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What is A patient with glaucoma is being treated with systemic beta blocker. All of the following can be given to the patient except? and explain in detail?
Ans. c. Levobunolol (Ref: KDT 7/e p154, 6/e p144: 5/e p85)Brimonidine, dorzolamide and prostaglandin are topical anti-glaucoma drugs. These drugs do not have systemic side effects, while levobunolol (beta-blocker) is systemic anti-glaucoma drug given orally, having systemic side effects. That is why in patients with glaucoma treated with systemic beta blockers, levobunolol may add on the side effects of beta-blockers, hence, avoided in the above mentioned patient.Topical Anti-glaucoma DrugsAdrenergic agonistNon-selective: Epinephrine, DipivefrineAlpha2-selective: Apraclonidine, BrimonidineAdrenergic antagonistBeta-blocker (Non-selective): Timolol, Levobunolol, Carteolol, Metipranolol, AdapralolBeta 1-blocker: BetaxololMiotics (direct parasympatomimetics)Pilocarpine, PhysostigmineEcothiophate. Carbachol, DemacariumProstaglandin analoguesLatanoprostCarbonic anhydrase inhibitorsDorzolamideSystemic Antiglaucoma DrugsCarbonic anhydrase inhibitorsHyperosmotic agents* Acetazolamide* Dichlorphenamide* Methazolamide* Mannitol* Glycerol