FRCOphth Part 1 Pharmacology

Start with general principles. Absorption, distribution, metabolism and excretion, half-life and steady state, agonists and antagonists, potency against efficacy, and the shape of a dose-response curve. Ocular drug delivery is then its own topic, because the corneal epithelium and stroma present alternating lipid and aqueous barriers and a topical drug has to cross both. Autonomic pharmacology follows from there, covering the muscarinic and adrenergic receptors behind mydriatics, cycloplegics and miotics.

Anti-glaucoma agents carry the most weight: prostaglandin analogues, beta blockers, carbonic anhydrase inhibitors, alpha agonists and rho kinase inhibitors, each tied back to whether it reduces aqueous production or improves outflow. Add corticosteroids and non-steroidal anti-inflammatories, the main anti-infectives, local anaesthetics and anti-VEGF agents. Keep a separate list for systemic drugs with ocular toxicity, including hydroxychloroquine, ethambutol, amiodarone and vigabatrin. They sit outside the ocular classes, so they fall through the gaps in most revision plans.

Revise pharmacology straight after aqueous dynamics rather than as a separate block. Once you can say where aqueous is produced and how it leaves, every glaucoma drug resolves to one of two answers and the questions stop being memory tests. Drill exam-style SBAs class by class, use the referenced explanations to confirm the mechanism rather than just the answer, and let spaced repetition carry the side-effect lists, which are pure recall and fade fastest.