Drug kept as a last reso in the management of primary open angle glaucoma is ?: (A) Latanoprost, (B) Topical beta blocker, (C) Brimonidine, (D) Oral acetazolamide
Answer is D. Ans. is 'd' i.e., Oral acetazolamide Treatment of POAG (Primary open angle glaucoma) Following treatment options are available for POAG : Medical therapy :- Total medical therapy is the treatment of choice for POAG. Topical 13-blockers (Timolol, Betoxalol, Levobunolol, caeolol) are the drugs of choice. Topical prostaglandin analogues (Latanoprost, bimatoprost, travoprost) are the second choice drugs. Other topical drugs for POAG are:- LI Alpha agonists (non - selective : epinephrine, dipivefrine; and Selective - a2: apraclonidine, brimonidine) Carbonic anhydrase inhibitors (Dorzalamide, brinzolamide) Cholinomimetic drugs (Pilocarpine, physostigmine, echothiophate, carbachol) Pilocarpire has several drawbacks, therefore, is being considered as an adjunctive therapy only as a last reso. Approach to treatment of POAG Sta monotherapy with topical P-blocker or latanoprost. If target IOT is not attained either change over to the alternative drug or use both the above concurrently. Brimonidine/dorazolamide/dipivefrine are used only when there are contraindications to PG analogues or 13-blockers. Topical miotics and oral acetazolamide are added only as the last reso. Systemic therapy is considered only as a last reso. Drugs used for systemic therapy are :- (i) Carbonic anhydrase inhibitors (Acetazolamide, Dichlorphenamide, methazolamide), (ii) Hyperosmotic agents (mannitol, glycerol).