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OD3 - Clinical Optometry Practice > DIS - Glaucoma Medications II - Week 5 > Flashcards

DIS - Glaucoma Medications II - Week 5 Flashcards

1
Q

What is the first choice drug class for treating glaucoma?

A

Prostaglandins

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2
Q

Are beta blockers advised in low tension glaucoma?

A

No

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3
Q

What is a good alternative for prostaglandins for glaucoma?

A

Beta blockers

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4
Q

How many drops per day for prostaglandins, beta blockers, alpha agonists, carbonic anhydrase inhibitors, and muscarinics?

A 
PGA - noce
Beta blocker - bid
Alpha agonist - tid-bid
CAI - gtt tid
Muscarinics - q4h
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5
Q

Is regular use of muscarinics recommended for glaucoma? Explain.

A

No, do not use for glaucoma

-except as an adjunct for pigment dispersion glaucoma

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6
Q

What is combigan?

A

Adjunct therapy

-timolol (0.5%) and brimonidine (0.2%) bid

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7
Q

Are adverse effects increased or decreased with combination drug?

A

Reduced

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8
Q

Do you get the full effect of timolol with combination therapy?

A

No

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9
Q

What is more typical for children with glaucoma, surgery or eyedrops? Explain.

A

Surgery - better and more successful outcomes

-temp. drugs before/after surgery

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10
Q

List four issues with eyedrops for children.

A

Greater absoprtion in children
Dose not tailored for child weight
Immature metabolic pathways
Smaller blood volume gives greater circulating dose/systemic effects

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11
Q

What glaucoma drug class should be avoided in children <2? Explain why.

A

Avoid alpha agonists - depresses CNS

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12
Q

What is the first choice drug for treating glaucoma in children (which drug specifically, not just drug class)? How should it be administered, considering the issues with eyedrops for children?

A

PGAs as a first choice - try travatan and continue use if IOP decreases
Minimise drug frequency/dose
Punctal occlusion, eyes closed

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13
Q

When is eye colour change from PGA use most evident?

A

If only one eye has glaucoma

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14
Q

Can monocular glaucoma be environmental or is it genetic?

A

Genetic - rare

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15
Q

Can beta blockers be used for combination therapy in children?

A

Yes, but monitor for bradycardia

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16
Q

True or false

All glaucoma medications cross the placenta

A

True

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17
Q

What is the safest glaucoma drug for use during pregnancy?

A

Timolol gel

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18
Q

What is the safest glaucoma treatment option for use during pregnancy?

A

Selective laser trabeculoplasty

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19
Q

Does IOP naturally increase or decrease during pregnancy? what does this mean for IOP tolerance?

A

Decreases

-tolerate higher IOP in first trimester

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20
Q

What is the preferred management in pregnant women (4)?

A

Selective laser trabeculoplasty&raquo_space;> dorzolamide > nyogel > brimonidine

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21
Q

What glaucoma drug class should be avoided in pregnant women?

A

PGAs

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22
Q

True or false

Not all glaucoma medications secrete into breast milk

A

False

All of them do

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23
Q

What glaucoma drug class should be avoided in lactating women?

A

Alpha agonists

-CNS depression

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24
Q

Which of the following are accpetable for lactating women? What is the best time to instil?
PGAs
CAIs
Beta blockers

A

All of them

Instil immediately after nursing

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25
Q

What is the safest glaucoma treatment option for lactating women?

A

Selective laser trabeculoplasty

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26
Q

What are the two recommended glaucoma eyedrops for lactating women?

A

Timolol and dorzolamide

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27
Q

Can brimonidine be used in mothers breastfeeding children <2?

A

No

28
Q

What can xalatan induce during pregnancy and should it be used? What about during lactation?

A

Potential to induce premature labour - avoid use in pregnancy
Use during lactation is ok

29
Q

What are three kinds of medications that can induce open angle glaucoma? Can these do so through any route of administration? Explain.

A

Steroids
Traditional medicines
Herbal medicines
All routes of administration cause induce it, but topical is the most potent

30
Q

What can adrenergic drugs often cause (relating to glaucoma)?

A

Pupil block

-primary angle closure

31
Q

What can anticholinergic drugs potentially cause (relating to glaucoma)?

A

Pupil block

-primary angle closure

32
Q

What can tri/tetracyclic antidepressant drugs potentially cause (relating to glaucoma)?

A

Ciliary body effusion

-primary angle closure

33
Q

What can sulpha based drugs potentially cause (relating to glaucoma)?

A

Ciliary body effusion

-primary angle closure

34
Q

Consider angle closure glaucoma. What is the cornea like and what does this mean for drug penetrance? Give an example of a drug with reduced penetration. Keeping this in mind, what is needed?

A

Swollen cornea with high IOP reduces penetration, especially lipophilic durgs - like PGAs
Need a high dose of drops

35
Q

Consider angle closure glaucoma. What is the best management (include drop frequency)? Can oral medication be considered? What about IV?

A

Best - iopidine (0.5%), timolol (0.5%) q2min x4
May need oral drugs - diamox 90 mins after onset
IV drugs to suck fluid from the eye, especially if patient is vomiting

36
Q

With a pupil block, when does iris ischaemia occur and what does this result in (2)?

A

Iris ischaemia at high IOP (>40mmHg)

Results in reduced muscle capacity as glucose runs out, then no capacity

37
Q

What drug can reverse a pupil block, and what is it limited by?

A

Reversal of pupil block with muscarinic agonist (pilocarpine 2%), limited by iris ischaemia if IOP >40mmHg

38
Q

Is pilocarpine of any use for a pupil block if IOP is >40mmHg?

A

No, unless the closure just occurred

39
Q

What are two hospital means of removing fluid from the eye?

A

Surgical - paracentesis

Medical - hyperosmotic agents

40
Q

What are three routes for CAIs depending on urgency?

A

Intravenous - fast, max effect
Oral - slower, strong effect
Topical - slowest, moderate effect

41
Q

What are hyperosmotic agents?

A

Large molecules that stay in the blood but are also non-toxic to the body

42
Q

Give two examples of oral hyperosmotic agents. Include dosage per kg weight, onset, and duration.

A 
Glycerine
-1 to 1.5g/kg
-onset 30-60m
-duration ~6h
Isosorbide
-1 to 3g/kg
-onset 30m
-duration dw
43
Q

Give two examples of intravenous hyperosmotic agents. Include dosage per kg weight, onset, and duration.

A 
Mannitol
-1 to 2g/kg
-onset 5m
-duration ~4h
Urea
-1 to 2g/kg
-onset 5m
-duration ~5h
44
Q

List a contraindication for mannitol. In what two conditions should it be used with caution?

A

Excessive diureses

Caution with renal diease and congestive heart failure

45
Q

How long does IV diamox take to reduce aqueous production if given IV?

A

10-20 mins for 2h

46
Q

List three side effects of diamox.

A

GI irritation

Numbness of periorbital region and extremities

47
Q

List 6 contraindications for CAIs.

A 
Renal disease
Liver disease
COPD
Sulphur allergy
Pregnancy
Metabolic acidosis
48
Q

What time period of ischaemia to the optic nerve head will lead to total loss of vision?

A

48 hours

49
Q

What is the definitive intervention for acute angle closure glaucoma?

A

Surgery in both eyes

PLI/iridoplasty/trabeculectomy

50
Q

List the OBA recommendation of first aid for acute angle closure glaucoma, including how long between drops (6). Give an example of the drug where applicable, including concentration.

A 
1 drop beta blocker (timolol 0.5%)
1 drop alpha agonist (alphagan 0.2%)
1 drop CAI (trustopt 2%)
1 drop pilocarpine (2%)
1 drop pred forte if eye is inflammed
-2 minutes between drops
Urgent referral
51
Q

Consider a case of acute angle closure glaucoma in the absence of a hospital within an hour. What should be done in this case (2)?

A

Oral diamox 2x250mg
500mg K+
-go to the pharmacy if necessary

52
Q

When should pilocarpine not be used in first aid for acute angle closure glaucoma?

A

Shallow Ac - retrolental cause

53
Q

Does IOP splike on dilation even with open angles?

A

Yes, 7% of patients show a spike

54
Q

Consider a pupil block induced by mydriasis. What will typically reverse it (2)?

A

Topical pilocarpine followed by alpha agonist 2 mins apart for most people

55
Q

What are two indications of iris ischaemia?

A

Cloudy cornea

Pupil unresponsive

56
Q

What should be done with patients who spike with mydriasis?

A

Pretreat with alphagan before dilating (if IOP >30mmHg during spike)

57
Q

Name a laser procedure to reduce aqueous inflow to decrease IOP.

A

Laser or cryodestruction of ciliary body

58
Q

Name two laser procedures to increase aqueous outflow to decrease IOP. Explain each and note which is not used nowadays.

A

Argon laser trabeculoplasty - punch holes in the TM
-tightens the meshwork on scar formation, not used nowadays for glaucoma
Selective laser trabeculoplasty - stimulates trabecular cells with low dose laser
-acts by increasing phagocytic activity and inflammatory response

59
Q

Name two surgical procedures to increase aqueous outflow to decrease IOP.

A

Trabeculoplasty - cut and remove TM or reshape it with laser

Trabeculectomy - create a new drainage channel to drain to the sub-conjunctival flap

60
Q

What is a minimally invasive glaucoma surgery?

A

Implant that facilitates aqeuous drainage

61
Q

Consider laser surgery options for glaucoma. How does pigment affect it and what does this mean for dark-skinned people?

A

Both procedures are related to the amount of pigment

-dark-skinned people have better outcomes

62
Q

Compare laser treatment to topical drugs in terms of glaucoma target IOP outcomes. what does Australia recommend as the first line therapy and what is the main issue? Compare costs.

A

Laser treatment tends to offer better outcome son reaching target IOP vs drops
-compliance is the main issue
Australia still recommends topical drops as first-line
Cheaper with laser treatment if only one procedure performed vs drops
-26% need two proceudres

63
Q

Does minimally invasive glaucoma surgery have a high or low safety profile? Compare complications and recovery rate to trabeculectomy.

A

High safety profile

Fewer complications and more rapid recovery time than trabeculectomy

64
Q

What is used to limit scarring and prevent surgically created alternate routes from sealing over in trabeculectomy? What is a complication of this?

A

Antimetabolites

-can cause tissue to melt

65
Q

List three complications of trabeculectomy.

A

Poor IOP control
Infection
-blebitis
-endophthalmitis

66
Q

What surgical procedure is the last resort for neovascular glaucoma?

A

Laser/cryo-ablation of ciliary body

OD3 - Clinical Optometry Practice (114 decks)

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