30 - Glaucoma

Question 1

Main modifiable goal of glaucoma?

Answer 1

lower IOP

Question 2

What are some drugs that may cause or worsen glaucoma?

Answer 2

• corticosteroids (common) - all routes
• antimuscarinics (rare) - antiistamines, decongestants, antidepressants, antispasmodics
• topiramate (anticonvulsant) has been associated with acute angle-closure glaucoma
• use of oral contraceptives x 3-5 years may be associated with a higher prevalence of primary open-angle glaucoma

Question 3

non-pharms

Answer 3

• aerobic exercise can decrease IOP modestly

- laser or surgical procedures may be necessary

Question 4

What BBs can be used for glaucoma?

Answer 4

betaxolol, levobunolol, timolol

Question 5

How do BBs decrease IOP?

Answer 5

decrease IOP by inhibiting formation of the aqueous humour

Question 6

What BB is relatively beta 1 specific and good for people with lung problems?

Answer 6

betaxolol

Question 7

Brinzolamide and dorzolamide are examples of what?

Answer 7

topical carbonic anhydrase inhibitors

Question 8

How do the topical carbonic anhydrase inhibitors decrease IOP?

Answer 8

inhibit an enzyme involved in the formation of aqueous humor

Question 9

List the prostaglandin analogues

Answer 9

latanaprost, travoprost, bimatoprost

Question 10

Prostaglandin analogues are slightly more effective than what other class?

Answer 10

non-selective BBs

Question 11

latanoprost and travoprost work through what pathway

Answer 11

uveoscleral pathway

Question 12

bimatoprost works through what pathways

Answer 12

uveoscleral and trabecular pathways

Question 13

s/e of prostaglandin analogues

Answer 13

• can darken brown-colored irides
• lengthen eyelashes
• cause mild conjunctival hyperemia

Question 14

brimonidine is an example of what?

Answer 14

alpha 2 agonist

Question 15

How does brimonidine (alpha 2 agonist) work?

Answer 15

Suppresses formation of aqueous humor and may increase uveoscleral outflow. Used for both open and closed glaucoma

Question 16

How does cholinergic agonist (such as pilocarpine) work?

Answer 16

contracts ciliary muscle and icnreases trabecular outflow

Question 17

s/e of cholinergic agonists?

Answer 17

mioisis, spasm, brow ache

Question 18

How do oral carbonic anhydrase inhibitors work (acetazolamide, methazolamide) ?

Answer 18

lower IOP by decreasing production of aqueous humor

*normally reserved for emergencies bc of significant s/e

Question 19

Avoid what drug if you have a sulfa allergy?

Answer 19

carbonic anhydrase inhibitors

Question 20

Most common preservative

Answer 20

benzalkonium chloride

Question 21

Brimonidine is now available with a preservative called ____

Answer 21

purite

Question 22

Wait how long before putting contact lenses in after drops?

Answer 22

15 mins