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Eye Disease > Anti-glaucoma drugs > Flashcards

Anti-glaucoma drugs Flashcards

1
Q

What is dependent on how glaucoma is treated?

A

The age of onset and the rate of progression

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2
Q

What is a huge risk factor of glaucoma?

A

Ocular hyper tension (they have a raised IOP but normal disc and fields)

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3
Q

In a forest plot, what does the vertical line down the middle indicate?

A

Line of no difference

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4
Q

Is there evidence to suggest that if you treat patients with ocular hypertension then you reduce the odds of visual field progression?

A

Yes- A meta analysis shows a 38% reduction in odds

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5
Q

What is latanoprost?

A

A prostaglandin which lowers IOP in treating px with open angle glaucoma

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6
Q

Is there a target IOP for glaucoma/ at risk glaucoma pxs?

A

No- there is not a single target, it is individually taking into account baseline iop, age of onset and determining what will cause slowest rate of progression

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7
Q

On average what percentage of mmHg is the target IOP we try to reduce the IOP by?

A

20-35%–> 5-7mmHg

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8
Q

What factors are taken to determine the target IOP?

A
  • Rate of progression
  • Early onset glaucoma
  • Long life expectancy
  • Late presenting glaucoma
  • Status of other eye
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9
Q

What is the drug of first choice for glaucoma treatment?

A

Prostaglandins

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10
Q

If the first line treatment of prostaglandins are well tolerated and effective on lowering IOPs, then what happens next?

A

Px maintained on therapy, evaluated periodically to assess vision loss, optic disc status, IOPs and quality of life

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11
Q

If the first line treatment of prostaglandins is not effective in lowering IOPs then what happens?

A

Substitute for a second drug or additionally a second drug is added or other therapeutic options are considered

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12
Q

How does the LiGHT trial work in order to lower IOPs?

A

Laser trabecular plasticity- the laser is directed at the trabecular mesh work to open it up and lower resistance to outflow for primary open angle glaucoma

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13
Q

What was significant about the LiGHT trial?

A

It could be more cost effective first-line open angle glaucoma and ocular hypertension treatment in lowering IOPs

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14
Q

Are majority of drugs used to treatment glaucoma topical or systemic?

A

Topical

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15
Q

Name the five classes of topical drugs

A

1) Prostaglandins
2) Beta receptor antagonists
3) Alpha 2 receptor agonists
4) Carbonic anhydrase inhibitors
5) Cholingeric agonists

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16
Q

Which of the five classes of topical drugs is less widely used?

A

Cholingeric agonists

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17
Q

Give an example of a cholingeric agonist?

A

Pilocarpine

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18
Q

Give an example of a beta blocker anatagonist that was used in 1978

A

Timolol

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19
Q

Give an example of a topical carbonic anhydrase inhibitor?

A

Dorzolamide

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20
Q

What is the first prostaglandin to be used?

A

Latanoprost

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21
Q

What is the mechanism of action of topical drugs? (3 ways)

A
  • Reduce aqueous production
  • Increase outflow through trabecular meshwork
  • Increase uveoscleral flow
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22
Q

Which class of drugs reduce aqueous production?

A

Alpha agonists, beta blockers and carbonic anhydrase inhibitors

23
Q

Which class of drugs increase outflow through trabecular meshwork?

A

Cholingerics

24
Q

Which class of drug increase uveoscleral flow?

A

Prostaglandins

25
Q

In which type of glaucoma would drugs be issues systemically and which drugs would be issues?

A

Acute angle closure
Carbonic anhydrase inhibitors
Osmotic agents

26
Q

Give an example of an carbonic anhydrase inhibitor

A

Acetazolamide (Diamox)

27
Q

Give an example of an osmotic agent

A

Glycerol, mannitol

28
Q

Before prescribing any new eye drop for glaucoma, what four things must you consider ?

A
  • General medical history (factors which may increase risk of someone developing adverse effects)
  • Drug history (any interactions)
  • History of topical allergy
  • Can the px use eye drops (memory and dexterity)
29
Q

What four points must you consider when CHOOSING a drug?

A
  • Efficacy (in lowering IOP)
  • Safety (which is the most appropriate drug fo this px)
  • Compliance (ensuring the px is taking the medication)
  • Cost
30
Q

Name the order high to lowest efficacy of glaucoma drugs

A

Prostaglandins agonists, beta blocker antagonists, alpha 2 agonists, cholingeric agonists, carnbonic anhydrase inhibitors

31
Q

What do the prostaglandin drugs end in?

A

Prost

32
Q

Name four prostaglandins

A

Latanoprost and travoprost and tafluprost and bimatoprost (prostamide)

33
Q

What is the trade name of latanoprost

A

Xalatan

34
Q

What is a side effect of prostaglandins?

A

Conjunctival hyperaemia (latanoprost is least likely for this to happen)
Darkening, thickening and lengthening of eye lashes
Increased iris pigmentation (affects px with light brown/ hazel eyes- not really the other colours)

34
Q

Name three beta-antagonist

A

Timolol maleate (non-selective) , betaxolol (selective) and levobunolol

35
Q

What is a side effect of beta- antagonists and why?

A

Can cause bronchoconstrition especially in patients with obstructive airways disease or asthma
- because lungs have beta 2 receptors and stimulating or blocking these receptors causes bronchoconstriction

36
Q

What dosage of timolol is normally prescribed with a prostaglandin or carbonic anhydrase inhibitor?

A

Timolol 0.5%

37
Q

What conditions normally co-exist with glaucoma?

A

Airways disease- SO IMPORTANT TO MENTION THIS IN HISTORY

38
Q

Why is excluding airway disease so important when prescribing beta blockers when taking history?

A

It can cause bronchoconstriction and there is a relationship between usage of topical beta antagonists and new use/ increased use of bronchodilators

39
Q

What must you ask about/ do before prescribing beta antagonsits?
*there are five

A
  • Ask about COAD (chronic obstructive airways disease)/ SOBOE (shortness of breath on exertion)/ inhaler usage
    -Check peak flow
  • Check pulse
  • Consider drug interactions
  • Recheck peak flow one month after starting treatment
40
Q

What are the two alpha agonists for glaucoma treatment?

A

Brimonidine and apraclonidine

41
Q

How does briminodine work to reduce IOPs?

A

Increases uveoscleral outflow and reduce aqueous production

42
Q

When is apraclonidine used?

A

For post-operative management as a short term therapy to lower IOPs

43
Q

What are side effects of alpha agonists?

A
  • High incidence of ocular side effects (e.g follicular conjunctivitis)
  • High incidence of systemic side effects such as hypotension, dry mouth, headache, anxiety, depression
44
Q

Name two topical carbonic anhydrase inhibitors

A

Dorzolamide and brinzolamide

45
Q

What are carbonic anhydrase inhibitors normally combined with?

A

Beta blockers

46
Q

What is an example of an oral carbonic anhydrase inhibitors?

A

Acetazolamide

47
Q

What are side effects of TOPICAL carbonic anhydrase inhibitors?

A

-Metallic taste
- Rashes
- Polyuria (excessive urination)
- Irritation
- Blurred vision

48
Q

What are side effects of ORAL carbonic anhydrase inhibitors?

A
  • Allergy
  • Hypokalemia
  • Polyuria
  • Acidesis
  • Depression
  • Parethesia
  • Kidney stones
  • Blood dyscrasia
49
Q

Why is cholingergic not used?

A

Not cost effective and causes misosis, myopia, symblepharon, post synechiae, RD, confusion, vomiting, nausea

50
Q

What are six points that may influence compliance?

A
  • Simplicity of regime
  • Memory
  • Manual dexterity
  • Understanding of disease
  • Topical side effects
  • Systemic side effects
51
Q

Why is cost important to consider?

A

We want to minimise cost to NHS

52
Q

If a patient needs more that two drops, then what are other options?

A

Selective laser trabeculaplastuy and trabeculemtory

Eye Disease (48 decks)

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