Brimonidine and Apraclonidine are contraindicated in patients taking which of the following?

The reason why the correct answer is that brimonidine and apraclonidine are contraindicated in patients taking MAOIs (Monoamine Oxidase Inhibitors) relates to the pharmacological effects of these medications and the potential for drug interactions.

Brimonidine and apraclonidine are alpha-2 adrenergic agonists that primarily lower intraocular pressure by decreasing aqueous humor production and increasing uveoscleral outflow. However, they also have central nervous system effects due to their ability to cross the blood-brain barrier. When these medications are administered in conjunction with MAOIs, which inhibit the enzyme monoamine oxidase and thereby affect neurotransmitter levels, there is a risk of significant increases in blood pressure due to an exaggerated sympathomimetic response.

The interaction can lead to what is termed a hypertensive crisis, which is characterized by a sudden, severe increase in blood pressure. Therefore, patients taking MAOIs should avoid using brimonidine and apraclonidine to prevent these adverse effects.

Other types of medications listed in the options, such as NSAIDs, statins, and steroids, do not have the same risk of severe drug interactions with brimonidine and apraclonidine,