Ocular Pharmacology and Therapeutics (Anti-VEGF, Anti-glaucoma Classes, Steroids) MCQs

Ophthalmology · 49 free questions with answers & explanations.

1. Aflibercept differs from ranibizumab and bevacizumab in its mechanism of anti-VEGF action because aflibercept:
2. A patient using topical timolol maleate 0.5% eye drops develops bradycardia and worsening of asthma. Timolol causes these systemic side effects primarily because:
3. Among the prostaglandin analogue class of anti-glaucoma drugs, the agent with the additional property of selective FP receptor agonism AND EP3 receptor agonism, giving it uveoscleral AND trabecular outflow enhancement, is:
4. Intravitreal triamcinolone acetonide (IVTA) is associated with which MOST clinically significant local complication when used for diabetic macular edema?
5. Rho kinase (ROCK) inhibitor netarsudil (Rhopressa) lowers IOP by a mechanism that is DISTINCT from other anti-glaucoma drugs. It primarily works by:
6. A patient with wet AMD on monthly intravitreal ranibizumab develops persistent subretinal fluid despite 6 monthly injections. Switching to intravitreal aflibercept is considered. The pharmacological reason aflibercept may overcome anti-VEGF resistance in this scenario is:
7. A patient with POAG develops a severe allergic conjunctivitis to topical timolol. The class of anti-glaucoma agent most likely responsible for this reaction (and one that should be avoided or substituted) is:
8. A 3-year-old child is treated with topical 1% atropine for amblyopia penalisation. The mother reports flushing, fever, and tachycardia 30 minutes after instillation. The mechanism of this systemic toxicity and its prevention is best explained by:
9. A patient on long-term topical steroid (prednisolone acetate 1%) for chronic anterior uveitis develops elevated IOP (32 mmHg). Which mechanism best explains steroid-induced ocular hypertension?
10. Bevacizumab (Avastin) is frequently used off-label for intravitreal injection. Compared to ranibizumab (Lucentis), bevacizumab:
11. A patient on long-term topical timolol maleate 0.5% eye drops develops worsening dyspnea and bradycardia. This systemic effect is best explained by:
12. Aflibercept differs from ranibizumab in its mechanism of action in the following way:
13. A patient on topical dexamethasone drops for 6 weeks after corneal transplant develops elevated IOP of 32 mmHg in the treated eye. Which receptor mechanism explains steroid-induced ocular hypertension?
14. Which prostaglandin analogue has a dual mechanism of action — both FP receptor agonism and EP2/EP3 receptor activity — and is available as a preservative-free formulation?
15. A patient with severe ocular surface disease and concurrent open-angle glaucoma requires IOP-lowering therapy. The preferred agent to minimize preservative-related ocular surface toxicity while achieving adequate IOP reduction is:
16. Ranibizumab differs from bevacizumab in terms of structure in that ranibizumab is a:
17. A patient on long-term topical timolol 0.5% for glaucoma develops bradycardia and worsening of obstructive airways disease. Which topical IOP-lowering agent would be the SAFEST substitute with a similar or better IOP-lowering efficacy?
18. Latanoprost, a prostaglandin F2α analogue used in glaucoma, lowers IOP primarily by which mechanism?
19. Which ocular side effect is UNIQUE to brimonidine (alpha-2 agonist) eye drops when used in neonates and young infants?
20. Which topical steroid preparation has the LOWEST potential for raising intraocular pressure (steroid-response) while retaining reasonable anti-inflammatory efficacy in the anterior segment?
21. Bevacizumab and ranibizumab are both anti-VEGF agents used intravitreally. Ranibizumab is preferred in some protocols because it:
22. Prolonged topical steroid use in the eye can cause which type of cataract?
23. Brimonidine (an alpha-2 adrenergic agonist) is preferred over beta-blockers in infants with glaucoma because beta-blockers can cause:
24. Faricimab (used for wet AMD and diabetic macular edema) has a dual mechanism of action targeting which two pathways?
25. Aflibercept (VEGF Trap-Eye) differs from ranibizumab in that it:
26. A patient on long-term topical timolol 0.5% twice daily for glaucoma develops worsening dyspnea and bradycardia. The most appropriate alternative anti-glaucoma agent with a similar mechanism but reduced systemic absorption would be:
27. Bimatoprost, a prostaglandin analogue used for glaucoma, primarily reduces intraocular pressure by:
28. The dexamethasone intravitreal implant (Ozurdex) is most appropriate as an intravitreal treatment in patients with diabetic macular edema who are:
29. A patient on long-term topical timolol maleate 0.5% develops bradycardia and bronchospasm. Which class of anti-glaucoma drug should be avoided in patients with reactive airway disease, and which is the safest alternative from the same first-line category?
30. Bevacizumab (Avastin) is used off-label for intravitreal anti-VEGF therapy. Compared to ranibizumab and aflibercept, which molecular property of bevacizumab accounts for its longer intravitreal half-life?
31. A patient using topical prednisolone acetate 1% for 6 weeks develops elevated IOP to 36 mmHg. The IOP rise is due to blockade of which pathway?
32. Which intravitreal anti-VEGF agent binds VEGF-A, VEGF-B, AND placental growth factor (PlGF), giving it the broadest VEGF-family binding profile among currently approved agents?
33. Brimonidine 0.2% eye drops exert their IOP-lowering effect primarily through which mechanism?
34. Ranibizumab differs from bevacizumab in its mechanism of anti-VEGF action primarily because ranibizumab is:
35. A patient with primary open-angle glaucoma is on timolol 0.5% eye drops. He develops bradycardia and worsening of asthma. The MOST appropriate ALTERNATIVE topical glaucoma therapy with a similar IOP-lowering efficacy but without systemic beta-blockade is:
36. Netarsudil, a newer topical glaucoma drug, lowers IOP by which mechanism DISTINCT from all other anti-glaucoma classes?
37. Topical steroids used in the eye carry the risk of steroid-induced glaucoma. Which steroid is associated with the LEAST risk of IOP elevation while retaining anti-inflammatory efficacy?
38. Phospholine iodide (echothiophate), a long-acting anticholinesterase, is used in paediatric accommodative esotropia. Its MAJOR ocular side effect with prolonged use is:
39. Ranibizumab (Lucentis) differs from bevacizumab (Avastin) in which of the following pharmacological characteristics?
40. A patient on long-term topical corticosteroids for vernal keratoconjunctivitis develops elevated IOP. The mechanism by which corticosteroids elevate IOP in steroid responders is:
41. Which class of anti-glaucoma medication works by increasing aqueous outflow through the uveoscleral (non-trabecular) pathway?
42. Aflibercept (Eylea) differs from ranibizumab and bevacizumab in its mechanism of anti-VEGF action primarily because:
43. Acetazolamide, a systemic carbonic anhydrase inhibitor used in acute angle closure glaucoma and before intraocular surgery, is CONTRAINDICATED in which condition?
44. A 72-year-old woman with neovascular AMD receives her 8th intravitreal bevacizumab injection. OCT shows persistent sub-retinal fluid despite monthly injections. The ophthalmologist switches to intravitreal aflibercept. Compared to bevacizumab and ranibizumab, aflibercept has a higher binding affinity for VEGF primarily because it:
45. A glaucoma patient on long-term topical timolol 0.5% presents with worsening breathlessness. She has a history of mild asthma. The MOST appropriate pharmacological substitute to lower IOP while avoiding pulmonary side effects is:
46. Brinzolamide 1% is a topical carbonic anhydrase inhibitor used for glaucoma. Its primary mechanism in reducing IOP is:
47. A patient develops a steroid-induced rise in IOP after prolonged use of topical dexamethasone 0.1% for allergic conjunctivitis. The pathomechanism of steroid glaucoma primarily involves:
48. A patient with wet AMD is being treated with intravitreal ranibizumab. After 3 monthly loading doses, the ophthalmologist switches to a treat-and-extend (T&E) protocol. What is the primary pharmacological advantage of aflibercept over ranibizumab that may allow less frequent dosing?
49. A patient with glaucoma on travoprost (prostaglandin analogue) develops periorbital skin darkening, increased eyelash growth (hypertrichosis), and periorbital fat atrophy. These are classified as: