmic solutions is most frequently implicated in ocular surface toxicity and dry eye symptoms?
- Benzalkonium chloride (BAK)
- Sodium chloride
- Chlorobutanol
- Polyvinyl alcohol
Correct Answer: Benzalkonium chloride (BAK)
Q15. Which topical glaucoma agent is most commonly associated with allergic follicular conjunctivitis as a local adverse effect?
- Brimonidine
- Latanoprost
- Timolol
- Dorzolamide
Correct Answer: Brimonidine
Q16. Co‑administration of topical timolol with which systemic medication increases the risk of severe bradycardia?
- Oral propranolol
- Oral acetazolamide
- Oral latanoprost
- Oral furosemide
Correct Answer: Oral propranolol
Q17. Which glaucoma drug class is generally recommended to avoid during pregnancy because of potential uterine effects and limited safety data?
- Prostaglandin analogs (e.g., latanoprost)
- Topical beta‑blockers (e.g., timolol)
- Topical carbonic anhydrase inhibitors (e.g., dorzolamide)
- Topical alpha‑2 agonists (e.g., brimonidine)
Correct Answer: Prostaglandin analogs (e.g., latanoprost)
Q18. Which statement regarding neuroprotective therapy in glaucoma is most accurate based on current clinical evidence?
- Several neuroprotective drugs are proven to reverse optic nerve damage
- Memantine is standard neuroprotective therapy with strong outcome data
- No pharmacologic agent has definitive clinical proof of neuroprotection in glaucoma
- Topical beta‑blockers are established neuroprotectants
Correct Answer: No pharmacologic agent has definitive clinical proof of neuroprotection in glaucoma
Q19. The primary therapeutic target for most glaucoma treatments is:
- Normalization of retinal perfusion pressure
- Reduction of intraocular pressure (IOP)
- Improvement of visual acuity
- Prevention of cataract formation
Correct Answer: Reduction of intraocular pressure (IOP)
Q20. In normal‑tension glaucoma, current treatment goals generally recommend lowering IOP by approximately what percentage from baseline?
- 5–10%
- 20–30%
- 50–60%
- Return to baseline IOP only if it exceeds 25 mmHg
Correct Answer: 20–30%
Q21. Which surgical or laser procedure primarily reduces aqueous humor production rather than increasing outflow?
- Trabeculectomy
- Tube shunt implantation
- Cyclophotocoagulation
- Laser peripheral iridotomy
Correct Answer: Cyclophotocoagulation
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