**Question:** A patient with glaucoma is being treated with systemic beta blocker. All of the following can be given to the patient except?

A. Beta-agonists
B. Calcium channel blockers
C. Alpha-blockers
D. Anticholinergics

**Core Concept:**
In patients with glaucoma, the use of systemic beta-agonists is contraindicated due to their ability to increase intraocular pressure (IOP). Beta-agonists, which are often used for treating asthma and hypertension, increase heart rate and contractility, leading to vasoconstriction and reduced aqueous humor outflow. This results in elevated IOP, worsening the condition in glaucoma patients.

**Why the Correct Answer is Right:**
Beta-agonists are contraindicated in glaucoma patients. The correct answer, "beta-agonists", is chosen because they directly increase heart rate and contractility, leading to vasoconstriction and reduced aqueous humor outflow. This results in elevated intraocular pressure (IOP), which is detrimental for patients with glaucoma.

**Why Each Wrong Option is Incorrect:**

A. **Beta-agonists**: As mentioned above, beta-agonists directly increase heart rate and contractility, leading to vasoconstriction and reduced aqueous humor outflow, which increases the IOP and worsens the glaucoma condition.

B. **Calcium channel blockers**: These medications are used to treat hypertension, angina, and arrhythmias. While they do not directly increase IOP, their use may lead to other complications that negatively impact the patient.

C. **Alpha-blockers**: Alpha-blockers are used to lower blood pressure and relieve symptoms of benign prostatic hyperplasia (BPH). Although they may not directly increase IOP, their use may lead to other complications that negatively impact the patient.

D. **Anticholinergics**: These drugs are used in the treatment of asthma, urinary incontinence, and glaucoma. Although they may not directly increase IOP, their use may lead to other complications that negatively impact the patient.

**Clinical Pearl:**
In patients with glaucoma, it is essential to consider the potential complications of various medications, even those that are not directly related to intraocular pressure. Medical management for other conditions should be tailored to avoid worsening the glaucoma and its complications. Always consider the patient's overall health and potential risks when prescribing medications, even for unrelated conditions.