ch 87 highlights Flashcards
1st line treatment in glaucoma
B Blockers
Who cannot use B Blockers
Asthma COPD Diabetics AV heart block cardiogenic shock hear failure (use with caution)
What glaucoma treatment can you use for asthma and copd patients
Betaxolol
B1 selective
What drugs can you use for angle closure glaucoma
B Blockers as adjunct
Pilocarpine
B blockers approved for glaucoma
Betaxolol carteolol levobunolol metipranolol timolol
latanoprost travoprost bimatoprost latanoprostene bunod tafluprost
Prostaglandin analogs for Glaucoma
considered 1st line
what prostaglandin was more effective in the African American population
Travoprost
what medication can cause a gradual increase in brown pigmentation of the iris, which may be irreversible. It can also increase pigmentation of the eyelid and growth to the eyelashes
Prostaglandin analogs for glaucoma
-prost
Apraclonidine
Brimonidine
Alpha 2 adrenergic agonists approved for Glaucoma
Which alpha 2 adrenergic agonist crosses the blood brain barrier and which does not
Brimonidine crosses the BBB
Apraclonidine does not
which Alpha 2 adrenergic agonist is sold OTC
brimonidine is sold as Lumify OTC
What Alpha 2 Adrenergic agonist is approved for short term use and which is approved for long term use
Apraclonidine is approved for short term use
Brimonidine is approved for long term use
Which Alpha 2 adrenergic agonist has special considerations with contacts and what are those instructions
Brimonidine
Wait 15 min before inserting contacts
Which Alpha 2 adrenergic agonist can promote hypotension
Brimonidine
it crosses the BBB so it can cause drowsiness, fatigue and hypotension
Combigan
Brimonidine + timolol
Simbrinza
Brimonidine + Brinzolamide
2nd line treatment for open angle glaucoma
Pilocarpine
Can Pilocarpine be used long term?
no, it can cause retinal detachment
What pt population cannot use Pilocarpine
Asthma and COPD
bradycardic patients
hypotensive
What is the reversal agent for Pilocarpine
Atropine
What drug class is Pilocarpine
Direct-acting muscarinic agent
what systemic effects can Pilocarpine cause
due to stimulation of muscarinic receptors Bradycardia bronchospasm hypotension urinary urgency diarrhea hypersalivation sweating
what type of drug is Echothiophate
cholinesterase inhibitor that is approved for glaucoma
when would you use Echothiophate
Due to the adverse effects this drug is reserved for patients who have not responded well to the preferred treatments (b blockers, alpha 2 agonists and prostaglandins)
what side effects for Echothiophate
stimulation of muscarinic receptors Bradycardia bronchospasm hypotension urinary urgency diarrhea hypersalivation sweating
development of cataracts
Dorzolamide
Brinzolamide
Carbonic anhydrase inhibitors: topical
used in glaucoma and ocular hypertension
which carbonic anhydrase inhibitor is generally better tolerated
Brinzolamide - causes less ocular stinking and burning than dorzolamide
Are there any contact precautions with the Carbonic anhydrase inhibitors
yes, for both dorzolamide and brinzolamide
wait 15 min after administering before wearing contacts
most common side effects for the Carbonic Anhydrase Inhibitors
ocular stinking
bitter taste immediately after dosing
transient blurred vision (Brinzolamide)
which Carbonic Anhydrase inhibitor do 10-15% of patients experience allergic reactions
Dorzolamide -
Conjunctivitis
lid reactions
stop med and contact provider
other reactions for Dorzolamide blurred vision tearing eye dryness photophobia
t/f
If I miss a dose of my glaucoma medication, it is okay. Try not to miss again
False - It is important to take the medication according to the schedule. If days are skipped or if prescriptions are not filled, loss of vision may occur
symptoms of angle closure glaucoma
vision loss
severe eye pain
headache
n/v
what should you do for photophobia in
use sunglasses, wide-brimmed hats, visors or baseball hats
what is the drug that you need to allow at least 15 min to elapse between administration and insertion of contacts
Benzalkonium
To improve topical absorption and minimize systemic absorption for topical eye meds
close eyes for 3 min after drops and lightly press a thumb over medial canthus (inner corner of eye)
eye itching burning thin, watery discharge red and congested conjunctiva
allergic conjunctivitis
pattern of symptoms for allergic conjunctivitis
symptoms appear 20 min after exposure and stop 20 min later and come back 6+ hours later due to recruitment off immune cells
cromolyn
lodoxamide
mast cell stabilizers
takes days to develop and 2 weeks to become maximally effective
treatment for allergic conjunctivitis
mast cell inhibitors (cromolyn, lodoxamine) - these take 2+ weeks to be effective
for immediate relief - H1 receptor antagonists (antihistamines)
If you use Azelastine and olopatadine - they do both
Toradol (NSAID) - inhibits prostaglandins
Glucocorticoids (ie) Loteprednol) -if having severe symptoms- may increase IOP if prescribed long term - also inhibits prostaglandins
ocular decongestants (naphazoline and phenylephrine) - decrease redness and edema - these are for no more than 2 weeks and are used just while the mast cell inhibitors take effect (more than 2 weeks may cause rebound congestion)
when are ocular decongestants contraindicated
history of angle closure glaucoma
if multiple topical drugs are being used, how do you apply
wait at least 5 min in between drugs so the second drug doesnt flush out the first drug
antiviral topical drugs
trifluridine
gancyclovir
bacterial eye infections will remain contagious
until they have been treated for 24-48 hours
viral eye infections remain contagious
until they are completely gone
mild allergic conjunctivitis
mild intermittent pruritus
moderate allergic conjunctivitis
mild to severe pruritis lasts a few days to 2 weeks with no eye redness
severe allergic conjunctivitis
moderate to severe pruritis that is chronic with eye redness
open angle glaucoma is more common in
African American Population where angle closure is not
effects of dilation with anticholinergic agent
tachycardia may indicate toxicity
mydriasis is an effect causing eye unable to focus. Blurred vision until wears off
taking Dorzolamide with the following symptoms ocular stinging bitter taste photophobia eye dryness blurred vision
normal
Taking Dorzolamide with
redness in eyes or eyelids
Allergic conjunctivitis
stop med
which med was marketed specific purpose of increasing eyelash length, darkness and thickness
Latisse (bimatoprost)
adverse effects of B Blocker drops for glaucoma
ocular stinging
occasionally conjunctivitis blurred vision photophobia dry eyes
B1 Blockade effects
bradycardia
AV heart block
B2 blockade effects
bronchospasm
prostaglandin analogues side effects
iris color change eyelashes - longer, thicker, darker blurred vision burning stinging conjunctival hyperemia conjunctival edema punctate keratopathy macular edema (rare)
Apraclonidine side effects
headache dry mouth dry nose altered taste conjunctivitis lid reactions pruritus tearing blurred vision
does not cross BBB
second line drug for open angle glaucoma and used for emergency treatment
Pilocarpine
pilocarpine side effects
decrease visual acuity
local irritation
eye pain
brow ache
bc its a direct acting muscarinic agonist bradycardia bronchospasm hypotension urinary urgency diarrhea hypersalivation sweating
what cholinesterase inhibitor for glaucoma
echothiophate
pilocarpine for children
may cause paradoxical increases in intraocular pressure
glaucoma in pregnancy
brimonidine
meds for glaucoma for older adults - what drugs contraindicated and why
B Blockers can worsen heart failure even topical
A2 agonists can cause orthostatic hypotension
if marked renal impairment, no carbonic anhydrase inhibitors
cholinesterase inhibitors may cause bradycardia and hypotension
side effect of Dorzolamide (Trusopt) for glaucoma
carbonic anhydrase inhibitor (topical)
ocular stinging
bitter taste after dosing
allergic reactions - conjunctivitis and lid reactions
blurred vision
tearing
eye dryness
photophobia
Brinzolamide (Azopt) for topical treatment of elevated IOP in open angle glaucoma or ocular HTN
Carbonic anhydrase inhibitor
adverse effect
bitter aftertaste
transient blurred vision
less ocular stinging and burning than dorzolamide
contact lens and brinzolamide
wait 15 min after drops to put contacts in
glaucoma pt teach
take according to schedule - you can lose vision if days are skipped
call if vision loss, severe eye pain, headache n/v - s/s of angle closure glaucomA
photophobia outdoors- wear sunglasses, wide brimmed hats, visors or baseball caps
check labels to see if they contain benzalkonium as a preservative. if so wait 15 min after drops to put in contacts
dont touch dropper to eyes and do not touch tip with finger. eye infection
to improve absorption, close eyes for 3 min after drops and lightly press a thumb or finger over the medial canthus (inner corner of eye)
iop in glaucoma pt should be checked how often
every 1-3 months
what can help reduce severity of symptoms for allergic conjunctivitis
avoid allergen
for example if allergic to pollen….avoid being outside on a windy day during pollen season
if oral antihistamines are taken for allergy symptoms what is a common side effect and what can you do (with eyes)
eye dryness
artificial tears or other eye lubricants
apply cold compresses 5-10 min
avoid rubbing eyes and wearing contacts if symptoms are bad to avoid worsening
when should you notify provider when being treated for allergic conjunctivitis
if no relief after 2 weeks - could indicate underlying issue
if using multiple topical drugs in eyes, how do you give
wait at least 5 min in between drugs
what prescription can be given for dry eyes due to inflammation
topical cyclosporine opthalmic emulsion (Restasis)
ocular decongestants for allergic conjunctivitis
phenylephrine naphazoline oxymetazoline brimonidine tetrahydrozoline
only local reactions (stingin, burning, reactive hyperemia with overuse
what do you need to ensure prior to giving a ocular glucocorticoid for inflammation of the eye (uveitis, iritis, conjuntivitis)
ensure there is no underlying viral or fungal infection or glucocorticoids can cause permanent vision loss
antiviral topical for eye infections
trifluridine
ganciclovir
what is applied to eye to look for lesions on the corneal epithelium
fluorescein
makes defects bright green
adverse effect of fluorescein
n/v
paresthesias
pruritus
anaphylaxis
pulmonary edema
cardiac arrest
what is rose bengal used
and lissamine green for
visualize abrasions of corneal and conjunctival epithelium
