RM is a 71-year-old male who walks up to your community pharmacy counter requesting a refill for one of his medications. He tells you he wants the eye drops for his glaucoma, but he can’t remember the name of the medication. He does tell you that it’s the bottle “with the teal lid”. Which of the following could be the eye drops that RM is referring to? Select all that apply. 

A. Timoptic

B. Azopt  

C. Lumigan  

D. Rhopressa 

E. Alphagan P 

F. Xalatan 

G. Trusopt 

Brand/Generics covered: Timoptic (timolol), Azopt (brinzolamide), Lumigan (bimatoprost), Rhopressa (netarsudil), Alphagan P (brimonidine), Xalatan (latanoprost), Combigan (brimonidine and timolol)  

Answer with rationale: C, F

Explanation: Glaucoma eye drops are another type of medication, like warfarin or levothyroxine, that can be more easily identified based on color. Each class of glaucoma agents has a specific lid color that can help both the pharmacist and the patient readily identify which kind of drug they are looking at. The lid colors correspond to the mechanism of action of the drug, so it would be helpful to know each type. All glaucoma drugs are made to decrease intraocular pressure. There are three main ways this is achieved: decreasing production of aqueous humor (beta-blockers and carbonic anhydrase inhibitors), increasing outflow of aqueous humor (prostaglandin analogs, cholinergic agents, and rho kinase inhibitors), or both decreasing production and increasing outflow of aqueous humor (alpha 2 adrenergic agonists). Below is a table that breaks down each class, the corresponding lid color, and examples of common eye drops in said class. As you can see, answer choices C and F are both prostaglandin analogs, so these could potentially be the drops with the teal lid that the patient was describing.  

Other eye drops that do not directly treat glaucoma also often have specific lid colors. In general, antibiotic drops are tan, NSAIDs are gray, anti-inflammatories/steroid drops are pink, and mydriatics/cycloplegics (eye dilating drops) are red. 

NAPLEX Exam Competencies Covered: Area 2 (Identify Drug Characteristics), 2.1 (Pharmacology, mechanism of action, or therapeutic class), 2.2 (Commercial availability; prescription or non-prescription status; brand, generic, or biosimilar names; physical descriptions) 

Happy April Fool's Day! No joke though...the NAPLEX will be coming very soon for the Class of 2022!

Dr. B