Which of the following drugs is mainly used in the management of glaucoma?

DSSSB 14 August 2024

Pharmacology

Easy

Appeared in: DSSSB 14 August 2024

Explanation

Acetazolamide is a carbonic anhydrase inhibitor, a class of drugs used to treat glaucoma.
Its primary mechanism of action is to decrease the production of aqueous humor in the ciliary body of the eye.
By reducing the volume of fluid inside the eye, Acetazolamide effectively lowers intraocular pressure (IOP).
It is particularly useful in managing acute angle-closure glaucoma and as an adjunctive therapy for open-angle glaucoma.

Option A: Penicillin is an antibiotic used to fight bacterial infections and has no therapeutic role in managing glaucoma or reducing intraocular pressure.
Option C: Atropine is a mydriatic (pupil-dilating) and cycloplegic agent. It is contraindicated in patients with angle-closure glaucoma because dilating the pupil can obstruct the drainage of aqueous humor, leading to a sharp and dangerous increase in intraocular pressure.
Option D: Tropicamide is another mydriatic agent, similar to atropine, used to dilate the pupil for diagnostic eye exams. It is also contraindicated in angle-closure glaucoma as it can precipitate an acute attack.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacological management of glaucoma as background academic context rather than a clinical decision trigger.
Nurses administering oral or IV Acetazolamide must monitor for systemic side effects, particularly electrolyte imbalances like hypokalemia and metabolic acidosis, due to its diuretic properties.
Patient education is a key nursing responsibility. This includes teaching about the purpose of the medication, potential side effects (e.g., tingling, fatigue), and the importance of follow-up appointments to monitor IOP and blood work.
What if? If a patient has a known allergy to sulfa drugs, Acetazolamide (a sulfonamide derivative) would be contraindicated. In this case, the nurse should anticipate the prescriber choosing an alternative class of medication, such as a topical beta-blocker (e.g., Timolol) or a prostaglandin analog (e.g., Latanoprost).

How to Approach the Question

First, identify the key condition in the question: 'glaucoma'.
Recall the primary pathophysiology of glaucoma, which is increased intraocular pressure (IOP) that can damage the optic nerve.
The goal of treatment is to lower this pressure. Therefore, you are looking for a drug that reduces IOP.
Analyze the mechanism of each option. Acetazolamide is a carbonic anhydrase inhibitor that decreases aqueous humor production, thus lowering IOP.
Evaluate the other options. Penicillin is an antibiotic. Atropine and Tropicamide are mydriatics that dilate the pupil and are contraindicated in angle-closure glaucoma because they can worsen the condition.
Based on this analysis, Acetazolamide is the only drug listed that is used to treat glaucoma.

Concept Tested & Keywords

Q_9LHwF0PAkWfWH7Y_vYrJ

E6 Pharmacology Nurses Shanbhag 3e p. 68-70

E6 Pharmacology KD Tripathi Essentials 9e Part 1 p. 196-198

E6 Pharmacology Nursing Lilley 11e Part 3 p. 258-260